Mid-term symptomatic relief after platelet-rich plasma infiltration in vulvar lichen sclerosus.

PURPOSE: Vulvar lichen sclerosus (LS) is a chronic, progressive, autoimmune dermatologic condition that causes cutaneous changes accompanied by pruritus and pain. There remains a small population with vulvar LS refractory to topical corticosteroids. Injection of platelet-rich plasma (PRP) has been reported to have positive effects on tissue repair. The aim of this pilot study was to evaluate changes in symptom scores during and after PRP vulvar infiltration. METHODS: Three PRP infiltrations were administered to 28 female postmenopausal patients with biopsy-proved LS with unsatisfactory response to steroid therapy. Change in score according to the Clinical Scoring System for Vulvar Lichen Sclerosus (CSS) was measured on six occasions over the course of a year. We used growth curve modeling to measure change over the period of the study. RESULTS: Women in our study experienced a statistically significant improvement in auto-assessed symptoms of vulvar lichen sclerosus, and this improvement appears to be maintained throughout the monitoring year. CONCLUSION: Platelet-rich plasma may have a role in symptom relief in certain cases of patients with LS that do not respond to first-line therapy.

Maternal anaemia after delivery: prevalence and risk factors.

The purpose of this study was to assess the prevalence of postpartum anaemia and determine the clinical risk factors for this condition to provide a viable alternative to postpartum haemoglobin measurement. In total, 1415 patients at Hospital Universitario del Tajo, Madrid, who underwent postpartum haemoglobin testing were included, and risk factors for having an Hb level <10 g/dl were determined. We found that 29% of the mothers were anaemic, and birth canal lacerations, caesarean delivery, episiotomy and South American origin were identified as the main risk factors for this condition. When we examined the performance of each risk factor alone in the prediction of postpartum anaemia, none of them achieved a sensitivity of 30%. Selective screening of women who had any of these five risk factors resulted in 23% of cases remaining unidentified. Despite the high incidence and disease burden of this condition, the management of puerperal anaemia is not standardised, and this condition is not easy to predict. Universal screening should be considered in high-prevalence settings. Impact statement The World Health Organisation (WHO) describes the postnatal period as the most critical and yet most neglected phase in the lives of mothers and infants. It is a common knowledge that a woman's adjustment to life with her new infant is very difficult. This period, known as the puerperium, often involves poor sleep quality, pain and fatigue, if not other major complications. In this context, we must face the challenge of increasing breastfeeding rates, which is why health care providers should be aware of the medical and psychological needs of the new mother. This work reports that postpartum anaemia, a potentially preventable or treatable condition that can make it more difficult to resume everyday activities, is highly prevalent. It remains to be seen whether ensuring the appropriate diagnosis and treatment of anaemia after delivery will result in improvements in the physical and psychological well-being of obstetric patients.

Endometriosis vesical aislada recidivante con repercusión renal / Recurrent isolated bladder endometriosis with renal involvement

La endometriosis vesical aislada es muy infrecuente y la aparición secundaria de hidronefrosis es un hecho escasamente descrito. La manifestación clínica más frecuente es el síndrome miccional cíclico y, en menor medida, la menuria. El método más sensible para su diagnóstico es la cistoscopia. Actualmente, el tratamiento que más se aplica es la resección transuretral con el uso posterior de análogos de la hormona liberadora de la hormona luteinizante(AU)

Isolated bladder endometriosis is very uncommon. A finding of secondary hydronephrosis has barely been described in the literature. The most common symptom is urethral syndrome and, to a lesser extent, menouria. The most sensitive diagnostic test for bladder endometriosis is cystoscopy. Currently, the most widely used treatment is transurethral resection, with subsequent ovarian suppression with luteinizing hormone-releasing hormone analogues(AU)

Cáncer de cérvix metastásico y gestación: una situación poco frecuente que invita a la reflexión / Metastatic cervical cancer and pregnancy: an unusual and thought-provoking association

Introducción. La coexistencia de una gestación y cáncer de cérvix con diseminación metastásica es una situación excepcional que marcará, en el caso que presentamos, la evolución de la misma. Caso clínico. Paciente de 34 años, gestante de 13 semanas, acude a urgencias por metrorragia. Es diagnosticada de carcinoma invasivo de cérvix. La evolución se complica con tromboembolismo pulmonar masivo y detección de metástasis pulmonares y supraclaviculares. La paciente decide interrupción de la gestación en la semana 17 de la misma. Discusión. Este es un caso muy poco frecuente, no tanto así la presencia de cáncer de cérvix en estadio precoz en una gestante. Debe recordarnos la necesidad de examen con espéculo y citología en la primera visita de control del embarazo, muchas veces omitida en nuestra práctica habitual (AU)

Background. Coexistence of pregnancy and metastasic cervical cancer in an exceptional situation that will mark, in the presented case, the evolution of the pregnancy. Case. A 34-year-old woman, gravida 2 para 1, at 13 weeks’ gestation was taken to our emergency service with menorragia, and was admitted under the suspicion of invasive cervical cancer. Patient¿s evolution was complicated by the detection of supraclavicular metastasis and massive pulmonary tromboembolism. The patient decides voluntary interruption of pregnancy in the 17th week. Conclusions. This is a very unusual case, not as much the presence of an early stage cervical cancer in a pregnant woman. It reminds us of the need to carry out the mandatory gynecological exploration and smear in the first visit of prenatal care, often omitted in our dayly practice (AU)