Comparison of econazole and clotrimazole in the treatment of vulvovaginal candidiasis.

The therapeutic effectiveness of econazole and clotrimazole was evaluated in 178 women with clinical symptoms of vulvovaginal candidiasis and positive laboratory findings for Candida. The patients were randomly assigned to treatment with either 1% econazole vaginal cream or 100-mg clotrimazole vaginal tablets, each used once daily at bedtime for 7 days. The mycologic cure rates were comparable in the 2 treatment groups. There was a low incidence of local adverse reactions with both drugs.

Upper genital tract changes and pregnancy outcome in offspring exposed in utero to diethylstilbestrol.

Hysterosalpingography (HSG) was performed on 267 diethylstilbestrol (DES)-exposed women. One hundred eighty-five (69%) of these women demonstrated an abnormality and 82 women had normal findings. A relationship between abnormal x-ray findings and structural abnormalities of the cervix and vaginal epithelial changes was noted. Ninety-three women on whom roentgenography was performed had a total of 144 pregnancies. The pregnancy outcome in this group of women was significantly worse than that found in a control population of 87 women who had 147 pregnancies. In addition, women with abnormal x-ray films were found to have a poorer pregnancy outcome than the group of women with normal findings. The women with abnormal x-ray films had more ectopic pregnancies, spontaneous abortions, and premature deliveries than women with normal x-ray films although these differences were not statistically significant. Significantly fewer women with abnormal findings than women with normal x-rays were delivered of term infants.

PIP: This study reviews the physical findings and results of hysterosalpingography in 267 women exposed in utero to diethylstilbestrol (DES); pregnancy outcome of 93 of these exposed women was correlated with the x-ray findings. Of the 267, 185 (69%) showed an upper genital tract abnormality and 82 showed normal genitalia according to the x-ray technique used. The abnormal hysterosalpingography findings found were correlated with structural abnormalities of the cervix and vaginal epithelium alterations particularly. 144 pregnancies had occurred in the 93 women who were studied by roentgenography, and pregnancy outcome in these 93 women was significantly worse in women with upper genital tract abnormalities as visualized by x-ray. For example, those with abnormal hysterosalpingograms had 78 pregnancies (vs. 66 among normal x-ray women), with 12 elective abortions (vs. 23), 5 (8%) ectopic pregnancies (vs. 2, i.e., 4%), a total of 24 spontaneous abortions (39% of pregnancies vs. only 12 or 23% in normal x-ray women), 38% (n=14) premature deliveries (vs. 8), and 23 (34%) term deliveries (vs. 58% in normals. Women with abnormal x-rays had more ectopic pregnancies and premature deliveries than normals also, though the differences were not statistically significant. Significantly fewer women with abnormal findings vs. women with normal x-ray delivered term infants.

Upper genital tract changes associated with exposure in utero to diethylstilbestrol.

Hysterosalpingograms of 60 young women exposed in utero to diethystilbestrol were obtained. In 46 instances, documentation of this exposure was obtained from the mother's chart review or confirmed by the attending physician. In 14 instances, the patients' mothers were sure they had received stilbestrol, but documentation could not be specifically confirmed. Hysterosalpingograms of 23 women being investigated for infertility during the same period that the current study was conducted were also reviewed. In 40 women exposed to stilbestrol, changes in the uterus which differed significantly from those seen in the past in nonexposed individuals were noted. These changes consisted of a 'T-shaped appearance of the uterus,' constricting bands in the uterine cavity, a hypoplastic uterus, and less frequently, intrauterine polypoid defects, synechiae, and in one instance a unicornuate uterus. In 36 of the 40 women gross defects were also noted in the cervix. By comparison, in none of the control subjects were defects noted which could be considered comparable with those seen in the DES-exposed patient.

PIP: Hysterosalpingography was employed to study 60 young women who were exposed in utero to diethylstilbestrol (DES). Exposure to DES was documented in 46 cases. 40 subjects exposed to DES displayed a ''T-shaped appearance of the uterus,'' constricting bands in the uterus, hypoplastic uterus, and in some cases, intrauterine polyploid defects, synechiae, and a unicornate uterus. 36 of these women also showed gross defects of the cervix. In contrast, none of the infertile control subjects exhibited defects comparable in degree to those observed in the subjects exposed to DES in utero.