洁童阴洗液治疗幼女外阴阴道炎的临床与实验研究

目的：探讨中药洁童阴洗液治疗幼女外阴阴道炎的临床疗效和作用机理。方法：随机设洁童阴洗液观察组（简称观察组）300例和日舒安洗液对照组（简称对照组）60例，对两组患儿治疗前后主要症状和体征积分值进行对比观察，并进行中药药理药效学的动物实验。结果：临床总有效率观察组与对照组分别为98％和93％，治愈率分别为93％和83％，观察组治愈率明显优于对照组（P＜0．05）。实验研究表明，该制剂具有抗炎，抗菌，止痒，镇痛，调节免疫功能的作用，且对粘膜无刺激。结论：洁童阴洗液治疗幼女外阴阴道炎具有良好可靠的疗效，它具有抗炎，抑菌，止痒，镇痛，调节免疫功能的作用，且无明显的不良反应。     

The aetiology of paediatric inflammatory vulvovaginitis

Vulvovaginitis is the most common gynaecological problem in prepubertal girls and clear-cut data on the microbial aetiology of moderate to severe infections are lacking. Many microorganisms have been reported in several studies, but frequently the paediatrician does not know the pathogenic significance of an isolate reported in vaginal specimens of girls with vulvovaginitis. A multicentre study was performed, selecting 74 girls aged 2 to 12 years old with a clinical picture of vulvovaginitis and inflammatory cells on Gram stain. All the specimens were cultured following standard microbiological techniques and the paediatricians completed a questionnaire to highlight risk factors after interviewing the parents or tutors. The data were compared with those obtained in a control group of 11 girls without vulvovaginitis attending a clinic. Streptococcus pyogenes and Haemophilus spp.were isolated in 47 and 12 cases, respectively. Upper respiratory infection in the previous month ( P <0.001) and vulvovaginitis in the previous year ( P <0.05) were identified as significant risk factors. Foreign bodies, sexual abuse, poor hygiene and bad socioeconomic situation were not identified as risk factors for the infection. Conclusion: Paediatric inflammatory vulvovaginitis is mainly caused by pathogens of the upper respiratory tract and the most common risk factor for this infection is to have suffered an upper respiratory tract infection in the previous month.Abbreviations HI Haemophilus influenzae - PIV paediatric inflammatory vulvovaginitis - SP Streptococcus pyogenes On behalf of the Spanish Study Group for Primary Care Infection     

Therapy of pediatric genital diseases

ABSTRACT:  Infants and children have special issues with regard to genital disease. Infants are incontinent, and have an increase in local irritation and infection risk. In addition, the adult sex hormones which enhance the health of genital skin are deficient. Also, the choice of therapy must be modified to take into account the more fragile nature of prepubertal skin, the tolerance of children to painful treatments, and the lack of experience of some medications in children.     

Menopause and the skin

Women live one-third of their lives in the post-menopausal state. Significant hormonal alterations occur at the time of menopause, leading to a range of physiological disorders affecting multiple organ systems in the body. The effects of menopause on the skin have been underresearched. Many skin changes occur at the time of menopause and the cutaneous effects of hormone replacement therapy are significant. Menopausal changes in hormones may alter the biomechanical properties of the skin and certain disorders are more common in menopausal women, such as lichen sclerosus, atrophic vulvovaginitis, flushing and dysaesthetic vulvodynia. Hair and oral changes may also be associated. As the average life expectancy increases, dermatologists need to be familiar with skin diseases affecting women in this age group.     

Group A Streptococcus vulvovaginitis in breastfeeding women

Group A beta-hemolytic streptococcus-associated vulvovaginitis is uncommon in adult women. Clinicians should include group A beta-hemolytic streptococcus as a possible cause of vulvovaginal symptoms in breastfeeding women. Along with appropriate antibiotic therapy, vaginal estrogen therapy may be considered to diminish susceptibility to recurrent infection in women with vaginal atrophy.     

咪康唑栓与克霉唑阴道片单次给药治疗单纯性外阴阴道假丝酵母菌病比较

目的比较咪康唑栓与克霉唑阴道片单次给药治疗单纯性外阴阴道假丝酵母菌病(VVC)的疗效和安全性。方法单纯性VVC患者80例随机分为2组,各40例。试验组采用咪康唑栓1 200 mg阴道给药1次,对照组采用克霉唑阴道片500 mg阴道给药1次,分别于用药前、用药后d 7和用药后d 28～35进行妇科检查、临床症状体征评分、真菌学检查及不良反应评估。结果试验组1例患者失访,对照组2例患者失访,2组共完成有效病例77例。2组患者治疗前瘙痒、疼痛、充血水肿和分泌物增多的症状和体征组间均无显著差异(P>0.05);治疗后d 7及d 28～35与治疗前相比均有显著差异(P<0.05,P<0.01),组间相比均无显著差异(P>0.05)。治疗后d 7,试验组总有效率87%(34/39),对照组总有效率82%(31/38);治疗后d 28～35试验组总有效率95%(37/39),对照组总有效率92%(35/38),组间均无显著差异(P>0.05)。试验组1例患者出现外阴烧灼感,对照组1例患者出现外阴疼痛,症状较     

Fluorometric determination of acid proteinase activity in Candida albicans strains from diabetic patients with vulvovaginal candidiasis

Vulvovaginal candidiasis is one of the most frequent disorders in obstetrics and gynaecology. Approximately three-quarters of all adult women experience at least one episode of vulvovaginal candidiasis during their life span. Diabetes mellitus (DM) increases the rate of vaginal colonisation and infection with Candida species. The secreted acid proteinase might be especially relevant in the pathogenesis of vulvovaginal candidiasis. The aim of this study was to determine the acid proteinase activity in the samples of Candida albicans from diabetic patients with vulvovaginal candidiasis by a fluorometric method. Vaginal swabs were taken from 33 women (aged between 22 and 57 years) having symptoms of vaginitis. Patients were divided into three groups: control group, controlled diabetic group and uncontrolled diabetic group. The proteinase activity in the culture supernatants was determined by a modified fluorometric method. Acid proteinase activities were significantly increased in the uncontrolled diabetic group in comparison with both the control group and the controlled diabetic group (P < 0.05). Acid proteinase may play an important role in C. albicans pathogenesis in diabetic patients. Improving glucose control may reduce the risk of Candida colonisation and potentially symptomatic infection, among women with diabetes and hence may be useful even for weaker enzyme activity measurements.     

Hypersensitivity to aeroallergens in patients with recurrent vulvovaginitis of undetermined etiology

AIM: Recent findings show that the vaginal mucosa can develop an allergic response to environmental allergens and there is a strong association between atopy and some recurrent vulvovaginal infections. In this study, we investigated prospectively the rate of atopy in patients with recurrent vulvovaginitis of undetermined etiology (RVV). MATERIAL AND METHODS: After being investigated by a gynecologist, 35 patients with RVV who were considered as undetermined etiology formed the study group. The control group consisted of 150 healthy females. Study and control groups were investigated for atopy by means of skin prick test for common aeroallergens. Associated allergic disease and familial atopy history of the subjects were recorded. RESULTS: The rate of atopy (11/35; 31.4% vs 9/150; 6%) was significantly higher (P < 0.001) in the study group than in the controls. Familial history of atopy was significantly more frequent in the study group than in the controls (10/35; 28.6% vs 8/150; 5.3%, P < 0.05). RVV in atopics is more associated with seasonal rhinitis than in nonatopics (5/11; 45.4% vs 2/24; 8.3%, P < 0.05). CONCLUSION: We concluded that a significant number of RVV is associated with atopy. Although the exact mechanism(s) of this relationship remains to be investigated atopy might be a causative and/or contributing factor in the pathogenesis of RVV.