Clinicians should need to be aware about the common presence of a variety of antibodies with low specificity but also the exceptional occurrence of anti-CCP antibodies in IE. Special attention to multifocal endocarditis and high RF is also suggested.
Only 40 cases of Stenotrophomonas maltophilia (S. maltophilia) endocarditis have been reported to date, and there is no description in patients with underlying autoimmunity. A 23-year-old woman with systemic lupus erythematosus (SLE) overlapping rheumatoid arthritis (RA) and no risk factors for endocarditis was admitted in our hospital because of community-acquired tricuspid valve endocarditis. During hospitalization, she was complicated with pulmonary thromboembolism and pneumonia. Laboratory showed autoimmune diathesis featured by anti-cyclic citrullinated peptide (anti-CCP), anti-Sm, anti-Ro/SSA, anti-cardiolipin, anti-β₂ glycoprotein 1, and antinuclear antibodies, rheumatoid factor (RF), low complement, lymphopenia and C-reactive protein (CRP) of 425mg/L. S. maltophilia grew in serial blood culture sets. Empirical broad-spectrum antimicrobials were ineffective until trimethoprim/sulfamethoxazole (TMP/SMX) was added to therapy. One month after admission, the patient underwent successful surgical replacement of the tricuspid valve and the subsequent course was satisfactory, allowing her to be discharged 14 days after. Nowadays, she remains free of complaints and her cardiac, renal and pulmonary functioning is stable. Noteworthy is that all auto-antibodies have been persistently raised over time. Here, we present a compilation of the available information about S. maltophilia endocarditis, and suggest that autoimmunity could be included as a novel predisposing factor for S. maltophilia endocarditis.
El bloqueo regional genital en urología ofrece ventajas como: menor tiempo de estancia hospitalaria y de complicaciones relacionadas con la técnica anestésica, mejor control del dolor peri y posoperatorio y disminución de costos asociados con la cirugía. Este tipo de bloqueo se utiliza para efectuar diversos procedimientos quirúrgicos en los genitales, principalmente: circuncisión, meatotomía, corrección de la enfermedad de Peyronie, incisión dorsal del prepucio, inserción de prótesis del pene, cirugía escrotal y testicular, hidrocelectomía, quiste de epidídimo, vasectomía, varicocelectomía, biopsia testicular, orquiectomía y orquidopexia. Esta revisión describe las técnicas de bloqueo genital en urología.PALABRAS CLAVE: bloqueo regional genital, bloqueo del pene, bloqueo en urología.
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