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Sayyeda Ghazala Irfan Kazi, Emaduddin Siddiqui, Irfan Habib, Saadia Tabassum, Badar Afzal, Irum Qamar Khan
Neonatal Purpura Fulminans is a rare and fatal disorder associated with perivascular haemorrhage and disseminated intravascular coagulation. Early clinical recognition, timely investigation and treatment is utmost important. A 6 days old baby boy was brought to emergency with blackish ulcers all over the body. Initially these were over the feet and scalp but later appeared on the abdomen. On examination, child was vitally stable, mildly icteric and had multiple erythematous large bullous blackish lesions on scalp, lower abdomen, perineum, back and soles...
March 2018: JPMA. the Journal of the Pakistan Medical Association
P R F Adkins, S Dufour, J N Spain, M J Calcutt, T J Reilly, G C Stewart, J R Middleton
The purpose of this study was to investigate non-aureus Staphylococcus spp. intramammary infections (IMI) in periparturient heifers and determine the relationship of precalving body site isolation with precalving IMI and postcalving IMI using molecular speciation and strain-typing methods. Primiparous heifers were enrolled at approximately 14 d before expected calving date. Precalving mammary quarter secretions and body site swabbing samples (teat skin, inguinal skin, muzzle, and perineum) were collected. Postcalving, mammary quarter milk samples were collected for culture and somatic cell counting...
March 7, 2018: Journal of Dairy Science
R T Winn, D Brass, S J Meggitt
A 58 year old gentleman developed multiple fissures and discharging sinuses in the groin and perineum. Skin biopsies showed non-caseating granulomas suggestive of Crohn's disease. The patient had no gastrointestinal symptoms and a radio-labelled white cell scan demonstrated no bowel involvement. This article is protected by copyright. All rights reserved.
March 10, 2018: Journal of the European Academy of Dermatology and Venereology: JEADV
Jaime F Perez, Ana María Díaz B, Gustavo U Ramos, Sara R Peralta
Congenital posterior urethral-perineal fistula is an abnormal communication extending from the posterior urethra to the perineal skin. We present the case of an 11-year-old boy who had recurrent febrile urinary tract infections and abnormal dribbling of urine from the perineum. Fistulogram showed a paraescrotal fistula tract, which was then surgically excised. During the 10 months of follow-up, the patient remained asymptomatic without recurrence of urinary pathology.
March 6, 2018: Urologia Internationalis
Priya Vijayvargiya, Michael Camilleri, Robert R Cima
A 22-year-old woman presented with 12 years of progressive constipation; she had increased joint flexibility, hyperextensible skin, and excessive perineal descent on examination. Radiological studies confirmed evidence of rectal evacuation disorder due to descending perineum syndrome, enterocele, and rectocele. In a wide genetic screen (∼611,000 single nucleotide polymorphisms), 4 variations were identified in COL1A1 gene ([rs72656352, Chr17: 50,185,535-50,185,539, deletion], [rs72654794, Chr17: 50,188,575, deletion], [rs72667023, Chr17: 50,198,170, deletion], [rs67828806, Chr17: 50,198,177 G→C])...
March 2018: Mayo Clinic Proceedings
X Fritel, B Gachon, D Desseauve, T Thubert
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors...
February 27, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Milan Spasojevic, Anthony B Mariathasan, Mariusz Goscinski, Ebbe B Thorgersen, Arne M Solbakken, Hans-Petter Gullestad, Truls Ryder, Kjersti Flatmark, Stein G Larsen
BACKGROUND: Radiotherapy (RT) and subsequent abdominoperineal resection (APR) for locally advanced rectal cancer (LARC) is associated with significant perineal wound morbidity. The aim of the present study was to investigate if vertical rectus abdominis musculocutaneous (VRAM) flap repair after APR in LARC patients improves perineal wound healing compared with direct perineal wound closure (non-VRAM). METHODS: LARC patients (n = 329) operated with APR between January 2006 and December 2015 after neoadjuvant RT of ≥ 25 Gy were identified, including 260 and 69 patients in the non-VRAM and VRAM groups, respectively...
March 1, 2018: Annals of Surgical Oncology
Chloé Barasinski, Anne Debost-Legrand, Didier Lemery, Françoise Vendittelli
OBJECTIVE: the principal objective of our study was to describe the practices reported by French midwives during the active second stage of labor (expulsion phase). DESIGN: this cross-sectional Internet survey questioned French midwives who attended at least one childbirth in 2013. SETTING: this open survey was posted on a website from June 15 through December 1, 2014. PARTICIPANTS: 1496 midwives from 377 maternity units participated in the study...
February 8, 2018: Midwifery
Matthew Howard, Anthony Hall
Vulval lichen planus-lichen sclerosus overlap is an emerging observation. Few clinical reports exist with no reviews of literature. We present a focused update of this phenomenon and discuss a clinical case. We report a 63-year-old woman with a 20-year history of ulcerative vulvo-vaginitis, initially diagnosed as benign mucous membrane (cicatricial) pemphigoid. This led to prolonged treatment with oral corticosteroids with minimal improvement in symptoms. Subsequent complications of long-term use of systemic corticosteroid ensued...
January 1, 2018: International Journal of STD & AIDS
Anastasiya Atanasova Chokoeva, Uwe Wollina, Torello Lotti, Georgi Konstantinov Maximov, Ilia Lozev, Georgi Tchernev
Condyloma acuminata represents an epidermal manifestation, associated with the epidermotropic human papillomavirus (HPV). They have been reported as the most common sexually transmitted disease, with prevalence exceeding 50%, increased up to 4 times, within the last two decades, as the most common side of affection are the penis, vulva, vagina, cervix, perineum, and perianal area, with increased prevalence in young, sexually active individuals. Increased attention should be focused on lesions, caused by types, with moderate (33, 35, 39, 40, 43, 45, 51-56, 58) or high risk potential (types 16, 18) for malignant transformation, leading to further development of cancers of anus, vagina, vulva and penis, as well as cancers of the head and neck...
January 25, 2018: Open Access Macedonian Journal of Medical Sciences
Uwe Wollina, Jacqueline Schönlebe, Katlein França, Georgi Tchernev, Torello Lotti
Idiopathic scrotal calcinosis is a rare disorder presenting with firm and painless nodules on the scrotal skin. The most common site is the frontal aspect of the scrotum whereas the dorsal aspect with the transition to the perineum is rarely involved. Surgery is the gold standard of treatment.
January 25, 2018: Open Access Macedonian Journal of Medical Sciences
Gregory M Taylor, David V Hess
Fournier's gangrene, a rare polymicrobial infection that affects the genitals and perineum, can present as an insidious onset to a rapid and fulminant course. Early recognition, diagnosis, initiation of broad-spectrum antibiotics and prompt surgical treatment remain the foundation of management. If treatment is not initiated aggressively, the patient will likely rapidly deteriorate, leading to organ failure and death. We present the case of a 58-year-old diabetic female presenting febrile, hypoxic, with severe respiratory distress and evidence of septic shock, found to have necrotizing fasciitis of the entire right hemi-pelvis...
February 2018: Oxford Medical Case Reports
Jonathan Frappell, Lia Riadin, Elhami Ebeid, Tilo Asmussen, Robert Morris
OBJECTIVE: To assess the long-term results of our experience with this technique which we have developed as an alternative to Fenton's procedure. STUDY DESIGN: A retrospective questionnaire study of all patients undergoing the procedure in our department from Jan. 2006 to Dec. 2013. The main outcome measure was the change in sexual satisfaction scores, using a visual analogue scale, before and after the procedure. RESULTS: There was a statistically significant improvement in sexual satisfaction scores in the majority of patients...
February 9, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Jennifer Yeung, Anna Stecher, Catrina C Crisp, Donna Mazloomdoost, Benjamin Smith, Steven D Kleeman, Rachel N Pauls
OBJECTIVES: Obstetric anal sphincter injuries (OASISs) are a devastating postpartum complication; reducing rates is paramount to improving quality of care. In Norway, implementation of a perineal protection program decreased the incidence of OASIS by 48%. We sought to assess impact on OASIS rates following a similar program. METHODS: This institutional review board-approved, retrospective cohort study was performed in an academic hospital system. The periods of analysis were November 2014 through October 2015 for the preintervention arm and November 2015 through October 2016 for the postintervention arm...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
Feng-Shu Chang, Chieh Chou, Chuan-Yu Hu, Shu-Hung Huang
Background: The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing. Methods: The Fournier's gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue...
January 2018: Plastic and Reconstructive Surgery. Global Open
Yaw A Wiafe, Bill Whitehead, Heather Venables, Alexander T Odoi
The purpose of this study was to investigate the diagnostic performance of the head-perineum distance, angle of progression, and the head-symphysis distance as intrapartum ultrasound parameters in the determination of an engaged fetal head. Two hundred and one women in labour underwent both ultrasound and digital vaginal examination in the estimation of fetal head station. The transperineal ultrasound measured head-perineum distance, angle of progression, and head-symphysis distance for values correlating with digital vaginal examination head station...
February 2018: Ultrasound: Journal of the British Medical Ultrasound Society
Teresa Arias, Kirstie Coxon
BACKGROUND AND OBJECTIVE: the limited availability of high quality evidence related to second stage management of the perineum (SSMP) combined with a perceived shift in UK practice towards a 'hands off' the perineum/fetal head approach are likely to have impacted significantly on student midwives' understanding of SSMP. This paper presents a classroom based educational session using low fidelity simulation, which was designed in response to student feedback and aimed to improve confidence in this skill...
February 13, 2018: Midwifery
L Bouhajja, S A Rammeh, S Sayari, R Zermani, F Farah
Angiomyofibroblastoma (AMF) is a rare benign mesenchymal tumor with tendency to arise in the lower genital tract of middleaged women, predominately in the vulva. A few cases of AMF in males have been reported involving the scrotum, perineum or spermatic cord. We report a new case of AMF arising in the right inguinal region of a 27-year-old man. The tumor was well-circumscribed, myxoid and measured 30 mm in maximum dimension. On microscopic examination, the tumor was composed of spindle cells without atypia and with less than one mitosis figure per 10 high-power fields...
December 2017: Pathologica
Ryan Goh, Daryl Goh, Hasthika Ellepola
BACKGROUND: The female perineum is the diamond-shaped inferior outlet of the pelvis. This structure is at risk of trauma during labour because of spontaneous perineal tears of varying degrees or iatrogenic episiotomies. These injuries can result in disabling immediate and long-term complications in the woman. OBJECTIVE: The aim of this article is to provide general practitioners (GPs) with a good understanding of perineal tears by discussing the different classifications, immediate and long-term management, and recommendations for future deliveries...
January 2018: Aust J Gen Pract
M Sun, J G Liu, Q Y Weng, L Yu, J Wang
Objective: To investigate the clinicopathologic features, differential diagnosis and biological behavior of pleomorphic leiomyosarcoma (PLMS) and dedifferentiated leiomyosarcoma (DLMS). Methods: Forty-nine cases were collected from November 2007 to December 2016, including eight that diagnosed at Fudan University Shanghai Cancer Center, and 41 consultation cases. The clinical findings and pathologic features were reviewed. Immunophenotype was obtained in 33 cases and follow-up information was available in 38 cases...
February 8, 2018: Zhonghua Bing Li Xue za Zhi Chinese Journal of Pathology
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