Hidrosadenitis supurativa glútea y perianal: tratamiento quirúrgico / Perianal and gluteal suppurativa hidradenitis: surgical treatment

Introducción: La hidrosadenitis supurada (HS) es una enfermedad inflamatoria crónica que compromete las glándulas sudoríparas apócrinas, comenzando por la oclusión de los folículos pilosos. Puede localizarse en axilas, ingle, periné, periano y glúteos. Fue descripta en 1.839, es infrecuente y afecta a1 c/300-600 adultos. De acuerdo a sus características y estadio puede ser tratada médicamente o en forma quirúrgica. Objetivo: Comunicación del tratamiento quirúrgico realizado a pacientes portadores de HS localizada en la región glútea y perianal. Diseño: Trabajo descriptivo, retrospectivo y multicéntrico. Lugar de aplicación: Hosp. Santa María Magdalena de Magdalena, Hosp. HIGA San Martin de La Plata y práctica privada. Pacientes y métodos: Se analizan los resultados del tratamiento quirúrgico realizado a 7 pacientes que fueron tratados entre los años 2001 y 2011, que presentaban HS supurada glútea y perianal, con una edad promedio de 35,4 y un rango de 23 a 56. Cuatro de ellos con estadio II de Hurley a los cuales se les realizó marsupialización y drenaje y 3 con estadio III extirpación e injertos diferidos con piel del mismo paciente y una variante de injerto de piel porcina liofilizada que aceleró el tiempo de regeneración. Resultados: No se observó enfermedad de Crohn o carcinoma de células escamosas. De los 4 que fueron tratados con marsupialización, 2 evolucionaron favorablemente y fueron controlados durante 3 y 6 años respectivamente. El resto de ellos tuvieron recidivas a los 4 y 8 meses respectivamente, siendo tratados de la misma forma. Solamente 1 permanece en control desde hace tres años. Los 3 con extirpaciones e injertos diferidos son controlados en la actualidad sin presentar nuevas alteraciones, con un periodo de evolución de 5, 3 y 2 años respectivamente. No se realizaron colostomías de derivación. Conclusiones: Los métodos conservadores de tratamiento tienen poco efecto cuando la HS glútea y perianal es extensa...

Introduction: The hidrosadenitis suppurativa (HS) is a chronic inflammatory disease that affects the apocrine sweat glands. This condition occludes the hair follicles and it can be found in the armpits, the groin, the perineum, the perianal area and the gluteus. It was first described in 1839 and it is a rare disease that affects 1 among 300-600 adults. Due to the stage and the features of the disease, it can be treated either with medication or with surgery. Purpose: The aim of this study is to report the surgical treatment carried out on patients suffering from HS in the perianal area and the gluteus. Layout: This is a descriptive, retrospective and multicentre study. Place: This study was carried out in the 'Hospital Santa María Magdalena', Magdalena, in the 1 Hospital HIGA San Martín, La Plata and in private practice. Patients and Methods: The results of the surgical treatment carried out on 7 patients who suffered from HS in the perianal area and the gluteus during the years 2001 and 2011 are analyzed. Those patients were 23-56 years old on average 35.4. Marsupialization and drainage was carried out on 4 patients who were in Hurley stage II. Surgical excisions and skin grafts stage III with the patient's own skin and lyophilized pigskin that speeded the time of regeneration were done to 3 patients. Results: Crohn's Disease or squamous cell carcinoma was not observed. 2 of the 4 patients who were treated with marsupialization recovered favorably and they were monitored during 3 and 6 years. The rest of the patients had recurrences within a period of 4 and 8 months. Only 1 patient has still been monitored for the last three years. The 3 patients who had excisions and skin grafts are monitored at present and they do not show alterations within a period of evolution of 5,3 and 2 years. No colostomy was perfonned. Conclusion: The traditional methods do not show useful results when the HS in the perianal area and the gluteus is extensive...

Hidradenoma papilífero perianal / Perianal papillary hidradenoma

El hidradenoma papilífero es una neoplasia benigna, quística y papilar, poco frecuente que por lo general aparece en la vulva, aunque también se ha descrito en otras zonas. Presentamos el caso de una mujer de 74 años con uno localizado en región perianal, cuyo diagnóstico clínico inicial fue sarcoma de Kaposi. El interés de este informe radica en recalcar que esta afección puede aparecer en una zona diferente a la vulva, para evitar diagnósticos erróneos...

Papillary hidradenoma is a rare benign neoplasm characterized by the presence of cystic and papillary structures that usually occurs on the vulva but has also been described in other locations. We report the case of a 74 year-old woman with a perianal papillary hidradenoma. An initial diagnosis of Kaposi´s sarcoma was made. In order to prevent mistaken diagnoses, this report aims to emphasize this lesion is not limited to the vulva and may appear in other locations...

Diagnosis and treatment of Fournier's gangrene: two cases and literature review

Fournier's gangrene [FG] is a rapid progressive disease with high mortality and is caused by polymicrobial infection. FG usually begins with infection and affects fascias in [the perianal and] perineal regions as well as the abdominal wall and other organs. Although this disease has been recognized for many years, there are only a few cases reported in the world and few from China. Here, we report our success in the diagnosis and treatment of two cases of FG, one of which had severe necrotic sing fasciitis spreading to the abdominal wall, perianal, and perineal regions. We have discussed the pathogenesis, diagnosis, and treatment of FG

Trypanosoma cruzi in the anal glands of urban opossums. I- isolation and experimental infections

Opossums (Didelphis marsupialis) captured in intensely urbanized areas of the city of Caracas, Venezuela, were found infected with Trypanosoma cruzi. The developmental cycle of trypomastigote-epimastigote-metacyclic infective trypomastigote, usually occurring in the intestine of the triatomine vector, was taking place in the anal odoriferous glands of the opossums. Material from the glands, inoculated in young, healthy opossums and white mice by different routes, subcutaneously, intraperitoneally, orally, and into the eye, induced T. cruzi infections in all animals. Parasitemia, invasion of cardiac and skeletal muscle, and intracellular multiplication of amastigotes were observed. Inoculation of metacyclics from anal glands, cultured in LIT medium, gave equivalent results. All opossums survived: all mice died. Excreta of opossums may thus transmit Chagas' disease by contamination, even in urban areas where insect vectors are not present.

Fístulas anales complejas / Complex anal fistulae

Antecedentes: Las fístulas anorrectales ponen a prueba la experiencia de los cirujanos del colon y recto. Objetivo: Este artículo de revisión se realizó para discutir los avances más recientes en el diagnóstico y tratamiento de las fístulas anales complejas. Resultados: Las fallas en el tratamiento de las fístulas anorrectales pueden ser minimizadas mediante el conocimiento completo de la anatomía anorrectal y de los múltiples trayectos que pueden ocacionar las fístulas. Su complejidad está determinada por su tipo, especialmente con relación al aparato esfinteriano, que obliga a extremar el cuidado para su identificación correcta y la diferenciación de su origén. La planeación del tratamiento debe individualizarse a cada paciente que las padece. Conclusiones: El papel de las diferentes alternativas quirúrgicas dependerá de las características y relaciones del trayecto fistuloso y el esfínter

Endometriosis perineal: experiencia clínica en 8 pacientes / Perineal endometriosis: clinical experience in 8 patients

We report our experience with 8 women with perineal endometriosis managed in a period of 20 years. All were multiparae women presenting with cyclical perineal painful masses related to menstrual periods. Symptomatology started 6 months to 16 years after last delivery. Three patients had partial involvement of the anal sphincter. The endometriosis area was locally resected in all women. There were no complications and no problems with anal continence. Two patients had local recurrences. The different lapses between delivery and symptomatic presentation can be related to the amount of endometrial basal cells omplantes in the episiotomy. The treatment is always surgical. All endometrial implants must be resected and sphincteric structures must be repaired posteriorly

Infecçäo natural das glândulas anais de gambás (Didelphis albiventris) pelo Trypanosoma cruzi no município de Bambuí - MG / Natural infection of opossum (Didelphis albiventris) anal glands by Trypanosoma cruzi at Bambuí-MG

De 87 gambás, didelphis albiventris, capturados na regiäo de Bambuí (MG), 32 (36,7%) estavam infectados pelo Trypanosoma cruzi. Os índices de infecçäo foram 34,9%, 81,8% e 7,7%, respectivamente, para animais capturados em ambiente silvestre, peridomiciliar rural e periodomiciliar urbano. Em 20 gambás infectados as glândulas anais foram examinadas repetidamente e apenas um (5%) animal (GA09) apresentou exame positivo. Foram positivos 7 dos 17 exames a fresco da secreçäo glandular desta animal ao longo de 18 meses. Material destas glândulas produziu parasitemia patente em gambás e infecçäo subpatente em camundongos. A análise isoenzimática realizada com amostras de T. cruzi do GA09, obtidas via hemocultura, xenodiagnóstico e glândulas anais demonstraram pertencerem rigorosamente ao mesmo Zimodema semelhante ao Zimodema Z1. As observaçöes mostram que a infecçäo das glândulas anias pelo T. cruzi em gambás naturalmente infectados da regiäo de Bambuí é baixa

Aspectos anatômicos e histológicos das glândulas peri-anais da cuíca Philander opossum Linnaeus, 1758 / Anatomic and histological aspects of the perianal glands of the four-eyed Philander opossum Linnaeus, 1758

Foram estudados os aspectos morfológicos das glândulas perianais da cuíca Philander opossum: Estes marsupiais apresentam dois pares de glândulas perianais situadas respectivamente à direita e à esquerda do ânus. Cada par está formado por uma glândula lateral e outra medial. Estas glândulas estäo alojadas na fossa ísquio-retal, sob a pele da regiäo perianal, sendo a glândula medial de coloraçäo perolácea e menor que a glândula lateral, que é de coloraçäo ocre. Cada uma destas glândulas está formada pela associaçäo de vários lóbulos interligados e envolvidos pela mesma cápsula fibro-muscular. Os ductos menores da glândula medial se reúnem formando um ducto principal único antes destes emergir na superfície da glândula. Os ductos menores da glândula lateral emergem separados na sua superfície, indo se reunir mais à frente, formando o ducto principal desta glândula. Os ductos principais de ambas as glândulas correm paralelos até próximo ao ânus, onde se fundem em um ducto comum que se abre na fosseta anal, distalmente à linha pectinada. O epitélio secretor destas glândulas apresenta características de secreçäo holócrina