Reinforcement of rectal anastomoses with a collagen-based haemostatic patch: a case series report.

In this case series report of 10 colorectal cancer patients, a polyethylene glycol-coated collagen-based haemostatic patch was applied after rectal resection to reinforce rectal anastomoses and reduce anastomotic leakage. Patients underwent rectal resection and anastomoses were stapled in place. The patch-Hemopatch®-was applied to 75% of the anastomotic circumference. The surgeon judged the simplicity of application using a reinforcement of rectal anastomosis score. Mean age of patients was 68.1 (range 50-94) years. The patch was successfully applied in eight patients; in seven patients, patch application was straightforward or only slightly complex, according to the reinforcement of rectal anastomosis score. Seven of eight patients experienced no leakage or signs of stricture 6 weeks post-surgery. All patients underwent radical resection. It is possible to apply Hemopatch® during colorectal surgery. However, the patch application procedure needs to be standardized and efficacy needs to be evaluated by conducting larger clinical studies.

Chronic stress in women with localised provoked vulvodynia.

BACKGROUND: Localised provoked vulvodynia (former vulvar vestibulitis syndrome) is the most common cause of superficial dyspareunia among young women. In a clinical setting, it is obvious that many women with localised provoked vulvodynia show signs of chronic stress. The objective of this study was to compare chronic stress in a group of women with localised provoked vulvodynia, referred to the vulvar unit at the Division of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden with control women of the same age and educational level, using two independent methods. METHODS: Forty-three women with localised provoked vulvodynia and 35 healthy control women underwent a gynecological examination, filled in a health questionnaire, and self-collected saliva for analysis of cortisol at awakening and after 15, 30 and 45 min (morning awakening cortisol). Thirty-three patients and 28 controls completed a stress questionnaire. RESULTS: Morning awakening cortisol was blunted in women with localised provoked vulvodynia (p < 0.05), indicating chronic stress. The stress questionnaire showed more signs of burnout (p < 0.005), and emotional (p < 0.05) and bodily symptoms of stress (p < 0.005) in women with localised provoked vulvodynia compared with control subjects (students t-test). CONCLUSION: More women with localised provoked vulvodynia showed blunted morning awakening cortisol and reported more symptoms of stress compared with healthy control women of the same age.

Perceived stress in women with recurrent vulvovaginal candidiasis.

OBJECTIVE: Recurrent vulvovaginal candidiasis (RVVC) has become very common. The aim of this study was to evaluate if women with RVVC perceive more signs of chronic stress than healthy control subjects. STUDY DESIGN: Thirty-three women with RVVC and 28 healthy control subjects completed a questionnaire about perceived stress at work and in private life, and a health questionnaire. A comparison of the results was performed with the one-way ANOVA test. RESULTS: More women with RVVC than control subjects reported signs of burnout (p < 0.001), emotional symptoms of stress (p < 0.005), impaired balance between work and leisure time (p = 0.01), bodily symptoms of stress (p < 0.05), worrying factors at work (p < 0.05), and presented type D-personality (p < 0.05). CONCLUSIONS: The results of this pilot study showed higher degree of perceived stress in women with RVVC compared with healthy controls. These results are in line with our earlier findings of blunted morning rise cortisol and lower mean levels of cortisol in women with RVVC compared with healthy controls.

Signs of chronic stress in women with recurrent candida vulvovaginitis.

OBJECTIVE: The purpose of this study was to determine whether there is an association between recurrent vulvovaginal candida and chronic stress. Chronic stress affects the hypothalamus-pituitary-adrenal axis, which influences the immune function. Recurrent candida vulvovaginitis is increasing. STUDY DESIGN: Women with recurrent vulvovaginal candida (n = 35) and age-matched healthy control subjects (n = 35) collected saliva for the analysis of cortisol. Hormone analyses of blood samples and vulvovaginal examinations were performed. A questionnaire was completed. RESULTS: Morning rise cortisol level was significantly blunted among patients compared with control subjects (P < .002). Mean levels of salivary cortisol were lower the first 45 minutes after awakening in women with recurrent vulvovaginal candida, compared with control subjects. More patients than control subjects reported a history of condyloma, bacterial vaginosis, and herpes genitalis. No differences were seen between patients and control subjects regarding sexual hormone binding globulin, dihydroepiandrosterone, testosterone or Hemoglobin A1c. CONCLUSION: Morning rise salivary cortisol level is blunted in women with recurrent vulvovaginal candida, which indicates signs of chronic stress. The higher incidence of vulvovaginal infections in these women compared with control subjects may reflect impaired immunity, which may be due to chronic stress.