Líquen escleroso vulvar: descrição de cinco casos de sucesso com laser Erbium-YAG 2940 / Vulvar lichen sclerosus: description of 5 cases successfully treated with the 2940nm Erbium-YAG laser

Líquen escleroso é dermatose crônica com predileção pela região genital. Acomete, principalmente, a raça branca, sendo mais frequente em mulheres. O tratamento-padrão é feito com corticosteroides tópicos de alta potência. Tratamentos com propionato de testosterona, imunomoduladores tópicos, terapia fotodinâmica, crioterapia, antibioticoterapia e laserterapia são citados na literatura. Neste artigo são relatados cinco casos de pacientes com liquen escleroso vulvar, sem sucesso com o clobetasol tópico, submetidas ao tratamento com Laser Erbium YAG 2940 fracionado. Os resultados foram bastante satisfatórios, sugerindo a laserterapia como opção no tratamento do líquen escleroso, incluídos casos de insucesso com o uso corticoides tópicos.

Lichen sclerosus is a chronic dermatosis, usually anogenital and mainly affecting pos-menopausal women. The use of topical corticosteroids is the mainstay of medical treatment. Other treatments are topical testosterone, calcineurin inhibitors, photodynamic therapy, cryotherapy, antibiotic therapy and laser therapy. In this article, five patients with vulvar lichen sclerosus which had no response to treatment with topical clobetasol, had good results when treated with fractional Erbium:YAG laser 2940.

The acceptability of vaginal smear self-collection for screening for cervical cancer: a systematic review.

Cervical cancer is a major cause of death in adult women. However, many women do not undergo cervical cancer screening for the following reasons: fear, shame, physical limitations, cultural or religious considerations and lack of access to health care services. Self-collected vaginal smears maybe an alternative means of including more women in cervical cancer screening programs. The objective of this systematic review was to evaluate the acceptability of vaginal smear self-collection for cervical cancer screening. We selected articles from PubMed, the Cochrane Library and Embase that were published between January 1995 and April 2016. Studies written in English, French, Italian, Portuguese or Spanish that involved women between 18 and 69 years of age who had engaged in sexual intercourse were included in this review. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Nineteen studies were ultimately evaluated in this review. Most of the included studies (n=17) demonstrated that the self-collection method exhibited outstanding acceptability among women with respect to cervical cancer screening, and only two studies indicated that self-collection exhibited low acceptability among women in this context. The acceptability of self-collection was determined subjectively (without standardized questionnaires) in 10 studies (53%) and via structured and validated questionnaires in the remaining studies. The results of our review suggest that the self-collection method is well-accepted and may therefore encourage greater participation in cervical cancer screening programs. However, additional studies are required to verify these results.

The acceptability of vaginal smear self-collection for screening for cervical cancer: a systematic review

Cervical cancer is a major cause of death in adult women. However, many women do not undergo cervical cancer screening for the following reasons: fear, shame, physical limitations, cultural or religious considerations and lack of access to health care services. Self-collected vaginal smears maybe an alternative means of including more women in cervical cancer screening programs. The objective of this systematic review was to evaluate the acceptability of vaginal smear self-collection for cervical cancer screening. We selected articles from PubMed, the Cochrane Library and Embase that were published between January 1995 and April 2016. Studies written in English, French, Italian, Portuguese or Spanish that involved women between 18 and 69 years of age who had engaged in sexual intercourse were included in this review. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Nineteen studies were ultimately evaluated in this review. Most of the included studies (n=17) demonstrated that the self-collection method exhibited outstanding acceptability among women with respect to cervical cancer screening, and only two studies indicated that self-collection exhibited low acceptability among women in this context. The acceptability of self-collection was determined subjectively (without standardized questionnaires) in 10 studies (53%) and via structured and validated questionnaires in the remaining studies. The results of our review suggest that the self-collection method is well-accepted and may therefore encourage greater participation in cervical cancer screening programs. However, additional studies are required to verify these results.

Prevalência da papilomatose vestibular e infecção pel HPV na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / The prevalence of vestibular papillomatosis and HPV infection analyzed in the division of gynecology of Hospital das Clínicas, São Paulo, University Medical School, São Paulo

Objetivos: determinar a prevalência da papilomatose labial em pacientes assintomáaticas na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Método: foram avaliadas 100 mulheres, todas fizeram citologia oncológica da face interna dos pequenos lábios, cervical e vulvoscopia quando o teste do acético ou lugol eram positivos...

Climaterio e hormonioterapia de reposicao (vantagens e desvantagens) / Climatery and hormonal therapy (indications and contra-indications)

As mulheres no periodo do climaterio estao predispostas a varias doencas como a osteoporose e as doencas cardiovasculares (CVD). Observou-se que estas doencas apresentam uma nitida relacao com a queda da taxa hormonal de estrogenios nesta fase. Para reverter este quadro, utilizamos a hormonioterapia de reposicao. Esta apresenta pontos discutiveis como o aumento da probalidade de cancer de mama e a hiperplasia endometrial, com posterior malignizacao em alguns casos. Isto levou os diversos autores estudarem os verdadeiros efeitos positivos da hormonioterpia de reposicao, principalmente no que diz respeito ao uso exclusivo de estrogenios.

Avaliaçåo clínica do tratamento do líquen escleroso vulvar com clostebol (acetato de 4-clorotestosterona) / Clinic evaluation of the vulvar lichen sclerosus treatment by clostebol (4-clorotestosterone acetate)

Realizou-se estudo aberto e comparativo entre cloetebol/neomicina e clostebol no tratamento tópico exclusivo do líquen escleroso vulvar. Foram estudadas 33 pacientes, cuja idade variou de 27 a 72 (53,23) anos, divididas de forma homogênea em grupos A (clostebol/neomicina) e B (clostebol). Aspectos clínicos (prurido, eritema, edema e extensåo da lesåo branca) e a avaliaçåo clínica global (efeito terapêutico) foram analisados na visita inicial e aos 30, 60 e 90 dias de tratamento. Os resultados nos grupos A e B revelaram-se: excelente em 5 (29,5 por cento) e 2 (12,5 por cento), bom em 7 (41,2 por cento) e 6 (37,5 por cemto), regular em 1 (5,8 por cento) e 2 (12,5 por cento) e nulo em 4 (23,5 por cento) e 6 (37,5 por cento) casos, respectivamente. Concluiu-se que o clostebol/neomicina é interessante alternativa terapêutica no líquen escleroso vulvar, mas nåo de forma absoluta ou exclusiva

Vaginites inespecíficas: tratamento comparativo entre secnidazol e metronidazol / Nonspecific vaginitis: comparative treatment between secnidazole and metronidazole

Foram estudadas, na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, 91 pacientes portadoras de vaginite inespecífica. O diagnóstico foi baseado nos seguintes parâmetros: positividade do teste das aminas; presença de células indicadoras (clue cells); pH vaginal maior ou igual a 5,0 e ausência de processos específicos detectáveis através do exame clínico e/ou bacterioscópico a fresco. Em estudo aberto, randomizado, comparativo, as pacientes foram divididas em dois grupos - grupo secnidazol com 43 pacientes e grupo metronidazol com 48 - que receberam, respectivamente, quatro comprimidos de 500 mg em dose única (2 g) e 400 mg duas vezes ao dia por sete dias, ambos exclusivamente por via oral. A avaliaçäo clínica e laboratorial foi realizada na visita inicial, três e 30 dias após o término da medicaçäo. Os resultados revelaram, nos grupos secnidazol e metronidazol, cura clínica ou melhora acentuada da vaginite em 93.1% e 95,8% das pacientes, respectivamente. Efeitos adversos leves foram registrados em 14 casos do grupo secnidazol e em 4 do grupo metronidazol. Os autores concluem que o secnidazol oral em dose única constitui alternativa terapêutica nas vaginites inespecíficas, pois apresenta eficácia e boa tolerabilidade