妊娠期阴道、宫颈微生态的评价

目的了解妊娠期阴道、宫颈感染状况,探讨妊娠期进行阴道分泌物检测及宫颈分泌物HPV、衣原体检测的临床意义。方法产前门诊常规围产保健孕妇980例（早孕期159例、中孕期612例、晚孕期209例）采集阴道分泌物,测定pH值、涂片常规检查及,宫颈分泌物行杂交捕获试验检测人乳头瘤病毒（HPV）及送微生物室行免疫层析法检测沙眼衣原体抗原。妇科门诊非阴道炎就诊的患者（年龄≤40岁）100例进行相同的检查作为非孕期对照。结果阴道pH值在妊娠期、非孕期分别为3．88±0．20及4．28±0．33,孕期低于非孕期（P〈0．01）。孕期细菌性阴道病（BV）、外阴阴道假丝酵母菌病（VVC）及沙眼衣原体（CT）感染率分别是23．9％、21．5％、22．0％,非孕期三项感染率分别为12．0％、11．0％、6．0％,孕期显著高于非孕期（P〈0．01）。孕期HPV感染率同非妊娠期。无症状体征孕妇中,仍有29．8％存在阴道微生态失调。在HPV阳性孕妇中BV、VVC、CT的患病率分别为48．7％、41．7％、45．2％,HPV阴性组中分别为20．6％、18．8％、19．0％,HPV阳性组BV、VVC、CT患病率明显高于阴性组（均P〈0．01）。结论妊娠期阴道微生态发生改变,表现为pH值降低,微生态失调比例升高,与HPV感染密切相关。     

Reactivity of the limulus lysate assay with uterine cervical secretions. A preliminary evaluation.

A limulus lysate assay was performed on cervical secretions from 66 women. When secretions were tested at a 1/100 dilution the assay gave a positive result in 15 (62.5%) of 24 patients with gonorrhoea confirmed by Gram-stained smear or culture or both. When secretions from seven of the nine remaining patients who had gonorrhoea but negative results to the limulus lysate test were retested at 1/50 dilution, two gave a positive result, increasing the positivity rate of the test to 17 (70.8%) of 24 infected patients. Material from one patient with a history of contact with gonorrhoea and from three (7.3%) of the other 41 patients without any history of gonorrhoea gave positive reactions.     

A link between malignant melanoma and cervical intra-epithelial neoplasia? A preliminary report

The risk of malignant melanoma was found to be six times as great in a group of 805 patients with cervical dysplasia as in case-matched controls. In the latter it was similar to that in the general population. In keeping with this observation a further series of 13,030 women with no record of cervical intra-epithelial neoplasia showed a slightly lower risk than that expected in the general population. Conversely in a small group of women (71) with melanoma the risk of cervical intra-epithelial neoplasia was nine times as great as in the general population; judged on the basis of both case-matched and 'first smear' controls. The possibility of a common risk factor is discussed.     

Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections

OBJECTIVES: To evaluate whether an elevated vaginal leucocyte count in women with bacterial vaginosis (BV) predicts the presence of vaginal or cervical infections, and to assess the relation of vaginal WBC counts to clinical manifestations. METHODS: We retrospectively analysed the relation of vaginal leucocyte counts to vaginal and cervical infections and to clinical manifestations in non-pregnant women diagnosed with BV at an STD clinic visit. RESULTS: Of 296 women with BV studied, the median age was 24 years and 81% were African-American. Elevated vaginal leucocyte counts were associated with objective signs of vaginitis and cervicitis and also predicted candidiasis (OR 7.9, 95% CI 2.2 to 28.9), chlamydia (OR 3.1, 95% CI 1.4 to 6.7), gonorrhoea (OR 2.7, 95% CI 1.3 to 5.4), or trichomoniasis (OR 3.4, 95% CI 1.6 to 7.3). In general, as a screening test for vaginal or cervical infections, vaginal leucocyte count had moderate sensitivities and specificities, low positive predictive values, and high negative predictive values. CONCLUSIONS: An elevated vaginal leucocyte count in women with BV was a strong predictor of vaginal or cervical infections. Vaginal leucocyte quantification may provide an alternative approach to assessing need for empirical therapy for chlamydia and gonorrhoea, particularly in resource-limited high STD risk settings that provide syndromic management.     

Problems and needs of women leprosy patients in Bombay and Goa--a preliminary report.

By studying the status of 151 women leprosy patients (24 from a leprosy asylum and 127 attending urban leprosy centres at Goa and Bombay), it was noticed that a sizeable proportion experienced problems in society ascribable to the disease especially at the initial stages of the disease. However, most of them seemed to have managed to settle well in their families as housewives subsequently. Younger women leprosy patients expressed the need for financial assistance for completing their own education and for starting small scale business. The older women were more interested in educating their children.     

Dilution of botulinum toxin A in lidocaine vs. in normal saline for the treatment of primary axillary hyperhidrosis: a double‐blind,randomized, comparative preliminary study

Background Botulinum toxin A (BTX‐A) is an effective and safe treatment modality for primary axillary hyperhidrosis. However, some patients experience considerable pain during injections. Design Dilution of botulinum toxin A in lidocaine vs. in normal saline for the treatment of primary axillary hyperhidrosis: a double‐blind, randomized, comparative preliminary study. Objective The aim of this study was to compare the efficacy, safety and pain tolerance of lidocaine‐diluted BTX‐A vs. saline‐diluted BTX‐A for the treatment of axillary hyperhidrosis. Methods Eight patients were injected with 50 U of BTX‐A diluted in 0.5 mL of saline and 1 mL of 2% lidocaine into one axilla and 50 U of BTX‐A diluted in 1.5 mL of saline into the other axilla in a randomized fashion. The pain associated with the injections were self‐assessed by the subjects using a 100‐mm visual analogue scale (VAS). Results Lidocaine‐diluted BTX‐A and saline‐diluted BTX‐A were similarly effective regarding the reduction in sweat production, the onset of sweat cessation and the duration of hypo/anhidrosis. Nevertheless, the pain VAS score during the injections was significantly lower in the axilla treated with lidocaine‐diluted BTX‐A than the one treated with saline‐diluted toxin. Limitations Preliminary study due to relatively small sample size. Conclusion Botulinum toxin A diluted in lidocaine causes significantly less pain than BTX‐A diluted in saline, whereas it is is equally effective and safe as the latter one in treating axillary hyperhidrosis. Therefore, we suggest that lidocaine‐diluted BTX‐A may be a better treatment option for the patients with primary axillary hyperhidrosis.     

Comparison of vaginal flora after treatment with a clotrimazole 500 mg vaginal pessary or a fluconazole 150 mg capsule for vaginal candidosis.

The effect of antifungal therapy on the vaginal microbial flora was studied in 23 patients suffering from culture-positive, symptomatic vaginal candidosis. They were randomly allocated to receive either a 500 mg clotrimazole vaginal pessary or a 150 mg fluconazole capsule. Quantitative microbiological examination was carried out on samples of vaginal secretions obtained prior, and at intervals up to 10 days after, treatment. No significant difference was found in the vaginal flora before or after therapy in individual patients or between the treatment groups. In patients with C glabrata or C krusei, the yeasts persisted longer in the vagina with poorer response to either of the medications.     

A comparison of cervical and vaginal human papillomavirus

OBJECTIVES: We wanted to compare detection of a broad spectrum of human papillomavirus (HPV) types detected in cellular specimens from the vagina and cervix, which could provide information about the potential of each anatomical site for harboring infection. Previous studies have failed to present data on or detect a broad spectrum of HPV genotypes and/or have not carefully sampled the vagina, instead relying on self-collection that is likely contaminated with cervical cells. STUDY DESIGN: We conducted follow-up study of 353 women who had participated in study of HPV and cervical neoplasia in Costa Rica. We collected paired cervical and vaginal specimens; vaginal specimens were collected from the fornix to minimize cervical contamination. Specimens were tested in a masked fashion for >40 HPV types using a MY09/MY11 PCR method and type-specific dot blot hybridization. RESULTS: The prevalence for any carcinogenic HPV type in vaginal and cervical specimens was similar (P = 0.3). However, the prevalence for any HPV type in vaginal specimens was greater than in cervical specimens (P = 0.0002), primarily due to a twofold increased vaginal prevalence of HPV types of the alpha3/alpha15 phylogenetic species (e.g., HPV61) (P <0.00005). CONCLUSIONS: Carcinogenic HPV types appeared to have a similar affinity for vaginal and cervical epithelium, but noncarcinogenic HPV types of the alpha3/alpha15 phylogenetic species may have a tropism for vaginal epithelium.     

A study of palmo-plantar lesions in leprosy: a preliminary report

Out of 500 leprosy patients screened for palmar and/or plantar lesions, eighteen cases were detected. They were classified according to Ridley-Jopling classification. In majority of cases it was macular lesion. Cases were from TT, BT and BB group. In 50% cases, palmo-plantar involvement was associated with type I reaction. In 66.7% cases, it was extension of patch from surrounding area, 11.1% cases isolated lesions were seen and in 22.2% cases both extension as well as isolated lesions were present.     

Efficacy of co-trimoxazole in Donovanosis. A preliminary report.

Co-trimoxazole (Septrin, Wellcome) was prescribed in a dose of two tablets twice daily for the treatment of 10 patients with Donovanosis. All the patients responded well to this treatment, and the ulcers healed completely within 10 days in eight patients and within 14 days in the remaining two. Ten days' treatment with 40 tablets of co-trimoxazole is suggested as sufficient to treat Donovanosis. No adverse reactions were noted in any patient.     

Prevalence of atopy in vitiligo. A preliminary report

59 patients suffering from vitiligo were investigated anamnestically and clinically with intradermal (prick tests) and laboratory tests (RAST and total IgE count) for the presence of atopy. Clinical manifestations (allergic rhinitis, asthma) and intense positive prick tests and RAST with an increase in total IgE count were found in 13 patients (22%). This frequency was significantly higher than that found in the normal population in our area (11.9%; p = 0.0212). These patients had a significantly higher incidence of vitiligo in their families (76.9 vs. 29.7% of the non-atopic; p less than 0.025), an earlier onset (14.1 vs. 24 years of the nonatopic) and a rapid worsening of the disease.     

Vaginal chemoprophylaxis in the reduction of reinfection in women with gonorrhoea. Clinical evaluation of the effectiveness of a vaginal contraceptive.

A clinical investigation was undertaken to determine if chemoprophylaxis in the form of a contraceptive pessary would reduce the rate of reinfection with gonorrhoea in 1245 female patients attending a venereal disease clinic. After the introduction of the pessary the reinfection rate over a 16-week period was 19% compared with 40% in the control clinic patients. It was also found that women could be motivated to use a pessary; 65% of women used pessaries before sexual intercourse at least some of the time. High reinfection rates in venereal disease clinic patients emphasise the need for improved methods of preventing reinfection. Vaginal chemoprophylaxis appears to be an alternative means of reducing gonorrhoea morbidity.     

Low prevalence of cervical infections in women with vaginal discharge in west Africa: implications for syndromic management

OBJECTIVES: To measure prevalence and risk factors for cervical infections among a large sample of women consulting for vaginal discharge in west Africa and to evaluate its syndromic management through a two visit algorithm. METHODS: In 11 health centres in Bénin, Burkina Faso, Ghana, Guinée, and Mali 726 women who presented with a vaginal discharge without abdominal pain and who denied being a sex worker (SW) were enrolled. Cervical samples were tested for the detection of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with polymerase chain reaction (PCR) assays. All participants were treated with single dose (2 g) metronidazole and clotrimazole cream for 3 days. They were randomised to be told either to come back on day 7 only if there was no improvement in the discharge (group A), or to come back on day 7 regardless of response to treatment (group B). RESULTS: Overall, the prevalence of NG and CT was only 1.9% (14/726) and 3.2% (23/726) respectively. Risk factors previously recommended by the WHO were not associated with the presence of cervical infection, with the exception of the number of sex partners in the past 3 months. When taken together, these risk factors had a positive predictive value of only 6.4% to identify cervical infections. Prevalence of cervical infection was not higher in women who came back on day 7, regardless of the strategy used. Prevalence of NG/CT was lower in Ghana and Bénin (5/280, 1.8%), where comprehensive interventions for SW have been ongoing for years, than in the three other countries (27/446, 6.1%, p = 0.01). CONCLUSIONS: NG and CT infections are uncommon in west African women who consult for vaginal discharge and who are not SW. Syndromic management of vaginal discharge should focus on the proper management of vaginitis. The control of gonococcal and chlamydial infection should be redesigned around interventions focusing on sex workers.