[Short and long-term efficacy of focused ultrasound therapy for vulva dystrophy].

OBJECTIVE: To investigate the short and long-term efficacy and complications, as well as the influential factors of focused ultrasound for the treatment of vulva dystrophy. METHODS: Seventy-six eligible patients with vulva dystrophy were randomized and treated with focused ultrasound between 1999 and 2002. Among them, 45 patients were with squamous hyperplasia (SH) and 31 patients were with lichen sclerosus (LS). Colposcopic examination and biopsies were used to monitor and evaluate the changes. Statistical analysis was performed using chi(2) (McNemar chi(2)) test. RESULTS: The median follow-up period was 28.3 month (range 24 months to 60 months). Complete remission (CR) occurred in 39 of 76 patients (27 SH and 12 LS). The cure rate was 51% at four years. The response rate was 95% (72/76). Four of the 76 patients (2 SH and 2 LS) had slight skin burn and a few blisters around the labia 2-4 hours after treatment. Moreover, two patients (1 SH and 1 LS) had superficial ulcers on the treated vulva skin two weeks after ultrasound treatment, which were cured without any complications with local anti-inflammatory drugs for 2-3 weeks. No other long-term side effects were found after a follow up for 24-60 months. The total recurrence rate at four years was 36% (26/72), all of whom were treated again with ultrasound therapy with good results and no complications. There was no obvious difference among the different anaesthesia types and pathological types of the lesions (P > 0.05). However, the shorter the history of the disease, the better the efficacy of the treatment. The younger the patient was, the better the efficacy of the treatment. CONCLUSIONS: Vulva dystrophy can be treated with focused ultrasound effectively and safely. This approach appears to be a new promising treatment method.

[Experimental study of repairing damaged human amniotic epithelial cells with formulated fibrin clot and cell growth factor].

OBJECTIVE: To investigate whether damaged human amniotic epithelial cells (HAEC) could be repaired on the matrix of formulated fibrin clot in vitro and the effects of epidermal growth factor (EGF), basic fibroblast growth factor (bFGF) and transforming growth factor beta(1) (TGF-beta(1)) on the proliferation of HAEC. METHODS: Ring drill was used to drill the HAEC layer on culture sheets to make quantified models of damaged HAEC, on which the lacks were then covered with fibrin clot. Subsequently, EGF (EGF group), bFGF (bFGF group) and TGF-beta(1) (TGF-beta(1) group) of different concentration were added into the sheets respectively. After the predesigned culturing time, the growing and transiting conditions of HAEC were observed under inverted microscope after Giemsa stain. Also, the proliferating conditions of HAEC were detected by using 5-bromodeoxyuridine (BrdU). RESULTS: In all groups, HAEC could transit toward damaged area on fibrin clot and grow there. Higher transiting speed and larger cell numbers were observed in the EGF and bFGF groups followed by the control group, while the TGF-beta(1) group showed the relatively poorer results. Proliferating rates of HAEC were 17.8%, 28.0%, 35.3%, 51.6%, 34.1%, 34.2% and 26.0% respectively by EGF of different cultured concentration (1.0 ng/ml, 5.0 ng/ml, 10.0 ng/ml, 20.0 ng/ml, 40.0 ng/ml, 80.0 ng/ml and 160.0 ng/ml). Proliferating rates of HAEC were 18.0%, 35.7%, 43.0%, 52.7%, 67.4%, 43.6% and 30.5% respectively by bFGF of different cultured concentration (1.0 ng/ml, 5.0 ng/ml, 10.0 ng/ml, 20.0 ng/ml, 40.0 ng/ml, 80.0 ng/ml and 160.0 ng/ml). Compared with the control group, EGF groups (EGF concentration ranging from 10 ng/ml to 80 ng/ml) and bFGF groups (bFGF concentration ranging from 5 ng/ml to 80 ng/ml) showed better proliferating effects of HAEC (P < 0.05), especially the 20 ng/ml EGF group and 40 ng/ml bFGF group had the best proliferating results among their own respective groups (P < 0.05). Proliferating rates of HAEC were 17.1%, 15.1%, 9.3%, 6.2%, 4.8%, 3.6%, 2.0% and 1.2% respectively by TGF-beta(1) of different cultured concentration (0.1 ng/ml, 0.2 ng/ml, 0.4 ng/ml, 0.8 ng/ml, 1.6 ng/ml, 3.2 ng/ml, 6.4 ng/ml and 12.8 ng/ml). Proliferating rates of HAEC in TGF-beta(1) groups (TGF-beta(1) concentration ranging from 0.8 ng/ml to 12.8 ng/ml) were significantly lower than that in the control group (P < 0.05). CONCLUSIONS: HAEC could transit and grow on the matrix of fibrin clot and repair the damaged area. EGF and bFGF could obviously stimulate HAEC proliferation, while TGF-beta(1) might have the inhibitive effects.

[Evaluation of white lesions of vulva treated with focused ultrasound].

OBJECTIVE: To explore the feasibility and efficacy of focused ultrasound for the treatment of vulvar dystrophy, including squamous hyperplasia (SH) and lichen sclerosus (LS). METHODS: A total of 76 eligible patients with vulvar dystrophy (45 SH and 31 LS) were treated with focused ultrasound between 1999 and 2002. Before and after ultrasound therapy, both ultrasonography and biopsies of the lesions were performed to monitor and evaluate the changes of the lesion being treated. The positive expressions of CD34 (cluster of differentiation of endothelial cells), a marker of the epithelial cells of blood vessels and myelin basic protein (MBP), a marker of the oligodendrocytes and Schwann cells were tested using the streptavidin-peroxidase (SP) immunohistochemistry method before and after the ultrasound procedure to evaluate the effects of ultrasound treatment. RESULTS: In two years, follow-up, 49 of 76 cases (32 SH and 17 LS) were cured, 23 (11 SH and 12 LS) improved, and 4 (2 SH and 2 LS) persisted. The response rate was 94.7% (72/76). The positive expression of CD34 and MBP significantly increased at the treated region (P < 0.05). Grey-scale ultrasound imaging showed a localized hypoechoic region after the treatment, which recovered to normal appearance within 7 - 10 days. CONCLUSION: Vulvar dystrophy can be treated with focused ultrasound effectively and safely. This approach appears to be a new promising treatment method, although further studies are still needed.