Biomedical subjects
G Dennerstein
Publications and source records attributed to G Dennerstein.
Vulvar vestibulitis syndrome.
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Pathogenesis and treatment of genital candidiasis.
BACKGROUND: Genital candidiasis is the most common gynaecological infection and has the potential to produce considerable long-term sequelae especially with regard to sexual health. OBJECTIVE: The implications of the relatively higher levels of oestrogen found in women with genital candidiasis will be explored with particular regard to management of the infection. DISCUSSION: Genital candidiasis occurs commonly in otherwise healthy women with no identifiable predisposing factors other than oestrogen levels above those found in the proliferative phase of the ovarian cycle. Coming to an understanding of the pathophysiology of this clinical infection has important therapeutic implications.
Re: Ultrasound guided aspiration of ovarian cysts.
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Audit of 114 non-neoplastic vulvar biopsies.
OBJECTIVE: The purpose of this study was to show the benefits and limitations of vulvar biopsy in the setting of a multidisciplinary clinic specialising in non-neoplastic diseases of the vagina and vulva. DESIGN: One hundred and fourteen vulvar biopsies were reviewed and classified according to the classification of the International Society for the Study of Vulvar Diseases. RESULTS: The histological diagnoses were lichen sclerosus 25%, lichen simplex chronicus 35%, non-erosive inflammatory dermatoses comprising psoriasis, spongiotic dermatitis, dermatophytosis and psoriasiform dermatitis 13%, erosive vulvitis and lichen planus 9%, nonspecific inflammation 6%, miscellaneous 9% and normal 4%. CONCLUSIONS: Biopsies in cases of lichen sclerosus were useful for confirmation of clinical diagnosis and to exclude early invasive malignancy. In lichen simplex chronicus, biopsies helped exclude an underlying dermatosis requiring specific treatment. Psoriasis, spongiotic dermatitis, dermatophytosis and excoriated lichen simplex chronicus posed a common clinical differential diagnosis of the reddened vulva. The eroded vulva often proved a diagnostic problem clinically and histologically. The clinical syndrome of vestibulitis did not have a specific histological picture, and biopsies showed nonspecific inflammation, mild hyperplasia or were normal. No case of squamous cell hyperplasia was diagnosed and the place of this diagnosis in the ISSVD classification needs review.
Angiolymphoid hyperplasia with eosinophilia of the vulva.
Vulvar angiolymphoid hyperplasia with eosinophilia is a rare benign itchy vascular lesion that, because of its nonspecific clinical features, requires biopsy for accurate diagnosis. Surgical excision is the preferred method of treatment.
Vulvitis circumscripta plasmacellularis. A clinicopathologic entity?
Four cases of vulvitis circumscripta plasmacellularis (plasma cell vulvitis) are presented. One case was associated with cutaneous lupus erythematosus and another with a history of desquamative vaginitis. Two patients were postmenopausal, and two were premenopausal. The presenting symptoms were pruritus, tenderness, superficial dyspareunia and vulvar dysuria. The lesions were situated in the introitus in three patients and on the lateral aspect of the labium minus in the fourth and appeared as well-circumscribed, glistening, erythematous patches with a faint orange hue. Histologically, epidermal edema and inflammation, a dense upper dermal band of chronic inflammatory cells, including many plasma cells, dilated capillaries, extravasated red blood cells and hemosiderin deposition, were seen. There was a variable response to local steroid therapy, but one of the postmenopausal patients responded to local estrogen alone. The term vulvitis circumscripta plasmacellularis is useful to describe an idiopathic form of erosive vulvitis with a characteristic clinical and histologic appearance.
Caudal analgesia by the obstetrician.
The results of 670 consecutive caudal blocks performed by the author for operative obstetrics over 20 years is reported. There was no morbidity attributable to the technique. Satisfactory analgesia was not achieved in 83 patients and obesity was not a major cause of failure. The causes of these failures are discussed. It is recommended that caudal analgesia continues to be used for operative vaginal obstetrics.
Depo-provera. A lesson in communication.
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Management of recurrent vaginitis.
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Effective treatment of vaginitis.
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A controlled intrauterine contraceptive device trial.
Three intrauterine contraceptive devices (IUCD) the Lippes Loop, the Dalkon Shield and the Inhiband, were prospectively compared after their random allocation to patients. Over a 12-month period after insertion, the Dalkon Shield was shown to be significantly superior to the Inhiband. Significant differences were not demonstrated between Shield and Loop or Loop and Inhiband in the duuration of this trial. It is submitted that the methodology detailed could, and probably should be used for future IUCD assessments.