摘要:

Background: In treating women with chronic fungal infections, it is important to know which organism is responsible for the infection. In the past, organisms thought to cause vaginitis and vulvitis could all be cultured on modified Sabouraud agar.Case: We describe a case of a woman whose chronic fungal vulvar folliculitis masqueraded as squamous epithelial hyperplasia. The 46-year-old woman, taking immunosuppressive therapy for rheumatoid arthritis, was referred with an 8-month history of vulvar vesicles, itching, and burning. Her examination revealed a vulvar folliculitis. When fungal cultures were initially negative, a vulvar biopsy revealed a squamous epithelial hyperplasia. However, a fungal culture covered with sterile olive oil eventually grew Malassezia furfur, a yeast with peculiar growth requirements. She was cured with a 2-week course of fluconazole.Conclusion: Malassezia furfur, an organism rarely described in the vaginitis literature, can cause vulvar folliculitis in a patient on immunosuppressive therapy.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: CD4+ T-lymphocytopenia immunodeficiency without human immunodeficiency virus (HIV) infection has been reported recently. The association between immunodeficiency and anogenital neoplasia secondary to human papillomavirus infections is well documented.Case: A woman with recurrent vulvar intraepithelial neoplasia (VIN) had idiopathic CD4+ T-lymphocytopenia without HIV infection.Conclusion: Human papillomavirus-related VIN may be associated with idiopathic CD4+ T-lymphocytopenia.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Intraperitoneal chemotherapy is an established treatment for abdominal and pelvic malignancies. Several catheter-related complications have been reported. We report a case of abnormal distribution of intraperitoneal chemotherapy into the pleural cavity.Case: A patient receiving intraperitoneal cisplatin developed shortness of breath. A pleural effusion was diagnosed and was evacuated by thoracentesis. Abnormal distribution of instilled fluid was responsible for her distress.Conclusion: Communications exist between the peritoneal and pleural cavities. The use of intraperitoneal chemotherapy or radioactive material may lead to respiratory complications if abnormal distribution occurs.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Increased attention has been focused recently on the estrogenic effects of tamoxifen. Review of the literature reveals an association between tamoxifen use and gynecologic umors.Case: A 52-year-old postmenopausal woman was treated with tamoxifen for stage II estrogen receptor-positive breast carcinoma. Her aspartate transaminase and alanine transaminase levels increased markedly after 6 months of tamoxifen use. After an additional 17 months of elevated serum transaminases, the patient was found to have a stage Icgranulosa cell tumor of the ovary.Conclusion: Patients with tamoxifen-induced liver dysfunction may be at increased risk for granulosa cell tumors because of alterations in tamoxifen metabolism.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: The growing teratoma syndrome has been described with regard to gonadal and extragonadal germ cell neoplasms in males, but few cases have been reported in the female population. In this condition, masses that enlarge during or after chemotherapy are found to contain mature teratoma without malignant elements.Cases: Three patients had either persistent or growing masses despite chemotherapy for germ cell malignancies of the ovary. All cases fit the description of the growing teratoma syndrome. The patients were aged 20–22 years. All three patients had immature teratomas before chemotherapy. The stages of disease ranged from la to IIIc. All patients had normal tumor markers while their masses showed growth or persistence. All were free of disease 6–31 months after diagnosis.Conclusion: Growth or persistence of a tumor after chemotherapy for malignant teratoma does not necessarily imply progression of malignancy, especially if tumor markers are normal. However, these masses should be resected because they may cause obstruction, compression, or displacement of adjacent organs, or undergo sarcomatous degeneration.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Although the association between large uterine fibromyomas and secondary polycythemia has been described previously, the mechanism has not been elucidated definitively. Investigators have measured erythropoietin levels in fibromyomas to determine whether these tumors are causing the polycythemia by erythropoietin overproduction; however, these studies were performed before the availability of recombinant erythropoietin assays.Case: A 59-year-old woman presented with a 3-year history of polycythemia. Pelvic examination revealed a large lower abdominal mass. Laboratory evaluation revealed a hemoglobin of 20.8 g/dL, red blood cell mass of 3300 mL, oxygen pressure of 58 mmHg with an oxygen saturation of 89%, and erythropoietin level of 18 mU/mL. Cardiac echocardiogram showed no evidence of shunt. Computed tomography scan of the abdomen showed a large mass arising in the pelvis and compressing both ureters. The patient was treated surgically with a total abdominal hysterectomy. Pathology confirmed a uterine leiomyoma weighing 2320 g. Two months post-surgery, the patient was asymptomatic with a hemoglobin of 13.9 g/dL and erythropoietin level less than 4.0 mU/mL.Conclusion: This case provides evidence for three of the postulated mechanisms by which uterine fibromyomas may cause polycythemia. First, the patient was hypoxic, suggesting shunting within the tumor. Second, the leiomyoma was compressing the ureters, so the kidneys may have been inappropriately producing excess erythropoietin. Third, the tumor itself may have been producing the erythropoietin. In any case, the erythropoietin level in this patient was inappropriately high, providing useful evidence that her polycythemia was secondary to her fibromyoma.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Benign glandular inclusion cysts occurring within lymph nodes have been well described in the literature. However, the malignant potential of these glands is unknown. One previous case report described an adenoacanthoma arising within one of these glands.Case: A 65-year-old woman was previously diagnosed with papillary serous cystadenocarcinoma in the inguinal and pelvic lymph nodes. She had no tumor involving the ovaries or peritoneal surfaces at the time of initial diagnosis. She presented to us 9 years later with a recurrence of this tumor in the obturator fossa and along the vaginal sidewall. Treatment consisted of surgery, radiation, and chemotherapy.Conclusion: Although rare, mullerian tumors can occur in the lymph nodes without simultaneous ovarian or peritoneal involvement, and most likely arise de novo within lymph node inclusion cysts.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Tamoxifen, a widely used drug in adjuvant therapy of breast carcinoma, is now being tested for its effectiveness in chemoprevention. Although its side effects are few, tamoxifen increases the incidence of proliferative lesions of the endometrium, which theoretically should be preventable with progestational agents.Cases: Two postmenopausal women treated with tamoxifen and progestational agents for breast carcinoma developed uterine enlargement and intermittent spotting. Hysterectomy revealed benign endometrial megapolyps with marked stromal decidualization and edema.Conclusions: The value of multihormonal therapy in breast carcinoma is not established, and the addition of progestogens to tamoxifen may not reduce the risk of developing endometrial lesions, including carcinoma. In both our cases, such a regimen did not prevent the occurrence of endometrial polyps which, although histologically benign, were unusually large and thought clinically to be malignant. Periodic gynecologic assessment should be part of the follow-up of all women on long-term tamoxifen therapy.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To gather, synthesize, and present useful scientific information concerning the anal continence mechanism that will aid obstetrician-gynecologists in managing vaginal birth and evaluating women with anal incontinence not caused by disruption of the external anal sphincter.Data sources: Sources included a Medline search and reference lists of relevant research articles and standard textbooks.Methods of study selection: Articles were identified that contained scientific data on the pathophysiology of anal incontinence, the influence of vaginal delivery on the continence mechanism, and therapeutic measures. Only those presenting original research results were included. Studies concerned exclusively with surgical management of the ruptured perineum were excluded.Data extraction and synthesis: All articles were reviewed and the physiologic data summarized. These findings were grouped by their relevance to each anatomical or physiologic issue involving anal incontinence and by whether they considered the issue of injury at the time of vaginal delivery. The data were then assembled into a functionally oriented overview of the continence mechanism. The subject of injury at the time of vaginal delivery was considered separately against a background of continence pathophysiology. Conclusion: Vaginal delivery may initiate damage to the continence mechanism by direct injury to the pelvic floor muscles, damage to their motor innervation, or both. Additional denervation may occur with aging, resulting in a functional disability many years after the initial trauma. These factors should be kept in mind when conducting vaginal birth and planning therapy for anal incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID