Female adnexal tumours of probable Wolffian origin: an immunohistochemical study comparing tumours, mesonephric remnants and paramesonephric derivatives

AIMS: To establish an immunohistochemical profile of presumed female adnexal mesonephric tumours (FATWO) for diagnostic purposes and to compare the findings with those of mesonephric and paramesonephric derivatives in order to establish supportive evidence for a mesonephric origin. METHODS AND RESULTS: Standard immunohistochemistry was performed on formalin-fixed tissues. Tumours, mesonephric remnants and paramesonephric structures generally show positive staining for vimentin, CAM 5.2 and cytokeratins 7 and 19 but are negative for CK20 and 34 beta E12. EMA is positive in both mesonephric and paramesonephric derivatives but is negative in the tumours. Glutathione S-transferase mu (GST mu) is generally positive in both tumours and mesonephric derivatives but negative in paramesonephric structures. CONCLUSIONS: Immunohistochemistry plays little part in the diagnosis of FATWO. The tumours are generally cytokeratin and vimentin-positive and EMA-negative. GST mu, as a marker for the mesonephric duct, is a useful adjunct. Our findings of the study support but do not prove that FATWOs are of mesonephric origin.     

Verrucous squamous cell carcinoma of the female genital tract. Report of three cases and survey of the literature

Three new cases of gynecological verrucous squamous cell carcinomas are reported; one in the uterine cervix, and two in the vulva. The English literature covering the 49 cases reported previously is surveyed with special reference to the diagnostic and therapeutic aspects of these tumors, as well as with their clinical behavior and possible relationship to viral (HPV) lesions (Condylomas) of the genital tract.It was concluded that so far the exact relationship between the different verrucous squamous cell lesions in the genital tract remains obscure, all such lesions should be regarded as potentially malignant, and treated accordingly by radical surgery.     

Recomendaciones para el cribado de enfermedad infecciosa,salud mental y mutilación genital femenina en pacientes inmigrantes atendidos en Atención Primaria

Immigrant health status may be improved if certain health conditions are identified early through the implementation of a screening program. This document presents the recommendations resulting from the Screening in immigrant population project (CRIBMI) aimed at implementing a screening program for infectious diseases (HIV, HBV, HCV, tuberculosis, strongyloidiasis, schistosomiasis and Chagas disease), as well as female genital mutilation and mental health (MH) in migrant population at Primary Care level. Screening recommendations were based on: coming from an endemic country for strongyloidiasis, schistosomiasis, and Chagas diseases; on a threshold level of prevalence for HIV (> 1%), HBV (> 2%), and HCV (> 2%), and on incidence (> 50 cases/100,000-inhabitants) for active tuberculosis in immigrants with < 5 years in Europe. Exploring the risk of FGM is recommended in women from countries where this practice is prevalent. Evaluation of MH status is recommended for people from areas of conflict and violence.     

Sociodemographic factors associated with female genital cutting among women of reproductive age in Nigeria

Objectives: The aims of the study were to determine the prevalence of female genital cutting (FGC) among women of reproductive age in Nigeria and identify the sociodemographic factors associated with the practice.

Methods: A secondary analysis of the 2013 Nigeria Demographic and Health Survey was carried out in 38,948 women of reproductive age (15–49 years).

Results: The prevalence of FGC among respondents was almost 25%, most of whom (82%) had undergone the procedure when they were under 5 years of age. Traditional circumcisers performed 72.2% of all procedures. Type 2 was the common form (62.6%) of FGC. Almost a quarter of respondents (23.1%) wanted the practice to continue. Women aged 45–49 years were approximately twice as likely to have undergone FGC compared with women aged 15–19 years (odds ratio [OR] 2.41; 95% confidence interval [CI] 1.99, 2.92; p?p?p?Conclusions: Our findings have programmatic implications for ending the practice of FGC in Nigeria. Elimination efforts should be intensified among women of Yoruba ethnicity. To instigate behavioural change, communication interventions should particularly target residents in parts of Nigeria other than the North East zone.     

Male genital schwannoma,review of 5 cases

Aim: To study the clinical features of male genital schwannoma. Methods: Five male patients with genital schwannoma admitted from 1991 to 2000 were reviewed. The lesions were located in the prostate, spermatic cord,testis or penis. Tumors were simply resected in 3 patients and radically eradicated in 2. Results: The average age of the cohort was 37 years. The most common sign at presentation was a palpable genital mass accidentally discovered by the patient or detected by the physician during a physical check. Diagnosis was made through postoperative pathological examination. Follow-up ranged from 2 years to 6 years (mean 4.5 years). Four cases were cured by simple excision and 1 patient with malignant testis schwannoma died of recurrence 1 year after surgery. Conclusion:Owing to the lack of characteristic clinical manifestation, the final diagnosis relys on postoperative pathological examination. S-100 and vimentin are useful markers for the diagnosis of these tumors. ( Asian J Andro12003 Sep; 5:251-254)     

腹腔镜对女性内生殖器官发育异常127例诊断与治疗价值

目的 探讨腹腔镜对女性内生殖器官发育异常的诊断及治疗价值。方法 应用腹腔镜诊断技术，回顾性分析127例女性内生殖器官发育异常患者腹腔镜检查的临床资料，根据镜下特点，作出诊断，对性腺／卵巢呈条索状、异位或可疑睾丸、卵睾行镜下活检。部分病人提供合适的手术＋激素替代治疗。结果 对内生殖器发育异常127例行腹腔镜检查，活检46例，镜下手术切除性腺9例，残角子宫切除1例，开腹行子宫整形术5例。临床诊断符合15例，腹腔镜诊断符合122例。腹腔镜诊断符合率96.07%，临床诊断符合率11.81%。经统计学χ^2检验：腹腔镜诊断符合率与临床诊断符合率相比有显著性差异（P＜0.001)。结论 腹腔镜下直视女性内生殖器官发育异常结合活检具有独特的诊断价值，有助于制定治疗方案，为女性生殖器官发育异常的快速、准确诊断开辟了新的途径。     

胎儿磁共振在先天性膈疝患儿预后评估中的应用研究CSCD

目的回顾性分析先天性膈疝患儿产前胎儿磁共振图像,探讨磁共振测量和评价参数与患儿预后的关系,初步探讨胎儿磁共振参数在先天性膈疝患儿预后评估中的应用价值。方法收集西安交通大学第二附属医院2011—2020年胎儿磁共振图像结果,收集诊断为先天性膈疝的50例胎儿磁共振图像,包括左侧膈疝37例,右侧膈疝13例,检测并分析观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线的完整性、肝脏及胃泡位置等与患儿预后的关系。结果50例患儿中,存活35例(为存活组),死亡15例(为死亡组)。胎儿磁共振图像观察-预期肺容积比:存活组比死亡组为(35.09±10.87)比(24.29±6.86);肺肝比:存活组比死亡组为(2.68±1.01)比(1.93±0.93);纵膈移位角:存活组比死亡组为(30.88±7.07)比(39.05±4.21);差异均有统计学意义(P<0.05)。图像分析结果显示,胎儿磁共振肺底基线不完整、肝脏及胃泡位置疝入胸腔患儿的预后较差,差异具有统计学意义(P<0.05)。受试者操作特征曲线分析结果显示,联合应用观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线的完整性、肝脏及胃泡位置等判断患儿预后,较单一参数判断更为准确,差异具有统计学意义(P<0.05)。结论胎儿磁共振观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线完整性、肝脏及胃泡位置均可作为判断先天性膈疝患儿预后的评价指标,联合应用上述六项参数可以更加准确地判断患儿预后,以上述参数为基础构建先天性膈疝的评估体系,有助于先天性膈疝患儿的肺发育评估、体外膜肺氧合的应用判断以及手术方式的选择。     

Maternal infibulation and obstetrical outcome in Djibouti

Objective: The objective of the present study was to assess the relation between female genital mutilation and obstetric outcome in an East African urban clinic with a standardized care, taking into account medical and socioeconomic status.

Methods: This was a cohort study conducted in Djibouti between October 1, 2012 and April 30, 2014. Overall 643 mothers were interviewed and clinically assessed for the presence of female genital mutilation. The prevalence of obstetric complications by infibulation status was included in a multivariate stepwise regression model.

Results: Overall, 29 of 643 women did not have any form of mutilation (4.5%), as opposed to 238 of 643 women with infibulation (37.0%), 369 with type 2 (57.4%), and 7 with type 1 mutilation (1.1%).Women with a severe type of mutilation were more likely to have socio-economic and medical risk factors. After adjustment, the only outcome that was significantly related with infibulation was the presence of meconium-stained amniotic fluid with an odds ratio of 1.58 (1.10–2.27), p value=0.014.

Conclusions: Infibulation was not related with excess perinatal morbidity in this setting with a very high prevalence of female genital mutilation, but future research should concentrate on the relation between infibulation and meconium.     

Úlcera vulvar aguda

Vulvar ulceration can occur as the primary or secondary event in a wide variety of processes: infections, autoimmune and/or inflammatory diseases and dermatoses, neoplasms and entities of unknown etiology. Diagnosis relies on positive criteria: acute onset of one or several deep, large, necrotizing and extremely painful ulcerations in young women, usually virgins, preceded by fever sometimes associated with tonsillitis. Specific microbiological, histological, immunological, and other investigations are often required to establish a diagnosis.     

Minimizing genital tract trauma and related pain following spontaneous vaginal birth

Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in reducing obstetric trauma, and also the role of pelvic floor and general exercise in pelvic floor recovery after childbirth.