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[Chronic idiopathic neutropenia improved by recombinant granulocyte colony stimulating factor].

A 55-year-old man was admitted to our hospital for the evaluation of neutropenia. On physical examination, he had apthae and splenomegaly. CBC showed 1,000/microliter WBC with 5% neutrophils, and microcytic anemia consistent with iron deficiency. Bone marrow examination revealed a marked decrease of mature neutrophils, but normal percentage of immature myeloid cells. There was no morphological abnormality in the hemopoietic cells. He had no drug or family history responsible for the neutropenia. Anti-neutrophil auto-antibody was negative. Hence, a diagnosis of chronic idiopathic neutropenia (CIN) was made. He developed frequent episodes of infection such as balanitis, peri-anal infection, gingivitis, and pharyngitis. He was treated with steroid pulse therapy, anabolic hormone, and high dose gamma-globulin infusion, but no significant improvement occurred. Then, recombinant granulocyte-colony stimulating factor (rG-CSF) was started. The neutrophil count was normalized by the 7th day of 5 micrograms/kg/day rG-CSF administration. The administration of G-CSF was discontinued after a 14-day course. Thereafter, the neutrophil count remained at near normal level (approximately 1,500/microliter) and there have been no episodes of infection in the last 5 months. However this cannot be explained simply by the direct effect of rG-CSF on the myeloid precursors; rather, it suggests some unknown effect of G-CSF on the bone marrow microenvironment regulating myeloid hemopoiesis. We consider this to be a rare case of CIN with frequent episodes of infection, which was successfully treated with G-CSF.

Agranulocytosis↗

Premalignant lesions and nonsquamous malignancy of the penis and carcinoma of the scrotum.

Premalignant lesions of the penis include cutaneous horn, balanitis xerotica obliterans, and leukoplakia. The true incidence of progression of each of these to squamous-cell carcinoma is unknown. Bowenoid papulosis, erythroplasia of Queyrat, and Bowen's disease are histologically identical to in situ carcinoma. Although the first is consistently benign, the latter two regularly evolve into invasive cancer. Malignant scrotal lesions include squamous-cell carcinoma, liposarcoma, leiomyosarcoma, basal-cell carcinoma, extramammary Paget's disease, erythroplasia of Queyrat, malignant melanoma, and metastases. Hemangioma can be confused with carcinoma.

Carcinoma↗

[Neurologic involvement in Reiter's disease. Report of 2 cases].

Neurologic involvements is a rare complication of Reiter syndrome. It may precede other manifestations and constitutes a cause of death. We report 2 cases. The first, an 18 year-old male developed arthritis, fever, balanitis and sacroileitis 2 months after non gonococcal urethritis. He received phenylbutazone and local steroids without improvement. Logic dysphagia, diplopia with bilateral paralysis of the IV and VI cranial nerves and generalized absent reflexes developed gradually 2 weeks after admission. Methylprednisolone pulses failed to improve the patient's condition and plasmapheresis was associated to near complete remission after 6 exchanges. The other patient, a 31 year old male started out with alternating lower extremity paresis. One month later, urethritis, conjunctivitis, arthritis and sacroileitis appeared. The electromyogram was characteristic of axon sensorimotor polyneuropathy. Administration of naproxen was associated to complete improvement within 2 weeks. Neither patient had shown evidence of recurrence after a 5 year follow up period.

Adolescent↗

[A case of Reiter's disease with severe skin manifestations successfully treated with oral etretinate].

A case of Reiter's syndrome with severe keratoderma being successfully treated with oral Etretinate is reported. A 38 year-old man was referred to our hospital in December, 1985 for treatment of refractory skin eruptions and polyarthralgia. He previously experienced urethritis in December, 1983 with subsequent development of high fever, balanitis, skin eruptions and polyarthritis. Treatments with antibiotics, anti-inflammatory drugs and glucocorticoids were ineffective at that time. The patient was diagnosed as Reiter's syndrome based on his clinical symptoms and the presence of HLA-B27. He was treated in our clinic with oral administration of Etretinate, aromatic retinoids, at the initial doses of 40 mg/day with subsequent increase up to 75 mg/day in 2 weeks. This maintenance dose was continued for two months, resulted in improvements of joint pain, skin eruptions and the laboratory abnormalities. The doses of Etretinate was gradually decreased and then was discontinued after 4 months, when approximately 90% of the skin lesion disappeared. No noticeable side-effect was observed except slight stomatitis. The remission continued for about 2 and half years after cessation of Etretinate without any medication. However, evidence of relapse with the same skin lesions and arthralgia was observed in March, 1989. A repeated treatment with oral Etretinate was attempted with similar but slightly delayed effects.

Adult↗

[Significance of skin changes in diabetes mellitus].

500 patients of a dispensaire of diabetes were inspected dermatologically. 335 patients had a duration of the glucose metabolism intoleration less than 10 years and 165 patients more than 10 years. 215 patients stated a striking family case history according diabetes. 54 per cent (273) of the cases showed an adiposity, 418 patients (83.6 percent) had pathological changes of the skin and mucosal changes. It is clear that dermatomycoses, eczema and pyodermias occur more often with acute metabolic disorder and adiposity. Neurovascular changes of the skin occur with long persistent glucose metabolism intoleration. Bad healing tendencles of wounds, pruritus, intensive dermatomycoses, balanitis, vulvitis, furunculosis and pyodermias are important references to a glucose metabolism intoleration. They should give rise to look for a diabetes irrespective of the age of the patient.

Adolescent↗

Postneonatal circumcision: population profile.

Because postneonatal circumcision includes the risk of general anesthesia and costs more than elective neonatal circumcision, a retrospective study was performed to describe the population currently undergoing postneonatal circumcision and to identify the factors influencing decisions that lead to this procedure. A chart review and follow-up telephone survey were done to gather information concerning patients admitted for postneonatal circumcision to two Salt Lake City hospitals during a 2-year period. From the 135 patients eligible for analysis, two distinct groups emerged: the "sick" group (n = 52)--those who had neonatal complications, and the "well" group (n = 83)--those with no neonatal complications. The median age at circumcision was 5.5 months for the boys in the sick group and 35 months for the boys in the well group (P less than .001, Student's t test). During the neonatal period, 32% of families in the well group received anticircumcision advice from their primary care physician. The decision in favor of circumcision was made by two thirds of the families of sick infants before their sons were 6 weeks of age. Other surgery was performed concurrent with the circumcision in 44% of patients in the sick group and 24% of patients in the well group (P less than .0001, chi 2). Balanitis, phimosis, or a physician's recommendation were listed as the primary reason for post-neonatal circumcision by 50% of patents in the well group. Phimosis was listed by the surgeon as an indication for postneonatal circumcision in 65% of all patients' charts, although only 13% of parents listed phimosis as an indication for their children's circumcision.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Urogenital chlamydial infection in men and their sexual contacts].

Cultivation and serological tests for Chlamydia trachomatis were made in a total of 39 male patients (24 married, 11 single, 3 divorced, 1 widower) and their female partners (9 extra-marital, 12 wives) on average 35 years old in both groups. Apart from the clinical diagnosis of non-specific urethritis found in all male patients, 11 patients suffered from other infections (5 from balanitis, 4 from prostatitis, 1 from prepuce infection, 1 from herpetic infection) and subjective disorders. Side by side with clinical diagnosis of cervicitis or in combination with urethritis found in 16 female sexual partners, two of them suffered also from vulvovaginitis, 2 from adnexitis, 1 from candidosis, 1 had dysuric difficulties and 1 female patient was found sterile. 11 women had no subjective problems. The cultivation-tinction technique used in 25 men (14 married, 11 single) and 14 female sexual partners respectively (8 marital and 6 extramarital), positive Chlamydia trachomatics was isolated 21 times (84%) and 9 times (64.3%) respectively. The immunofluorescence technique using monoclonal antibodies applied to 39 men (24 married, 15 single) and 21 female sexual partners respectively, (i. e. 12 marital and 9 extramarital) gave positive results in 29 cases (74.4%) and 16 persons (76.2%) respectively. One patient was homosexual with a positive finding in the urethra and rectum, and, in addition, he was found to have BWR positive with Candida albicans and group B streptococci, however, his serological HIV was negative. The immunoenzymatic test (EIA) showed borderline titres as being positive in men in 28.2% cases and women in 26.3% and high levels (1:128+) in 41.0% in male patients and 21.1 percent in female patients respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Chlamydia Infections↗

Basal keratinocyte herniation.

Basal cell herniations, i.e. basal keratinocyte processes protruding through basal lamina gaps were observed in psoriasis, circinate balanitis, pityriasis rubra pilaris, patch tests, gold dermatitis and conjunctivitis. This indicates that they are not specific to psoriasis and tumours as has been reported.

Basement Membrane↗

Diagnosis of systemic candidosis by immunodiffusion test with locally prepared antigen.

Locally-made C. albicans, C. tropicalis, C. krusei antigens and antisera were made and compared with reference C. albicans and C. krusei antigens and antisera from the Center for Disease Control (CDC), Atlanta, Georgia, U.S.A., and the Provincial Laboratory of Public Health, University of Alberta, Edmonton, Alberta, Canada, respectively. The local antigens and antisera showed 3 precipitin bands when reacted with locally-made and reference antisera. When tested with human sera from 171 normal persons (aged 17-24 years), 30 Candida vaginitis, 30 Candida balanitis, 30 mucocutaneous candidosis, 30 pityriasis versicolor and 10 aspergillosis patients revealed no precipitin band. When tested with cryptococcosis, 2 out of 6 sera showed a precipitin band but only at 1:1 dilution. Four candidosis sera offered by CDC showed precipitin bands at dilutions up to 1:4. Three Thai candidosis sera also showed precipitin bands at dilutions up to 1:2. Therefore, we judged the baseline titer for Thai population to be 1:2.

Adolescent↗

Reiter's syndrome in uremia: report of a case.

A 35-year-old male uremic patient developed the classical presentation of Reiter's syndrome after 3 years of regular hemodialysis. He had painful swelling of the left knee, sacroilitis, urethritis, balanitis, painless oral ulcers, acute uveitis and positive HLA-B27. Disease activity persisted and was aggravated although immune function studies showed depressed cellular immunity. The clinical course of this patient seemed to contradict our belief that activity of immunologically mediated disease will abate after uremia, but it concurred with the report that Reiter's activity was unchanged in AIDS despite the significant immunodeficiency of AIDS patients.

Acquired Immunodeficiency Syndrome↗

Systemic administration of recombinant methionyl human interleukin-2 (Ala 125) to cancer patients: clinical results.

Nineteen evaluable patients with advanced malignancy were treated with recombinant methionyl human interleukin-2 (Ala 125), 5 days per week by intravenous bolus. Patients were entered in five groups at starting doses ranging from 0.05 to 2.56 x 10(6) U/m2. Doses were escalated weekly as tolerated toward a potential maximal dose of 11.6 x 10(6) U/m2. Maximal tolerated dose was 3.84 x 10(6) U/m2. Dose-limiting toxicity included fatigue, rigors, nausea/vomiting, fever, and diarrhea. Other toxicities included hyperesthesias, arthralgias/myalgias, rash, fluid retention, balanitis, and mild confusion. Leukocytosis, including granulocytosis, eosinophilia, and mild lymphocytosis, was observed, as was rare mild thrombocytopenia. No partial or complete response occurred. T1/2 alpha averaged 13.4 min, with interleukin-2 detectable 2 h after doses of greater than or equal to 2.56 x 10(6) U/m2. Three patients developed anti-IL-2 antibodies without demonstrable clinical significance.

Body Weight↗

[Laboratory and clinical studies of cefpodoxime proxetil in pediatric field].

We have carried out laboratory and clinical studies on cefpodoxime proxetil (CS-807, CPDX-PR). The results are summarized as follows. CPDX-PR was given via oral administration to each 2 children at a single dose of 3 mg/kg and to each of 3 children in a 100 mg tablet. After the oral administration, mean peak serum levels of CPDX obtained for the 2 dose levels were 1.86 +/- 0.35 micrograms/ml and 2.16 +/- 0.63 micrograms/ml at 2 hours, respectively, and mean half-lives were 1.31 +/- 0.02 hours and 1.47 +/- 0.18 hours, respectively. The mean urinary excretion rate of CPDX was 32.8 +/- 1.0% in the first 12 hours after the oral administration of 3 mg/kg. When a dose of 100 mg tablet was given to each of the 3 children, urinary excretion rates in the first 12 hours were 43.5%, 48.6% and 24.8%, respectively. Treatment with CPDX-PR was done in 38 cases of pediatric bacterial infections; 19 cases of tonsillitis, 3 cases of pharyngitis, 1 case of bronchitis, 3 cases of pneumonia, 3 cases of scarlet fever, 2 cases of impetigo, 4 cases of UTI and 1 case each of phlegmone, subcutaneous abscess and balanitis. Results obtained were excellent in 23 cases, good in 15 cases. No significant side effect due to the drug was observed in any cases.

Absorption↗

[Vulvovaginitis circinata in Reiter's disease].

A case of Reiter's disease with circinate vulvovaginitis is presented. As a clinical analogue to circinate balanitis, it should have the same diagnostic value. A combined treatment of prednisone and aromatic retinoid proved to be effective.

Adult↗

[Ischemic colitis in Reiter syndrome].

Involvement of visceral organs is a recognized condition of Reiter's Syndrome. To our knowledge, however, involvement of the colon, as it is seen in other rheumatoid-like processes mostly caused by vasculitis, has not been described before. We present the case of a patient with incomplete Reiter's Syndrome with arthritis, circinate balanitis and psoriasilike lesions of skin and nails who developed ischemic colitis. Angiographic features point to vasculitis as a potential cause, although this could not be proved. It is possible but, as we believe, unlikely that simultaneously administered steroid treatment may have contributed to the development of the lesions.

Arteries↗

[Possible relations between Reiter's disease and psoriasis (author's transl)].

Description of a characteristic venereal type of Reiter's disease with a pustular exanthem and a balanitis circinata. In the course of the disease the pustular exanthem probably transformed into a typical Psoriasis vulgaris. In search of genetical markers it was not possible in this case to show the HLA-antigens, which are characteristic of the Reiter's disease and the Psoriasis vulgaris; the HLA-antigens A 10, B7 and B12 however could be proved. The question is up for discussion, wether a HLA-B 27-negative Reiter's disease might include a disposition to the appearance of a phenotypical Psoriasis vulgaris, the genotype of which is represented by rather "unusual" histocompatibility-gens.

Adult↗

[Reiter-Fiessinger-Leroy syndrome].

A patient with Reiter- Fiessinger - Leroy disease is described. He presented all the symptoms: urethritis , conjunctivitis , arthritis, balanitis circinata and keratodermia. The antigen reward HLA-B27 lean up on the diagnostic. The treatment with methotrexate disappeared the clinical manifestations.

Adult↗

[Hypospadias: tactical considerations and surgical technic].

The Auther present the results of hypospadias modern treatment. Glandular or balanic aspects, traited by MAGPI or similar techniques insure an absence of complications. Esthetic results are better than Mathieu. In penile aspects with chordee, Mollard urethroplasty don't expose to two-stage urethroplasty, Duckett or Devine-Horton complications. On makes use of classical 2 or 3 stage operations only in perineal hypospadias.

Humans↗