Lipschütz Ulcer: An Unusual Diagnosis that Should Not be Neglected

Abstract The diagnosis of genital ulcers remains a challenge in clinical practice. Lipschütz ulcer is a non-sexually transmitted rare and, probably, underdiagnosed condition, characterized by the sudden onset of vulvar edema along with painful necrotic ulcerations. Despite its unknown incidence, this seems to be an uncommon entity, with sparse cases reported in the literature. We report the case of an 11-year-old girl who presented at the emergency department with vulvar ulcers. She denied any sexual intercourse. The investigation excluded sexually transmitted infections, so, knowledge of different etiologies of non-venereal ulcers became essential. The differential diagnoses are extensive and include inflammatory processes, drug reactions, trauma, and malignant tumors. Lipschütz ulcer is a diagnosis of exclusion. With the presentation of this case report, the authors aim to describe the etiology, clinical course, and outcomes of this rare disease, to allow differential diagnosis of genital ulceration.

Prescription pattern for treatment of hemorrhoids under the universal coverage policy of Thailand.

The Universal Coverage Policy (UCP) or "30 Baht Scheme" was launched in Thailand in 2001. The policy caused a cutback in the budgets of all public hospitals and health service centers. Traditional medicine was then viewed as an alternative to save costs. This study examines whether this had any influence on hemorrhoid treatment prescription patterns, ratio of traditional/modern medicine, or the cost of hemorrhoid treatment after the UCP was implemented at a community hospital. The traditional medicine prescribed was Petch Sang Kart and the modern alternative was Proctosedyl. All hemorrhoid prescriptions at a community hospital from October 2000 to January 2003 were surveyed. Segmented Regression Analysis was applied to evaluate prescription trends, the ratios between the types of medicine, and the hemorrhoid treatment cost. A total of 256 prescriptions were analyzed. The average number of traditional medicine prescriptions per month were more than modern medicine (41 versus 16). During the study period, the trend of modern medicine use and the treatment cost was decreased (p < 0.01). The ratio of traditional/modern medicine increased 0.2 times (p = 0.02).

Anti-Leishmania effect of intralesional procaine and dibucaine in hamsters

Se compara el efecto terapéutico de los anestésicos locales "caínicos" Procaína y Dibucaína administrados intralesionalmente (IL), con el del tratamiento intramuscular (IM) convencional con Glucantime®, para lograr la cura clínica y parasitológica sobre lesiones dérmicas en la base de la cola de hámsters machos heterocigotos experimentalemente infectados con 4 x 10³ amastigotes de Leishmania (Viannia) braziliensis. Los resultados revelaron que todas las drogas ensayadas reducen significativamente (P<0,01) los tamaños promedio de las lesiones granulomatosas, cuando se comparan con los aninales controles sin tratamiento. El tratamiento local con la Dibucaína fue tan eficaz clínicamente como el Glucantime® administrado sistémicamente, y tuvo mejor eficacia para la resolución clínica de las lesiones que la Procaína IL. Se detectó la presencia de amastigotes viables en nódulos granulomatosos o cicatrices en su totalidad de los hámsters evaluados, después de 75-165 días de haberse finalizado los tratamientos, mediantes los métodos de frotis directo, histopatología convencional, medios de cultivo (NNN) y la técnica de la inmunoperoxidasa, lo que sugiere que la medición de las lesiones cutáneas por sí solo no es un método totalmente confiable y válido para evaluar la eficacia quimioterapéutica en la LC experimental. La eficiencia clínica de los anestésicos locales parece estar relacionada con sus tiempos de vida media y lipofilia relativa. De una manera preliminar, estos resultados parecieran apoyar la inclusión de los anestésicos locales "caínicos" como parte del armamentarium alternativo para el tratamiento de las LC animal y humana

Revisión analítica de estudios multicéntricos con policresuleno en patología hemorroidal / Analytical review of multicenter studies with polycresulene for hemorrhoidal pathologies

Seven centers investigated the therapeutic efficacy and tolerability of policresulene associated to cinchocaine administered locally as ointment, suppositories or both formulations in 2287 patients with hemorrhoid pathology. The studies were conducted with a standardised protocol and case report forms and with the same score criteria for rating efficacy and tolerability according to the physicians and the patients. Highly satisfactory results were achieved in 1904 patients (83.2 per cent) according to the investigators criteria. Patients rated the outcome most satisfactory for 1881 cases (82.2 per cent). The following were found to be the principal indications: external and internal hemorrhoids associated with bleeding, acute anal fissures, rhagades and perforated or incised perianal thrombosis, anal eczema and anal pruritus, proctitis and wound treatment after proctologic surgery. None of the investigators found any serious adverse event. Mild to moderate adverse reactions in 10 per cent of the patients were local discomfort, pruritus, burning or irritation. Such symptoms occurred at the beginning of treatment. The favourable effects of pol icresulene are attributed to its unique mechanism of action. The highly acid characteristic of the substance causes a selective coagulation of the necrotic tissues leaving healthy tissues unaffected. The desquamation and remotion of the necrotic tissues induces rapid wound cleansing, and a reactive hyperemia of the treated area enhancing epithelization. Its highly acid pH produces a marked bactericidal action on the most common pathogens and C. albicans as well. Policresulene has hemostyptic properties producing vasoconstriction of the myofibrils of the blood vessels arresting profuse bleeding from large areas. The local anesthetic cinchocaine contributes to the initial pain relief. None of the formulations contains corticosteroids which makes this preparations also suitable for long term treatment periods.