Vaginal lichen sclerosus: report of two cases.

BACKGROUND: Lichen sclerosus most commonly affects the genital area. Contrarily to lichen planus, the involvement of the oral or vaginal mucosa is rare. Only four cases of vaginal lichen sclerosus have been described in the literature. CASE REPORT: The authors report two cases of postmenopausal women with a history of vulvar pruritus and burning. Both presented with lesions of the vaginal mucosa compatible with lichen sclerosus, and genital prolapse. Vaginal biopsies confirmed the diagnosis. Initial treatment with topical clobetasol was effective in one of the patients, but in the other patient line therapy with pimecrolimus, triamcinolone, and retinoids was needed. CONCLUSION: Vaginal lichen sclerosus may be underdiagnosed and genital prolapse may favour the development of vaginal lesions.

Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities.

The purpose of this investigation was to evaluate the impact of the vaginal milieu on the presence of abnormal Pap smears and a positive human papilloma virus (HPV) test. A cross-sectional study was conducted between June 2014 and May 2015, evaluating the vaginal discharge by fresh wet mount microscopy and comparing these data with Pap smear findings. Wet mount slides were scored for bacterial vaginosis (BV), aerobic vaginitis (AV), presence of Candida and Trichomonas vaginalis. Cytologic evaluation was done on all Pap smears according to the Bethesda criteria. The cobas© HPV Test (Roche) was performed for HPV detection. A total of 622 cases were evaluated. The mean age of the patients was 41.6 ± 10.65 years (range 21-75). Eighty-three women (13.3 %) had a cytology result worse than low-grade squamous intraepithelial lesion (LSIL). When comparing this group with the one with normal or minor [atypical squamous cells of undetermined significance (ASC-US) or LSIL] Pap smear abnormalities, there were no differences in the presence of Candida (32.5 % vs. 33.2 %, p = 1.0), absence of lactobacilli (38.6 % vs. 32.5 %, p = 0.32) or BV (20.5 % vs. 13.2 %, p = 0.09). On the other hand, moderate or severe inflammation (msI) (41.0 % vs. 28.8 %, p = 0,04), moderate or severe AV (msAV) (16.9 % vs. 7.2 %, p = 0.009) and msAV/BV (37.3 % vs. 20.0 %, p = 0.001) were more common in women with such major cervical abnormalities. No significant association was found between deviations of the vaginal milieu and high-risk HPV infection. The presence of msI or msAV, but not BV, is independently associated with an increased risk of major cervical cytological abnormalities, but not with HPV infection.

Recipient's vascular doppler pattern immediately following death of the donor in a case of untreated severe twin-to-twin transfusion syndrome.

In a stage III twin-to-twin transfusion syndrome, death of the donor at 31 weeks was followed by unusual umbilical artery (UA) doppler findings in the recipient, with a high diastolic peak velocity and a low S/D ratio. Besides, middle cerebral artery waveforms could not be obtained in the recipient. The recipient was delivered by emergency cesarean section, weighed 1,230 g, was strikingly pale and had a cord hemoglobin concentration of 15 g/dl. Neonatal blood average pressure was of 29 mm Hg, immediately after delivery, and ranged from 33 to 43 mm Hg in the first 12 h of life. Neonatal heart function returned to normal on day 2. We hypothesize that death of the donor twin induced an acute decrease in placental resistance. This phenomenon, combined with decreased systolic blood flow due to the recipient's systolic function impairment, could account for the umbilical artery flow pattern we observed. The acute decrease in volemia and the presence of systemic hypertension and cardiomyopathy may explain the inability to obtain middle cerebral artery doppler. This complex hemodynamic disturbance in the recipient may be responsible for morbidity unrelated to anemia in case of donor's demise, as acute fetal distress.

Subcapsular hepatic hematoma in an otherwise uncomplicated pregnancy.

Subcapsular hepatic hematoma is rare in pregnancies not complicated by pre-eclampsia or the HELLP syndrome. We now report such a case.

Birth after electroejaculation coupled to intracytoplasmic sperm injection in a gun-shot spinal cord-injured man.

We describe the case of a man who, after a gun-shot wound, has become paraplegic. As a consequence of his spinal cord injury he developed infertility due to incomplete erection and anejaculation. After several unsuccessful penile vibratory stimulation attempts, it was possible to achieve ejaculation by means of transrectal electrostimulation. However, the total sperm motility count, the percentage of normal sperm morphology, and the vitality and hypo-osmotic swelling test scores were rather low, and in particular viability was strikingly decreased during sperm preparation. These parameters further decreased following electroejaculate, forcing us to use intracytoplasmic sperm injection instead of conventional in vitro fertilization for the treatment cycle. A normal pregnancy was achieved which resulted in birth of a healthy girl on 1st January 1997.

Pregnancy and birth after intracytoplasmic sperm injection with totally immotile sperm recovered from the ejaculate.

OBJECTIVE: To report the birth of two healthy children after intracytoplasmic sperm injection (ICSI) with totally immotile spermatozoa recovered from the ejaculate. DESIGN: Retrospective case report. SETTING: University-based hospital. PATIENT(S): Four couples in whom spermatozoa recovered from the ejaculate were totally immotile but presented normal vitality scores. INTERVENTION(S): Therapeutical IVF-ET attempts coupled with ICSI. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy results after ICSI. RESULTS: With random sperm injection, 19 of the 36 injected oocytes showed normal fertilization and cleavage. One of four patients had a twin pregnancy that resulted in birth of two healthy children. CONCLUSION(S): In cases in which totally immotile ejaculated sperm present normal vitality scores, normal clinical outcomes can be achieved by using the usual random sperm selection during conventional ICSI.

Reverse end-diastolic umbilical artery blood flow at 11 weeks' gestation.

This report describes a case of reverse end-diastolic blood flow in the umbilical artery of one of the fetuses of a twin pregnancy at 11 weeks' gestation. Cytogenetic studies after amniocentesis performed at 12 weeks revealed a 45.X karyotype of this twin whose death was registered 1 week later. Spontaneous delivery of the co-twin occurred at 37 weeks; the newborn was healthy and normal. This is the earliest record of reverse diastolic flow in the umbilical artery. Even in the first trimester of pregnancy this is an ominous sign and fatal demise is expected.