Exactitud diagnóstica de la imagen fotográfica en la granulación de las úlceras diabéticas mediante segmentación / Diagnostic accuracy of photographic imaging in the granulation of diabetic ulcers by segmentation

Introducción: La evaluación del estado de las úlceras por imagen fotográfica se realiza cuando se encuentran los colores rojo y rosado, que corresponden a granulación. Objetivo: Determinar la sensibilidad, especificidad y exactitud de la imagen fotográfica con respecto al estudio histológico en la granulación de úlceras diabéticas. Métodos: El diseño fue una prueba diagnóstica realizada a 29 pacientes diabéticos con 45 úlceras diabéticas no infectadas, en la cual se comparó la observación directa de un área de granulación por imagen fotográfica como prueba diagnóstica en la evaluación referente al estándar por anatomía patológica, a través de una biopsia sacabocado. La imagen fotográfica se obtuvo mediante un Smartphone CATS61 y se analizó a través de la segmentación en colores rojo y negro con el software ImageJ. El estudio lo autorizó un comité de ética. Las estadísticas se realizaron con el software SPSS 22 y EPIDAT 4.4. Resultados: Las úlceras diabéticas presentaron un promedio de 3,03 ± 2,39 cm de largo y 2,26 ± 1,62 cm de ancho; de la úlcera tipo 2 según Wagner en 73,3 por ciento; y de la úlcera tipo A, según la Universidad de Texas en 60 por ciento. Las pruebas de diagnóstico por imagen fotográfica mostraron una sensibilidad, especificidad y exactitud en 90 por ciento, 33,3 por ciento y 61,6 por ciento, respectivamente. Conclusiones: La identificación de la imagen fotográfica y el estudio histológico de las úlceras diabéticas con granulación fueron factibles. La sensibilidad, especificidad y exactitud de la imagen fotográfica resultaron elevada, baja y moderada(AU)

Introduction: The evaluation of the state of the ulcers by photographic image is carried out when the red and pink colors are found, which correspond to granulation. Objective: Determine the sensitivity, specificity and accuracy of the photographic image with respect to the histological study in the granulation of diabetic ulcers. Methods: The design was a diagnostic test performed on 29 diabetic patients with 45 uninfected diabetic ulcers, in which the direct observation of an area of granulation by photographic image was compared as a diagnostic test in the evaluation referring to the standard by pathological anatomy, through a punch biopsy. The photographic image was obtained using a CATS61 Smartphone and analyzed through segmentation in red and black colors with the ImageJ software. The study was authorized by an ethics committee. Statistics were performed with SPSS 22 and EPIDAT 4.4 softwares. Results: Diabetic ulcers presented an average of 3.03 ± 2.39 cm long and 2.26 ± 1.62 cm wide; of type 2 ulcer according to Wagner in 73.3 percent, and type A ulcer, according to the University of Texas at 60 percent. Photographic imaging tests showed sensitivity, specificity and accuracy in 90 percent, 33.3 percent and 61.6 percent, respectively. Conclusions: The identification of the photographic image and the histological study of diabetic ulcers with granulation were feasible. The sensitivity, specificity and accuracy of the photographic image were high, low and moderate(AU)

The value of terminal lleum intubation during colonoscopy

Abstract It is uncertain whether terminal ileum intubation should be performed routinely during colonoscopy, as there is uncertainty regarding its diagnostic value. The aim of the present study is to assess the diagnostic yield of terminal ileum intubation during colonoscopy according to indications for colonoscopy. This is a cross-sectional study in which the results of 294 total colonoscopy procedures were reviewed; ileal intubation was performed in 269 (91.49%) patients. The indications for colonoscopy, the results of ileoscopy, and the histopathological results of ileal biopsies were evaluated. A total of 54 (20%) out of 269 patients who had successful intubation into the terminal ileumshowed macroscopic abnormalities on the terminal ileum. Biopsies were positive in 4 out of 54 (7.4%); all were of Crohn disease. Two were erosions (9.5%.) and 2 were ulcers (18.8%). The two erosions were presented as abdominal pain, abdominal pain and alternating bowel motion. Those with ulcers were presented with diarrhea and perianal disease. Conclusions Considering the low diagnostic yield of ileal intubation during colonoscopy, the decision to performileoscopy or not during colonoscopy needs to bemade on a case-by-case basis. However, routine ileal intubation, brief attempts should be considered despite low diagnostic yield. (AU)

Case for diagnosis. Ulcerated lesions: a diagnostic challenge in Behçet's syndrome

Abstract This study reports the clinical case of a 42-year-old patient with ulcerated lesions who was followed up by general practitioners with the diagnosis of recurrent cellulitis. However, when referred to the Dermatology division a diagnosis of Behçet's syndrome was established based on clinical criteria. Although there are defined clinical criteria for this syndrome, sometimes its diagnosis can be challenging, due to lack of knowledge of the disease and extremely heterogeneous clinical phenotype. The authors highlight the potential difficulties in establishing the diagnosis considering the multiple clinical findings during the investigation process, contributing to the risk of increased morbidity and mortality.

Ulceración esofágica por ingestión de doxiciclina / Doxycycline induced esophageal ulceration

La ulceración esofágica por ingestión de doxiciclina es una de las causas más frecuentes de lesión esofágica. Ha sido subdiagnosticada y escasamente reconocida en dermatología. El dolor retroesternal, la odinofagia de aparición brusca y el antecedente de ingesta de doxiciclina u otros fármacos son características que facilitan su diagnóstico. Puede presentar complicaciones serias, como hemorragias, estenosis y mediastinitis.

Esophageal ulceration due to ingestion of doxycycline is one of the most frequent causes of esophageal injury. It has been underdiagnosed and scarcely recognized in dermatology. Retrosternal pain, sudden odynophagia and a history of doxycycline or other drugs intake are some of the characteristics that lead to diagnosis. It may cause severe complications such as bleeding, stenosis and mediastinitis.

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.

Tratamientos utilizados en los pacientes hospitalizados por úlceras flebostáticas / Treatments Used in Patients Hospitalized for Phlebostatic Ulcers

Introducción: Las úlceras flebostáticas son de difícil curación, no existe un tratamiento único y efectivo, por lo que hay que combinarlos en un mismo paciente. Objetivo: Identificar los tratamientos utilizados en los pacientes ingresados por úlceras flebostáticas y la relación entre el tiempo de estadía hospitalaria, el tratamiento recibido y el estado de las úlceras al egreso hospitalario. Métodos: Estudio descriptivo ambispectivo en 121 ingresos hospitalario con el diagnóstico de úlceras flebostáticas. Las variables de estudio fueron: tratamientos recibidos, estado de la lesión al egreso y estadía hospitalaria. Se asociaron las variables entre sí utilizando la prueba Ji-cuadrada no paramétrica para variables independientes. Resultados: En los 121 ingresos se realizó tratamiento convencional, el 93,4 por ciento recibió antibióticos; el 60,3 po ciento tratamiento compresivo; y quirúrgico en el 56,2 por ciento, con predominio del injerto libre de piel en 72,1 por ciento de estos tratamientos quirúrgicos. El 42,2 por ciento egresó con la lesión curada (tratamiento quirúrgico). Se encontraron asociaciones directas entre el tratamiento quirúrgico con la estadía hospitalaria (( 2 = 31,22; p= 0,0001), con la cura de la lesión (( 2 = 19,92; p= 0,0100) y con su estado al alta hospitalaria (( 2 = 36,07; p= 0,0001). Conclusiones: El tratamiento más empleado es el quirúrgico y dentro de estos, el autoinjerto dermo-epidérmico es el más utilizado, puesto que presenta los mejores resultados en cuanto a la curación de la lesión pero mayor estadía hospitalaria en los pacientes(AU)

Introduction: Phlebostatic ulcers are difficult to heal; there is no single and effective treatment, so several treatments must be combined in the same patient. Objective: To identify the treatments used in patients admitted for phlebostatic ulcers and the relationship between hospital stay, treatment received, condition of the ulcers at hospital discharge. Methods: Ambispective descriptive study of 121 hospital admissions with the diagnosis of phlebostatic ulcers. The study variables were treatments received, status of the injury at discharge, and hospital stay. The variables were associated with each other, using the non-parametric Chi-square test for independent variables. Results: The 121 admissions received conventional treatment. 93.4 percent received antibiotics; 60.3 percent, compression treatment; and 56.2 percent, surgical treatment, with predominance of free skin grafting in 72.1 percent of these surgical treatments. 42.2 percent was discharged with the lesion healed (by surgical treatment). Direct associations were found between surgical treatment with hospital stay (( 2 = 31.22; p = 0.0001), with the cure of the lesion (( 2 = 19.92; p=0.0100), and with the ulcer state at hospital discharge (( 2 =36.07; p= 0.0001). Conclusions: The most used treatment is the surgical one, specifically the dermo-epidermal autograft, which presented the best outcome regarding the healing of the injury, but a longer hospital stay for the patients(AU)

Úlceras vulvares agudas en adolescentes, reporte de una serie de casos clínicos / Severe vulvar ulcers in adolescents, a report of clinical cases series / Úlceras vulvares agudas em adolescentes, informe de uma série de casos clínicos

Introducción: las úlceras genitales se caracterizan por su gran heterogeneidad clínica y etiológica. Pueden corresponder a entidades patológicas cutáneas o sistémicas de naturaleza infecciosa o no infecciosa. Dentro de estas últimas, se destacan las úlceras de Lipschütz y la enfermedad de Behcet. Objetivo: describir cuatro casos clínicos de adolescentes con úlceras vulvares agudas de causa no infecciosa hospitalizadas en dos prestadores del Sistema Nacional Integrado de Salud de Montevideo con el objetivo de brindar herramientas a profesionales para el correcto abordaje diagnóstico y terapéutico. Discusión: la realización de una anamnesis detallada y un examen físico minucioso son esenciales para realizar un adecuado abordaje diagnóstico y terapéutico. En el análisis clínico es importante considerar la edad de la paciente, el inicio de relaciones sexuales, el número, topografía y características de las úlceras incluyendo la presencia o no de dolor, así como la asociación de manifestaciones sistémicas. Resulta necesario el conocimiento de esta patología poco frecuente en niñas y adolescentes cuyo abordaje diagnóstico y terapéutico depende de la orientación etiológica basada en criterios epidemiológicos y clínicos bien definidos. Ello contribuirá a mejorar la calidad de la asistencia y a minimizar las repercu¬siones biológicas y psicológicas.

Introduction: genital ulcers are characterized by great clinical and etiological heterogeneity. They may correspond to infectious or non-infectious skin or systemic pathologies. Lipschütz ulcer and Behcet disease stand out among non-infectious conditions. Objective: to describe four clinical cases of adolescents with non-infectious severe vulvar ulcers hospitalized in two institutions of the national integrated health system in Montevideo, with the purpose of providing professionals with tools for the adequate diagnostic and therapeutic approach. Discussion: a detailed anamnesis questionnaire and a thorough physical examination are of the essence for an adequate diagnostic and therapeutic approach. The clinical analysis should include considering the patient's age, initiation of sexual intercourse, the number, topography and characteristics of the ulcers including finding out whether there is pain or not, as well as the association of systemic manifestations. It is important to learn about this rather unusual condition in girls and adolescents, whose diagnostic and therapeutic approach depends on the etiological orientation based on well-defined epidemiological and clinical criteria. This will contribute to improving the quality of assistance and minimizing biological and psychological effects.

Introdução: as úlceras genitais se caracterizam por uma grande heterogeneidade clínica e etiológica. Podem ser causadas por patologias cutâneas ou sistémicas tanto infecciosas como não infecciosas. Entre as últimas, destacam-se as úlceras de Lipschütz e a doença de Behçet. Objetivo: descrever quatro casos clínicos de adolescentes com úlceras vulvares agudas de causa não infecciosa hospitalizadas em duas unidades de saúde do sistema nacional integrado de saúde de Montevidéu buscando oferecer ferramentas para uma correta abordagem diagnóstica e terapêutica. Discussão: é fundamental realizar uma anamnese detalhada e um exame físico minucioso para uma abordagem diagnóstica e terapêutica adequada. O exame clínico deve incluir a idade da paciente, o inicio das relações sexuais, o número, topografia e características das úlceras incluindo a presencia ou não de dor, bem como a associação com manifestações sistémicas. É necessário conhecer esta patologia pouco frequente em meninas e adolescentes cuja abordagem diagnóstica e terapêutica depende da orientação etiológica baseada em critérios epidemiológicos e clínicos bem definidos. Isso contribuirá para melhorar a qualidade da assistência e a minimizar as repercussões biológicas e psicológicas.

Úlcera vulvar aguda de Lipschütz / Acute vulvar ulcer of Lipschütz

RESUMEN La úlcera de Lipschütz es una entidad poco frecuente e infradiagnosticada. Se presenta el caso de una paciente de 24 años sin antecedente de contacto sexual que consultó por aparición súbita de úlceras vulvares dolorosas, en el contexto de un cuadro pseudogripal. Se discuten los principales diagnósticos diferenciales, dado que es una enfermedad no relacionada con enfermedades de transmisión sexual y poco reconocida por los profesionales de la salud, que precisa de manejo conservador.

ABSTRACT Lipschütz ulcer is a rare underdiagnosed entity. We present the case of a 24-year-old patient without history of sexual contact who consulted for sudden occurrence of painful vulvar ulcers, in the context of flu-like symptoms. The main differential diagnoses are discussed, as it is a disease unrelated to sexually transmitted diseases and little recognized by health professionals, which requires conservative management.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Síndrome aórtico agudo: Revisión de la literatura y actualización del tema / Acute aortic syndrome

Acute aortic syndrome (AAS) is a term that describes interrelated aortic emergencies with similar clinical characteristics and challenges. These are aortic dissection (AD), intramural hematoma (IH), and penetrating atherosclerotic ulcer (PAU). The incidence of AAS is three cases per 100.000 persons per year. Diverse genetic disorders and acquired conditions have been related to the pathogenesis of this disease. Clinical features of patients with any of the three conditions comprising AAS are very similar. A high degree of clinical suspicion and imaging studies are necessary for an accurate diagnosis. Prognosis is clearly related to underlying diagnosis and appropriate surgical repair, in the case of proximal involvement of the aorta. Involvement of distal segments of the aorta may require medical or endovascular therapy according to the presence of complications. After hospital discharge, patients require lifelong follow-up.

Úlcera genital aguda de Lipschütz: caso clínico / Lipschütz acute genital ulcer: case report

La úlcera genital aguda (UGA) o úlcera de Lipschütz constituye una infrecuente entidad clínica caracterizada por la aparición de úlceras genitales en niñas y adolescentes que no han iniciado su actividad sexual. El cuadro es de inicio agudo, con formación de úlceras dolorosas habitualmente precedidas en su aparición por manifestaciones sistémicas tales como fiebre, cefalea, astenia, adinamia, mialgias y adenopatías inguinales, y donde el estudio microbiológico de la lesión descarta un posible origen infeccioso. A pesar de presentar un cuadro clínico característico, esta enfermedad constituye una entidad poco conocida y por tanto subdiagnosticada, motivo por el cual presentamos el caso de una paciente de 10 años con diagnóstico de UGA realizado en el Departamento de Dermatología de la Pontificia Universidad Católica de Chile.

Acute genital ulcer (AGU) or Lipschütz ulcer is a rare clinical entity characterized by the appearance of genital ulcers in children and adolescents who have not initiated sexual activity. The picture is of acute onset, with formation of painful ulcers on their occurrence usually preceded by systemic manifestations such as fever, headache, fatigue, weakness, muscle pain and inguinal lymphadenopathy, and where the microbiological study of injury rule out a possible infectious origin. Despite presenting a characteristic clinical picture, this disease is a little known entity and under diagnosed, we present the case of a 10 years old girl diagnosed with UGA conducted at the Department of Dermatology, Catholic University of Chile.

Úlcera cecal idiopática: reporte de un caso / Idiopathic cecal ulcer: report of a case

Las úlceras solitarias de ciego no específicas son raras en frecuencia, existen reportes de casos y pequeñas series en la literatura pero en el Perú aún no se han descrito. Son de etiología desconocida y diagnóstico diferencial amplio, presentamos el caso de un interno de medicina con historia de hemorragia digestiva baja y una úlcera cecal única a descartar neoplasia maligna, realizándose una hemicolectomía derecha laparoscópica de emergencia, luego de un amplio estudio, se concluye que se trata de una úlcera cecal idiopática.

The idiopathic cecal ulcer is rare in frequency, there are case reports and small series in the literature but in Peru have not been described yet. They are of unknown etiology and wide differential diagnosis, we report the case of a medical intern with lower gastrointestinal bleeding history and a solitary cecal ulcer that was suspected of being cancer, then an emergency laparoscopic right hemicolectomy was performed, after an extensive study we conclude that it is an idiopathic cecal ulcer.

Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS.

Lipschütz ulcer (ulcus vulvae acutum): a rare cause of genital lesion / Úlcera de Lipschütz (ulcus vulvae acutum): uma causa rara de lesão genital

Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.

A Úlcera de Lipschütz, ou ulcus vulvae acutum, é uma entidade rara mas provavelmente subdiagnosticada, que se apresenta como úlcera vulvar aguda dolorosa numa mulher jovem. A etiologia é desconhecida embora relatos recentes a tenham associado à primo-infecção pelo vírus Epstein-Barr. O diagnóstico é estabelecido após exclusão de doenças sexualmente transmissíveis, causas autoimunes, traumáticas e outras etiologias de úlceras genitais. Relatamos o caso de uma jovem que desenvolveu quadro gripal e dolorosas úlceras genitais. Os exames complementares excluiram doenças sexualmente transmissíveis e as outras causas habituais de ulceração genital. As lesões cicatrizaram sem sequelas e sem recorrências. Este caso representa um diagnóstico diferencial importante e raro de ulceração genital.

Behcet’s disease in pregnancy – A rare phenomenon.

Behcet’s disease is a multisystem relapsing disorder that affects the mucocutaneous surfaces. Though it is rare in pregnancy, suspicion should be kept in mind when any pregnant woman presents with multiple oral and genital ulcers. We wish to share our experience of managing a woman who was diagnosed as having Behcet’s disease first time during pregnancy.