Experience With a Non-Hormonal Centella Asiatica, Hyaluronic Acid and Prebiotic-Based Vaginal Gel in Women With Recurrent Vulvovaginal Candidiasis: Case Studies.

Recurrent vulvovaginal candidiasis (RVVC) affects millions of women worldwide, severely impairing their quality of life. Despite the existence of multiple induction and maintenance therapeutic strategies, mainly based on antifungals, relapse rates are still high. Palomacare® is a vaginal gel containing, among others, hyaluronic acid and Centella asiatica, with repairing and moisturizing properties. A series of 5 clinical cases showed that symptoms improved and even disappeared in women with RVVC receiving Palomacare®. None of the patients experienced recurrence after the treatment, having their vaginal health restored, suggesting that the non-hormonal Centella asiatica, hyaluronic acid and prebiotic-based gel is effective for preventing RVVC relapse in women of reproductive age.

Incarceración y torsión uterina en gestante / Incarceration and uterine torsion in a pregnant woman

La torsión uterina es un evento raro, más aún cuando se produce en ausencia de embarazo. Se define como una rotación de más de 45° sobre el eje longitudinal uterino, y habitualmente tiene lugar a lo largo de la transición entre cuerpo y cérvix. En 2 tercios de los casos se produce hacia el lado derecho. Normalmente, está causada por la presencia de una condición anormal o patología que afecta al útero y/o a las estructuras adyacentes. Las manifestaciones clínicas pueden ser agudas, crónicas, o incluso un cuadro asintomático, constituyendo entonces un hallazgo intraoperatorio. La confirmación diagnóstica se realiza únicamente durante la realización de la laparotomía. La congestión de vasos en el ligamento ancho y la colocación anterior de los ovarios, hacen que la histerotomía baja realizada habitualmente en la cesárea no pueda realizarse en determinadas situaciones, optando por una histerotomía clásica en la superficie posterior del útero (AU)

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed (AU)

Medical therapy (methotrexate and mifepristone) alone or in combination with another type of therapy for the management of cervical or interstitial ectopic pregnancy.

OBJECTIVE: To describe cases of cervical or interstitial ectopic pregnancy managed conservatively with combined medical treatment (methotrexate and mifepristone) alone or in association with other minimally invasive strategies. STUDY DESIGN: We describe four cervical and two interstitial ectopic pregnancies at our hospital between 2006 and 2010. All received combined treatment with methotrexate and mifepristone. A search of MEDLINE is also described. RESULTS: The literature search identified only four previous cases of cervical ectopic pregnancies and no cases of interstitial ectopic pregnancy managed with combined therapy. In our study, all patients were successfully treated and had no adverse reactions with intramuscular methotrexate 50 mg/m² and oral mifepristone 600 mg, either alone or in association with minimally invasive treatment (uterine artery embolization and evacuation dilation and curettage). All patients remained asymptomatic with ß-HCG levels that decreased and became negative within 14-49 days: the median hospital stay was 5.5 days. We also describe the first patient with a cervical ectopic pregnancy treated with methotrexate and mifepristone, followed by vaginal misoprostol 800 mcg for cervical evacuation. CONCLUSION: Methotrexate-mifepristone, either alone or in combination with other minimally invasive strategies, could be considered an option for the treatment of both cervical and interstitial ectopic pregnancy. An individualized approach should be used in each patient, however, given the wide variety of possible clinical situations and the potential seriousness of ectopic pregnancy.