Helena Giraldo

Prevalence of anal squamous intra-epithelial lesion in women presenting genital squamous intra-epithelial lesion

OBJECTIVE To determine the frequency of anal squamous intra-epithelial lesions (ASIL) in women with genital squamous intra-epithelial lesions (GSIL). STUDY DESIGN In a cross sectional study, 184 patients with histopathological diagnosis of GSIL and 76 controls without GSIL, were submitted to anuscopy in order to determine the presence of ASIL. All the women were HIV-negative with anal aceto-white lesions were biopsed for histological diagnosis. RESULTS The frequency of ASIL was 17.4% in the GSIL group (3.2% high grade ASIL) and only 2.6% in the control group (0% high grade ASIL) (p<0.001). All the high grade ASIL diagnoses were found in women with cervical SIL. CONCLUSION Women presenting GSIL have high prevalence of ASIL.

Influência da freqüência de coitos vaginais e da prática de duchas higiênicas sobre o equilíbrio da microbiota vaginal

PURPOSE: to verify if the high frequency of vaginal intercourses and the use of doushing interferes with vaginal microbiota. METHODS: ninety-seven women were examined at a health center located in the prostitution area of the city of Campinas, and evaluated in a prospective cross-sectional study. Anamnesis determined the frequency of vaginal intercourse and the use of douching in the 44 sex professionals and 53 non-professionals studied. The vaginal content was collected with a sterile Dacron swab, from the right vaginal wall, and placed on to two glass laminas. The vaginal microbiota smear stained by the Gram technique was studied with light microcopy using immersion lens and the data were analyzed. The sex professionals and non-professionals presented mean age of 24.9±6.4 and 31.5±9.7, habit of smoking in 52.2 and 24.5%, the use of vaginal lubricants in 56.8 and 0%, and the use of condoms in 100 and 41.5% of the cases, respectively. RESULTS: only 1.8% of the women in the control group had seven or more sexual intercourses per week, contrasting evidently with the sex professionals (97.7%). There were no significant differences regarding race, educational level and number of pregnancies. Bacterial vaginosis and abnormal vaginal flora were more observed in sex professionals (p=0.02 and 0.001) and were associated with the high frequency (seven times or more) of weekly vaginal intercourses (p=0.04 and 0.001). Cytolytic vaginosis was more related to non-professionals (p=0.04) and to a lower frequency of sexual intercourses (p=0.04). The use of doushing was more common in the sex professionals (p=0.002). However, this practice was not associated either with the vaginal microbiota problems or with the presence of vulvovaginitis. CONCLUSIONS: sex professionals with seven or more sexual intercourses per week presented a higher frequency of bacterial vaginosis and abnormal vaginal flora. The doushing habit did not interfere with the vaginal environment ecosystem of the studied women.

Deep infiltrating endometriosis treatment with dienogest: a pilot study

Background The aim of this study was to evaluate treatment with dienogest in women with deep infiltrating endometriosis (DIE). Methods A prospective cohort study was conducted at the Department of Gynecology and Obstetrics in the University of Campinas (UNICAMP), Brazil. The study included 16 women with DIE and pain which was not responsive to treatment with other progestins, who were treated with dienogest, and who attend a tertiary university hospital in 2013. Scores for pain complaints, quality of life, sexuality and extent of endometriotic lesions were evaluated before and 6 months after treatment. Statistical methods included the Wilcoxon matched-pairs test, which was used for the analysis of the quantitative data, and the relationship between them was tested by the Spearman correlation index. Results Women were a mean 36 ± 6.2 years old and reported onset of painful symptoms at a mean 29.9 ± 8.6 years of age. A significant reduction in dysmenorrhea, acyclic pelvic pain, dyspareunia and defecation pain was reported after treatment. There was no significant change in the assessment of quality of life or the Female Sexual Function Index. Intestinal lesions, which had an initial 3.4 ± 4.2 cc average size, decreased to 1.6 ± 1.8 cc, but this reduction was not statistically significant. The most common side effects were headaches and acne. Conclusions Dienogest can be used for clinical pain control in DIE.

Mammographic breast density in women with premature ovarian failure: a prospective analysis.

ObjectiveThis study aims to compare breast density between two mammograms in women with premature ovarian failure (POF). MethodsA cohort study evaluated 56 women with POF. Two mammograms performed at least 2 years apart were analyzed. Mammogram films were digitalized, and images were assessed using a computer-assisted method; the percentage of breast image that is radiologically dense is referred to as the percentage of mammographic density (PMD). Age at menarche, age at onset of POF, length of POF, length of estrogen-progestin therapy (EPT), body mass index (BMI), pregnancy, and age at the time of each mammogram were evaluated. ResultsThe mean (SD) age at POF diagnosis was 32.35 (5.95) years. In the first mammogram, the mean (SD) age, BMI, and length of POF were 37.58 (3.72) years, 26.79 (4.86) kg/m2, and 5.25 (4.61) years, respectively. EPT had been used for a mean (SD) of 2.71 (3.12) years. In the second mammogram, the mean (SD) age, BMI, and length of POF were 43.23 (4.98) years, 27.6 (5.39) kg/m2, and 10.5 (5.11) years, respectively. EPT had been used for a mean (SD) of 7.25 (4.6) years. The mean (SD) interval between mammograms was 5.25 (3) years, and the mean (SD) PMD decreased from 27.78% (21.04%) to 17.53% (15.71%) (P = 0.007). Comparing PMD between women taking EPT and those not taking EPT, we observed no significant differences. In both instances, multiparous women had lower PMD than nulliparous women (P < 0.05). BMI, length of POF, and pregnancy were negatively correlated with PMD. ConclusionsBreast density in young women with POF decreases across a period of 5 years, regardless of EPT use. Further studies may elucidate how this result will correlate with decision-making in clinical therapeutics and breast cancer risk in POF.

Nodular vulvar herpes in an HIV‐positive woman

Article history:Received 29 May 2009Received in revised form 17 June 2009Accepted 2 July 2009Keywords:HerpesHIVVulva⁎ Corresponding author. Tenente Benevolo st., 1560 – 202, Meireles, 60160-041,Fortaleza, Brazil. Tel.: +55 85 32530100.E-mail address: prof.eleuterio@gmail.com (J. Eleuterio).Fig. 1. Soft noninfiltrative exophytic lesion seen on the left labium majus in a HIV-infected woman.

Actinomyces-like organisms from a vaginal granuloma following intravaginal slingplasty with polypropylene mesh.

a Division of Genital Tract Pathology and Colposcopy, Universidade Federal do Ceara (UFC) , Fortaleza, Brazil b Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, Sao Paulo, Brazil c Division of Surgical Pathology and Molecular Biology, Laboratory Prof. Eleuterio da Costa (LABPEC), Fortaleza, Brazil d Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil e Jundiai Faculty of Medicine, Sao Paulo, Brazil

A systematic review of the effect of daily panty liner use on the vulvovaginal environment

Whether panty liners predispose to vulvovaginitis is unclear.

Standard hormone therapy is inadequate for bone density in premature ovarian insufficiency.

Abstract To assess standard dose hormone therapy (HT) and bone mass in premature ovarian insufficiency (POI), 239 women with POI, 132 using standard estrogen dose HT and 107 women without HT, were evaluated. All underwent bone mineral density (BMD) evaluation in the lumbar spine (LS) and total femur (TF). Mean age, age at last period and body mass index (BMI) for the untreated and for the HT groups were 38.1 ± 6.1 and 36.8 ± 7.3 years; 31.4 ± 7.3 and 30.7 ± 7.2 years; 26.6 ± 7.1 and 25.8 ± 4.6 kg/m2, respectively, (p=NS). The women taking standard dose HT started treatment at the age of 33.8 ± 6.3 years and had been on hormone treatment for 3 years at the time of the bone densitometry examination. The BMD in LS was 1.06 ± 0.15 and 1.00 ± 0.17 g/cm2 (p = 0.003); the BMD in TF was 0.92 ± 0.19 and 0.91 ± 0.13 g/cm2 (p = 0.039), respectively, for the untreated and HT groups. A 45% altered BMD (osteopenia/osteoporosis) in LS was verified in women without treatment and 60.1% in those using the standard dose TH (p = 0.01). The BMD in TF was altered in 32.3% in those without HT and 36.4% in the HT users (p = 0.34). In conclusion, standard dose HT was not adequate to reduce impaired bone mass in the spine and femur of women with POI.

Vulvar calcinosis in childhood

endoscopic placement of a gastric tube. A CT scan showed progressive dilatation of the small bowel and a target-shaped lesion that suggested proximal ileum intussusception. The patient underwent exploratory surgery owing to a lack of alternatives and her positive performance status. The findings included dilated loops of small bowel, bulky mesenteric lymphadenopathy, liver and peritoneal studding. The intussusception was located 90 cm proximal to the ileocecal junction and involved 25 cm of ileum. A 3×3 cm tumor mass was palpated at the lead point (Fig. 1). Normal anatomy of the small bowel was restored, 60 cm was resected, and an endileostomy was created. The patient was discharged 7 days postoperatively, but died of her cancer 40 days later following 2 further chemotherapy cycles. Most authors recommend surgical intervention for adult intussusceptions. If the small bowel has intussuscepted, initial reduction of viable bowel is recommended to salvage as much bowel as possible for nutritional purposes [3]. Other gynecologic malignancies reported to be associated with intussusceptions secondary to metastasis include 2 cases of choriocarcinoma, 1 uterine leiomyosarcoma, and 1 case of endometrial carcinoma. Intussusception is uncommon in adults with gynecologic malignancies but should be considered in the differential diagnosis of patients with metastatic diseases presenting with persistent small bowel obstructions.