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[A case of diaper fetishism].

Some people cannot obtain satisfaction from ordinary sexual relationships; instead they prefer alternative methods. They are referred to in psychiatric terminology as paraphiliacs. Fetishism is a type of paraphilia in which a person is sexually attracted to objects and some body parts. Most fetishists do not intend to cause harm to other people, but may have problems when others become involved in the problem. Underlying personality disorders extending through childhood are thought to be the source of the etiology. Perverted people do not wish to change their behavior pattern. They never seek treatment from a therapist. Psychological issues obviously play a crucial role in determining the choice of paraphilia and the underlying meaning of the sexual acts. Psychodynamic models (object relations theory, self psychology, drive theory) can shed light on the meaning of a perversion. In this case report, a 22- year-old man with diaper fetishism is presented. When family dynamics are considered, the mother has been described as psychologically distant from her son. The fetish object was recognized during childhood at around the age of four. During puberty, the fetish object became sexually attractive. Our patient exhibited his first perverted behavior when he was six years old. Later, he could control this behavior. At the age of twelve, the perverted behavior became sexually arousing. This paper emphasizes the diaper fetishism case through the patient's past psychiatric and medical history. Diaper fetishism is discussed in the light of forensic, cognitive and psychodynamic theories.

Adult↗

Topical miconazole nitrate ointment in the treatment of diaper dermatitis complicated by candidiasis.

Diaper dermatitis (DD) complicated by candidiasis is a common problem in diaper-wearing infants and children. We report a double-blind, vehicle-controlled, parallel-group study evaluating the efficacy and safety of a low concentration of miconazole nitrate in a zinc oxide/petrolatum ointment for the treatment of DD complicated by candidiasis. Patients (N=330) who had DD with a severity score of 3 or higher were enrolled. Those patients with a baseline potassium hydroxide (KOH) preparation and a baseline culture specimen that both tested positive for Candida were retained for efficacy analysis (n=236). Miconazole nitrate 0.25% ointment or a zinc oxide/petrolatum vehicle control were applied to all clinically affected areas of patients with DD for 7 days at each diaper change and after bathing. A follow-up test-of-cure visit was conducted at day 14. Among the patients completing the study, the overall rate of cure (clinical cure plus microbiologic cure) was 23% for the miconazole nitrate group and 10% for the vehicle control group (P=.005); the rate of clinical cure (complete rash clearance, DD severity score=0 at day 14) was 38% for the miconazole nitrate group and 11% for the vehicle control group (P<.001); and the rate of microbiologic cure (no culture growth of Candida) was 50% for the miconazole nitrate group and 23% for the vehicle control group. The vehicle control resulted in mild improvement at day 3 but little or no subsequent improvement. The discontinuation rate due to clinical failure was substantially lower for the miconazole nitrate group (4%) than the vehicle control group (47%). The mean DD severity index score for the miconazole nitrate group was significantly lower from day 3 through day 14 compared with that of the vehicle control group (P<.001). Adverse events were assessed as either unlikely to be related to study medication or unrelated to study medication. By including only those patients with microbiologically confirmed Candida infection, the study population may not be fully indicative of patients treated for DD in routine clinical practice. Our data show that miconazole nitrate 0.25% ointment was well tolerated and significantly more effective than the zinc oxide/petrolatum vehicle control for treatment of DD complicated by candidiasis.

Administration, Topical↗

Practical management strategies for diaper dermatitis.

Common diaper dermatitis is an irritant contact diaper dermatitis (IDD) created by the combined influence of moisture, warmth, urine, feces, friction, and secondary infection. It is difficult to completely eradicate these predisposing factors in a diapered child. Thus, IDD presents an ongoing therapeutic challenge for parents, family physicians, pediatricians, and dermatologists. This article will focus on practical management strategies for IDD.

Candidiasis↗

Relation between the intestinal flora and diaper dermatitis in infancy.

In this study, 40 patients with diaper dermatitis and 20 healthy infants were investigated. Mycological and bacteriological cultures were obtained from affected and healthy skin areas and stool specimens. Candida albicans was isolated simultaneously in 37 out of 40 patients subjected to mycological examination of skin lesions and stool specimen cultures. Of 34 Gram-stained smears from the skin lesions, 27 revealed Candida in hyphal form. In the control group, C. albicans was not grown from the diaper area. No significant difference was observed in the growth of bacteria from the skin with or without lesions (p greater than 0.05). In conclusion, C. albicans-infection originating from the gastrointestinal tract, plays a major role in diaper dermatitis. Thus, a Gram-stained smear can be used as a practical method in early diagnosis.

Candida albicans↗

Urinary ammonia and ammonia-producing microorganisms in infants with and without diaper dermatitis.

Free ammonia was determined in diaper squeezings from 26 infants with "ammoniacal dermatitis" and in 82 controls. No significant difference was found (402 ppm in diaper dermatitis compared to 465 in controls). The groups did not differ with regard to the incidence of organisms capable of splitting ammonia from urea. Experimental application of highly ammoniacal urine on intact infant and adult skin failed to provoke a dermatitis. Erythema could be induced only when ammoniacal urine was applied occlusively to scarified skin. These findings do not support the notion that ammonia is a primary factor in common diaper rash, but do not exclude a possible role for further irritation in an already existent condition.

Ammonia↗

[Candidiasis in children with diaper rash. Study of 140 cases].

The frequency of genito-crural candidiasis in infants presenting diaper rash, as well as the possible influence of bacterial flora in this region on the pathogenicity of Candida was studied. Skin scraping were made with sterile swabs and processed by bacteriological and mycological methods in 140 children whose ages ranged between 0 and 20 months. The most commonly found microbiological flora were Candida spp (65.7%), non hemolytic Streptococcus (18.5%), Staphylococus epidermidis (19.2%); beta hemolytic Streptococcus (12.8%) and alfa-hemolytic Streptococcus (9.2%). Of the 140 cases, 76 (54.3%) showed candidiasis associated with diaper rash and 16 (11.4%) had Candida as normal flora. C. albicans was most frequently found (66.3%) followed by C. tropicalis (19.6%). Candidiasis was more frequent in those infants that had no other associated of pathogenic flora. Factors significantly influencing the increase in the frequency of candidiasis were: A) Evolution time, which was directly proportional; B) Use of cotton diapers covered with plastic pants; C) Feeding with cow's as opposed to maternal milk; and D) Malnutrition associated with poor hygiene.

Bacteria↗

Diaper dermatitis. How to treat and prevent.

Dampness, maceration, fecal enzymes, chemicals, and other irritants lead to diaper dermatitis in infants. Most cases can be cleared with frequent diaper changes, use of superabsorbent disposable diapers (which contain gelling material in their core), and a low-potency topical corticosteroid. If the eruption lasts for more than 3 days or classic erythematous satellite lesions are present, addition of an antifungal agent should help resolve the condition. Recalcitrant or clinically atypical eruptions may signify rarer disorders, such as psoriasis, Langerhans' cell histiocytosis, Leiner's disease, or acrodermatitis enteropathica. Patients with these conditions should be referred to a dermatologist, if possible, for further evaluation and treatment.

Acrodermatitis↗

Changes in diapered and nondiapered infant skin over the first month of life.

Time- and site-dependent differences in epidermal barrier properties were investigated over the first 28 days of life in healthy term newborn infants. Diapered and nondiapered skin sites were contrasted to the volar forearm of adults (mothers). Thirty-one term infants were evaluated in the hospital on postnatal day 1 and at home on days 4, 7, 14, 21, and 28 for a total of six visits. Measurements included baseline skin hydration, continuous capacitive reactance, peak water sorption, rate of water desorption, skin pH, skin temperature, and environmental conditions. Changes in epidermal barrier properties over the first 4 weeks of life included an increase in surface hydration, a decrease in transepidermal water movement under occlusion, a decrease in surface water desorption rate, and a decrease in surface pH. Diapered and nondiapered regions were indistinguishable at birth but exhibited differential behavior over the first 14 days, with the diapered region showing a higher pH and increased hydration. Maternal measurements remained constant throughout the period. We conclude that healthy newborn skin undergoes progressive changes in epidermal barrier properties over the first 28 days. Adult skin testing does not replicate newborn skin during the first month of life.

Adult↗

Diaper burn: accident, abuse, or neglect.

A 7-year-old, female with mental retardation and seizure disorder was admitted with burns. Reportedly, her brother who was 12 years old was cooking dinner for himself. A towel caught fire. He threw the towel over his head, and the patient's diaper ignited. She had partial thickness second-degree burns over her right elbow, upper abdomen, both inner thighs, and buttocks with multiple blistering, which was estimated to be 7% of the total body surface. The child abuse team took a diaper similar to the one the child was wearing at the time of injury and found that it easily ignited and melted in several seconds. This is the first medically reported burn case due to a disposable diaper.

Abdominal Injuries↗

Two cases of diaper area granuloma of the adult.

Two cases of diaper area granuloma are reported. Patient 1, a 34-year-old man, had multiple reddish-purple nodules over the diaper area of the right part of the genitocrural region. Candida albicans was not detected from the lesion. Histological examination of the nodule showed acanthosis and dense infiltrates. The granulomas became smaller and flatter after the control of urination. Patient 2, a 28-year-old man, had two large decubitus lesions and multiple nodules over the diaper area of the gluteal region. The decubitus became smaller and the granulomas disappeared after the lesion was kept clean. Because these granulomas resemble granuloma gluteale infantum, but occurred in adults rather than in the aged or infants, we propose to call this condition "granuloma gluteale adultorum." We suggest that these granulomas may represent an inflammatory reaction to the irritation of urine or feces. It is, therefore, of great importance to treat and prevent this condition by controlling the flow of urine and keeping the region clean.

Adult↗

Obscuring urinary incontinence. Diapering of the elderly.

To assess the prevalence, evaluation, and treatment of urinary incontinence in an institutionalized elderly population, the charts of 511 residents in a New York City nursing home were reviewed. Whereas the nurses' notes documented urinary incontinence in 62.4% of the total resident population, the physicians' notes listed this as a problem in only 10% of the residents. Most (90.3%) of the cases of incontinence were not classified as to etiology or pattern. Treatment emphasized the use of diapers in 78.2% of the cases, which was combined with bladder conditioning in most instances. This treatment approach had been initiated, administered, and monitored by the nursing staff. Indwelling catheters were used in 4.0% of the situations, and pharmacologic therapy was used in 2.5% of the cases. It is suggested that adult diapers may not be the optimal treatment for urinary incontinence since they treat the symptom instead of the cause. There should be a systematic approach to the classification and treatment of urinary incontinence prior to the long-term utilization of diapers.

Aged↗

Reliability of sampling urine from disposable diapers in elderly incontinent women.

OBJECTIVE: To assess the reliability for biochemical and microbiological analysis of urine collection from disposable diapers in elderly women with severe urinary incontinence. DESIGN: Cross-sectional comparison of two methods of collection. PATIENTS AND MEASUREMENTS: Urine was sampled from 52 women inpatients (aged 68-98 years) in a geriatric hospital ward by pressing a diaper which the patient had worn for 3 hours. Just after this collection, another sample was obtained by retrograde catheterization. Both samples were analyzed for sodium, potassium, chloride, proteins, urea, creatinine, calcium, and phosphate and for cell counts, the presence of bacteria, and bacteria culture. RESULTS: For all the biochemical parameters, the urinary concentrations obtained by the two methods were strongly and significantly correlated. The following differences (mean and range, in mmol/L) were found between the values obtained by the two methods: sodium: 6.05 (-26 to 27), potassium: (-16 to 14), chloride: -1.13 (-24 to 23), urea: 6.85 (-33 to 37), creatinine: 0.24 (-0.95 to 1.45), calcium: -0.22 (-1.27 to 1.70), and phosphate: 2.17 (-2.5 to 13.4). For diagnosis of urinary tract infection, agreement between the two methods was good (kappa = 0.84), and bacteriological agreement was obtained in 25 out of 28 cases (89%). However, for diagnosis of microscopic hematuria, agreement was poor (kappa = 0.50), probably due to the overestimation of the true urinary red cell count in the samples collected by catheterization. CONCLUSION: For routine microbiological and biochemical analysis, urine extraction from disposable diapers is a simple and reasonably reliable method of sampling urine from elderly women with severe incontinence.

Aged↗

[Analysis of urinary tract infections in hospitalized elderly patients, with particular reference to the use of diapers].

We investigated the clinical and laboratory data of 215 hospitalized patients (mean age were 76.9 +/- 12.1) to analyze both the characteristics of senile UTI and the influence of the way of urination. UTI was present in 121 of 1897 patients (6.4%), 95 of whom (78.5%) were female. Comparison of the parameters between non-infected and infected patients were as follows: body temperature was 36.57 +/- 0.64 degrees C vs. 37.49 +/- 0.77 degree C; WBC, 5410 +/- 2040/microliters vs. 7260 +/- 3230/microliters; CRP, 1.2 +/- 2.4 mg/dl vs. 3.5 +/- 3.4 mg/dl; mean class of urinary RBC, 0-1/hpf vs. 3-5/hpf; and mean class of urinary WBC, 5-10/hpf vs. 30-50/hpf. All parameters were significantly elevated (p < 0.001) in the patients with UTI. The rate of detection of causative bacteria was 88.7%; with 14.8% Escherichia coli, 12.8% Providencia species, 9.6% Enterococci, and 8.7% Pseudomonas aeruginosa. Patients with UTI were divided into three groups according to their method of urination: normal urination, use of diapers and catheterization. Body temperature (> or = 37.5 degrees C) was 2.8%, 10.1% and 34.9%; WBC (> or = 9.000), 2.7%, 6.1%, and 14.3%; CRP, 16.9%, 36.1% and 51.1%; urine RBC (> or = 6-10/hpf), 8.4%, 7.1% and 36.1%; urine WBC (> or = 15-30/hpf), 20.4%, 44.4% and 76.9%, respectively. There was a significant difference (p < 0.05-0.001) between all parameters except for urine RBC between the normal-urination patients and diaper using patients. This investigation suggested that the use of diapers was a risk factor for UTI in elderly patients.

Adult↗

Disposable plastic diapers: a foreign body hazard.

Foreign body ingestion and aspiration in children has been a serious problem, occasionally resulting in airway obstruction and death. Airway obstruction by balloons and subsequent asphyxiation is well documented. Respiratory blockage by plastic dry-cleaning sacks has resulted in warning labels on most such materials. Two recent cases of nasal aspiration of plastic coating from a commonly used disposable diaper are compared to reports of similar occurrences documented by the U.S. Consumer Product Safety Commission. On the basis of these reports we recommend that disposable diapers be continuously covered by other clothing to prevent the child's access to the plastic. Otolaryngologists and pediatricians should be aware of the potential hazard when examining diapered children with chronic rhinorrhea or sudden respiratory distress.

Accident Prevention↗

[Repair of anterior hypospadias with transurethral vesical catheter: comparison of ambulatory surgery with the "between 2 diapers" catheter and traditional hospitalization].

OBJECTIVE: To evaluate the morbidity of ambulatory repair of anterior hypospadias with a transurethral vesical catheter (TUVC) draining the urine between 2 diapers. MATERIAL AND METHODS: 34 children divided into two comparable groups were operated for anterior hypospadias. Group A comprised 17 children operated by ambulatory surgery, with catheter drainage of urine between 2 diapers. Group B consisted of 17 children operated by a conventional inpatient procedure, with the catheter connected to a urine collector. Postoperative complications and the results of a satisfaction questionnaire sent to the parents of children in group A are reported. RESULTS: In group A, one case of TUVC dysfunction was reported and 13 parents declared to be satisfied. One urethral fistula occurred in group B. CONCLUSION: Ambulatory repair of anterior hypospadias with TUVC draining urine between 2 diapers does not induce a higher complication rate than when repair is performed by conventional hospitalisation with the TUVC connected to a urine collector. Urine drainage by TUVC is not a contraindication to ambulatory surgical repair of anterior hypospadias in children.

Ambulatory Surgical Procedures↗

[An avoidable cause of parental anxiety and unnecessary medical workup: diaper crystals (pannolithiasis)].

Five infants aged 6 to 23 months had a history of passing crystals in urine. They were not ill, but micturition was reported to be associated with pain in two of them. Physical examination was normal, and urinalysis and culture were negative. In one case we observed "jelly-like crystals" of about 2 mm diameter which dissolved spontaneously in tap water. When the parents were re-questioned it became evident that all used a new brand of highly absorbent diapers. "Jelly-like crystals" developed in our laboratory when the absorbent material of the new diapers was put in contact with urine or tap water. The new highly absorbent diapers help to keep the baby dry. However, "jelly-like crystals" may be observed and possibly alarm both parents and physicians. Information for parents and physicians may avoid unnecessary anxiety or medical workup.

Crystallization↗

Disposable diapers: safe and effective.

Nappy rash is a common problem in infants due to their thinner skin, wetness, heat and friction under cloth nappy, fecal enzymes and alkaline urine. The disposable diapers containing Super Absorbent Material (SAM) reduce the incidence of nappy rash. SAM quickly absorbs urine and keeps the skin dry. Also disposable diapers prevent fecal contamination by absorbing the urine and containing stools.

Diaper Rash↗

[Cryptosporidium hominis diarrhea outbreak and transmission linked to diaper infant use].

BACKGROUND AND OBJECTIVE: On the basis of several cases of cryptosporidiosis detected in a child day-care center, we stablished the extent of the outbreak and investigated causes of parasite transmission. PATIENTS AND METHOD: A retrospective cohort study was designed on all children attending day-care center and care givers to determine their infection status and identify risk factors associated to the outbreak. RESULTS: 24 cases of cryptosporidiosis were detected, with an attack rate of 0.46 (24/52); 12 of them were parasitologycally confirmed. All care givers were negative for Cryptosporidium and none of them reported symptoms of acute gastroenteritis. Transmission pattern was compatible with person to person modes. Among the factors investigated, two were associated with the risk of disease: diaper wear (relative risk = 2.06; p = 0.059); and diarrhea in relatives (relative risk = 2.05; p = 0.01). In all confirmed cases, Cryptosporidium hominis (previously known as C. parvum, genotype 1), was identified. CONCLUSIONS: Cryptosporidiosis should be considered as a possible cause of outbreaks of gastroenteritis at day-care centers. Increasing care on diaper changing practices, specially over children with diarrhea, may be the key factor to prevent transmission of Cryptosporidium.

Child Day Care Centers↗