Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium at pharyngeal and anorectal sites in patients presenting to an STI outpatient ward.

BACKGROUND: The incidence of sexually transmitted infections (STIs) is unbridled and on the rise. Extragenital STIs (anal and pharyngeal infections) are commonly asymptomatic, resulting in delayed diagnosis and treatment and consequently higher chances of onward transmission. OBJECTIVE: The aim of this observational single-centre study was to determine the prevalence of STIs at extragenital sites in symptomatic and asymptomatic patients presenting at an STI outpatient clinic. METHODS: We conducted a retrospective analysis of patients who presented between October 2019 and February 2021 at the STI outpatient clinic of a tertiary centre in Central Europe. Patients were included in the study if they received at least one pharyngeal and/or anorectal swab in addition to a genital swab for multiplex-PCR STI diagnostics. Demographic data, symptoms and serological results were collected and analysed. RESULTS: Data collected from 440 patients were analysed (mean age: 33.9 years, male: n = 345, 78.4%, female: n = 95, 21.6%). Ninety-seven males reported having sex with men (MSM); 174 patients identified as heterosexual (132 males, 42 females), and 10 females as bisexual. The sexual orientation was not reported in 159 cases. An STI was confirmed in 195 patients (44.3%) and, among those, 109 patients (55.9%) tested positive for an STI at extragenital sites. Seventy-one patients had a pharyngeal STI whereas 61 were infected in the anorectal region. Of those suffering from an extragenital STI, 64.2% (70 out of 109) tested negative for relevant pathogens at genital sites. The most frequently detected extragenital pathogen was Neisseria gonorrhoeae (71.8% of all pharyngeal STIs [51 out of 71], 55.7% of anorectal STIs [34 out of 61]), followed by Chlamydia trachomatis (41.0% of all anal infections [25 out of 61], 5.6% of pharyngeal infections [4 out of 71]). Pharyngeal and anorectal infections were asymptomatic in 88.7% [63 out of 71] and 65.6% [40 out of 61] of the cases, respectively. CONCLUSION: These results underline the need to perform multisite testing, regardless of the presence of symptoms.

Proposal for a clinical-dermoscopic classification of scalp naevi.

BACKGROUND: Recent research suggests that scalp naevi differ with respect to their epidemiology, patient characteristics and morphological patterns, but currently a classification of scalp naevi is lacking. OBJECTIVES: To investigate the prevalence, together with clinical and dermoscopic features, of scalp naevi detected in persons attending a skin cancer screening programme, and to elaborate a classification of scalp naevi based on their most common morphological patterns. METHODS: Participants were recruited during the melanoma prevention programme 'sun watch' of Austrian Cancer Aid in Styria. Each participant received a clinical and dermoscopic total-body skin examination including the scalp. For each participant, demographics and clinical characteristics including number of scalp naevi were recorded. Clinical and dermoscopic photographs of at least one scalp naevus per participant were taken and evaluated for specific clinical and dermoscopic features. RESULTS: In total 867 subjects, including 119 participants (13·7%) with scalp naevi, participated in the study. Compared with those without scalp naevi, subjects with scalp naevi were significantly younger, were more often men and more often exhibited congenital naevi on the body (P < 0·01 for all). Analysis of the clinical and dermoscopic variability of scalp naevi allowed for a proposal to classify scalp naevi into six main groups, namely common, papillomatous, eclipse, congenital, blue and atypical naevus. CONCLUSIONS: Scalp naevi can be classified into six morphological groups; scalp lesions deviating from these six main patterns should be carefully managed to rule out melanoma.

Patient acceptance and diagnostic utility of automated digital image analysis of pigmented skin lesions.

BACKGROUND: Computerized analysis of pigmented skin lesions may help to increase diagnostic accuracy for melanoma, help to avoid unnecessary procedures and reduce health care costs. OBJECTIVES: We evaluated both the patient acceptance and diagnostic utility of such an analysis tool in a real clinical setting. METHODS: Two hundred nine consecutive patients (median age: 34 years, range: 2-73 years), who were concerned about a pigmented skin lesion, answered a questionnaire about their attitude towards computerized analysis and their confidence in the resulting findings. Using a dermoscopy analyser, their skin lesions (n = 219) were then grouped into the categories, benign, suspicious and malignant, and results were compared with those obtained by in-person examination of dermato-oncologic experts. RESULTS: More than half of the patients (n = 114) would accept the use of computer analysis for melanoma screening; although 16 (14.0%) patients would accept this method solely, 98 (86.0%) patients would prefer an additional in-person examination by a dermatologist. Of the 219 pigmented skin lesions, the dermoscopic experts rated 171 (78.1%) as benign, 36 (16.4%) as suspicious and 12 (5.5%) as malignant, whereas computer analysis revealed 102 (46.6%) benign, 78 (35.6%) suspicious and 39 (17.8%) malignant lesions. At the expense of specificity (48.8%), the sensitivity of computerized analysis was excellent (100%) and equal to that of in-person examination. CONCLUSIONS: Most patients would accept computer analysis for melanoma screening, some of them even without reservations. However, due to a high rate of false positive computer assessments, it cannot be recommended as a screening tool at this time.

[Numerous pigmented lesions on sun-damaged skin. Where is the "wolf between the lambs"?]. / Zahlreiche pigmentierte Läsionen auf UV-geschädigter Haut. Wo ist der "Wolf unter den Lämmern"?

A 64-year-old patient presented with bronzed, sun-damaged skin presented with numerous light and dark brown macules, mainly with sharply demarcated with irregular borders, present. Dermatoscopy showed a faint, light and dark brown network, fingerprint-like structures and irregular, sharp, moth-eaten borders in most lesions. In contrast, one dark-brown and bluish, asymmetrical flat plaque on the patient's right arm showed blue-grey globules, blue ovoid structures and leaf-like areas. Histology revealed a pigmented superficial basal cell carcinoma. Dermatoscopy allowed filtering out the malignant lesion easily despite the large number of solar lentigines and some melanocytic nevi because of the characteristic dermoscopic criteria and the "ugly duckling sign".

Frequency, clinical and dermoscopic features of benign papillomatous melanocytic naevi (Unna type).

BACKGROUND: Most previous studies on melanocytic naevi have not distinguished between the different types of naevi, except for some studies trying to define atypical naevi. No large, population-based studies on papillomatous or Unna-type melanocytic naevi have been performed. OBJECTIVES: To investigate the dermoscopic and clinical features of papillomatous naevi and to study some of the factors which could potentially influence their development. METHODS: Seven hundred and seven caucasians aged 1-82 years participated in a screening campaign at open-air recreation facilities in Austria. The volunteers underwent a total body examination by experienced dermatologists and answered a questionnaire. Clinical and dermoscopic images of one representative papillomatous naevus per person were taken. RESULTS: Twenty-nine per cent of the volunteers exhibited papillomatous naevi, the highest frequency being found in young adults. No correlation between the frequency of papillomatous naevi and gender, skin type, sunburns, sunbed use or hormonal factors was found. Most lesions were brown papules (median diameter 5.0 mm), located on the trunk. Dermoscopy showed a predominance of homogeneous and globular pattern, multifocal hypo/hyperpigmentation and comma vessels. Of the papillomatous naevi, 9.8% showed suspicious scores with dermoscopic algorithms. CONCLUSIONS: The lack of exogenous influencing factors and the predominance of globular dermoscopic pattern strengthen the hypothesis that papillomatous naevi belong to the same spectrum as small congenital melanocytic naevi. As the role of papillomatous naevi as precursors of melanoma remains unclear and they are frequently not recognized by the patients, one should perform dermoscopy of papillomatous naevi during skin cancer screening.

[Parenteral nutrition in gastro-intestinal surgery (author's transl)]. / Alimentation parentérale en chirurgie digestive.

Forty-two postoperative patients received by parenteral route on 24 hours a total of 2,610 calories by means of a simultaneous infusion of 1,500 ml Trivé 1000 and 1,500 ml 10% invert sugar through a central venous line. Of those 42 cases 12 had peritonitis with 7 of them an enteric fistula, 18 underwent an extensive bowel resection and 12 suffered malnutrition secondary to their primary pathology. The average duration of parenteral nutrition was 13 days and the average hospital stay 27 days. No major metabolic derangement was noted except for a temporary transient elevation of SGOT and AF. A systematic bacteriological study of the perfusion lines disclosed an associated morbidity of about 6%. We are convinced that with the used solutions the postoperative catabolism can be managed successfully and that the association of aminoacids, lipids and glucides as used by us facilitates, nursing care.