Lichen planus with multiple system involvement including the mouth, vagina, urethra, and scalp: a case report

This is a case report of lichen planus (LP) with multiple system involvement. A 35-year-old female patient was admitted in November 2014 with a 5-year history of painful/difficult sexual intercourse and loss of oral mucosa, and an 8-year history of focal hair loss. Earlier, the patient had been unable to adhere to corticosteroid therapy because of severe adverse side effects. In September 2014, labia minora mucosa defects and stricture of the urethral orifice (with dysuria), vaginal orifice, and vagina were identified. Biopsy was performed and a diagnosis of erosive LP was made. The patient was treated with an oral immunosuppressant (cyclosporine A) and urethral/vaginal dilatation. Urine flow rate and sex life were improved after 6 months and she discontinued medication. Four years later, the patient reported a good overall treatment efficacy. LP can involve multiple systems and should be considered in patients with dyspareunia. Immunosuppressive agents can achieve a satisfactory effect in patients with contraindication to corticosteroid.

Carcinoma neuroendocrino primario de vagina. Revisión de literatura a propósito de un caso / Primary neuroendocrine carcinoma of the vagina. Literature review on the subject of a case

RESUMEN El carcinoma primario de vagina representa 1 a 2% de los cánceres ginecológicos, siendo la diferenciación histológica neuroendocrina de células pequeñas extremadamente infrecuente, sólo se han reportado 28 casos en la literatura, describiéndose en orden de frecuencia en cérvix, endometrio, ovario, vagina y vulva. Se observa con más frecuencia en mujeres postmenopáusicas. Se presenta el caso de paciente femenino, de 39 años de edad, quien acude a la consulta por presentar secreción genital serohemática, fétida, de 1 mes de evolución, evidenciándose al examen físico lesión exofítica, friable, renitente, de aproximadamente 4 cm de diámetro, en tercio superior y cara posterolateral izquierda de vagina, por lo que se realiza biopsia excisional de dicha lesión, siendo el diagnóstico anatomopatológico carcinoma neuroendocrino de células pequeñas, grado histológico: 3. A propósito de este caso, se realiza una revisión del tema, haciendo hincapié en la importancia de la exploración ginecológica exhaustiva que incluya tomas de citologías y colposcopias periódicas, tomando en cuenta la vagina y así, realizar diagnóstico precoz en vista que el riesgo de carcinoma en dicha zona es infrecuente, mejorando el pronóstico y sobrevida de las pacientes.

ABSTRACT The primary carcinoma of the vagina represents 1 to 2 % of gynecologic cancers, being the histological differentiation neuroendocrine of small cells extremely infrequent, only 28 cases have been reported in the literature, describing in order of frequency: in the cervix, endometrium, ovary, vagina and vulva. It is most commonly seen in postmenopausal women. We present the case of a female patient, 39 years old, who comes to medical consult due to serohematic, fetid, genital discharge of 1 month of evolution, evidencing at physical examination an exophytic lesion, friable, renitent, with a diameter of approximately 4 cm, in the upper third and posterolateral left side of the vagina, for which an excisional biopsy of said lesion is performed, being the anatomopathological diagnosis neuroendocrine carcinoma of small cells, histological grade: 3. A bibliography reviewed was made, emphasizing the importance of exhaustive gynecological exploration with periodic cytology and colposcopy examinations, including the vagina for early diagnosis in view of carcinoma risk in this area is uncommon, improving the prognosis and survival of patients.

Comparison of culture and PCR methods for diagnosis of vaginal infection due to Mycoplasma Hominis

Background and Objective: Mycoplasma Hominis is the smallest pathogenic bacteria, with no cell wall and free living organisms. It grows slowly and the conventional clinical microbiology techniques can not be applied due to difficulties in cultivation in particular slow growth incubation. This study was done to compare the culture and PCR methods for diagnosis of vaginal infection due to Mycoplasma Hominis

Methods: This laboratory test evaluation study was done on 150 patients with bacterial vaginosis and 50 healthy people with no infection as control, whom refereed to Imam Khomeini and Imam Zaman Hospitals in Tehran. Samples were collected in PPLO culture for growth and PBS to perform PCR method

Results: 35.3% and 76% of patients were positive using culture and PCR methods, respectively. Using PCR method 8% of control subjects was positive. There was no significant association between PCR method with abortion, place of residence and also level of educations. There was a significant association between the age [P<0.05], times of changing under wear cloths [P<0.05] and parity [P<0.05]

Conclusion: PCR method is a more reliable technique to detect the vaginal infection due to Mycoplasma Hominis compared to culturing

Granulomatosis con poliangeítis de presentación atípica: revisión de la literatura a propósito de un caso de localización ginecológica / Cervicovaginal granuloma as the first manifestation of granulomatosis with polyangiitis

La granulomatosis con poliangeitis (GPA) es una vasculitis sistémica, granulomatosa, con compromiso de pequeños vasos y presencia de anticuerpos c-ANCA. Ocasionalmente es localizada y es rara su manifestación genitourinaria. Se presenta el caso de una mujer de 68 años con sangrado genital causado por una lesión cervicovaginal verrucosa ulcerada, cuya histopatología descartó malignidad, hongos y TBC, con mala respuesta a antibióticos, ácido tricloro acético y crioterapia. Por recidiva al año se practica histerectomía total y colpectomía parcial, pero reincide al mes acompañada de epistaxis, cuyo estudio pornasofibroscopía e imágenes concluye en una lesión de tipo granulomatosa, agregándose anticuerpo anti PR-3 positivo. Se diagnostica GPA y se trata con ciclofosfamida con buena respuesta. La revisión de la literatura permite concluir que la GPA con localización cervicovaginal es muy poco frecuente, especialmente como manifestación inicial, y se debe considerar en el diagnóstico diferencial con cáncer y otras lesiones granulomatosas localizadas.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis, granulomatous, with commitment of small vessels and the presence of c-ANCA antibodies. Occasionally it is located and its genitourinary manifestation is rare. Presented the case of a 68 year old woman with genital bleeding caused by a lesion cervicovaginal ulcerated verrucosa, whose histopathology ruled out fungal, malignancy and TBC, with poor response to antibiotics, acid trichloro acetic and cryotherapy. By relapse a year is practiced total hysterectomy and partial colpectomia, but repeated a month accompanied by epistaxis, whose study by nasofibroscopia and images concludes in a type granulomatous lesion, adding antibody anti PR-3 positive. GPA is diagnosed and treated with cyclophosphamide with good response. Review of the literature leads to th conclusion that the GPA with cervico-vaginal location is very rare, especially as an initial manifestation, and should be considered in the diagnosis diferenttial with cancer and other localized granulomatous lesions.

Evisceración vaginal tras tratamiento con radioterapia e histerectomía abdominal / Vaginal evisceration after treatment with radiotherapy and abdominal hysterectomy

La evisceración vaginal es una complicación muy rara. Es más frecuente en mujeres posmenopáusicas y con antecedente de cirugía vaginal, fundamentalmente histerectomía. También puede darse en mujeres premenopáusicas, vinculándose en estos casos a traumatismos, iatrogenia o introducción de cuerpos extraños. El íleon distal es el órgano más frecuentemente eviscerado, aunque el prolapso de epiplón, trompas de Falopio y apéndice también se han descrito. Presentamos el caso de una mujer de 43 años con evisceración transvaginal de epiplón a los seis meses de realizarse una histerectomía abdominal por recidiva de un cáncer escamoso de cérvix.

Vaginal evisceration is a very rare complication. It is more often in postmenopausal women with a history of vaginal surgery, mainly hysterectomy. It can also occur in premenopausal women, linking these cases to trauma, iatrogenic or foreign bodies. The distal ileum is most often gutted organ prolapse, although omentum, fallopian tubes and appendix are also described. We report a 43-year old transvaginal omental evisceration after six months of an abdominal hysterectomy for recurrent squamous cervical cancer.

Insights into the role of cervical mucus and vaginal pH in unexplained infertility / Sobre o papel do muco cervical e do PH vaginal na gênese da infertilidade inexplicada

Unexplained infertility diagnosis is made in the presence of a normal semen analysis when tubal patency and normal ovulatory function are established. Among several potential causes, unexplained infertility could be attributed to vaginal pH and cervical mucus abnormalities. Although the vaginal canal and the cervix generally function as effective barriers to sperm, and although the production of mucus is essential to transport them from the vagina to the uterine cavity, these factors receive little attention in the investigation of couples with unexplained infertility. A substantial reduction in sperm number occurs as they transverse the cervix. From an average of 200 to 300 million sperm deposited in the vagina, only a few hundred achieve proximity to the oocyte. Given this expected high spermatozoa loss, a slight modification in cervical mucus may rapidly transform the cervix into a "hostile" environment, which, together with changes in vaginal environment and cervix structure, may prevent natural conception and be a cause of infertility. In this review, we discuss the physiological role of the vaginal pH and cervical mucus in fertility, and describe several conditions that can render the cervical mucus hostile to sperm and therefore be implicated in the pathophysiology of unexplained infertility.

RESUMO O diagnóstico de infertilidade inexplicada baseia-se na presença de espermograma normal, constatadas também permeabilidade tubária e função ovulatória normais. Entre as várias causas potenciais de infertilidade inexplicada, a presença de muco cervical e pH vaginal anormais devem ser consideradas. Embora a produção adequada de muco cervical seja essencial para o transporte dos espermatozóides da vagina para a cavidade uterina, e tanto o canal vaginal quanto o colo do útero desempenham função importante como barreira à passagem dos espermatozóides, estes fatores recebem pouca atenção na investigação de casais com infertilidade inexplicada. Uma redução substancial do número de espermatozoides ocorre à medida que estes percorrem o trato reprodutivo feminino. Partindo de cerca de 200 a 300 milhões de espermatozoides depositados na vagina, apenas algumas centenas alcançam a proximidade do oócito. Alteracões do muco cervical podem rapidamente transformar o colo do útero num ambiente hostil, que em conjunto com alterações no ambiente vaginal e da estrutura de colo do útero, podem apresentar-se condicões impedientes para a concepção natural; desse modo, convertem-se em causa de infertilidade. Nesta revisão, discutimos o papel fisiológico do pH vaginal e do muco cervical na fertilidade, descrever várias condicões que podem tornar o muco cervical hostil aos espermatozoides e, por fim analisamos como estes fatores interferem na fisiopatologia da infertilidade inexplicada.

Patología vaginal: utilidad de la citología y la colposcopia como métodos diagnósticos / Vaginal pathology: usefulness of cytology and colposcopy as a diagnostic

Evaluar la citología y la colposcopia como métodos diagnósticos de patología vaginal. Estudio prospectivo y descriptivo que incluyó 100 pacientes. Se realizó citología, colposcopia y biopsia dirigida o del tercio superior de vagina, cuando no había lesiones. La edad media de las pacientes fue 37,7 años. Hubo patología vaginal en 81 pacientes: 19 (23,4. por ciento) neoplasias intraepiteliales vaginales I y 62 (76,5 por ciento) lesiones no neoplásicas, entre ellas 47 (75,8. por ciento) con infección por virus de papiloma humano y 15 (24,2 por ciento) con otras lesiones. Entre las 37 pacientes con cambios colposcópicos, 56,8 por ciento tenían epitelio acetoblanco fino, 45,9 por ciento de los cambios estaban en el tercio superior. Hubo 5 casos de lesiones multifocales. Dos citologías presentaron cambios por virus de papiloma humano. En 66 pacientes hubo cambios histológicos compatibles con infección por este virus, 19 con neoplasia. La sensibilidad y especificidad de la citología para lesiones neoplásicas intraepiteliales fue 0 por ciento y 100 por ciento, de la colposcopia 47 por ciento y 78 por ciento y de ambos 75 por ciento y 16 por ciento, respectivamente. Los factores de riesgo significativos para infección por virus de papiloma humano y neoplasia intraepitelial fueron: edad, patología cervical y vulvar previa, uso de anticonceptivos orales y tabaquismo. Existe asociación significativa entre patología cervical o vulvar y el diagnóstico de infección por virus de papiloma humano en vagina. La citología no debe ser usada aisladamente como método de pesquisa de lesiones neoplásicas de la vagina; se recomienda asociarla a la colposcopia vaginal

To evaluate the colposcopy and cytology as vaginal pathology diagnostic methods. Prospective and descriptive study involving 100 patients. Cytology, colposcopy and directed biopsy, or in the upper vagina third when there was no injuries, was conducted. The average age of the patients was 37.7 years. There was vaginal pathology in 81 patients: 19 (23.4 percent) vaginal intraepithelial neoplasia I and 62 (76.5 percent) injuries non neoplastic, including 47 (75.8. percent) with infection by human papillomavirus and 15 (24.2 percent) with other injuries. Among the 37 patients with colposcopy changes, 56.8 percent had fine acetoblanco epithelium, 45.9 percent of the changes were in the upper third. There were 5 cases of multifocal lesions. Two PAP submitted changes for human papillomavirus. In 66 patients there were histological changes consistent with infection by this virus, 19 with neoplasia. The sensitivity and specificity of cytology for intraepithelial neoplastic lesions was 0 percent and 100 percent, for the colposcopy 47 per cent and 78 per cent, and for both methods, 75 percent and 16 percent, respectively. Significant risk factors for infection of human papillomavirus and intraepithelial neoplasia were: age, prior cervical and vulvar disease, use of oral contraceptives and smoking. There is significant association between cervical or vulvar pathology and the diagnosis of infection of human papillomavirus in vagina. Cytology should not be used alone as a method of investigation of neoplastic lesions of the vagina; It is recommended to associate it with the vaginal colposcopy

Detección de infección por Mycoplasma en las gestantes con riesgo de parto pretérmino / Detection of Mycoplasma infection in pregnants with a risk of preterm delivery

Introducción: el parto pretérmino es el que se produce antes de las 37 sem de gestación; la sepsis vaginal constituye uno de los factores de riesgo predisponentes para este, de ahí que continúe siendo motivo de preocupación para obstetras y neonatólogos. Objetivo: evaluar el uso del Test Mycoplasma System Plus en gestaciones con riesgo de parto pretérmino, así como algunos de sus aspectos clínicos. Métodos: se realizó un estudio retrospectivo descriptivo de enero a septiembre de 2010 en el Hospital Profesor Eusebio Hernández, la muestra estuvo constituida por 88 pacientes ingresadas en el servicio de cuidados especiales perinatales con gestaciones menores de 34 sem a las que se les realizó el test y tuvieron el parto en este centro, los datos fueron recogidos de las historias clínicas e informes de microbiología agrupados en un formulario y procesados mediante estadísticas descriptivas y de distribución de frecuencia. Resultados: el 67 porciento, de las pacientes presentaban infección moderada o severa a ureaplasma mientras que los exudados vaginales simples fueron negativos en un 71,5 porciento, el antimicrobiano más utilizado fue la eritromicina. Conclusiones: la mayoría de las pacientes después del tratamiento adecuado llegaron al término de la gestación, así como presentaban exudados vaginales simple negativos, pero con un alto índice de infección a ureaplasma urealyticum

Introduction: the pre-term labor is produced before the 37 weeks of pregnancy; the vaginal sepsis is one of the predisposing risk factors to it, being a motive of worry for obstetricians and neonatologists. Objective: to assess the use of Test Mycoplasma System Plus in pregnancies with risk of pre-term labor, as well as of its clinical features. Methods: a descriptive and retrospective study was conducted from January to September, 2010 in the Profesor Eusebio Hernández Hospital; sample included 88 patients admitted in the perinatal special care unit with pregnancies under 34 weeks and performing of test who gave birth in this institution; data were collected from the medical records and microbiology reports grouped in a form and processed by descriptive statistics and of frequency distribution. Results: the 6l7 percent of patients had a moderate or severe infection due to ureaplasma where as the vaginal exudates were negatives in the 71.5 percent, the more used antimicrobial agents was the erythromycin. Conclusions: most of patients after an appropriate treatment arrive to a term pregnancy and also had negative simple vaginal exudate but with a high rate of infection due to ureaplasma urelyticum

Síndrome de flujo vaginal / Vaginal discharge syndrome

INTRODUCCIÓN: El Síndrome de flujo vaginal es un proceso infeccioso de la vagina caracterizado por uno o varios síntomas: leucorrea, prurito vulvar, ardor, irritación, disuria, dispareunia y fetidez vaginal. OBJETIVOS: Caracterizar el Síndrome de flujo vaginal y su relación con las conductas sexuales de riesgo, los gérmenes más frecuentes y sus características e identificar el grupo etario en que predomina, en un consultorio médico de Barrio Adentro I de la parroquia Sucre, municipio Libertador. Caracas, Venezuela. MÉTODOS: Se realizó un estudio observacional y prospectivo en el consultorio médico ubicado en la comunidad de la Silsa de la parroquia Sucre en Caracas, durante los años 2008 y 2009, con un universo constituido por 97 pacientes del sexo femenino de 20 a 49 años de edad. Se analizaron variables del universo, cuyos datos fueron obtenidos de la revisión de historias clínicas y tarjetas control. RESULTADOS: Se encontró que el grupo etario que predominó fue el de 25 a 29 años para un 22,6 por ciento. La edad de inicio de las relaciones sexuales de entre los 15 y 17 años presentó mayor frecuencia para un 41,3 por ciento. Los factores predisponentes más frecuentes: aseo inadecuado de los genitales con un 48,4 por ciento. Uso de anticonceptivos orales 40,2 por ciento y sexo no protegido para un 25,7 por ciento. La característica del flujo que predominó fue la homogénea, no adherente, blanca grisácea y fétida, 35,1 por ciento, y el germen más frecuente encontrado fue la gardnerella 31 por ciento, seguida de la monilia, 23,8 por ciento. CONCLUSIONES: El síndrome de flujo vaginal fue más frecuente en las adultas y las que iniciaron precozmente las relaciones sexuales, (antes de los 18 años de edad). Hubo un predominio clínico y microbiológico de infección por gardnerella vaginalis

The vaginal discharge is a infectious process characterized by on or by some symptoms including leucorrhea, vulvar pruritus, heat, irritation, dysuria, dyspareunia and vaginal fetidness. OBJECTIVES: To characterize the vaginal discharge syndrome and its relation to risky, sexual behaviors, the more frequent germs and their characteristics and to identify the age group with more predominance seen in a medical consulting room of Barrio Adentro I of Sucre jurisdiction, Libertador municipality, Caracas, Venezuela. METHODS: A prospective and observational study was conducted in the medical consulting room located in Silsa community of the Sucre jurisdiction in Caracas in 2008 and in 2009, where the universe included 97 female patients aged 20-49. The universe variables were analyzed where data were obtained from the medical records and control cards control. RESULTS: The predominant age group was that of 25-29 for a 22,6 percent. The 15 to 17 years old at the onset of intercourses was the more frequent for a 41,3 percent. The more frequent predisposing factors: inappropriate hygiene of genitals with a 48,4 percent, use of oral contraceptives was of 40,2 percent and unprotected intercourse for a 25,7 percent. The predominant characteristic of discharge was the homogenous, non-adherent, white color, grayish and fetid for a 35,1 percent and the more frequent germ present was the gadnerella for a 31 percent followed by Monilia for a 23,8 percent. CONCLUSIONS: The vaginal discharge syndrome was more prevalent among the adult women and in those with an early onset of intercourses (Before 18 years old). There was a clinical and microbiological predominance of gardenella vaginalis infection

Diagnóstico y prevalencia de infecciones vaginales / Diagnosis and prevalence of vaginal infections

Las infecciones del aparato genital femenino constituyen un problema importante de la práctica ginecoobstétrica. Son causa de morbilidad, mortalidad materna y neonatal. Entre los factores que explican su frecuencia están: aborto provocado, aumento de intervenciones quirúrgicas e infecciones de transmisión sexual. OBJETIVO: Realizar el diagnóstico y determinar la prevalencia de infecciones vaginales en mujeres que asisten al Laboratorio de Microbiología del Hospital Ginecoobstétrico "Ramón González Coro" con la utilización del Juego de diagnóstico de infecciones vaginales Newvagin C-Kure. MÉTODOS: Se examinaron 150 mujeres, de edades entre 17 y 74 años, de mayo a octubre de 2007. Se utilizó examen directo, criterios de Amsel y cols, así como prueba de aglutinación al látex. RESULTADOS: La prevalencia de las infecciones vaginales estudiadas fue de 62 % al examen directo y de 58,6 % con la prueba de aglutinación al látex. La infección vaginal con mayor prevalencia fue vaginosis bacteriana, seguida de candidiosis vaginal y trichomoniosis vaginal. El grupo de edad con mayor prevalencia de estas infecciones fue el de 28-37 años. La manifestación clínica más frecuente fue la leucorrea. El inicio precoz de las relaciones sexuales, la realización del acto sexual sin protección y el uso de métodos anticonceptivos, estuvieron relacionados con la presencia de estas infecciones vaginales. CONCLUSIONES: El uso del Juego de diagnóstico de infecciones vaginales NEWVAGIN C-Kure, en consultorios de médicos de familia, policlínicos comunitarios y consultas de ginecología resulta ventajoso. La realización del diagnóstico por el personal paramédico, su rapidez y la certeza en la indicación del tratamiento médico son los principales factores a considerar

The infections of female genital tract are a significant problem of gynecologic and obstetric practice. They are cause of morbidity and of mother and neonatal mortality. Among factors explaining its frequency are: provoked abortion, increase of surgical interventions and sexual transmitted infections. OBJECTIVES:To make the diagnosis and to determine the vaginal infections prevalence in women served in Microbiology Laboratory of "Ram¾n Gonzßlez Coro" using the NEWVAGIN C-Cure diagnosis kit. METHODS: Authors examined to 150 women aged between 17 and 24 from May to October, 2007. Direct examination, Amsel et al criteria and latex agglutination test were used. RESULTS: Prevalence of study vaginal infections was of 62 percent in direct examination and of 58.6 percent using the latex agglutination test. The more prevalent vaginal infection was the bacterial vaginosis followed by vaginal candidiasis and vaginal trichomoniasis. The more prevalent age group with these infections was that aged 28-37. More frequent clinical manifestation was the leucorrhea. The early onset of sexual intercourse, the intercourse without protection and the use of contraceptive methods were related to presence of these vaginal infections. CONCLUSIONS: The use of NEWVAGIN C-Kure diagnosis kit for vaginal infections in family consulting room, community polyclinics and Gynecology consultations is very advantageous. Making diagnosis by paramedical staff, its speed and accuracy in prescription of medical treatment are the leading factors to be considered

[Oro-vulval-vaginal and peno-gingival syndromes: 4 case reports]

Regarding the importance and prevalence of lichen planus among patients and rarity of Oro-Vulval-Vaginal and Peno-Gingival syndromes, that need more attention for diagnosis because of simultaneous oral and genital involvement, we are going to review the symptoms and early diagnosis of these patients. The aim of this article is to report two patients with Oro-Vulval-Vaginal syndrome and two patients with Peno-Gingival syndrome with a short review on these syndromes and their treatments. This study is a case report four patients with these syndromes who attended oral medicine department. For each patient a complete document consisting of demographic information, medical, dental, familial and social history was prepared and a photograph was taken from the oral lesions at the first visit and for definite diagnosis of genital lesions consultation with Dermatologist and OB and GYN Surgeon was done.After biopsy and definite diagnosis simultaneous treatment for oral and genital lesions started. Regarding the severity of lesions and acceptable response to the primary treatment, type and dose of the drug was changed and finally the patients were placed in follow up phase. Regarding the outcome of neglecting Lichen Planus in other organs and delay in accurate diagnosis and lack of receiving enough and on time treatment, performing an exact examination and taking a complete history with attention to other organ's symptoms is of great importance. More over malignant changes in even asymptomatic oral and genital lesions is probable

Infección vaginal en gestantes hospitalizadas en el Hospital de Ciego de Ávila: 1er semestre de 2007 / Vaginal Infection in pregnant women hospitalized in Ciego de Ávila Hospital during the first semester 2007

Se realizó un estudio observacional descriptivo con el objetivo de determinar el comportamiento de la de infección vaginal en 518 gestantes hospitalizadas durante el primer semestre del año 2007 en el Hospital Provincial General Docente Dr Antonio Luaces Iraola, de las cuales 160 embarazadas presentaron algún tipo de infección vaginal para un 30.8 por ciento. Las embarazadas adolescentes fue el segundo grupo de edades de mayor frecuencia, la vaginosis bacteriana y levaduras (candidiasis) fueron las infecciones más diagnosticadas, siendo el bajo peso al nacer la complicación más relacionada con la infección. Los tratamientos más utilizados fueron Metronidazol para la vaginosis y Clotrimazol para la candidiasis.

A descriptive observational study was carried out with the objective of determining the behavior of the vaginal infection in 518 pregnant women during the first semester of 2007 in the Docent Provincial Hospital General Dr.Antonio Luaces Iraola, of which, a total of 160 presented some type of vaginal infection (30,8 percent). The teenager future mothers were the second age group of higher frequency, the Bacterial Vaginosis (BV) and the Candida Vaginal Infection were the most diagnosed of them, being the low weight of the newborn children the complication more related to the infection. The most effective treatments used were Metronidazole for Vaginosis and Clotrimazole for Candidiasis.

Longitudinal vaginal septum 'obstructive variety'--a challenge for gynaecologist.

The cases which have been presented here have varied presentations but all the three patients in the series had acyclical abdominal pain. Since the uterus is functional there is collection of blood in the pouch formed due to the vaginal septum. This is a potential site for infection and could result in foul smelling discharge. Failure of fusion of lower ends of mullerian ducts that form vagina results in longitudinal vaginal septum. The septum may be partial or complete. The clinical syndrome of double uterus with vaginal obstruction (unilateral, partial or complete) and ipsilateral renal agenesis (same as of the side of obstruction) is rare. This combination is suggestive of embryologic arrest occuring at 8 weeks of pregnancy that simultaneausly affected the mullerian and metanephric ducts.

Vaginoscopia en niñas prépuberes en el Instituto Nacional de Salud del Niño de Lima-Perú / Vaginoscopy in prepubertal girls at the National Institute of Child Health in Lima, Peru

Objetivo: conocer las diferentes patologías ginecológicas que requirieron para su diagnóstico el uso del vaginoscopio, en la población de niñas prepúberes que acudieron al Instituto Nacional de Salud del Niño de Lima, durante el período 2000-2007. Material y métodos: estudio descriptivo, retrospectivo y transversal que evaluó 32 pacientes, en las cuales se realizó vaginoscopia con el vaginoscopio, para realizar el diagnóstico o facilitar el manejo de las diferentes patologías ginecológicas, durante el período descrito. Resultados: de los 32 casos estudiados se encontró que las patologías en las que se indicó la realización de vaginoscopia con más frecuencia fueron la vulvovaginitis crónica, 23 casos (71,88%); sangrado vaginal, 3 casos (9,38%); fístulas rectovaginal, 2 casos (6,25%); maltrato infantil, tumoración vaginal, cloaca baja y displasia cervical, 1 caso en cada uno (3,13% cada uno). Los diagnósticos posoperatorios fueron vulvovaginitis crónica (40,63%), vaginitis más cervicitis (34,38%), tabique vaginal más fístula rectovaginal, vulvovaginitis más secuela de traumatismo genital, tumor de células germinales, sarcoma botriodies, pólipo vaginal, cuerpo extraño en vagina, displasia cervical y vagina normal 1 caso (3,13%). El tiempo operatorio promedio fue de 23 minutos y el tiempo de anestesia general promedio fue de 39 minutos, la mayoría de las pacientes fueron dadas de alta en buenas condiciones y solo 3 permanecieron hospitalizadas (9,38%). Conclusión: la viginoscopia bajo anestesia en niñas prepúberes permitió el diagnóstico de diferentes patologías ginecológicas de manera segura y definitiva.

Estudo da incidência de amostras clínicas do gênero Candida Estudo da incidência de amostras clínicas do gênero Candida isoladas de diversos sítios anatômicos / Study of the incidence of clinical samples belonging to the genus Candida obtained from different anatomic sites

A candidíase, principal infecção fúngica do ser humano, é provocada por leveduras do gênero Candida, que fazem parte da microbiota endógena e exógena do corpo humano. O objetivo deste trabalho foi avaliar a presença das espécies de Candida spp, em diversos sítios anatômicos. Um total de 90 amostras clínicas foram isoladas em ágar Sabouraud contendo antibióticos e identificadas em meio cromogênico CHROMagar Candida ®. Deste total, 58 amostras foram provenientes de secreção vaginal, 17 de raspado de unha, 8 de escarro e 7 de raspado de pele. Das amostras de secreção vaginal, 89% corresponderam a espécie C. albicans, seguido de espécies de Candida não-albicans, sendo 5,1% de C. krusei e 1,7% de C. glabrata, C. tropicalis e Cândida sp. , individualmente. Para as amostras isoladas de raspado de pele não foi observada prevalência de C. albicans (28%). As espécies Candida não-albicans corresponderam a 70% das amostras, sendo distribuídas em C. glabrata (14%), C. krusei (28%) e demais espécies de Candida (28%). A prevalência de espécies Candida não-albicans foi também observada para as amostras isoladas de raspado de unha, sendo que 29% foram caracterizadas como C. glabrata, 23% C. krusei e Cândida sp. , individualmente e 11% de C. tropicalis. Amostras de C. albicans, isoladas neste sítio anatômico, representaram somente 11%. Em amostras obtidas de escarro foi observada somente duas espécies, com prevalência de C. albicans (75%) seguida de C. tropicalis (25%). As amostras identificadas como C. albicans em meio CHROMagar Candida ® , foram confirmadas quanto ao crescimento a 42ºC e pelo emprego da técnica de seminested PCR.

Candidiasis is the main human fungal infection caused by yeasts of the genus Candida which are part of endogenous microflora of the human body. The aim of this study was to analyze the incidence of Candida species obtained from different infection processes. A total of 90 clinical samples were isolated in Sabouraud agar supplemented with antibiotics, and identified by CHROMagar Candida ®. Among them, 58 samples were isolated from vaginal secretion, 17 samples were from nail, 8 were from sputum and 7 were from skin. From the former, 89% were identified as C. albicans, followed by non albicans species, being 5.1% C. krusei, 1.7% C. glabrata, 1.7% C. tropicalis and 1.7% Candida sp. For samples isolated from nail it was not observed prevalence of C. albicans (28%); species nonalbicans corresponded to 70% of the samples, being 14% C. glabrata, 528% C. krusei and 28% Candida sp. The prevalence of non albicans species was also observed from samples isolated from nail, being 29% C. glabrata, 23% C. krusei, 23% Candida sp and 11% C. tropicalis. C. albicans in this infection site represented only 11%. Only two species were present in samples from sputum, being 75% C. albicans and 25% C. tropicalis. Samples identified as C. albicans in CHROMagar Candida ® agar were confirmed by growth at 42ºC and by seminested PCR approach.

Quistes vaginales

Se reportan dos casos de quistes vaginales: se analiza el cuadro clínico y su dificultad diagnóstica.

We report two cases of vaginal cysts: clinical presentation and diagnostic difficulties are analysed.

hemivagin borgne: Methode diagnostique et problemes therapeutiques

Blind hemivagina with duplex uterus and agenesis of the homolateral urinary tract is a rare malformation. For this reason, diagnosis may be not found. We report one case of duplex uterus with blind hemivagina in a fourteen-year-old adolescent girl. From this case, clinical signs, principal diagnosis criteria, complications and treatment are discussed, transvaginal resection of the hemivaginal septus is the best method of treatment but resulting hymeneal rupture may constitute a real problem of treatment in some social environments. So we propose to evaluate endoscopic septotomy

Despistaje de infecciones vaginales a través de citología en la población de Bramón 2001 / Screening for vaginal infections through cytology in population Bramón 2001

Las infecciones vaginales constituyen la razón más frecuente de consulta ginecológica, ya sea por vaginitis, vaginosis, enfermedades de transmisión sexual. Nuestro objetivo es determinar la prevalencia de infecciones vaginales, a través de citología relacionándola con sus principales factores de riesgo. Se estudiaron 108 pacientes entre 16 y 82 años, se les tomó citología exo cervical, siendo agrupados y analizados los datos bajo método estadístico porcentual simple. El 43,52 por ciento presentó algún tipo de infección, siendo el VPH la de mayor incidencia, seguida de Gardnerella vaginalis y Moniliasis. Con inicio de actividad sexual en la adolescencia, más de dos parejas sexuales y consumo de cigarrillos. Sugerimos realizar estudios de mayor tamaño, a fin de tener estadísticas propias para fortralecer los programas de prevención primaria.

Aspectos biológicos, socioeconömicos e culturais de mulheres com corrimento vaginal / Biologycals socio-cultural-economics aspects women with vaginal discharge

Apesar do corrimento vaginal ser uma das mais antigas e frequentes afecçöes que acometem a saúde física e emocional da mulher, do diagnóstico laboratorial ser relativamente fácil e de baixo custo, das recidivas e reinfecçöes serem constantes, ainda na atualidade, sua abordagem é feita de maneira simplista e empírica, tanto para o diagóstico como para a terapêutica. Este estudo objetiva enfatizar a importåncia de uma abordagem holística no atendimento à mulher com corrimento vaginal, pois acreditamos que tal afecçäo, suas recidivas e reinfecçöes näo estäo exclusivamente associadas a infectividade e virulência do patógeno envolvido, mas também ao contexto socioeconömico e cultural em que a mulher está inserida

Diagnosis of bacterial vaginosis by Amsel's criteria

To evaluate Amsel's criteria for the diagnosis of bacterial vaginosis in reproductive age group. Design: Prospective study. Place and Duration of Study: This study was conducted in a private hospital in Jeddah, K.S.A between January, 2001 and January, 2002. Subjects and Patients attending the clinic with complaint of vaginal discharge were selected and screened out for bacterial vaginosis on the basis of Amsel's criteria. Ot of 100 cases 35 [35%] cases were diagnosed as bacterial vaginosis, 25 [25%] were of Candida albicans and 15 [15%] were suffering from trichomoniasis. No pathogen was found in 25 patients. Amsel's criteria is an accurate test for the diagnosis of bacterial vaginosis