Cervical and vaginal pathology in women with vulvar condylomata

All women referred to the Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, for evaluation of vulvar condylomata were reviewed to identify concurrent cervical and vaginal pathology. Over the five-year period 1981-1985, referrals to our colposcopy clinic for vulvar condylomata increased from 7.8% to 29.2%. All patients underwent a thorough history, physical examination and colposcopic evaluation of the cervix, vulva and vagina. Of the patients with vulvar condylomata, 68% had biopsy-proven cervical and vaginal pathology. While 50% of patients with cervical disease had human papillomavirus infection alone, the other 50% had concurrent cervical intraepithelial neoplasia (CIN) or CIN only. Proper evaluation of patients with vulvar condylomata must include colposcopy of the cervix and vagina.     

Human papillomavirus-type predict the clinical outcome of imiquimod therapy for women with vulvar condylomata acuminata

OBJECTIVE: To investigate the effect of determination of human papillomavirus (HPV) subtype on the success of imiquimod therapy in women with vulvar condylomata acuminata. METHODS: A total of 132 women with biopsy-proven vulvar condylomata acuminata were enrolled in this prospective study. HPV DNA detection and determination of genotype were made through polymerase chain reaction (PCR) technique. The women were treated with imiquimod cream 5% in the area of the visible lesions, three times a week at night for 16 weeks. RESULTS: Twelve of the 132 women (9.1%) failed to detect any improvement with this therapy during the 16-week period. However, 80 women (60.6%) experienced total clearance of the lesions, and 20 women (15.2%) observed a partial response. The complete response rates were 76.2% for HPV-6, 66.7% for HPV-11, 35% for HPV-6 plus 11, and 6.3% for unclassified HPV subtypes (other HPV subtypes than HPV 6 and -11). CONCLUSIONS: Topical imiquimod 5% cream is an appropriate treatment modality for HPV-6 or -11 positive vulvar warts.     

Abnormalities of lymphocyte transformations in women with condylomata acuminata

The cellular immunity of 16 women with recalcitrant condylomata acuminata was investigated with an in vitro assay of antigen-induced lymphocyte transformations. Results were compared to those of 24 age-matched controls. Lymphocyte transformation responses (in counts per minute) for women with condylomata were much lower than controls for phytohemagglutinin-P, 32,285 and 60,015, (P less than .001); for concanavallin A, 28,664 and 58,605, (P less than .001); and for pokeweed mitogen, 34,941 and 73,394 (P less than .0001). No significant differences in lymphocyte transformations were noted between the 2 groups to Candida or streptokinase-streptodornase antigens. Immunosuppressive diseases, recurrent infections, and intraepithelial neoplasms of the genital tract were more frequent in the group of women with condylomata, and this seems to clinically substantiate the depressions noted in their in vitro cellular immunity. A refractory course of condyloma acuminatum in some women may be a reflection of an underlying state of immunosuppression.     

Treatment of cervical and vulvar condylomata by co2 laser also with a immunostimulant

Condylomata are of viral origin and are found in increasing frequency. The CO2 laser has contributed significantly to the treatment of this condition with a failure rate approximating 35 p. cent of cases. Two groups of patients with cervical or vulvovaginal condylomata were treated by CO2 laser or by CO2 laser and Isoprinosine. After the initial treatment, there were 31,6 p. cent failures in the group treated only by CO2 laser in patients with cervical condylomata, and 66,3 p. cent failures in those with vulvovaginal condylomata. Following 3 laser treatments, there was a 5,3 p. cent failure rate with the cervical condylomata, and 33,3 p. cent with the vulvovaginal condylomata. In the group treated by CO2 laser and Isoprinosine, there were 6,9 p. cent failures in patients with cervical condylomata and 5,7 p. cent failures in those with vulvovaginal condylomata following the initial treatment. After 3 treatments there were no failures. The combined use of CO2 laser and Isoprinosine reduces significantly the number of recurring condyloma acuminata, and appears to us to be an effective form of treatment.     

The changes of circulating lymphocyte sub-populations in women with preterm labour: a case-controlled study

OBJECTIVE: The aim of this study was to determine the changes in circulating T-cell subpopulations, B cells and natural killer cells in patients with imminent preterm labour. METHODS: Thirty-five pregnant patients with imminent preterm labour and 35 women with uncomplicated pregnancies were included in the study. The gestational ages of the patients ranged from 28 to 36 weeks in both groups. The specific lymphocyte antigens were detected using direct staining with monoclonal antibodies, and analysed by flow cytometry. RESULTS: We observed no significant difference in the mean percentage of T cell subpopulations, natural killer cells and active T cells in the group of patients with preterm labor when compared to controls. The mean percentage of T CD3+ lymphocytes was significantly lower and that of B CD19+ cells higher in the study group when compared to controls. CONCLUSION: The alterations in maternal circulating lymphocyte subpopulations could be associated with the mechanisms mediating preterm labour.     

Photodynamic therapy in vulvar intraepithelial neoplasia

INTRODUCTION: Vulvar intraepithelial neoplasia may lead to vulvar cancer. Vulvar cancer is a rare (accounting for about 2,5-5% of all malignant neoplasms), female genital organs cancer. Photodynamic therapy is a new treatment for a wide variety of malignancies and premalignant dysplasias. We wanted to examine the effectiveness of photodynamic therapy (PDT) on vulvar intraepithelial neoplasia (VIN). DESIGN: The aim of the study was to analyze the effectiveness of photodynamic therapy (PDT) on vulvar intraepithelial neoplasia (VIN). MATERIAL AND METHODS: We have analyzed 20 women with VIN, who were treated in our center - Clinic of Vulvar Diseases. All these women had photodynamic diagnosis (PDD), photodynamic therapy followed (PDT), with 5% ALA applied to the entire vulva. CONCLUSIONS: We have noted the reduction of subjective complaints, but the histopathological improvement was observed in fewer degree.     

CO2-laser therapy in patients with vulvar intraepithelial neoplasia

It is generally accepted to consider vulvar intraepithelial neoplasia grade III (VIN III) a premalignant condition. The lesion is more frequently diagnosed in younger patients. Conventional surgical treatment is often mutilating and recurrence rates have been reported of approximately 30%. Laser vaporization is a promising alternative therapy. Ten patients with VIN III were treated with CO2 laser. Two patients were retreated with laser for residual disease, and two patients for recurrent disease. One failure was observed, and one patient was off-study. In all patients excellent cosmetic results were obtained. Laser vaporization appears to be an effective and nonmutilating therapy, and preferable for young VIN patients.     

Photodynamic therapy of vulvar lichen sclerosus with 5-aminolevulinic acid

Objective: To evaluate the therapeutic effect of photodynamic therapy on vulvar lichen sclerosus.Methods: Twelve women with lichen sclerosus were enrolled in a prospective, single-arm pilot study. Four to 5 hours before photodynamic therapy, 10 mL of a 20% solution of 5-aminolevulinic acid was applied topically to the vulva. Photodynamic therapy was administered with an irradiation of 80 J/cm² at an irradiance of 40–70 mW/cm². Light with a wavelength of 635 nm was delivered by an argon ion–pumped dye laser. The degree of pruritus was evaluated using a horizontal visual analog scale before and after 6–8 weeks, and patients were followed tri-monthly after photodynamic therapy.Results: Two women underwent two cycles of photodynamic therapy, one underwent three cycles, and the remaining nine women underwent one cycle each. Treatment was tolerated moderately well, with eight patients not requiring any analgesia; three treated with opioids intravenously during the procedure, due to burning sensations; and one undergoing separation of adhesions under general anesthesia. Minimal local toxicity included vulvar erythema but no necrosis, sloughing, or scarring. No generalized cutaneous photosensitivity was present. Six to 8 weeks after photodynamic therapy, pruritus significantly improved in ten of the 12 women. A prolonged effect of photodynamic therapy was reported, with a mean of 6.1 months.Conclusion: Photodynamic therapy after topical application of 5-aminolevulinic acid produced statistically significant relief of symptoms of vulvar lichen sclerosus for an average of 6.1 months with minimal side effects.     

Cryotherapy for treatment of genital condylomata during pregnancy

Cryotherapy for treatment of genital condylomata acuminata was safely and successfully employed on 34 pregnant women in the second (4 cases) and third (30 cases) trimesters of pregnancy. No fetal, maternal or neonatal complications occurred during or following cryosurgery. No recurrences were observed before or six weeks following delivery. Cryotherapy eliminated the need for elective cesarean section in many patients with genital condylomata. Cryotherapy can be safely employed on pregnant women on an outpatient basis irrespective of the gestational period.     

Gonadal dysgenesis with vulvar carcinoma.

An unusual case of vulvar carcinoma in a gonadal dysgenesis patient is described. In addition to clinical manifestations, certain laboratory data related to endocrine status were gathered from serum and urine analyses. Finally, receptors for estrogens, progestins, and glucocorticoids were determined on biopsies of the vulvar carcinoma.     

Human lymphoblastoid interferon (Wellferon) in primary therapy of two children with condylomata acuminata

Human lymphoblastoid interferon (Wellferon) was administered parenterally to two prepubertal girls as primary therapy for genital condylomata acuminata. One child probably had contracted the disease as the result of sexual molestation. Both patients experienced minimal side effects during therapy and underwent complete remission within six weeks. These cases support use of interferon as primary therapy in young patients with extensive condylomata and in those who may have contracted the disease as the result of sexual abuse.     

Diagnosis and therapy of dystrophic vulvar diseases

Mainly women in the postmenopause suffer from dystrophic diseases of the vulva which develop in a chronically progressive way. Because of the often very irritating pruritus and the secondary alterations of the skin these diseases are mainly a therapeutical problem which can become very annoying both, the patient and the doctor. In 32 patients, the progressive development of the diseases could be stopped. Very satisfying results could be obtained by a combined treatment of a local testosterone application and the systemic regulation of the metabolism.     

Changes in lymphocyte function during pregnancy.

A gradual increase in spontaneous lymphocyte DNA synthesis was demonstrated in each trimester of pregnancy. Autoradiographic studies indicated that lymphocytes were primarily responsible for this activity. PHA-induced lymphocyte transformation in both fetal calf serum and autologous serum was significantly reduced in the second and third trimesters of pregnancy. Spontaneous lymphocyte DNA synthesis was significantly reduced in patients with mild pre-eclampsia. However, no significant differences were seen in patients with severe pre-eclampsia in the third trimester of pregnancy compared with the normal control subjects. No evidence was adduced to implicate inhibitory humoral factors affecting the peripheral blood lymphocytes in pregnany patients in experiments in which washed lymphocytes were cultured in medium containing heterologous serum. In vitro experiments demonstrated that cortisol, progesterone and HPL caused a significant reduction in lymphocyte DNA synthesis, and HGH and HCG had a variable effect. However, only cortisol was regularly inhibitory at physiological concentrations. The progesterone effect was dose-related, producing 90 per cent inhibition of activity at a concentration of 10 mug/ml. No synergism could be shown between HPL and progesterone on lymphocyte transformation. The increase in activity of circulating immunoreactive cells during pregnancy and its depression with the onset of pre-eclampsia is discussed.     

Results of different forms of therapy in vulvar neoplasms

In this retrospective study 216 patients who have been treated for malignant vulva neoplasms between the years 1968 and 1987 at the Department of Obstetrics and Gynaecology of the University of Kiel are reviewed. Staging according to the Figo-Classification revealed stage I in 13.0%, stage II in 63.0%, stage III in 20.2% and stage IV in 3.8%. During these years treatments applied to these elderly patients often with multimorbidity, aside from the combined treatment according to Berven (27.9%) was in the majority of cases a modified radical treatment (34.1%). The modified radical treatment consisted primarily of simple vulvectomy and tumor excision followed by radiation therapy. Primary radiation therapy was performed in the cases where either local or general noperabilityx was established (29.3%). The 5-years-survival rate of the investigated patients was 31.7%, whereby radical vulvectomy which was performed in a few cases offered the best results. A comparison between the modified radical therapy and the combined therapy according to Berven resulted in equally divided staging groups similar 5-years-survival rates of 39% and 38% respectively. However, the modified radical therapy group demonstrated better results in the first 4 years. Within the modified radical treatment group patients undergoing simple vulvectomy revealed a better survival rate after 3 years than did patients undergoing tumor excision followed by radiation therapy. The long term results of these two modes of modified treatment equal out over 10 years. Therefore, from the results presented we recommend in the case of elderly patients with multimorbidity the modified radical therapy via simple vulvectomy.