Recalcitrant vulvodynia. A clinicopathological study.

This study is an analysis of 26 women with burning vulva syndrome. They seldom had frankly abnormal physical findings, and application of acetic acid and colposcopically directed biopsy are therefore mandatory. Histopathological study showed characteristic features of human papillomavirus (HPV) in 20 patients (77%). HPV has been shown to be a cause of vulvar vestibulitis syndrome and was an associated problem in 3 of the 5 patients who had essential or dysaesthetic vulvodynia. The latter is similar to causalgia, with a poor prognosis for resolution. Single patients had the following specific conditions: lichen planus, lichen sclerosus, mature neuroma and chronic candidiasis. The study shows that vulvodynia is a multifactorial problem for which management strategies have evolved over the course of time. Although interferon-alpha-2b offers much promise for the treatment of vulvodynia caused by subclinical HPV infection, the complete cure rate was only 58%. Overall 38% of patients still experience their problem, which indicates that they should be discouraged from going from physician to physician in the hopes of finding a 'cure'.

Intestinal obstruction as a cause of death in the mentally handicapped.

This paper reviews the occurrence of symptoms of intestinal obstruction in mentally handicapped people. A retrospective study was done on all residents dying in mental handicap hospitals over a 7-year period. It was noticed that people dying of intestinal obstruction were younger, male, gave a history of constipation, other gastrointestinal problems and dietary indiscretion.

Diagnostic accuracy of the Accurette endometrial sampler.

The value of the Accurette endometrial sampler in the cytological and histological assessment of the endometrium was studied in 42 anaesthetized patients. Satisfactory samples for cytological diagnosis of endometrial state were obtained in 23 patients out of 24 (96%), whereas endometrial specimens suitable for histological diagnosis were obtained in 23 out of 29 patients (79%). Immediately following Accurette sampling, conventional dilatation and curettage was performed. Histological diagnosis of Accurette samples correlated with that of formal curettage in all instances except in the detection of polyps. Cytological findings with the Accurette did not correlate with those of formal curettage in 2 cases. Nevertheless, interpretation of endometrial cytology, which requires specialized knowledge and experience, is shown to provide helpful information especially in cases where curettage fails to yield tissue.

Uterine actinomycosis. A case report and review.

Current literature documents an association between intra-uterine contraceptive usage and genital tract colonization or infection with actinomycosis. Uterine involvement, however, is extremely rate. A case of severe pelvic infection with uterine perforation due to an actinomycosis fistula as confirmed by tissue is presented. The condition of actinomycosis is reviewed with special attention to involvement of the female pelvic organs and the difficulties in diagnosis.

Blastomycosis of the tongue: a case report.

A clinically malignant tongue ulcer in a 63-year-old White man was proved by histological examination and culture to be due to Blastomyces dermatitidis. In addition, pulmonary lesions caused by B. dermatitidis were found at autopsy.