[Quality of life and symptoms before and after surgical treatment of rectovaginal fistula]. / Évaluation de la qualité de vie et des symptômes avant et après prise en charge chirurgicale des fistules rectovaginales.

INTRODUCTION: Rectovaginal fistula requires a complex management because it has an important psychological impact associated with impaired quality of life of patients. Thus, the aim of our study was to evaluate the improvement of the quality of life of patients after surgical management. METHODS: This is a retrospective study. We included patients operated between 2009 and 2014 for the treatment of a rectovaginal fistula, whose data were available and who agreed to answer a questionnaire. We evaluated the satisfaction of short-term and long-term patients on the answer to the basic PFDI-20 and PFIQ-7 questionnaires. We then evaluated whether there was an improvement in symptoms and quality of life after surgery. RESULTS: Nine patients were included but only 4 patients completed the PFDI-20 and PFIQ-7 questionnaires. Fistula was secondary to either surgical intervention (44%, n=4) or complicated perineal tear (44%, n=4) or unknown cause (11%, n=1). After surgery, we found the short term a significant decrease in stool incontinence, as there was no stool incontinence (0/5) in the postoperative period, while preoperatively 55% (5/9) (P=0.03). Postoperatively, 33% (3/9) of the patients had genital discomfort and 44% (4/9) had gas incontinence compared to 0% preoperatively (P=0.2 and P=0.6). There appears to be an improvement in pelvic static disorders after surgical management. However, we found a slight improvement in nauseous leucorrhoea in the immediate postoperative period, as the prevalence decreased from 33% (3/9) preoperatively to 22% (2/9) postoperatively (P>0.9). In the long term, we observed an improvement in the sensation of perineal heaviness and gas incontinence because only 25% (1/4) of the 75% (3/4) preoperative patients still showed slight discomfort (P=0.5). The quality of life and the emotional state of the patients were no altered postoperatively. Indeed, preoperatively, 50% (2/4) of the patients reported anxiety compared to 0% (0/4) postoperatively (P=0.4). Similarly, 75% (3/4) complained of a decrease in their quality of life (social, sports, etc.) preoperatively compared with 0% (0/4) postoperatively (P>0.9). CONCLUSION: A simple surgical management of rectovaginal fistulas would allow a significant decrease in stool incontinence and improved quality of life and their emotional state, which confirms the beneficial effect of this therapeutic strategy. LEVEL OF EVIDENCE: 4.

Epidemiology and outcome of cervical cancer in national institute of Morocco.

BACKGROUND: On behalf of the medical staff of the National Institute of Oncology of Rabat, we conducted a retrospective study to report epidemiology and 5-year outcomes of cervical carcinoma in Moroccan women. METHODS: We reviewed all women diagnosed with invasive cervical carcinoma in our institute between January 2006 and December 2006. Outcomes and prognoses are analyzed in patients who received at least one treatment. RESULTS: The analysis included 646 women. Median age was 50 years (23-85 years). Bleeding was the most frequent symptom (95 %). The most predominant histology was squamous cell carcinoma (94 %). The majority of patients were diagnosed at locally advanced stages (88 %). Among patients who received treatment (n = 550), the management was based on concurrent chemoradiotherapy in 69.7 % of cases. The median duration of follow-up was 60 months (range 2-78 months). Overall survival, progression free survival, and locoregional recurrence free survival were 63.2, 60.7 and 79.1 % respectively. Significant poor prognostic factors in univariate analysis included stage, tumor size, lymph node involvement, anemia and absence of response to radiotherapy. The prognostic significance of response to radiotherapy and stage were retained in multivariate analysis. CONCLUSION: Cervical cancer in our Institute is diagnosed at locally advanced stages. Two third of patients were treated by concurrent chemoradiotherapy. Outcome of Moroccan patients are comparable to that of western countries. Significant prognostic factors were stage, tumor size, lymph node involvement, anemia, and response to radiotherapy. The way to reduce the global burden of cervical cancer in our country continues to be the development of vaccination and screening programs.

Risk factors for candida infection of the genital tract in the tropics.

OBJECTIVE: To investigate the risk factors associated with candida infection of the genital tract in the tropics. METHODS: We performed questionnaire survey and experiments at the Hainan branch of General Hospital of People's Liberation Army, Hainan General Hospital and Sanya Maternity and Child Health Care Hospital in 2013. Controls were without Candida infection of genital tract, and cases had from Candida infection. RESULTS: We recruited 689 cases and 652 controls. The average age of cases with Candida infection of the genital tract was higher than that of controls. In the multivariate modeling, marriage (adjusted odds ratio: 2.49, 95% confidential interval: 1.09-5.67) and vaginal lavage (adjusted odds ratio: 4.41, 95% confidential interval: 1.13-5.14) were significantly associated with Candida infection of genital tract in tropics. CONCLUSION: Candida infection was related with age. Marriage and Vaginal lavage were significant risk factors. Attention should be paid to health education for the prevention of these infections.

Correlation of leukorrhea and Trichomonas vaginalis infection.

Trichomonas vaginalis is a common sexually transmitted infection (STI) causing vaginitis. Microscopy has poor sensitivity but is used for diagnosis of trichomoniasis in resource-poor settings. We aimed to provide a more reliable diagnosis of trichomoniasis by investigating an association with leukorrhea. Women presenting for evaluation of vaginal discharge, STI exposure, or preventative gynecologic examination were evaluated for Trichomonas infection. Vaginal pH was determined and microscopy was performed by the provider, who recorded the number of polymorphonuclear leukocytes (PMNLs) per epithelial cell and the presence of clue cells, yeast, and/or motile trichomonads. Leukorrhea was defined as greater than one PMNL per epithelial cell. Culture and a nucleic acid amplification test (NAAT) were used to detect T. vaginalis. Patients were evaluated for Chlamydia trachomatis and Neisseria gonorrhoeae using NAATs and bacterial vaginosis using Gram stains. Two hundred ninety-four women were enrolled, and 16% were found to have Trichomonas (46/294). Trichomonas infection was more common in parous non-Hispanic, black women, who reported low rates of contraceptive use (33% versus 17%; P = 0.02) and a STI history (85% versus 55%; P = 0.002). These women were more likely to report vaginal discharge (76% versus 59%; P = 0.02) and have an elevated vaginal pH (87% versus 48%; P < 0.001) and gonorrhea infection (15% versus 4%; P = 0.002). Leukorrhea was associated with a 4-fold-increased risk of Trichomonas infection. Leukorrhea on microscopy was associated with Trichomonas vaginitis. Patients with leukorrhea should be evaluated with more-sensitive tests for T. vaginalis, preferably NAATs, if microscopy is negative.

[In vitro susceptibility of vaginal Candida albicans to antifungal drugs in Abidjan (Ivory Coast)]. / Sensibilité in vitro des souches de Candida albicans d'origine vaginale aux antifongiques à Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of this study was to evaluate in vitro susceptibility of vaginal Candida albicans to common antifungal drugs in Abidjan, Ivory Coast. PATIENTS AND METHODS: From January to September 2008, 150 women with leucorrhoea were sampled for vaginal mycosis at the Pasteur Institute (Ivory Coast). Samples were analyzed by direct examination, Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture. C. albicans was identified after blastesis, chlamydosporulation and auxanogram tests. The susceptibility of this fungus to amphotericine B, 5-fluorocytosine, fluconazole, itraconazole and voriconazole was evaluated by a semi-solid medium microdilution technique: ATB(®) Fungus 3. RESULTS: Among 62 yeasts strains isolated, C. albicans represented 45 cases or 72.6%. Vaginal itching (P=0.04) and urinary burning (P=0.002) was statistically correlated with vaginal candidosis. We observed a range of susceptibility of C. albicans strains to antifungals: 100% to amphotericine B (CMI90=0.5µg/mL); 98% to 5-fluorocytosine (CMI90=4µg/mL); 86.7% to voriconazole (CMI50=0.06µg/mL) and 80% to fluconazole (CMI50=2µg/mL and CMI90=32µg/mL). However, only 46.7% of C. albicans strains were sensitive to itraconazole (CMI50=0.125µg/mL). CONCLUSION: These results show that vaginal C. albicans remain sensitive to the most commonly antifungal drugs used in Abidjan. However, this susceptibility should be regularly monitored.

Purulent vaginal and cervical discharge in the diagnosis of pelvic inflammatory disease.

In this structured review, we evaluated purulent vaginal and cervical discharge as diagnostic tests for pelvic inflammatory disease (PID). Using a pretest probability of PID (diagnosed clinically) of 50%, we used the odds-likelihood formulation of Bayes' theorem to calculate post-test probabilities of PID (proven by laparoscopy or endometrial biopsy). If abnormal discharge was present, the post-test probabilities of PID ranged from 50% to 73%, with a mean value of 57%. If abnormal discharge was absent, the post-test probabilities ranged from 24% to 52%, with a mean value of 39%. Therefore, the presence or absence of excess white blood cells in vaginal or cervical discharge was not particularly helpful in confirming or excluding PID in patients in whom the diagnosis was suspected from the clinical examination.

Prognostic factors and clinicopathologic characteristics of invasive adenocarcinoma of the uterine cervix.

OBJECTIVE: The purpose of this study was to evaluate the outcome of patients with cervical adenocarcinoma and to determine the characteristics and the prognostic factors of this entity. STUDY DESIGN: This retrospective study was done in the Department of Surgical Oncology of the Salah Azaiz Institute of Tunis with 79 cases of invasive adenocarcinoma of the uterine cervix that were collected from 1990 to 1999. Survival was analyzed according to the Kaplan-Meier method. Univariate analysis of prognostic factors was performed with the test of log rank. Cox regression model was used in multivariate analysis of prognostic factors. RESULTS: Mean age was 50 years, and metrorrhagia was mostly revealing in 73% of the cases. Early stages (I, IIa, IIb with 1/3 proximal parametrial invasion) and "pure" type adenocarcinoma were found in 78% and 87% of the cases, respectively. Treatment consisted of a radiosurgical combination in 52 cases; exclusive radiotherapy was practiced with 17 patients. The 5 year-overall and disease-free survival percentages were, respectively, 68% and 72.4%. Poor prognostic factors were age >50 years, tumor size >4 cm, advanced stage, tumor grade, and lymph nodes and lymph-vascular space involvement. With the use of multivariate analysis, only stage and lymph node metastases remained significant prognostic factors. CONCLUSION: This report shows survival and prognostic factors that are similar to those found in previous studies, but unlike the Western countries, our results demonstrate a high rate of early stages and no increase in frequency of cervical adenocarcinoma.

Efficacy and safety of a contraceptive vaginal ring (NuvaRing) compared with a combined oral contraceptive: a 1-year randomized trial.

This open-label, randomized, Phase III study compared the efficacy and tolerability of and compliance with NuvaRing, a combined contraceptive vaginal ring releasing 15 microg of ethinylestradiol (EE) and 120 microg of etonogestrel daily, with those of and with a combined oral contraceptive (COC) containing 150 microg of levonorgestrel (LNG) and 30 microg of EE. Subjects received NuvaRing or a COC for 13 cycles (3 weeks of ring/pill treatment followed by a 1-week ring-/pill-free period). A total of 1030 subjects (NuvaRing, n=512; COC, n=518) was randomized and started treatment (intent-to-treat [ITT] population). The percentage of women in the ITT population who completed the trial was 70.9% for the NuvaRing group and 71.2% for the COC group. Five in-treatment pregnancies occurred in each group, giving Pearl indices of 1.23 for NuvaRing and 1.19 for the COC. Compliance with both treatments was excellent and both were well tolerated. In conclusion, NuvaRing has comparable efficacy and tolerability with a COC containing 150 microg of LNG and 30 microg of EE and does not require daily dosing.

[Peritoneovaginal fistula after vaginal hysterectomy]. / Fistule péritonéo-vaginale après hystérectomie vaginale.

Peritoneovaginal fistula is a rare complication of hysterectomy. A patient with pelvic pain and vaginal discharge due to peritoneovaginal fistula, 6 months after hysterectomy, is presented. The laparoscopic approach with an intravaginal blue-test, provided the evidence of the peritoneovaginal fistula. The transvaginal approach offered a surgical closure of the fistula and a resolution of the symptoms. In addition, we have reviewed the literature, the symptoms, the differential diagnosis and the management of this problem.

[The microbial findings in leukorrhea]. / Mikrobni nakhodki pri genitalen fluor.

During two periods /1984/86 and 1998/01.00/ were studied microbial findings from vaginal specimens of women in reproductive age /16-48/. Candida spp. was isolated most frequently /17.3% to 21.5%/. BV was increased from 4.6% to 13.1%. T. vaginalis was decreased from 8.7% to 1.8%, probably as a consequence of metronidazole appliance.

[Cervical adenocarcinomas: diagnostic, prognostic and therapeutic aspects in a 49 case-control study]. / Aspects diagnostiques, pronostiques et thérapeutiques des adénocarcinomes du col utérin: à propos d'une série de 49 cas.

OBJECTIVES: The aim of this study was to search for potential diagnostic, therapeutic and prognosis differences between a series of 49 adenocarcinomas of the cervix and a matched series of epidermoid carcinomas. METHODS: Forty-nine adenocarcinomas were treated between 1978 and 1992 and retrospectively compared to a series of 98 paired epidermoid carcinomas. RESULTS: The adenocarcinoma incidence is 5.4%. There was no significant difference for age distribution, parity, or hormonal status. There was also no significant difference for clinical features. Stage I appeared more frequently in the adenocarcinoma group (stage I: 69.4%, stage II: 14.3%, stage III: 14.3%, stage IV: 2%). Stage I are also more frequently found in the adenocarcinoma group (69.4% versus 42. 9%, p< 0,05). Combined radio-surgical treatment was proposed more often for the adenocarcinoma group (respectively radio-surgery combination 73%, radiotherapy alone 18%, surgery 9%); in the epidermoid carcinoma group, combined radio-surgical treatment and radiotherapy were the usual treatment (46%); surgery alone appeared in third rank place (8%). Adenocarcinoma pelvic recurrences appeared more frequently (28.6% for adenocarcinoma group versus 13.3% for epidermoid group p< 0.05), while distant recurrence was the same (12. 2% for adenocarcinoma group versus 11.2% for epidermoid group, p< 0. 05). Five years overall survival rate was worse for the adenocarcinoma group (52% versus 63.7%, p< 0.05) but the difference was not significant for the disease free survival rate. Only for stage Ib, there are also more pelvic recurrences (35.4% versus 13.1%, p< 0.05), more distant recurrences (9.6% versus 2.6%, p< 0.05), and lower overall survival for adenocarcinomas (58.7% versus 88.5%, p< 0. 01). CONCLUSION: The incidence of adenocarcinomas is slightly increasing (absolute value in our experience) and the low stages seem to be more frequent in our experience probably by staging inaccuracy. Adenocarcinoma prognosis seems to be worse because of its poor radio-sensitivity. It seems necessary to optimize clinical staging and therapeutic protocols excluding radiotherapeutic approach, including surgical purposes or radio-surgical associations if unfavorable histological features or tumoral enlargement (T> 3 cm) are found.

Tecido adiposo heterotopico na cervix uterina / Heterotopic adipose tissue in the uterine cervix

Lesöes lipomatosas uterinas säo incomuns e os poucos relatos limitam a descreve-las associadas a neoplasias de partes moles, como o leiomioma, ou puras, caracterizando um lipoma, e näo há descriçäo de forma difusa, näo neoplasica. Uma mulher de 34 anos, para 4 e 1 abortamento, apresentou-se com leucorreia discreta, sem outras queixas. Macroscopicamente, ao exame especular, observou-se ectopia papilar polipoide que poderia ser causadas por hiperplasia epitelial na infecçäo por papilomavirus ou devido ao uso anovulatório. Ao exame histológico demonstrou-se infiltraçäo difusa de adipocitos maduros no estroma endocervical, caracterizando um coristoma. A paciente näo recebeu qualquer tratamento e encontra-se bem dois anos depois da biopsia. Näo há relato previo da presença de tecido gorduroso maduro heteropico näo neoplasico na cervix uterina. A histogenese da lesao näo está definida, porém sugere-se, através de estudo imuno-histoquimico, a hipotese de transformaçäo direta de celulas musculares lisas do estroma cervical em adipocitos

Vulvovaginitis en pediatría: un problema frecuente / Vulvovaginitis in pediatrics: a frequent problem

La vulvovaginitis es un problema frecuente en las niñas. Por lo general, no constituye el motivo principal de consulta sino que es una patología por la que el pediatra debe preguntar. Es importante conocer las situaciones normales como la leucorrea fisiológica de la recién nacida y previo a la menarquia. La recomendación de medidas generales de higiene permiten prevenir la vulvovaginitis. Una vez diagnosticada la descripción de las características de la leucorrea así como el cultivo se podrá indicar el tratamiento específico

Giant cervical polyp. A case report.

BACKGROUND: Very large cervical polyps are rarely reported. CASE: A giant cervical polyp, 17 x 10 x 5 cm, protruded through the vaginal introitus in a 27-year-old, sexually inactive woman. CONCLUSION: Although carcinomatous change occurs in 1.7% of cervical polyps, malignant degeneration did not occur in the six reported cases. Thus, biopsy of these tumors before excision may not be necessary.

Leucorrea: causas infecciosas e inbalances en el ecosistema vaginal

La alteración del escosistema vaginal puede ser mas dificil de tratar que una infeción dado que con frecuencia los factores precipitantes son desconocidos y, además porque el diagnóstico incorrecto puede llevar a tratamientos que complican el cuadro

Detection of Chlamydia trachomatis by immunofluorescence, papanicolaou and immunoperoxidase in women with leucorrhea.

Bacteriological, Papanicolaou, direct immunofluorescense (DIF) and immunoperoxidase studies were done in 245 samples from women with vaginal discharge and the frequency of Chlamydia trachomatis was investigated. The samples were obtained from two hospitals of the Public Health Services of Mexico City. Samples were taken from the endocervical and posterior fornix areas and streaked in different cultures media for the isolation and microbiological differentiation. Smears were done and stained by Gram, Papanicolaou, DIF and immunoperoxidase techniques and the presence of cytological alterations and Chlamydia trachomatis was investigated. The microorganism was detected in 8 patients by the three methods, only 4 of these were found by DIF, 7 by cytological and 6 by immunoperoxidase techniques. The infection caused by C. trachomatis cytologically was associated with mild or moderate dysplasia but not with some special microorganism.