Hematoma traumático de vulva poco frecuente / Uncommon traumatic vulvar hematoma

El hematoma vulvar es la colección de sangre a nivel vulvar. Generalmente es secundario a un trauma obstétrico, lesiones por contusión o relaciones sexuales consensuadas. Se presenta una paciente de 21 años de edad que acude a esta unidad de salud en el mes de enero de 2017, refiriendo que posterior a un acto sexual comenzó a presentar aumento progresivo de volumen de vulva, acompañado de dolor y de dificultad para la deambulación. Se realizó incisión y drenaje del hematoma, se dan puntos hemostáticos, se colocó drenaje y se inició terapia antimicrobiana con ceftriaxone y metronidazol. El hematoma vulvar de la magnitud presentada constituyó una urgencia quirúrgica por el compromiso de la funcionalidad del aparato genitourinario. El drenaje del hematoma y la indicación de antimicrobianos permitió su evolución satisfactoria(AU)

The vulvar hematoma is the collection of blood in the vulvar area. It is usually secondary to obstetric trauma, contusion injuries or consensual sexual relations. We present a 21-year-old patient who came to this health unit in January 2017, reporting that after a sexual intercourse, she began to present a progressive increase in vulvar volume, pain and difficulty in walking. The hematoma was incised and drained, hemostatic stitches were given, drainage was placed and ceftriaxone and metronidazole were the antimicrobial therapy of choice. The vulvar hematoma of this magnitude was a surgical emergency due to the compromised functionality of the genitourinary system. The drainage of the hematoma and the indication of antimicrobials allowed satisfactory evolution(AU)

Massive vulvar edema in 2 prepartum dairy cows.

Two late gestation Holstein cows about to begin the third lactation developed massive vulvar edema. These were the only affected animals in the herd of 500 milking cows. The vulvar edema spontaneously regressed postpartum for both cows. Massive vulvar swelling is seldom observed in dairy cows in advanced pregnancy and is not described in the literature.

Edème vulvaire massif chez deux vaches laitières prépartum. Deux vaches Holstein en fin de gestation s'apprêtant à commencer la troisième lactation ont développé un œdème vulvaire massif. Il s'agissait des seuls animaux touchés dans le troupeau de 500 vaches laitières. L'œdème vulvaire a spontanément régressé postpartum pour les deux vaches. L'enflure vulvaire massive est rarement observée chez les vaches laitières aux stades avancés de la gestation et elle n'est pas décrite dans la littérature.(Traduit par Isabelle Vallières).

Serum estradiol levels in infants with and without labial adhesions: the role of estrogen in the etiology and treatment.

No strong evidence has been found that estrogen levels in girls with labial adhesions are lower than in girls without. Therefore, this study was based on the determination of estradiol levels in girls with and without labial adhesions in order to show whether a considerable difference exists between these two groups. Serum estradiol levels were measured in 59 infants with labial adhesions and in 60 healthy infants. No significant age difference was seen between affected infants and controls, with a mean age of 12.7 and 12.4 months, respectively. Serum estradiol levels ranged from 6.5 to 14.3 pg/ml (10.27 +/- 1.897) in those with labial adhesions and from 6.4 to 15.1 pg/ml (10.47 +/- 2.006) in controls, a statistically insignificant difference (p = 0.5764). When taking into consideration the effect of estrogen on wound healing and the fact that the difference in estrogen levels between the infants with and without labial adhesion is not significant, it is concluded that hypoestrogenism does not take place in the development of labial adhesions, but that creams containing estrogen might have a beneficial effect on healing after mechanical separation of the adhesion by enhancing wound reepithelialization.

Parvovirus B19 infection presenting as 'bathing trunk' erythema with pustules.

A 7-year-old girl presented with acute vulval erythema and pustules, associated with a petechial eruption in her flexures and over her feet. There was a mild prodromal illness and the patient was afebrile. There were minimal symptoms associated with the rash. Skin and throat swabs were negative and blood examination showed mild neutrophilia and lymphopaenia. Parvovirus B19 IgM was detected on serology and cutaneous features resolved within 4 days. This is a further case of parvovirus B19 infection presenting as a 'bathing trunk' exanthem that has unique dermatologic features, including the presence of pustules and distant petechiae.

21-Hydroxylase-deficient nonclassic adrenal hyperplasia is a progressive disorder: a multicenter study.

OBJECTIVE: Our aim was to determine whether the clinical features of 21-hydroxylase-deficient nonclassic adrenal hyperplasia are correlated with either age at symptom onset or age at presentation, or both, and with the degree of adrenocortical abnormality. STUDY DESIGN: In a multicenter cohort design 220 women with nonclassic adrenal hyperplasia, with a basal or adrenocorticotropic hormone-stimulated 17-hydroxyprogesterone level >30.3 nmol/L, were studied, either prospectively (n = 39) or retrospectively (n = 181). Patients were stratified by age of presentation into 5 groups: (1) <10 years (n = 25), (2) 10 to 19 years (n = 64), (3) 20 to 29 years (n = 83), (4) 30 to 39 years (n = 30), and (5) 40 to 49 years (n = 16). Two patients >50 years old were excluded from the analysis because of age. RESULTS: Ninety-two percent of patients <10 years old had premature pubarche at presentation, whereas clitoromegaly and acne were each present in only 20% of these younger subjects. With only patients > or =10 years old considered, presenting clinical features included hirsutism (59%), oligomenorrhea (54%), acne (33%), infertility (13%), clitoromegaly (10%), alopecia (8%), primary amenorrhea (4%), and premature pubarche (4%). Among the patients >/=10 years old, the prevalence but not the degree of hirsutism increased significantly with age. Basal levels of 17-hydroxyprogesterone in adolescents were significantly higher than the levels found either in children (<10 years old) or women 40 to 49 years old (P <.01 and P <.03, respectively), although no difference was noted in the stimulated 17-hydroxyprogesterone levels between age groups. The adrenocorticotropic hormone-stimulated levels but not the basal levels of 17-hydroxyprogesterone were significantly higher in patients with clitoromegaly than in women without clitoromegaly. Alternatively, there were no differences in either basal or stimulated 17-hydroxyprogesterone levels between patients with and those without hirsutism, acne, or alopecia. CONCLUSION: In children <10 years old the most common presenting complaint was premature pubarche, whereas hirsutism and oligomenorrhea were more common in older patients. The prevalence of hirsutism increased with age, suggesting the progressive nature of nonclassic adrenal hyperplasia. Furthermore, the adrenocorticotropic hormone-stimulated levels of 17-hydroxyprogesterone were higher in patients with clitoromegaly, which suggests that the degree of adrenocortical dysfunction in nonclassic adrenal hyperplasia determines, at least in part, the clinical presentation.

Vulvar lichen sclerosus: comparative study of sexual plasmatic steroids

O líquen escleroso (LS) é uma doença de etiologia desconhecida, com marcada predileçäo pela vulva, em torno da menopausa. Há relatos de involuçäo espontânea de casos infantis na época da puberdade. O tratamento com testoterona tópica controla os sintomas e melhora a lesäo cutânea. Sugeriu-se que uma deficiência da enzima 5-alfa-redutase pudesse ser responsável pela doença. O objetivo deste estudo foi investigar alterçöes nos esteróides sexuais plasmáticos em mulheres co LS vulvar. Realizamos um estudo transversal controlado. Andrógenos e estrógenos foram dosados no plasma de 67 mulheres, entre 21 e 81 anos de idade, com LS vulvar antes de iniciarem o tratamento com testoterona tópica, em 23 destas pacientes durante o tratamento e num grupo controle de 30 mulheres com LS apresentaram níveis plasmáticos de estradiol e de testoterona livre superiores aos dos controles e niveis de DHEA-SO e de estrona inferiores. Durante o tratamento com testoterona tópica houve elevaçäo significativa da testoterona total. A involuçäo de estruturas anatômicas andrógeno-dependentes, assim como a alteraçäo de componentes da pele, também influenciados pelos andrógenos, característicos do LS vulvar, e as alteraçöes encontradas nos níveis plasmáticos dos esteróides sexuais destas pacientes fortemente sugerem que um distúrbio do metabolismo androgênico participe da patogenia do LS

Vulvar acanthosis nigricans: a marker for insulin resistance in hirsute women.

OBJECTIVE: To determine the frequency of acanthosis nigricans (AN) in a group of hirsute, hyperandrogenic women and to determine the body site most frequently affected. DESIGN: Cross-sectional observational study. SETTING: University teaching hospital. PATIENTS, PARTICIPANTS: Reproductive age, nonhypertensive, nondiabetic women referred for evaluation of hirsutism, documented to have hyperandrogenism, without medications known to influence lipid, carbohydrate, or hormonal metabolism. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Presence of AN. Insulin resistance was assessed by measuring fasting glucose, fasting insulin, and nadir glucose after a 0.1 U/kg i.v. insulin bolus in both obese and nonobese, hirsute, hyperandrogenic women. RESULTS: Twenty-four of 43 women were found to have AN. Although AN was identified at several body sites including the axilla (n = 14), on the nape of the neck (n = 13), below the breasts (n = 7), and on the inner thigh (n = 7), it was always present on the vulva in women who displayed one or more lesions. Acanthosis nigricans was found only in the obese, hirsute, hyperandrogenic women. These women were the most insulin resistant. CONCLUSIONS: Acanthosis nigricans and insulin resistance are found frequently in obese, hirsute, hyperandrogenic women. The vulva is the most likely place to find this marker.

[Clinical and rheological efficacy of troxerutin in obstetric gynecology]. / Efficacité clinique et rhéologique de la troxérutine en gynécologie obstétrique.

The success of treatment aimed at improving manifestations of venous insufficiency appears today to be closely linked to a therapeutic impact on blood viscosity and the macrorheological parameters upon which it depends. This double-blind placebo-controlled trial of troxerutine was designed to evaluate changes during treatment in rheological abnormalities in 60 women with vulval varicosities and venous insufficiency of the lower limbs, half in the context of premenstrual syndrome and half in pregnant women from the 4th month on. Initial examination revealed no significant difference between the treated and control groups from a clinical and rheological standpoint in the gynecological and obstetric categories. Analysis of results showed that a high dose of troxerutine was associated with a very marked improvement in symptomatic parameters by the first month of treatment with a significant correlation between clinical criteria and rheological parameters in pregnant women as well as in those with a premenstrual syndrome. These data were confirmed by excellent acceptability as well as subjective assessment by patients after 4 months' treatment at the dosage of 4 g/d.

[The measurement of plasma-free testosterone in normal menstrual females, pregnant females, post menopausal females and vulvar dystrophy].

It is considered that plasma-free testosterone is a bioactive androgen in blood and is more reflective in androgenicity than plasma total testosterone. We measured plasma-free testosterone by dialyzable method in normal menstrual females, pregnant females, post menopausal females and vulvar dystrophy. The values of plasma total testosterone (T), fractional free testosterone (%FT) and plasma-free testosterone (free T) were 0.61 +/- 0.27 (mean +/- SD)ng/ml, 1.19 +/- 0.34% and 0.61 +/- 0.20 ng/kl in the follicular phase of normal menstrual females (n = 25), and 0.57 +/- 0.23 ng/ml, 1.29 +/- 0.46% and 0.56 +/- 0.35 ng/dl in the luteal phase of normal menstrual females (n = 24), respectively. The values in both phases showed no differences from each other. In post menopausal females (n = 18), the concentration of T (0.36 +/- 0.27 ng/ml) and free T (0.52 +/- 0.12 ng/dl) was significantly lower (T: P less than 0.01, free T: P less than 0.05) than that in normal menstrual females. However, %FT in post menopausal females (1.37 +/- 0.12%) was not different as compared with that in normal menstrual females. In pregnant females (n = 2) of second and third trimester, T (0.53 +/- 0.07 ng/ml) was not different as compared with that in normal menstrual females, but %FT (0.67 +/- 0.45%) and free T (0.33 +/- 0.23 ng/dl) were significantly lower (P less than 0.05) than in normal menstrual females. In vulvar dystrophy, lichen sclerosus (n = 19) and hyperplastic dystrophy without atypia (n = 12) were measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum levels of vitamin A, E, and selenium in women with lichen sclerosus of the vulva treated with etretinate.

Forty-six patients with Lichen sclerosus (Ls) of the vulva were treated with peroral etretinate for 3 months. The pretreatment serum levels of vitamins A and E, and selenium were measured. Etretinate therapy proved to be effective in the treatment of Ls; however, it did not affect the vitamin A status of the Ls patients. Vitamin E and selenium levels did not differ from the control values, nor did they have any prognostic value.

Serum levels of sex hormones in vulvar lichen sclerosus, and the effect of topical testosterone.

Lichen sclerosus is a chronic cutaneous disorder of unknown cause that most commonly occurs on the vulva in postmenopausal women. Earlier investigations suggested that the affected tissue is reversibly atrophic and that it has normal metabolic potential. The present study was designed to determine whether levels of sex steroid hormones in serum are altered in this disease and how they are affected by topical testosterone, a recognized form of therapy. As compared with normal values for age, serum levels of dihydrotestosterone, free testosterone, and androstenedione were significantly decreased in patients with untreated vulvar lichen sclerosus. Dihydrotestosterone and testosterone levels rose and exceeded normal values after therapy. These results suggest that abnormal enzymatic activity (5 alpha-reductase) may be responsible for this disease and indicate a need for similar studies of the disorder in other locations.