Applying graph theory to improve the quality of scientific evidence from textual information: Neural injuries after gynaecologic pelvic surgery for genital prolapse and urinary incontinence.

AIMS: To provide the overall rate for all types of neurologic iatrogenic injuries during urogynaecologic surgery from textual data. METHODS: Systematic research focused on complications of gynaecologic surgery and neurologic injuries in abstracts. Keywords concerning complications (cluster A), unspecific; neurologic issues (cluster B); surgery (generic words) (cluster C); specific gynaecologic operations (cluster D); and specific gynaecologic operations for pelvic organ prolapse and urinary incontinence (cluster E) were extracted. Associations among clusters of keywords were assessed by using multiple runs of text-mining software Semantic Brand Score (SBS, https://semanticbrandscore.com/#primary). Association scores were converted into probabilities. The rate of neurologic complications in urogynaecologic surgery was calculated ("a priori" probability) by applying Bayes' theorem. Textual estimates of neurological injuries in urogynaecologic surgery are 0.035554 (95% confidence intervals 0.019607-0.0515001; no quantitative data were found). To test if the probability calculated on textual information was the same as quantitative data reports ("a posteriori" probability), the rate of neurologic complication of all gynaecologic surgery was calculated using a meta-analytics approach and was compared with the textual analysis value. RESULTS: The rate of neurologic complications in gynaecologic surgery after meta-analytic data synthesis has been 0.016489 (95% confidence intervals 0.012163-0.022320), which is equal to the textual estimate (0.016889, 95% confidence intervals 0.019607-0.051501). Therefore, 0.035554 is a reliable likelihood to observe a neurologic complication in urogynaecologic surgery. CONCLUSION: Iatrogenic nerve injuries in urogynaecologic surgery are higher than whole gynaecologic surgery. Text-mining software SBS and probability conversion can provide reliable answers from overall scholars' opinions on unsolved clinical questions when better evidence is lacking.

Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted. METHODS: In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references. Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies). Two authors extracted the data. Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol. A modified GRADE score was used for quality assessment. Random-effect models were already assumed. Mean rates were compared among subgroups. RESULTS: One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility. Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis. Wide heterogeneity was found. In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (. CONCLUSION: In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.

Data on correction of pelvic organ prolapse by laparoscopic lateral suspension with mesh: A clinical series.

This DIB article provides additional data on laparoscopic lateral suspension with mesh for correcting pelvic organ prolapse. Data come from a multicentric sample of Italian women (https://doi.org/10.1016/j.ejogrb.2019.07.025). Data are collected retrospectively. Descriptive and raw data on surgery and descriptive and raw data on symptoms of pelvic organ prolapse pre-surgery and post-surgery are provided. Kaplan-Meier curves and scores of 7-items King's Health Questionnaire for quality of life assessment are also reported.

Correction of pelvic organ prolapse by laparoscopic lateral suspension with mesh: A clinical series.

OBJECTIVE: Illustrating the outcomes of laparoscopic lateral suspension by mesh for pelvic organ prolapse repair. STUDY DESIGN: A retrospective observational study was conducted collecting medical records of 48 patients treated between May 2016 and April 2018 in two different centers in Italy. Pre- and post-operative clinical evaluations as well as patients' satisfaction scores were considered. Patients were followed for two years. Statistical analysis was determined using the chi-square test in intention-to-treat and per-protocol analyses, while Kaplan-Meier curves were built for assessing the prolapse recurrence and the symptoms recurrence. The Steel-Dwass test for pairwise comparisons was used to compare median scores from the King's General Health Perception Questionnaire answers. RESULTS: Regarding the anatomical result, the outcome was either optimal or satisfactory (PoP-Q ≤1) at 12 months in 92% of patients for anterior compartment, in 100% for apical compartment, and in 75% for posterior compartment (intention-to-treat). Kaplan-Meier curves depicted a repair of prolapse in 70% of cases, with better outcomes for the anterior and the apical compartment. Patient self-perception of health was over 80% at each follow-up evaluation. CONCLUSION: Laparoscopic lateral suspension is a reasonable technique for treatment of pelvic organ prolapse. Further studies are needed to prove such a technique versus alternative surgeries.

Which is the destiny of ulipristal acetate for uterine fibroids? A commentary on the Italian medicines agency (AIFA) pronouncements

The 19 of February 2018 the Italian Medicines Agency (AIFA - Agenzia Italiana del Farmaco) temporary stopped the new administration of Ulipristal Acetate (UPA) for treating uterine leiomyomas symptoms, because liver injury and hepatic failure had been reported in relationship with UPA use. After the European Medicines Agency review of risks of UPA, the 3 of August 2018 the AIFA produced another note, disclosing that a cause-effect relationship between the UPA use and liver injury is not proved and that some patients can be discontinuously treated if surgery is not recommended. However, a close monitoring of hepatic function must be done in Ulipristal users. As Ulipristal has not been prescribed since February 2018 in our center, the rate of surgical operations for uterine leiomyomas significantly doubled. Therefore it will be useful know exactly which restricted indications allow to use UPA for more than 3 months. In this way it could be minimized the risks of liver injury and it could be prevented the rise of surgeries for uterine leiomyomas.

Outcome of endometrial cancer after lymphadenectomy: a single center retrospective analysis with long-lasting follow-up.

BACKGROUND: Role of lymphadenectomy in endometrial cancer is unclear. Our objective is to assess the role of lymphadenectomy in endometrial cancer. METHODS: The study reviewed retrospectively 829 cases of endometrial cancer from a single non-oncological center from 1981 to 2014. Multivariable Cox regression analyses were performed. Independent variables were: 2009 FIGO stage, histological type of endometrial cancer (non-endometrioid, endometrioid, grading 1, 2 and 3), radicality on parametria, lymphatic dissection (any kind) (yes/no), any kind of chemotherapy, any kind of radiotherapy, brachytherapy, patients' age. Dependent variable was death for endometrial cancer and first relapse. Time variable was the semester of follow-up. P value for significance was set <0.05. RESULTS: Many data about the extension of node dissection were missing. Pelvic node dissection or sampling seem the more common procedure performed. At the 10-semester of follow-up, at the 20-semester of follow-up and at the 30 semester of follow up, lymphadenectomy does not improve overall survival at a p value of less than 0.05. Lymphadenectomy reduces the risk of relapse at the 10 semester and 20-semester of follow-up. CONCLUSIONS: Lymphadenectomy plays a role in preventing relapses but it is not proved that non-aggressive lymphadenectomy in endometrial cancer improves overall survival at p level of 0.05. Therefore, it cannot be excluded that a very small improvement in long lasting survival in few cases of endometrial cancer could be due to node dissections.

Sonographic Cervical Shortening after Labor Induction is a Predictor of Vaginal Delivery.

Objective Analyzing if the sonographic evaluation of the cervix (cervical shortening) is a prognostic marker for vaginal delivery. Methods Women who underwent labor induction by using dinoprostone were enrolled. Before the induction and three hours after it, the cervical length was measured by ultrasonography to obtain the cervical shortening. The cervical shortening was introduced in logistic regression models among independent variables and for calculating receiver operating characteristic (ROC) curves. Results Each centimeter in the cervical shortening increases the odds of vaginal delivery in 24.4% within 6 hours; in 16.1% within 24 hours; and in 10.5% within 48 hours. The best predictions for vaginal delivery are achieved for births within 6 and 24 hours, while the cervical shortening poorly predicts vaginal delivery within 48 hours. Conclusion The greater the cervical shortening 3 hours after labor induction, the higher the likelihood of vaginal delivery within 6, 24 and 48 hours.

Sonographic Cervical Shortening after Labor Induction is a Predictor of Vaginal Delivery / Ultrassonografia para encurtamento do colo do útero após indução de parto é um preditor de parto normal

ABSTRACT Objective: Analyzing if the sonographic evaluation of the cervix (cervical shortening) is a prognostic marker for vaginal delivery. Methods: Women who underwent labor induction by using dinoprostone were enrolled. Before the induction and three hours after it, the cervical length was measured by ultrasonography to obtain the cervical shortening. The cervical shortening was introduced in logistic regression models among independent variables and for calculating receiver operating characteristic (ROC) curves. Results: Each centimeter in the cervical shortening increases the odds of vaginal delivery in 24.4% within 6 hours; in 16.1% within 24 hours; and in 10.5% within 48 hours. The best predictions for vaginal delivery are achieved for births within 6 and 24 hours, while the cervical shortening poorly predicts vaginal delivery within 48 hours. Conclusion: The greater the cervical shortening 3 hours after labor induction, the higher the likelihood of vaginal delivery within 6, 24 and 48 hours.

RESUMO Objetivo: Analisar se a avaliação ultrassonográfica do colo do útero (encurtamento) é um marcador prognóstico para parto normal. Métodos: Consideramos mulheres com trabalho de parto induzido usando dinoprostona. Antes da indução e três horas após, a extensão cervical foi medida por ultrassonografia para obter o encurtamento do colo do útero. O encurtamento do colo do útero foi aplicado em modelos de regressão dentre variáveis independentes. Curvas de Característica de Operação do Receptor foram calculadas. Resultados: Cada centímetro no encurtamento do colo do útero aumenta as chances de parto normal para 24,4% dentro de 6 horas; 16,1% dentro de 24 horas; e 10,5% dentro de 48 horas. Os melhores preditores de parto normal são alcançados para partos dentre 6 e 24 horas, enquanto o encurtamento prevê mal o parto normal dentro de 48 horas.

Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy.

STUDY QUESTION: What is the prevalence of chronic endometritis (CE) in women with repeated unexplained implantation failure (RIF) at IVF, and how does antibiotic treatment affect the reproductive outcome? SUMMARY ANSWER: Chronic endometritis, associated with infection with common bacteria or mycoplasma, is common in women complaining of RIF and antibiotic treatment significantly improves the reproductive outcome at a subsequent IVF cycle. WHAT IS KNOWN ALREADY: We have reported that CE is a frequent finding in women with repeated pregnancy loss and a significantly higher rate of successful pregnancies was achieved after adequate antibiotic treatment. Moreover, CE was identified in 30.3% of patients with repeated implantation failure at IVF and women diagnosed with CE had lower implantation rates (11.5%) after IVF cycles. In contrast, other authors reported that the clinical implication of CE should be considered minimal and that the reproductive outcome at IVF/ICSI cycles was not negatively affected by CE. STUDY DESIGN, SIZE, DURATION: A retrospective study was performed from January 2009 through June 2012 on 106 women with unexplained infertility and a history of RIF. PARTICIPANTS/MATERIALS, SETTING, METHODS: All patients underwent hysteroscopy and endometrial sampling for histology and microbiological investigations. Women diagnosed with CE underwent antibiotic treatment and the effect of treatment was confirmed by hysteroscopy with biopsy. Within 6 months after treatment all women had a further IVF attempt. The IVF outcomes were compared in women without signs of CE (Group 1) and persistent CE (Group 2) after antibiotic treatment. Clinical pregnancy rate (PR), and live birth rate (LBR) were compared at post-treatment IVF attempt. MAIN RESULTS AND THE ROLE OF CHANCE: Seventy (66.0%) women were diagnosed with CE at hysteroscopy. In 61 (57.5%) CE was confirmed by histology and 48 (45.0%) by cultures. Common bacteria and mycoplasma were the most prevalent agents. In 46 (75.4%) out of 61 women, with diagnosis of CE at hysteroscopy and histology, examinations were normal after appropriate antibiotic treatment control (Group 1) while in 15 (24.6%) cases signs of CE were still present (Group 2). At IVF attempt after treatment, a significantly higher PR and LBR was reported in women from Group 1 compared with women from Group 2 (65.2 versus 33.0% P = 0.039; 60.8 versus 13.3%, P = 0.02, respectively). LIMITATIONS, REASONS FOR CAUTION: Possible biases related to retrospective studies and to preferential referral of patients with CE, and limited number of cases. WIDER IMPLICATIONS OF THE FINDINGS: A prospective randomized clinical trial is needed to confirm our findings but in women with RIF a hysteroscopic evaluation of the uterine cavity to exclude CE should be considered and appropriate antibiotic treatment should be given before submitting the patient to a further IVF attempt.

ACE inhibitors and angiotensin receptor blockers could promote the onset of endometrial polyps in hypertensive women.

OBJECTIVE: To investigate whether anti-hypertensive therapy is a risk factor for the onset of endometrial polyps in hypertensive women. METHODS: A sample of 305 hypertensive patients was analyzed. By applying multivariable logistic regression analysis, the odds of developing endometrial polyps relative to the known risk factors for endometrial polyps and to the class of anti-hypertensive drugs were calculated. RESULTS: The variables reaching significance after multivariable logistic regression analysis included the following: hypertension not-in-therapy (odds ratio 2.544; 95% confidence intervals 1.249 - 5.182; p = 0.010); ACE inhibitor therapy (odds ratio 2.400; 95% confidence intervals 1.248 - 4.614; p = 0.009); angiotensin receptor blockers (odds ratio 2.091; 95% confidence intervals 1.044 - 4.187; p = 0.037); and fasting glucose level (odds ratio 1.018; 95% confidence intervals 1.007 - 1.030; p = 0.001). CONCLUSIONS: Although the results should be interpreted carefully, it appears that ACE inhibitors and, to a lesser extent, angiotensin receptor blockers may promote the onset of endometrial polyps in hypertensive patients.

Can endometrial arylsulfatase A activity predict the onset of endometrial polyps over the years?

PURPOSE: To assess if arylsulfatase A activity (ASA) and sulfatide (SL) concentration in the human endometrium can be predictive of the development of endometrial polyps over the years, since ASA activity reflects the endometrial sensitivity to hormones. METHODS: ASA activity and SL concentration were determined by biochemical procedures on endometrial samples collected between 1990 and 1994 in non-menopausal women. These women underwent a new endometrial sampling following the clinical indication some years after the first endometrial sampling. The histological assessment of the second endometrial specimens found four patients with normal endometrial pattern and 10 patients with one or more endometrial polyps. ASA activity/years elapsed and SL concentration/years elapsed were compared using two tailed Mann-Whitney test for unpaired data between patients with normal pattern and patients with endometrial polyps. RESULTS: Median ASA activities were 2.62 (normal pattern) versus 1.85 (endometrial polyps) nmol hydrolized substrate/min. Median activity/years elapsed is higher in patients with second endometrial sample presenting normal pattern (p=0.006) and median SL concentration/years elapsed does not differ significantly among groups, even if median SL concentration seems to be higher in patients who subsequently developed polyps (1031 µg/g of fresh tissue versus 341,5 µg/g of fresh tissue). CONCLUSIONS: ASA activity can predict the onset of endometrial polyps over the years.

Can endometrial arylsulfatase A activity predict the onset of endometrial polyps over the years? / A atividade da arilsulfatase endometrial A pode prever a aparição de pólipos endometriais ao longo dos anos?

PURPOSE: To assess if arylsulfatase A activity (ASA) and sulfatide (SL) concentration in the human endometrium can be predictive of the development of endometrial polyps over the years, since ASA activity reflects the endometrial sensitivity to hormones. METHODS: ASA activity and SL concentration were determined by biochemical procedures on endometrial samples collected between 1990 and 1994 in non-menopausal women. These women underwent a new endometrial sampling following the clinical indication some years after the first endometrial sampling. The histological assessment of the second endometrial specimens found four patients with normal endometrial pattern and 10 patients with one or more endometrial polyps. ASA activity/years elapsed and SL concentration/years elapsed were compared using two tailed Mann-Whitney test for unpaired data between patients with normal pattern and patients with endometrial polyps. RESULTS: Median ASA activities were 2.62 (normal pattern) versus 1.85 (endometrial polyps) nmol hydrolized substrate/min. Median activity/years elapsed is higher in patients with second endometrial sample presenting normal pattern (p=0.006) and median SL concentration/years elapsed does not differ significantly among groups, even if median SL concentration seems to be higher in patients who subsequently developed polyps (1031 µg/g of fresh tissue versus 341,5 µg/g of fresh tissue). CONCLUSIONS: ASA activity can predict the onset of endometrial polyps over the years.

OBJETIVO: Avaliar se a atividade da arilsulfatase A (ASA) e a concentração de sulfatida (SL) no endométrio humano pode ser preditivo em relação ao desenvolvimento de pólipos endometriais ao longo dos anos, posto que atividade da ASA reflete a sensibilidade do endométrio aos hormônios. MÉTODOS: A atividade da ASA, assim como a concentração de SL, foi determinada por meio de procedimentos bioquímicos em amostras de endométrio coletadas entre 1990 e 1994, em mulheres que não se encontravam na menopausa. Essas mulheres foram submetidas a uma nova amostragem endometrial após indicação clínica alguns anos depois da primeira amostragem endometrial. A avaliação histológica dos segundos espécimes endometriais permitiu identificar quatro pacientes com padrão endometrial normal e 10 com um ou mais pólipos endometriais. A atividade da ASA/anos depois e a concentração de SL/anos depois foram comparadas, utilizando o teste bilateral U de Mann-Whitney para dados não pareados entre as pacientes com padrão normal e as pacientes com pólipos endometriais. RESULTADOS: A ativitade da ASA foi 2,62 (padrão normal) em comparação com 1,85 (endometrial pólipos) de substrato hidrolisado/min. A atividade da ASA/anos depois é maior em pacientes com segunda amostra endometrial a apresentarem um padrão normal (p=0,006), e a concentração mediana de SL/anos depois não difere de forma significativa entre os grupos, apesar de a concentração mediana de SL parecer maior em pacientes que posteriormente desenvolveram pólipos (1031 µg/g de tecido fresco em comparação com 341,5 µg/g de tecido fresco). CONCLUSÕES: A atividade da ASA pode prever a aparição de pólipos endometriais ao longo dos anos.

A simplified classification for describing colposcopic vaginal patterns.

OBJECTIVE: This study aimed to highlight that colposcopic vaginal patterns are not specific, unlike cervical colposcopic patterns, and to provide a simpler classification of vaginal colposcopic patterns. MATERIALS AND METHODS: A total of 223 patients who underwent colposcopy with Schiller test were assessed (hierarchical log-linear model) retrospectively. RESULTS: The greatest predictability for histologically confirmed warts and cancers is represented by colposcopic patterns of wart and cancer. Lugol-negative area is strongly predictive of koilocytosis, even if it is found in other vaginal lesions. Thickened epithelium seems to better predict a severe vaginal lesion, whereas thin white epithelium better suggests a mild vaginal lesion. Colposcopic patterns were simplified as follows: Lugol-negative area, white epithelia (thin white epithelium and white thickened epithelium), vascular lesions (regular and irregular mosaicisms and punctations), wart, and cancer. Thus, koilocytosis is predicted by the Lugol-negative area, whereas white epithelia patterns and vascular patterns are not specific, suggesting overall vaginal intraepithelial neoplasias. Wart and cancer patterns are pathognomonic for histologically confirmed warts and cancers. CONCLUSIONS: Vaginal colposcopy poorly predicts the severity of vaginal lesions. By including each type of white epithelium within a new category called "white epithelia patterns" and each type of vascular pattern within a new category called "vascular patterns," it is possible to simplify vaginal colposcopy without compromising its accuracy.

Relationship between adenomyosis and uterine polyps.

OBJECTIVE: To evaluate whether adenomyosis is associated with uterine polyps. STUDY DESIGN: To perform an ethical human study, we planned a large retrospective observational study covering the entire patient population of the ULSS 17-Veneto district who underwent resectoscopy in 2007 and 2008 (959 patients). We enrolled all the patients underwent resectoscopy with resection of uterine polyps, with resection of myomas, with endometrial ablations by slicing, and with endometrial biopsies in both the presence and absence of hysteroscopically visible lesions. The diagnosis of adenomyosis was made by pathological examination of tissue specimens obtained using a resectoscope loop. Multivariate logistic regression was performed to determine if adenomyosis was one of the various risk factors for the presence and number of uterine polyps. Statistical Package for the Social Sciences (SPSS 16.0) was employed, and p≤0.05 was the minimum for significance. RESULTS: Age (p=0.005), adenomyosis (p=0.013), high fasting glucose levels (p=0.004), and hypertension (p=0.045) were significantly associated with endometrial polyps. The presence of multiple endometrial polyps seemed to be associated with the presence of adenomyosis (p=0.016). The presence of cervical polyps was significantly associated only with presence of adenomyosis (p=0.002). The presence of multiple cervical polyps did not seem to be influenced by any of the variables considered. CONCLUSIONS: The results clearly demonstrate an association between adenomyosis and uterine polyps. The pathogenetic role of adenomyosis in the development of polyps should therefore be investigated further.

Cecal endometriosis as a cause of ileocolic intussusception.

Endometriosis is a disease that can affect various organs, has an unclear symptomatology, and in extreme cases, can result in intestinal obstruction. This particular case illustrates the synchronous localization of endometriosis, both genital and intestinal, resulting in ileo-colic and colonic intussusception. The relative diagnostic and therapeutic approach for such a rare occurrence is discussed.

A case of ovarian psammocarcinoma associated with endometrioid cysts: a morphological and immunohistochemical study.

BACKGROUND: Psammocarcinoma of the ovary is an uncommon neoplasm, currently classified among the low-grade epithelial serous tumors. Little is known about its pathogenesis and biological behavior. CASE: A 35-year-old woman underwent laparotomic myomectomy and surgical removal of the right gonad after the incidental discovery of an adnexal mass. The pathological findings were consistent with serous psammocarcinoma and multiple endometrioid cysts of the ovary. Tissue specimens from the neoplasm were tested by immunohistochemistry for the p53, HER-2/neu and bcl-2 cancer-related proteins; diffuse overexpression for bcl-2 was detected, while tumor cells were negative for p53 and HER-2/neu. CONCLUSION: Although the pathogenesis and clinical course of ovarian psammocarcinoma are still to be determined, the molecular profile of this case highlights the similarities with ovarian tumors of the serous borderline group.

Are diabetes, hypertension, and obesity independent risk factors for endometrial polyps?

STUDY OBJECTIVE: To investigate whether diabetes, hypertension (HTN), and obesity can be considered risk factors for endometrial polyps (EPs) independently of age and menopausal status. DESIGN: Retrospective analysis (Canadian Task Force classification III). SETTING: Department of Obstetrics and Gynecology of the University of Foggia, Italy. PATIENTS: A total of 353 Caucasian women undergoing office hysteroscopy to assess abnormal uterine bleeding, infertility, cervical polyps, and abnormal sonographic patterns. INTERVENTIONS: Demographic characteristics and data on diabetes, HTN, and menopausal status were collected and anthropometric parameters were analyzed. Vaginoscopic hysteroscopy was performed with a 5-mm continuous-flow operative office hysteroscope. When present, EPs were treated during the same procedure by means of 5-Fr scissors or electrode. MEASUREMENTS AND MAIN RESULTS: In 134 (38%) of 353 cases, EPs were found. Univariable and multivariable analysis were performed to verify the presence of a statistically significant association among age, menopause, HTN, obesity, diabetes (independent variables), and the presence of EPs. Univariable logistic analysis showed a statistically significant association among age, menopause, HTN, obesity, and the presence of EPs. However, when multivariable logistic regression was performed, all the independent variables, except age, lost statistical significance (OR 1.05, 95% CI 1.02-1.07, p <.001). CONCLUSION: Although it appears that EP is a disorder of aging, the significance of diabetes, HTN, and obesity, as well as menopause, on the development of EPs should be reconsidered.

Anaphylactic-like reaction to lugol solution during colposcopy.

There are a lack of reports about the adverse effects of Lugol iodine solution staining of the genital epithelia, known as a Schiller test, during colposcopy. We report that during the Schiller test, a patient complained of an anaphylactic-like reaction to the Lugol solution with vaginal and generalized pruritus, vaginal edema, hypotension, tachycardia, and breathing difficulties. Vaginal iodine was completely washed out with saline solution, resulting in improvement and a disappearance of the symptoms without the use of any drugs. The safety of Lugol staining during colposcopy needs to be assessed.