Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital

Abstract Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Esclerodermia localizada: serie de casos en un hospital general y revisión de la literatura / Localized scleroderma: cases report in a general hospital and literature review

La esclerodermia localizada o morfea es una entidad inflamatoria que se caracteriza por fibrosis de la piel y tejido subyacente, se manifiesta clínicamente por zonas induradas y delimitadas con un halo eritematovioláceo, que luego se tornan hipopigmentadas o hiperpigmentadas. Se recolectaron 11 casos de esclerodermia localizada en el periodo de 1990 a 2014 en el Hospital Nacional Dos de Mayo de los cuales se excluyeron 4 por no presentar registros fotográficos. De Los 7 casos estudiados, uno correspondió a morfea circunscrita; cinco a morfea lineal, dentro de Los cuales se incluyeron dos casos de síndrome de Parry-Romberg que fueron seguidos desde el inicio de su enfermedad; una a morfea mixta y una a morfea panesclerótica. Correspondieron al sexo femenino 71 % de todos los casos, el rango de edad de los pacientes fue de 10 a 23 años y el tiempo promedio de evolución de su enfermedad desde el momento del diagnóstico fue de 3,9 años. Cinco (5) de Los pacientes presentaron evolución favorable, con remisión parcial de la enfermedad, y dos (2) pacientes, con síndrome de Parry-Romberg, fallecieron por complicaciones asociadas a la afectación neurológica.

Morphea or localized scleroderma is an inflammatory entity characterized by fibrosis of the skin and underlying tissue, is clinically manifested by areas thickened and delimited with a halo erythematous becoming then hypopigmented and hyperpigmented. Eleven cases of scleroderma in the period of 1990 to 2014 in the Hospital Nacional Dos de Mayo from which we excluded 4 by not showing photographic records were collected. Of the 7 cases studied, one corresponded to circumscribed morphea; five a linear morphea, within which included two cases of Parry-Romberg syndrome who were followed from the beginning of his illness; a mixed morphea and one to pansclerotic morphea; 71 % of all cases corresponded to the female sex, the age of the patients ranged from 10 to 23 years and the average time of evolution of his disease from the time of diagnosis was 3,9 years. Five of the patients presented a positive evolution with partial remission of the disease and two patients, with Parry-Romberg syndrome, died of complications associated with the neurological compromise.

Manifestaciones cutáneas de enfermedades asociadas a infección por HTLV-1 / Cutaneous manifestations of diseases associated with HTLV-I infection

Se presentan siete casos, cuatro mujeres y tres varones. La edad promedio de los pacientes fue 29,5 años, incluido un niño. Todos fueron seropositivos a HTLV-l; y, dos de ellos también lo fueron para el VIH. Solo en dos casos se planteó inicialmente como posible diagnóstico de infección por HTLV-l. El diagnóstico clínico e histopatológico correspondió a dermatitis infectiva, uno; estrongiloidiasis sistémica, dos; sarna costrosa, dos; leucemia/linfoma de células T del adulto, uno; y, una presentación atípica de carcinoma escamoso infiltrante. Se concluye que existe una baja sospecha clínica inicial de diagnóstico de enfermedades sistémicas con manifestaciones cutáneas asociadas a la infección por HTLV-l, no obstante, que se realiza la práctica médica en un área endémica...

Seven cases, four women and three men, are presented. The average age was 29,5 year-old, including a child. All were seropositive to HTLV-l and two of them were also for HN. Only in two cases was initially raised a possible diagnosis of HTLV-l infection. The clinical and histopathological diagnosis corresponded to infective dermatitis, one; systemic strongyloidiasis, two; crusted scabies, two; adult T-cell leukemia/lymphoma, one; and, an atypical presentation of invasive squamous cell carcinoma. lt is concluded that there is a low initial suspicion for clinical diagnosis of cutaneous manifestations of generalized diseases associated to HTLV-l infection despite of we live in an endemic area...