Urologic experience in 48 heart transplant recipients

BACKGROUND

Urologic experience in heart transplant recipients as a population group has not been reported.

METHODS

We reviewed the charts of 48 consecutive heart transplant recipients who were evaluated and treated in our outpatient urologic clinic. Patients were treated for various urologic conditions by both medical and surgical means.

RESULTS

No major complications were encountered.

CONCLUSIONS

Heart transplant recipients may be treated with minimal morbidity; thus, their urologic complaints should be addressed and treated with confidence.

Immunohistochemical investigations of genital ulcers caused by Haemophilus ducreyi

To gain information on the specific composition of the inflammatory infiltrate of genital ulcers caused by Haemophilus ducreyi, biopsies of 6 genital ulcers which were diagnosed as chancroid on clinical and microbiological grounds were subjected to immunohistochemical investigations after conventional haematoxylineosin staining. A variety of antibodies reactive against B- and T-cells, plasma cells and granulocytes were used with each tissue sections. The lymphocytic infiltrate of chancroid ulcers consisted of both B- and T-lymphocytes and showed a cluster-like formation. B-lymphocytes were preferentially localized perivascularly in the middle layer, T-lymphocytes mainly in the deep layer of the inflamed oedematous tissue. Results stress the importance of both B- and T-cell mediated immune responses in Haemophilus ducreyi infection.

[Bilateral abscess of cavernous bodies]

Report of a rare case of abscess in both cavernous bodies. Its peculiarity is based on the location, the bilateral nature and the absence of a clear causative factor, although it was probably related of a local septic focus (rectal or prostatic). Diagnosis was established with CAT because of the primarily posterior location and the significant peripheral inflammatory reaction. The patient was treated successful with a vigorous antibiotic therapy and open drainage from both cavernous bodies with no development of sequelae such as fibrosis and penial incurvation or impotence.

[Chancroid in Algeria: the status of this sexually transmitted disease in 1995]

Absent for several decades, the chancroid reappeared in Algeria in 1988. In the unique department of Dermatology and Venereology of the University Hospital of the country of Tlemcen (more than 700,000 inhabitants), we wanted to know the state of this STD seven years after the report of the first cases. The file of the consulting patients were examined. We looked for the principal characteristics of this STD: age, sex, incubation period, place infection contact, type of relation, clinical presentation, evolution without and with treatment, other associated STD (syphilis, HIV). From August 1988 (1st case) to December 1995, 144 cases of chancroid were collected = 1988: 6, 1989: 5, 1990: 7, 1991: 18, 1992: 11, 1993: 33, 1994: 48, 1995: 16. The presentation is quite stereotyped; it concerns males only, singles in must cases, having had sexual relations with prostitutes. The incubation period is short (less than 10 days), the characteristic ulceration presents, very often, some adenopathies. The treatment by cotrimoxazole is efficient. They are no concomitant syphilis or HIV infection. The chancroid is the first cause of genital ulceration in the world. Since 1991, it is the principal STD in our department. It spreads within a male population, young singles associated with prostitutes. It is well installed in Algeria, and its role, although minor, in the transmission of the HIV infection, should not be neglected.

[The microbial etiology of genital discharges in Nouakchott, Mauritania]

The survey carried on 579 patients of both sexes, consulting for genital discharges (spontaneous or referred), showed that in 61.1% men cases, STD agents were isolated (Neisseria gonorrhoeae 51.5%) and 64.4% in women cases (Gardnerella vaginalis 24%, Candida albicans 20%. Trichomonas vaginalis 14%). 17% of Neisseria gonorrhoeae strains were penicillinase-producing (PPNG).

A morphological study of penile chancroid lesions in human immunodeficiency virus (HIV)-positive and -negative African men with a hypothesis concerning the role of chancroid in HIV transmission

Chancroid, the most common cause of genital ulceration in Africa, is known to be associated epidemiologically with heterosexual transmission of human immunodeficiency virus (HIV). The pathophysiological mechanisms by which chancroid might facilitate the spread of HIV are obscure. To investigate the role of chancroid in HIV transmission, the authors studied the histological features of biopsies from 11 men with penile chancroid lesions including five who were serologically positive for HIV. The histomorphologic and immunophenotypic nature of the inflammatory infiltrates suggests that there is a significant role for cell-mediated immunity in the host response to Hemophilus ducreyi infection. This response may be critical to the role of chancroid in HIV transmission.

Penile mass caused by the newly described organism Mycobacterium celatum

We report a penile infection in a man with the acquired immunodeficiency syndrome caused by a newly described infectious organism, Mycobacterium celatum. Mycobacterium tuberculosis is the only mycobacterial species previously reported to cause infection in the penis. This is only the third documented human infection with M celatum, and the first to involve the genitourinary system.

Evidence for cryptosporidial infection as a cause of prolapse of the phallus and cloaca in ostrich chicks (Struthio camelus)

Cloacas of male ostrich chicks that had suffered prolapse of the phallus and cloaca were compared with cloacas of normal ostrich chicks of both sexes from the same area. Heavy infection of the cloacal and bursal tissue with Cryptosporidium sp. was present in all the cases of prolapse, while no cryptosporidia were observed in the normal chicks. Histopathological lesions as described in cryptosporidial infection in other species were present in the infected cloacas. These included loss of the microvillous border and epithelial hyperplasia and degeneration, which was indicated ultrastructurally by vacuolation of the apical cytoplasm, swelling of organelles, and nuclear changes. It is suggested that these lesions, in combination with the anatomy of the male ostrich cloaca, may be responsible for prolapse of the phallus and cloaca.

The features and aetiology of Fournier's gangrene

This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier's gangrene) and a review of previous publications. Even though found mostly in elderly male patients, the disease spares no age group and can involve the external genitalia in neonates and women as well. The disease is a necrotising fasciitis of infective origin and always has a portal of entry of the infecting organisms even though it may be so trivial as to be undetected. The commonest portals of entry of infection are periurethral sepsis, groin wound sepsis, anorectal sepsis, prostatic sepsis and trauma. The infecting organisms comprise both aerobic and anaerobic organisms such as Escherichia coli, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, enterococci, Bacteroides fragilis and anaerobic streptococcus. Fournier's gangrene is probably the same disease as necrotizing fasciitis occurring in other parts of the body, but modified by the peculiar anatomy of the genitoperineum.

Identification of penile prosthetic infection on 67gallium scan

We report on a patient who presented with unexplained fever 7 weeks after placement of a penile prosthesis. A whole body 67gallium scan demonstrated a peri-prosthetic infection, which was confirmed at surgery.

[Primary tuberculosis of the penis]

Presentation of one case of primary tuberculosis of the penis which presented as a skin ulcer. The need of preparing a good clinical history, with special emphasis on sexual habits, as well as the convenience of taking a biopsy for diagnosis and further treatment is analyzed.

Advances in the treatment of superficial candida infections

This article reviews recent controlled studies of treatment for candida infections of the skin and mucous membranes. In general, excellent agents are available for treatment, with reasonable alternatives for the uncommon emergence of resistant strains. Cutaneous infections in immunocompetent patients are effectively treated with topical agents. The major clinical problems that remain include frequently recurrent vulvovaginal candidiasis, and oroesophageal candida infections in patients with malignancies and immunosuppression. These often require systemic therapy. A number of treatment strategies have been investigated and are reviewed.

Prolapse of the phallus and cloaca in the ostrich (Struthio camelus)

The incidence of cloacal prolapse in ostrich chicks hatched and raised on the Oudtshoorn Experimental Farm during the 1992-1993 breeding season was investigated. The condition which occurred primarily in male chicks, affected 14.65% of the total number of chicks hatched. The mortality rate amongst chicks with cloacal prolapse was very high. Although the pathogenesis and aetiology of the condition is unknown, a species of Cryptosporidium was present in large numbers in affected cloacas. Treatment with systemic antibiotics was found to be effective in some cases.

Topical tromantadine in the treatment of genital herpes. A double-blind placebo controlled study

A randomised double-blind placebo controlled trial was performed to assess the efficacy and safety of tromantadine ointment 1% in male patients with genital herpes. 45 patients with penile genital herpes of less than three days duration were randomised to local treatment with tromantadine ointment 1% or placebo (ointment base alone) five times daily up to 12 days. No difference in time of healing could be detected between the two groups (p = 1.0). Both the objective signs (vesicles, pustules, ulceration, and glandular swelling) and the subjective symptoms (itching, burning, pain and dysuria) all diminished simultaneously in the two groups.

Detection and typing of genital papillomaviruses in men with a single polymerase chain reaction and type-specific DNA probes

BACKGROUND

Human papillomavirus (HPV) infection of the genitalia can produce both visible and subclinical lesions. Because different genotypes are preferentially associated with benign or malignant lesions, HPV detection and typing is clinically important.

OBJECTIVE

Our purpose was to assess a polymerase chain reaction (PCR)-based, noninvasive procedure for HPV diagnosis and evaluate the reliability of the acetic acid test for revealing subclinical HPV lesions.

METHODS

Mucosal samples were collected by gentle scraping, and PCR-positive samples were typed by hybridization with specific DNA probes.

RESULTS

Seventy-eight men were assessed. The PCR procedure was reliable and easy to perform. No significant difference was found in the prevalence of HPV infection between patients whose results were acetowhite-positive and those whose results were acetowhite-negative.

CONCLUSION

Detection of acetowhite epithelium, although useful for clinical examination, is not sufficiently specific and should not be used as a sole criterion for the diagnosis of HPV infection.

Histoplasmosis of the penis

Histoplasmosis is a common cause of systemic mycosis in endemic areas of the United States. Genitourinary and cutaneous involvement with this dimorphous fungus is rare. We report a case of disseminated histoplasmosis associated with nonpainful ulcerative lesions of the glans and shaft of the penis.

Primary HIV-1 infection associated with prominent genital ulcers

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History of circumcision, medical conditions, and sexual activity and risk of penile cancer

BACKGROUND

Epidemiological evidence suggests lack of neonatal circumcision as the strongest risk factor for penile cancer, but the role of sexually transmitted diseases in the etiology of penile cancer has remained unclear.

PURPOSE

To further clarify risk factors for penile cancer, we examined the role of circumcision, personal characteristics and habits (such as smoking), sexually transmitted diseases, past sexual activity, and medical conditions of the penis.

METHODS

A population-based, case-control study was conducted in western Washington state and in the province of British Columbia. We interviewed 110 men with penile cancer diagnosed from January 1979 to July 1990 and 355 control subjects from the general population, frequency matched to case subjects on age and date of diagnosis. Tumor tissue from 67 case subjects was tested for human papillomavirus (HPV) DNA by polymerase chain reaction. Results of blood tests from 69 case subjects and 208 control subjects were available for study. STATISTICALLY SIGNIFICANT RESULTS: Relative to men circumcised at birth, the risk for penile cancer was 3.2 times greater among men who were never circumcised and 3.0 times greater among men who were circumcised after the neonatal period. For current smokers, the risk was 2.8 times that of men who never smoked. The risk among men reporting a history of genital warts was 5.9 times that of men reporting no such history. Of 67 tumors tested for HPV DNA, 49% were positive; the majority of these positive tumors (70%) were type 16, which has been associated with anogenital carcinoma. Relative risks (RRs) associated with a reported history of penile rash or penile tear were 9.4 and 3.9, respectively. Among men not circumcised at birth, RRs associated with presence of smegma and difficulty in retracting the foreskin were 2.1 and 3.5, respectively. Twenty-eight percent of case subjects, compared with only 10% of control subjects, reported 30 or more sexual partners, and men with HPV-positive tumors were more likely to report a greater number of sexual partners.

CONCLUSIONS

These results suggest that the absence of neonatal circumcision and potential resulting complications are associated with penile cancer. Additionally, medical conditions of the penis, sexual activity, infection with HPV, and smoking may increase the risk for penile cancer.

IMPLICATIONS

A larger study would allow examination of interrelationships of circumcision, infection with HPV, and smoking as risk factors.

Viral co-infections in human papillomavirus-associated anogenital lesions according to the serostatus for the human immunodeficiency virus

In HIV-infected men, human papillomavirus (HPV) infection is strongly linked with the development of anogenital lesions but is not a sufficient factor to explain the neoplastic transformation of such lesions. We investigated the association between HPV and herpesvirus infections in penile and anal lesions from 54 HIV-seronegative and 54 HIV-seropositive men by means of colposcopy, histopathology and in situ hybridization. Our patients showed condyloma acuminata (39%), papular warts (35%) and macular warts (26%). High-grade lesions were predominant in the HIV+ men, whereas low-grade lesions were more frequent in the HIV- men. In the HIV+ group, potential oncogenic HPV were the most frequently detected (83.4%) whereas the "low-risk" HPV were found chiefly in HIV- men (62.1%). The CD4 number was lower in patients showing "high-risk" HPV than in men showing lesions without HPV or with non-oncogenic HPV. HPV types 6/11 were found mainly associated with koilocytosis or with AIN(PIN)I. Oncogenic HPV were more often detected in AIN(PIN)II-III. The herpesviruses DNA detection revealed a higher prevalence of HSVI and -2 than CMV and EBV in the studied biopsies. The frequency of HSV and CMV detection was higher in the HIV+ than in the HIV- men. A link was found between the "high-risk" HPV and the CMV detection whatever the population considered. The detection in HPV lesions of other sexually transmitted viral agents could therefore represent an important means of preventing progression of the anogenital disease, especially in immunosuppressed patients.

Granuloma inguinale: three cases diagnosed in Toronto, Canada

Granuloma inguinale (GI) is a sexually transmitted disease seldom seen in the United States and Canada. We are reporting three cases recently seen in Toronto, Ontario, two in immigrants, and one in a native born Canadian who had an intimate relationship with a foreign visitor. The basic features of the disease are discussed.

[Malpighian epithelia and papillomavirus infections]

Human papillomaviruses (HPV) are a large group of DNA viruses, with over 60 types identified to date, which can cause the development of benign tumors in the skin and mucosal squamous epithelia. Most of these tumors regress spontaneously but some, especially in the mucosal membranes, become malignant. HPV types with a high risk for inducing malignancies (e.g. 16 and 18) are the subject of increasing interest. HPVs are both host-specific and tissue-specific: some types preferentially infect specific epithelia, giving rise to lesions with distinct topographic characteristics. HPVs are difficult to study because they do not replicate in available in vitro models. In vivo, HPVs replicate well in epithelial cells undergoing terminal differentiation, e.g. in keratinized cells. Some 40 different types have been reported in epidermal keratinocytes, the most common being types 1 and 2 which produce large amounts of viral antigens and viral particles. In contrast, HPVs replicate poorly in the weakly keratinized squamous epithelia which line the digestive, respiratory, and genital tracts. Junctional epithelia, e.g. on the uterine cervix, are especially prone to HPV infection. The most prevalent HPV types in benign genital lesions are types 6 and 11, whose characteristic features include extrachromosomal DNA and production of only small amounts of viral antigens. The profound nuclear and cytoplasmic changes induced by HPVs lead to the formation of koïlocytes which are found mainly in the granular layer of epithelia and have been especially well described in the uterine cervix and vagina. HPV epithelial tumors are squamous cell carcinomas that often harbor HPV types 16 and 18; this is especially true of cervical intraepithelial neoplasias.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructural visualization of human papillomavirus DNA in verrucous and precancerous squamous lesions

Human papillomavirus (HPV) DNA was ultrastructurally localized by the non-isotopic in situ hybridization technique in formalin-fixed, paraffin-embedded specimens of verruca vulgaris of the skin, condyloma acuminatum of the penis and severe dysplasia of the uterine cervix. Biotinylated DNA probe cocktails were employed for the visualization of HPV-DNA, types 6 and 11 (HPV 6/11) and types 16 and 18 (HPV 16/18). The papillomavirus genus-specific antigen was also visualized by pre-embedding immunoelectron microscopy using rabbit antiserum. In verruca vulgaris, HPV antigen-positive 50-60 nm-particles of mature viral size were observed in the nuclei of the granular cells and parakeratotic cells with perinuclear haloes, whereas HPV 6/11 and HPV 16/18 DNA were negative. In condyloma acuminatum, the nuclei were positive for the HPV antigen and HPV 6/11 DNA, but were negative for HPV 16/18 DNA. More cells were labeled for the viral DNA than for the viral antigen. The ultrastructural observation indicated the presence of the naked (plasmid) viral DNA as fine particles sized 15-20 nm. In the dysplastic cervical mucosa, dot-like positivity of HPV 16/18 DNA was recognized. The HPV antigen and HPV 6/11 DNA were undetectable. HPV 16/18 DNA was localized in part of the nuclear chromatin. This pattern of localization may suggest integration of the viral DNA into the host cell DNA.

Pearly penile papules: absence of human papillomavirus DNA by the polymerase chain reaction

Pearly penile papules clinically resemble the sexually transmitted papular variant of genital condylomata. Histologically, however, pearly penile papules consist of fibropapillomata that lack the characteristic morphologic features of human papillomavirus (HPV) infection. To study the possible association of HPV infections with pearly penile papules, we examined tissue specimens from 13 men with pearly penile papules with and without associated penile condylomata. Biopsy specimens were tested for the presence of HPV DNA by the polymerase chain reaction. None of the pearly penile papules contained HPV DNA sequences, whereas four of seven cases clinically suspected of being condylomata associated with pearly penile papules contained HPV DNA. These results confirm that pearly penile papule lesions do not contain HPV DNA; therefore, the distinction between pearly penile papules and penile condylomata is clinically significant.

Isolation of anaerobes from bubo associated with chancroid

Ten men with bubo associated with chancroid were studied for bacterial flora especially anaerobes. Anaerobes were isolated from all 10 buboes and eight out of 10 ulcers of chancroid. Anaerobic cocci, B melaninogenicus and B fragilis were the most common isolates. anaerobes probably play a role in the pathogenesis of bubo in chancroid.

[Penoscrotal gangrene: our series of cases]

Ten cases of penoscrotal gangrene seen in our department over the last 8 years are presented. In 80% of patients causative factors of the gangrenous process were demonstrated and were equally distributed between urology and colorectal pathologies. The most commonly associated pathology was diabetes mellitus affecting up to 50% of our patients. Two or more germs were isolated from the necrotic-purulent material for cultures, mainly E. coli (90%) and Proteus mirabilis (50%) as aerobic organisms, and Bacteroides fragilis (40%) in the anaerobic group. Despite emergency surgical therapy and high doses of broad spectrum antibiotics, mortality in our series was about 20%.

Perianal streptococcal cellulitis with penile involvement

Perianal streptococcal cellulitis is described occurring in a 5-year-old boy. The condition also involved the penis and presented as a possible case of sexual abuse. The correct diagnosis was established by culturing beta-haemolytic streptococci group A from the penile and perianal skin.

Primary tuberculosis of the penis in an infant

Primary tuberculosis of the penis with associated bilateral inguinal lymph node enlargement and a discharging sinus is described. Its rarity is emphasized and its likely mode of transmission is also highlighted so that it can be looked for in areas where infantile circumcision is practised, particularly in developing countries.

Herpes simplex mimicking leukemia cutis

We present a patient with chronic lymphocytic leukemia who developed a painful penile ulcer that was initially diagnosed as leukemia cutis, as evidenced by an atypical leukemic infiltrate on biopsy. A Tzanck preparation was positive for multinucleated giant cells, and the diagnosis of herpes genitalis was confirmed by viral culture. In patients with hematologic malignancies, herpes simplex virus must be included in the differential diagnosis of ulcerative lesions. The histopathologic findings of inflammatory dermatoses in these patients may include an atypical infiltrate, because of the predominance of atypical inflammatory cells in the peripheral circulation.

Tinea of the glans penis

A 56-year-old Japanese man with tinea of the glans penis is described. He did not carry any other tinea lesions except that of the glans penis. Mycological examinations revealed that the causative organism was Trichophyton mentagrophytes.

Human papillomavirus: the untreated male reservoir

Human papillomavirus infection currently is accepted as a major factor in the etiology of carcinoma of the cervix, vagina and vulva. While the nature of genital human papillomavirus infection in women is well documented, detailed knowledge of the disease in the male partners is lacking. Therefore, a prospective study was done to define the disease in the genitals of heterosexual men and to formulate an appropriate plan of management. We studied 52 men during an 8-month period for evidence of genital human papillomavirus infection. The majority of the lesions occurred on the shaft of the penis and on the foreskin of uncircumcised men. Deoxyribonucleic acid dot hybridization of biopsies of macroscopic warts and suspected warty lesions with mixed human papillomavirus types 6 and/or 11 and 16 and/or 18 probes revealed that 87 and 55 per cent, respectively, were positive for 1 or more of these human papillomavirus types. Of the macroscopic warts and subclinical lesions 52 and 29 per cent, respectively, contained the more potentially oncogenic types 16 and/or 18, either alone or in combination with types 6 and/or 11. There was no evidence of human papillomavirus in any semen or urine sample but human papillomavirus deoxyribonucleic acid sequences were detected in 31 per cent of the biopsies from apparently normal penile skin and in 18 per cent of the urethral mucosal biopsies. We suggest that management of human papillomavirus infection be directed toward prevention and contact screening, together with ablation of localized lesions.

Advantage of human papillomavirus typing in the clinical evaluation of genitoanal warts. Experience with the in situ deoxyribonucleic acid hybridization technique applied on paraffin sections

Genitoanal warts are predominantly induced by human papillomavirus (HPV) types 6, 11, 16, and 18. A strong association has been established between infection by HPV 16 and HPV 18 and the subsequent development of cancer in the uterine cervix. Therefore, a clinical challenge exists with respect to identification of patients harboring the latter type of high-risk HPV types. The present study on 108 men with genitoanal warts focuses on whether reliable gross and/or histopathologic criteria exist to predict the presence of HPV 16 and HPV 18 or whether there is a need for HPV typing by deoxyribonucleic acid (DNA) hybridization assay in future epidemiologic studies. The high-risk HPV types were identified in 9 of 91 HPV DNA-positive lesions (11%). The gross appearance of the lesions appeared to be of limited predictive value for the presence of these HPV types. HPV 16 was most common in warts exhibiting some degree of dysplasia (p less than 0.001) and also occurred in the two lesions with a severe dysplasia. Lack of dysplasia correlated with the presence of HPV 6 and/or 11 (p less than 0.01). However, absence of dysplasia did not preclude infection with high-risk HPV types, and a mild to moderate dysplasia was associated with all of the four HPV types studied. Therefore, we emphasize the value of HPV typing in clinical routine in order to trace men harboring the high-risk HPV types 16 and/or 18.