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PubMed1998

The spectrum of skin, mucosa and other extra-articular manifestations.

The seronegative spondyloarthropathies appear to be the genetically predisposed host's clinical expression to acute, subacute or chronic reaction to the invasion by environmental microorganisms. In the ensuing days or weeks, depending on the infectious load, clinical manifestations may occur ranging from constitutional complaints such as fever, to a variety of symptoms and/or signs related to the portal of entry-intestinal, genitourinary or respiratory. Within weeks or months, the initial or other target organs, such as the mucocutaneous, ocular and cardiovascular systems, may develop an acute reaction of greater or lesser specificity regarding the triggering agent (oral ulcers, circinate balanitis, erythema nodosum, acute anterior uveitis, pericarditis, heart blocks). Lastly, many years later, a minority of patients, probably those with a large genetic component, exhibit a spectrum of clinical manifestations related to those organs, with a chronic or recurrent course. Acute clinical manifestations--reactive arthritis--are prominent in the initial phase of the clinical spectrum, while chronic manifestations--ankylosing spondylitis--are seen at the other end of the spectrum.

Arthritis, Reactive↗
PubMed2000

Can some cases of 'possible' spondyloarthropathy be classified as 'definite' or 'undifferentiated' spondyloarthropathy? Value of criteria for spondyloarthropathies. Spanish Spondyloarthropathy Study Group.

OBJECTIVES: When evaluating patients for spondyloarthropathy, clinicians use the 'possible spondyloarthropathy' category to indicate that they are unsure about the diagnosis. We sought to determine whether Amor's criteria or the European Spondyloarthropathy Study Group (ESSG) criteria could lift thi uncertainty. PATIENTS AND METHODS: During a Spanish study designed to validate criteria for spondyloar thropathies, 102 patients were classified in the 'possible spondyloarthropathy' category. We divided these patients into subgroups based on whether or not they met criteria for spondyloarthropathy. We compare baseline characteristics (N = 102) and five-year outcomes (N = 52) in these subgroups. RESULTS: The following features were significantly more common in the subgroups of patients who met Amor's criteria for spondyloarthropathy: oligoarthritis, heel pain, uveitis, balanitis, family history of spondyloarthropathy, an presence of the HLA B27 antigen. No differences were found for age at symptom onset, disease duration, buttock pain, gender, dactylitis, diarrhea, or psoriasis. Of the 52 patients followed up for five years, 17 me Amor's criteria at baseline and 13 were subsequently found to have definite spondyloarthropathy, whic was undifferentiated in six cases. There were only three cases of spondyloarthropathy among the 2 patients who did not meet Amor's criteria at baseline. Of the 28 patients who met ESSG criteria at baseline, 13 had spondyloarthropathy versus three of the 17 patients who did not meet ESSG criteria at baseline CONCLUSION: Amor's criteria or the ESSG criteria allow early classification of most patients with 'possible spondyloarthropathy' and early identification of undifferentiated spondyloarthropathy corresponding to minimal-symptom or incipient disease. In this study, Amor's criteria performed better than the ESSG criteria.

Adult↗
PubMed2002

Distal hypospadias repair: comparison of two different techniques.

The cosmetic results and the morbidity of Mathieu and Barcat techniques are presented and compared in a series of 52 children aged between five months to 19 years during January 1991 to May 2001. All patients treated with the Mathieu procedure had negligible glandular hypospadias at some level. The neomeatus was slit-like or elliptic in majority of the cases. The horizontal bucket handle deformity was eliminated which remains as a meatal problem of the original Mathieu procedure. Four patients had fistula, which was closed by surgery whereas another three had mild stricture formation. Cosmetic and functional results were excellent with the Barcat balanic groove technique. There was no fistula formation, only two had meatal stricture which responded to dilatations. The Barcat technique allows anatomically superior glans reconstruction resulting in a vertical and slit like neomeatus in distal hypospadias repair with a low complication rate.

Adolescent↗
PubMed1999

The incidence of phimosis in boys.

OBJECTIVE: To establish the incidence of pathological phimosis in boys. PATIENTS AND METHODS: A 2-year review of circumcisions was performed for phimosis among a known population of boys, with the histological findings of the circumcision specimens assessed. RESULTS: Sixty-two boys (all but one aged 5-14 years) had typical pathological (cicatrizing) phimosis and among the 51 circumcision specimens examined histologically, 43 (84%) showed appearances of balanitis xerotica obliterans. During the same period, 30 boys were circumcised for developmental unretractability of the foreskin ('physiological phimosis'). CONCLUSIONS: The incidence of pathological phimosis in boys was 0.4 cases/1000 boys per year, or 0. 6% of boys affected by their 15th birthday, a value lower than previous estimates and exceeded more than eight-fold by the proportion of English boys currently circumcised for 'phimosis'.

Adolescent↗
PubMed2001

Frequency and spectrum of Malassezia yeasts in the area of the prepuce and glans penis.

OBJECTIVE: To investigate the frequency and spectrum of lipophilic Malassezia yeasts within the area of the glans penis and preputial space in healthy men, most of whom were uncircumcised. SUBJECTS AND METHODS: As the glans penis and the prepuce are abundant in sebaceous glands, 130 clinically healthy men were examined for the presence of Malassezia spp. Two impression preparations each were made on modified Dixon (mDixon) and Leeming-Notman agar. The media were used with no added cycloheximide to allow the identification of the full spectrum of Candida yeasts. After 10 days of incubation at 32 degrees C Malassezia and Candida yeasts were differentiated by micromorphological and biochemical criteria. RESULTS: Malassezia spp. were found as part of the microflora of the glans penis in 49% of the men. The two media yielded comparable results for isolation frequency and spectrum: On mDixon agar, 47.6% of the isolates were identified as M. sympodialis, 42.8% as M. globosa, 4.8% as M. pachydermatis and 2.4% as M. furfur. Candida spp. (especially C. albicans) were found in 20.8%. There were no significant differences in the distribution of different Malassezia spp with age. CONCLUSIONS: Malassezia yeasts may belong to the resident microflora of the male genital region, which is supported by the finding that free sebaceous glands ('Tyson's glands') normally occur at this site. They may also be involved in pathological processes of the glans penis, e.g. balanitis, seborrheic eczema or psoriasis.

Adolescent↗
PubMed1999

Monomeric structure of the human EphB2 sterile alpha motif domain.

The sterile alpha motif (SAM) domain is a protein module found in many diverse signaling proteins. SAM domains in some systems have been shown to self-associate. Previous crystal structures of an EphA4-SAM domain dimer (Stapleton, D., Balan, I., Pawson, T., and Sicheri, F. (1999) Nat. Struct. Biol. 6, 44-49) and a possible EphB2-SAM oligomer (Thanos, C. D., Goodwill, K. E., and Bowie, J. U. (1999) Science 283, 833-836) both revealed large interfaces comprising an exchange of N-terminal peptide arms. Within the arm, a conserved hydrophobic residue (Tyr-8 in the EphB2-SAM structure or Phe-910 in the EphA4-SAM structure) is anchored into a hydrophobic cleft on a neighboring molecule. Here we have solved a new crystal form of the human EphB2-SAM domain that has the same overall SAM domain fold yet has no substantial intermolecular contacts. In the new structure, the N-terminal peptide arm of the EphB2-SAM domain protrudes out from the core of the molecule, leaving both the arm (including Tyr-8) and the hydrophobic cleft solvent-exposed. To verify that Tyr-8 is solvent-exposed in solution, we made a Tyr-8 to Ala-8 mutation and found that the EphB2-SAM domain structure and stability were only slightly altered. These results suggest that Tyr-8 is not part of the hydrophobic core of the EphB2-SAM domain and is conserved for functional reasons. Cystallographic evidence suggests a possible role for the N-terminal arm in oligomerization. In the absence of a direct demonstration of biological relevance, however, the functional role of the N-terminal arm remains an open question.

Amino Acid Motifs↗
PubMed2000

Diagnosis and clinical presentation of premalignant lesions of the penis.

Although a considerable number of penile cancers may arise de novo, certain potentially premalignant conditions do exist. We account in some detail for precancerous growths, which may initially be misclassified and not submitted to proper therapy and follow-up. At one end of the spectrum disorders exist that are generally considered as medically benign, such as warty tumors; at the other end growths occur that are highly indicative of being potentially invasive, i.e. giant condylomas, bowenoid papulosis, eythroplasia of Queyrat and Bowen's disease. We also focus on elucidating the clinical behavior of some inflammatory conditions, which may either be of pathogenic significance for squamous cell carcinoma development or give rise to differential diagnostic problems, most importantly lichen sclerosus et atrophicus (balanitis xerotica obliterans). We advocate a vigilant approach for histopathological evaluation whenever any clinical diagnostic uncertainty or therapeutic recalcitrance exists. We also favor the administration of highly active topical therapy against penile chronic inflammatory conditions such as lichen sclerosus et atrophicus, careful clinical follow-up of these cases and surgical treatment of phimosis.

Carcinoma in Situ↗
PubMed1991

Clarithromycin versus penicillin in the treatment of streptococcal pharyngitis.

The safety and efficacy of oral clarithromycin 250 mg every 12 h treatment and of oral penicillin VK (the potassium salt of phenoxymethylpenicillin) 250 mg every 6 h were compared in the treatment of streptococcal pharyngitis caused by Streptococcus pyogenes in an eight centre in-vivo study. A total of 243 patients were enrolled in the study and 125 patients were evaluated for efficacy; evaluable patients included 67 patients in the clarithromycin treatment group and 58 patients in the penicillin VK group. Both antibiotic regimens were effective in the treatment of streptococcal pharyngitis. The clinical cure rate during the initial post-treatment period (between two and ten days post-treatment) for the penicillin VK treated group was 98% (57/58) and for the clarithromycin treated group was 96% (64/67). The bacteriological cure rate during the initial post-treatment period for the penicillin VK treated group was 97% (56/58) and for the clarithromycin treated group was 100% (67/67). A total of 17 patients reported adverse events; seven patients were in the clarithromycin treatment group and ten patients in the penicillin VK treatment group. One patient in the penicillin VK group was withdrawn because of the severity of the adverse advent (balanitis). No clinically significant differences were reported between the two treatment groups for haematology, blood chemistry, or urinalysis evaluations. Oral clarithromycin 250 mg 12-hourly treatment was as safe and effective as penicillin VK 250 mg 6-hourly in the treatment of streptococcal pharyngitis.

Adolescent↗
PubMed1989

Comparison of integrated electromyographic activity and lumbar curvature during standing and during sitting in three chairs.

The purposes of this study were to monitor the integrated electromyographic activity of the erector spinae (ES) muscles and to measure lumbar curvature (LC) during static and dynamic postures in three chairs--a Balans Multi-Chair (BC), and office chair (OC), and a straight-back chair (SBC)--and during standing. Integrated electromyographic data were recorded in relaxed and erect postures at L2 and L5 in 20 volunteers. Lumbar curvature was measured with a flexible ruler. Analyses of variance for repeated measures (p = .05) and paired t tests were used to compare the IEMG and LC measurements. During relaxed postures, there was more IEMG activity and greater LC in standing than in the OC or the SBC. During erect postures, there was more IEMG activity in standing than in the OC and no difference in LC between chairs. The IEMG activity at L5 was greatest on the left side across chairs. In typing and writing, significant differences in IEMG activity were found between sides, but not between chairs. The LC was greater in the BC than in the SBC in relaxed sitting, typing, and writing. The pattern of IEMG activity is not similar to corresponding LC measurements. Care and prevention of low back injury is a critical focus in physical therapy. The BC could contribute to treatment. Further research is needed to support its use in back care programs.

Adult↗
PubMed1990

Lumbar curvature in standing and sitting in two types of chairs: relationship of hamstring and hip flexor muscle length.

A purpose of this study was to determine the difference in the lumbar curves of subjects while they stood compared with while they sat in two chairs with different seat angles--the Balans Multi-Chair (BMC) and a standard conventional chair (SCC). An additional purpose was to determine the relationship between lumbar curvature and 1) anthropometric factors and hamstring and hip flexor muscle length during standing and during sitting in the two chairs and 2) amount of time spent sitting. Sixty-one men between 20 and 30 years of age served as subjects. Lumbar curve measurements were taken with a flexible ruler with the subjects first standing and then sitting in the two chairs. Hamstring and hip flexor muscle lengths were indicated by range-of-motion measurements taken with a gravity goniometer. Age, number of hours spent sitting per day, upper body length, and right leg length also were recorded. Subjects had significantly more lumbar extension when they sat in the BMC than when they sat in the SCC. Hip flexor length was the only factor that appeared to relate significantly to the difference between the standing lumbar curve and the lumbar curves in the BMC and the SCC.

Adult↗
PubMedDate not supplied

Clinical and microbiologic features of urethritis in men in Toulouse, France.

On hundred twenty-six men who attended a hospital microbiology laboratory and 99 men who attended a private laboratory in Toulouse, France, for symptoms of urethritis were examined during 1988, for evidence of urethral pathogens. The following incidences were found: Neisseria gonorrhoeae: 24 (10.7%); Chlamydia trachomatis: 58 (25.8%); Ureaplasma urealyticum: 46 (20.4%); Gardnerella vaginalis: 21 (9.3%); Haemophilus parainfluenzae: 21 (9.3%); Streptococcus agalactiae: 15 (6.7%); Candida albicans: 10 (4.4%); and Trichomonas vaginalis: 4 (1.8%). The prevalence of these microorganisms was similar in the two groups of patients. No pathogen was isolated from 71 patients (31.6%). Mixed infections with at least two pathogens were found in 49 men (21.8%). Another goal of this study was to determine the relative prevalence of urethral pathogens in relation to clinical findings. N. gonorrhoeae was isolated significantly more often in patients who had a urethral discharge (P less than .05) that contained five or more polymorphonuclear cells per high-power field (PMN/HPF) (P less than .001). G. vaginalis was isolated significantly more often in patients who did not have an urethral discharge (P less than .05) and in men with less than five PMN/HPF (P less than .05). Isolation of C. albicans was significantly associated with pruritus (P less than .05) and balanitis (P less than .001). Like the clinical features, the gram-stained urethral smear was of limited value in diagnosis and therapeutic decision-making regarding non-gonococcal urethritis. In contrast, this study underlines the importance of full identification of urethral isolates in the management of urethritis in men.

Adult↗
PubMed2002

Skin graft for 2-stage treatment of severe hypospadias: back to the future?

PURPOSE: Despite the introduction of more refined surgical techniques, the optimal treatment of the most severe forms of hypospadias remains to be determined. Single stage procedures, whether with the use of flaps or grafts, have long been regarded as the best approach, although the complication rate is nonnegligible with all procedures. MATERIALS AND METHODS: We report the use of a 2-stage repair with preputial graft interposition and subsequent tubularization of the urethral plate applied it to all severe cases of hypospadias with significant chordee or small glans. RESULTS: Both stages of the procedure were completed in 34 patients. Complications in 8 cases (23.5%) included 4 glans disruption in 4, coronal grove fistula in 2, urethral diverticulum in 1 and urethral stenosis due to balanitis xerotica obliterans in 1. Two pinhole fistulas also occurred which closed spontaneously. No complete disruptions or postoperative hematomas/bleeding was noted. Cosmetic and functional outcome after a minimum followup of 1 month was optimal in all cases with a normally located "slit" meatus and straight penile shaft. CONCLUSIONS: Although the controversy between use of grafts and flaps will probably continue forever, we believe that our 2-stage approach should be considered as a valid alternative for the most severe forms of hypospadias. Long-term results appear to outnumber the necessity of a learning curve for appropriate graft manipulation.

Adolescent↗
PubMed1995

Zosteriform atrophoderma of Pasini and Pierini.

Astophoderma of Pasini and Pierini is generally regarded as an atrophic variant of morphoea. It arises most commonly on the trunk and abdomen. We describe a 53-year-old man who had a 12-year history of unilateral atrophoderma of Pasini and Pierini affecting the left side of his trunk in a zosteriform distribution. Within these clinically atrophic lesions, there were localized areas of induration which were typical of morphoea. The patient also had a preceding history of balanitis xerotica obliterans. The occurrence of atrophoderma of Pasini and Pierini, morphoea and lichen sclerosus within the same individual supports the view that these conditions are closely related, and suggests that common factors may be involved in their aetiologies.

Humans↗
PubMed1994

The treatment of childhood phimosis with topical steroid.

A prospective study of the efficacy of topical steroid in the treatment of childhood phimosis is reported. Boys referred to a paediatric surgical practice with pathological non-retractable foreskins were treated for at least 1 month with topical beta methasone cream. One hundred and thirty-nine patients were treated and 111 completed the study. A satisfactory result, defined as foreskin retractability appropriate for the boys' age, was achieved in 80% of patients. In 10% the response was inadequate at the end of the study period, but these boys were still under treatment or surveillance because their parents declined circumcision. In 10%, circumcision was performed because of failure of treatment. In six patients this was due to balanitis xerotica obliterans (lichen sclerosis et atrophicus) which does not respond to conservative treatment. Successful treatment depends upon the presence of a normal, supple foreskin at the outset, and on parental compliance.

Administration, Topical↗
PubMed1988

Urethral strictures in childhood.

Thirty-six children have been treated for a non-hypospadiac urethral stricture. Of 12 patients with meatal or submeatal stenosis, 10 had undergone circumcision for balanitis xerotica obliterans. The strictures were successfully treated by meatoplasty or meatal dilatation. Twenty-four children had a more proximal urethral stricture: 16 were caused by urethral catheterisation, 4 were post-traumatic, 2 were congenital and 2 were idiopathic. Sixteen children were treated by visual urethrotomy; this was successful in 12 after a maximum of 2 urethrotomies. Two children required 4 or more urethrotomies and 2 required urethroplasty for restricturing. Seven children were treated by a formal urethroplasty. There were no complications. Two patients died of unrelated medical conditions. Follow-up was for a mean of 2 years.

Child↗
PubMed2005

[Anogenital dermatoses--allergic and irritative causative factors. Analysis of IVDK data and review of the literature].

BACKGROUND: Anogenital dermatoses (AGD) are common and often very distressing. Clinically it is often unclear if allergic contact dermatitis or irritant dermatitis is involved. In order to optimize therapy and prophylaxis, it is essential to identify relevant allergens or irritants. PATIENTS AND METHODS: Data of the Information Network of Departments of Dermatology (IVDK, data center in Göttingen) collected between 1999 and 2003 were analyzed. The anogenital area was involved in 1 168 patients with suspected allergic contact dermatitis. Clinical variables and patch test results were statistically compared with the remaining IVDK patch test population, the latter standardized for age and sex. RESULTS: Allergic contact dermatitis had been suspected prior to patch testing in 39.5 %, while in 24.6 % this diagnosis was eventually confirmed. Irritant contact dermatitis was diagnosed in 11.8 %. Other diagnoses, included balanitis, lichen sclerosus et atrophicus and herpes genitalis. Positive reactions to cinchocaine (6.6 %), bufexamac (3.5 %) and benzocaine (2.4 %) were observed significantly more often among patients with anogenital dermatitis. Among those in whom co-factors were considered important (n = 422), wetness (38.4 %), occlusion (30.3 %), mechanical strain (4.7 %) and heat (3.6 %) were mentioned as irritation factors. CONCLUSION: Because of the significantly higher frequency of sensitization to cinchocaine, benzocaine and bufexamac in patients with anogenital dermatitis, these ingredients should be used only with caution. According to the literature, ingredients of toiletries, cosmetics and contraceptives of any kind seem to cause allergic contact dermatitis rarely although there are several case reports. Comprehensive patch test including the standard series plus major sensitizers such as cinchocaine, benzocaine and bufexamac, and in particular patients' own skin care products, is recommended.

Adult↗
PubMed1986

Circumcision for phimosis--indications and results.

A follow-up study including all boys (n = 117) operated with circumcision for phimosis during 1976 was performed. Most patients were operated on an outpatient basis. Early complications like bleeding or infection were few and mild. In 13 cases there was a postoperative stricture of the urethral orifice which had to be widened. Five patients had complaints about the cosmetic result. Eight boys expressed shyness and unwillingness to undress in school gym. In no instance were there any signs of a more serious psychological disorder. The operative indications are discussed and it is concluded that worried parents of boys with phimosis can be safely advised to have their boys circumcised if the prepuce is scarred or there has been recurrent balanitis, or if the boy has reached school age and the foreskin is still unretractable.

Child↗