Michael Deutsch

Vulvar vestibulitis severity—assessment by sensory and pain testing modalities

&NA; Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre‐menopausal women. Previous quantitative sensory test (QST) studies have demonstrated reduced vestibular pain thresholds in these patients. Here we try to find whether QST findings correlate to disease severity. Thirty‐five vestibulitis patients, 17 with moderate and 18 with severe disorder, were compared to 22 age matched control women. Tactile and pain thresholds for mechanical pressure and thermal pain were measured at the posterior fourcette. Magnitude estimation of supra‐threshold painful stimuli were obtained for mechanical and thermal stimuli, the latter were of tonic and phasic types. Pain thresholds were lower and supra‐threshold magnitude estimations were higher in VVS patients, in agreement with disease severity. Cut‐off points were defined for results of each test, discriminating between moderate VVS, severe VVS and healthy controls, and allowing calculation of sensitivity and specificity of the various tests. Our findings show that the best discriminative test was mechanical pain threshold obtained by a simple custom made ‘spring pressure device’. This test had the highest &kgr; value (0.82), predicting correctly 88% of all VVS cases and 100% of the severe VVS cases. Supra‐threshold pain magnitude estimation for tonic heat stimulation also had a high &kgr; value (0.73) predicting correctly 82% overall with a 100% correct diagnosis of the control group. QST techniques, both threshold and supra‐threshold measurements, seem to be capable of discriminating level of severity of this clinical pain syndrome.

Metastatic brain tumor following negative second-look operation for ovarian carcinoma

Three patients with stage III ovarian cancer had brain metastases following aggressive chemotherapy with Platinol and Adriamycin, and negative second-look surgery. The possibility of brain metastasis following complete control of intraperitoneal ovarian disease should be considered in patients with neurological symptoms.

A life-threatening event: uterine cervical arteriovenous malformation.

BACKGROUND: Uterine cervical arteriovenous malformation is a rare cause of vaginal bleeding. CASE: A 32-year-old multigravida presented with severe vaginal bleeding originating in the cervix, which resulted in a hypovolemic shock. Attempts to control the bleeding included hysterectomy, pelvic arterial embolization, and upper vaginectomy. Each proved unsuccessful. Histopathologic examination revealed an arteriovenous malformation. Despite local packing, suturing of the vault area, and brachytherapy to the vaginal vault, bleeding persisted. Treatment with GnRH agonist and tranexamic acid stopped the bleeding. CONCLUSION: Severe vaginal bleeding can be the result of cervical arteriovenous malformation, and GnRH agonist may be used for treatment.

Early diagnosis of proximal femoral deficiency.

A case of proximal femoral deficiency in a fetus, associated with ventriculomegaly and oligohydramnios is described. Vaginal ultrasonographic diagnosis was made in the 14th week of gestation in a 37-year-old asthmatic woman. Ultrasonic follow-up until termination of pregnancy in the 20th week of gestation was performed. The importance of early diagnosis and the possible roles of oligohydramnios and antiasthmatic medications are discussed.

Increased Alpha-Fetoprotein Levels in Mixed Mesodermal Tumor of the Ovary

2 Cases of mixed mesodermal tumor of the ovary with elevated peripheral levels of alpha-fetoprotein (alpha-FP) were studied. The morphology of these tumors is presented. The finding of hyaline droplets of alpha-FP is of special interest. The histogenesis of the tumor was reappraised in light of the increased level of the marker.

Acute Urinary Retention Secondary to Uterus didelphys with Imperforate Vagina

Cyclic dysmenorrhea, unilateral abdominopelvic mass, acute urinary retention and renal agenesis ipsilateral to the pelvic mass in a young woman suggest uterus didelphys with unilaterally imperforate vagina.

Successful Surgical Management of a Severe Case of Starch Peritonitis

A severe case of starch peritonitis is presented where surgical intervention and resection of the major granuloma abruptly improved the patients condition. The theoretical basis of the syndrome and the treatment are discussed.

Recurrent ascites due to oral contraceptives and pregnancy.

BACKGROUND: Ascites during pregnancy is a rare disorder with wide differential diagnosis. CASE: We report on 8 years of follow-up of a patient suffering from recurrent episodes of ascites following oral contraceptive use and during both her pregnancies. Each ascitic event resulted in spontaneous recovery. CONCLUSION: The mechanism underlying our patient’s fluid shift remains an enigma. We hypothesize that during her pregnancy and when oral contraceptives were administered, high levels of endogenous or exogenous sex hormones led to increased permeability and fluid displacement.

Hyperplastic and atypical changes in adenomyosis coexisting with endometrial adenocarcinoma

SummaryPremalignant and malignant changes in 35 cases of adenomyosis among 80 patients with adenocarcinoma of the endometrium were studied. Premalignant changes in adenomyosis were detected ranging from mild hyperplasia (four cases) to moderate hyperplasia (eight cases), atypical hyperplasia (six cases) and carcinoma in situ (three cases). Three cases showed invasion of adenomyosis by adenocarcinoma.Most histological changes in adenomyosis were seen in stage I, grade I and in cases where endometrial carcinoma invaded the myornetriurn up to one third of its depth.