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Pediatric vulvovaginitis.

Childhood gynecologic problems are different from adult problems in physiology, disease, psychology, evaluation and management. The most common is vulvovaginitis. The child is susceptible to vulvovaginitis because of a relatively exposed vulva, a thin vaginal wall and poor hygiene. Additional problems are heat and moisture, clothing, coverings and possible sexual abuse. Most vulvovaginitis is primary, nonspecific vulvitis with secondary vaginitis. It is set off by poor hygiene and responds to keeping the vulva clean, cool and dry. Persistent or recurrent vulvovaginitis may be due to a variety of causes, including vulvar skin disease, a foreign body in the vagina, primary vaginitis, ectopic ureter and rhabdomyosarcoma. Vaginoscopy is indicated for recurrent vulvovaginitis or bleeding and for suspicion of a foreign body, neoplasm or congenital anomaly. The extent of evaluation depends on the anxiety of the child versus the extent of the problem, and therefore individualization is required.

Bacterial Infections↗

Bovine genital mycoplasmosis.

Infection, lesions and clinical significance of Acheloplasmas, Mycoplasma bovis and Mycoplasma bovigenitalium in genital disease of cattle are described. A more detailed account is given of ureaplasma infections. Acute and chronic forms of granular vulvitis in both field and experimental disease are described as well as the role of the organism in abortion. Recovery rates of ureaplasma and mycoplasma from semen and preputial washings in bulls are outlined and their significance in disease is discussed. There are problems in differentiating pathogenic from nonpathogenic isolates. Methods are being developed to treat semen for these organisms. This paper provides a concise summary of clinical and microbiological aspects of bovine genital mycoplasmosis.

Acholeplasma laidlawii↗

[Clinical studies on SY5555 in pediatric infections].

Pharmacokinetic and clinical studies on SY5555, a new oral penem antibiotics, were performed in pediatric infections and the following results were obtained. 1. Pharmacokinetics studies Pharmacokinetics of SY5555 was studied in 5 children (5y1m-10y11m) using doses of 5 mg/kg (n = 3) and 10 mg/kg (n = 2). The average peak plasma levels were 0.65 microgram/ml at 1 or 2 hours after administration of 5 mg/kg and 2.12 micrograms/ml at 1 or 2 hours after administration of 10 mg/kg, and the plasma half-lives were 0.81 and 1.08 hours, respectively. Average cumulative urinary recovery rates at 0-6 hours were 2.97 and 3.96%, respectively. 2. Clinical studies SY5555 was administered to 45 patients with various infectious diseases (2 with acute pharyngitis, 8 with acute tonsillitis, 4 with lacunar tonsillitis, 3 each with acute bronchitis, pneumonia and pertussis, 7 with scarlet fever, 3 with impetigo contagiosa, 6 with acute urinary tract infections, 2 with balanoposthitis and 1 each with cervical lymphadenitis, S.S.S.S., vulvitis and acute colitis) at daily doses between 3.4-10 mg/kg, t.i.d., for 3-14 days. Clinical responses were excellent in 27 patients, good in 15 patients, fair in 1 patient, and poor in 2 patients, and the efficacy rate was 93.3%. Causative organisms were examined and 39 strains of 11 species were identified. The eradication rate was 78.9%. Side effects were observed in 1 patient with diarrhea. An abnormal laboratory test value was observed in 1 patient with elevation of eosinophils. The above results suggest that SY5555 may be a very useful and safe drug for the treatment of pediatric infection.

Administration, Oral↗

The vulvovaginal-gingival syndrome of lichen planus. The clinical characteristics of 22 patients.

BACKGROUND AND DESIGN: The vulvovaginal-gingival syndrome is a variant of mucosal lichen planus characterized by erosions and desquamation of the vulva, vagina, and gingiva. The clinical features of patients initially evaluated for vulvitis who exhibited the additional features of this syndrome have been described in one previous study. In the current study, 22 women with biopsy-proved oral lichen planus and clinical evidence of vulvovaginal lichen planus were examined and treated. This group of patients represents the largest reported series demonstrating the vulvovaginal-gingival syndrome. RESULTS: Gingival lichen planus, present in all patients, was characterized by erosions and erythema in 16 subjects and by white, reticulated lesions in six others. Vulvovaginal lichen planus also displayed erosions in the majority of patients. The response to a wide variety of therapeutic agents was satisfactory in most patients. However, concomitant use of several drugs was usually required to achieve beneficial results. CONCLUSIONS: Patients with oral lichen planus should be routinely examined for the presence of disease on other mucosal surfaces. The recognition of this syndrome, which is undoubtedly more common than previously reported, will avoid unnecessary delay in the treatment of these patients.

Adult↗

Immune response of heifers to vaginal submucosal or subcutaneous vaccination and intravaginal challenge with Ureaplasma diversum.

Twenty beef heifers were randomly assigned to five equal groups and vaccinated: Group 1--in vaginal submucosa (VM) with Ureaplasma diversum ultrasonicated whole cells (WC) in complete Freund's adjuvant (CFA); Group 2--in VM with U. diversum cell membranes (CM) in CFA; Group 3--subcutaneously (SC) with CM in CFA; Group 4--in VM with CM alone; and Group 5--in VM with phosphate buffered saline (PBS) in CFA. A second vaccination with the same antigens in incomplete Freund's adjuvant was given after four weeks, and three weeks later, all heifers were challenged intravaginally with 3.6 x 10(7) colony-forming units (CFU) of U. diversum strain 2312. Immunoglobulins that reacted with U. diversum were measured in serum and cervicovaginal mucus (CVM) by an enzyme-linked-immunosorbent assay. In groups 1 and 2, vaccination by the VM route with WC or CM antigens, stimulated high levels of U. diversum-reactive IgG1 and IgG2 antibodies in serum as well as CVM, but a low IgA response only in CVM. In group 4, VM vaccination with CM (no adjuvant) elicited a minimal IgG1 and IgG2 response in serum and CVM. In group 3, SC vaccination with CM antigen stimulated high IgG1 and IgG2 reactivity in both serum and CVM, but no IgA reactivity. Very little IgM reactivity was detected in the four vaccinated groups. Intravaginal challenge resulted in characteristic granular vulvitis in all vaccinated and control heifers, with all animals remaining culture-positive for the 35 day observation period. The infection stimulated a marked increase in the specific IgA response in CVM of the three groups vaccinated with either, adjuvanted antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravaginal↗

[Studies on S-1108 in pediatric infection].

Pharmacokinetic and clinical studies on S-1108, a new oral cephem antibiotic, were performed in pediatric infections and the following results were obtained. 1. Pharmacokinetics studies Pharmacokinetics of S-1108 was studied in 4 children (3 y 7 m-11 y 1 m) using doses of 2 mg/kg (n = 2) and 4 mg/kg (n = 2). The average peak plasma level was 0.88 microgram/ml at 2 hours after administration of 2 mg/kg and 2.00 micrograms/ml at 3 hours after administration of 4 mg/kg, and plasma half-lives were 1.45 and 0.96 hours, respectively. Average cumulative urinary recovery rates at 0-6 hours were 30.0 and 34.8%, respectively. 2. Clinical studies S-1108 was administered to 32 patients with various infectious diseases (6 with acute tonsillitis, 2 each with pertussis and acute bronchitis, 3 with pneumonia, 4 with scarlet fever, 5 with impetigo contagiosa, 6 with acute urinary infection and 1 each with subcutaneous abscess, impetigo, vulvitis and urethritis) at daily doses between 6-12 mg/kg/day, t.i.d., for 5-12 days. Clinical responses were excellent in 17 patients, good in 13, and poor in 2, and the efficacy rate was 93.8%. Bacteria were identified and 33 strains of 12 species were found. The eradication rate was 93.9%. No side effects were observed in 43 patients. Abnormal laboratory test values were observed in 2 patients, 1 with elevation of eosin. and the other with elevations of GOT and GPT. The results suggest that S-1108 may be a very useful and safe drug for the treatment of pediatric infections.

Administration, Oral↗

Primary vulvar neoplasia: a review of in situ and invasive carcinoma, 1935-1972.

This survey reports the past 38 years of experience with 192 cases of carcinoma of the vulva seen and treated at the Johns Hopkins Hospital. The review stresses the increased incidence of in situ neoplasia and the importance of individualization of therapy. Also the changing concepts in terminology (eg, the leukoplakic vulvitis of the past is the dystrophy of the present) suggest that the precursory alterations of previous discussions must be reviewed in the light of such an altered nomenclature. Features of epidemiologic and histologic importance are discussed.

Adult↗

[Modern approach to classification of precancerous conditions and vulvar dystrophy].

Precancerous conditions of vulva are diseases which can exceed into carcinomas and are called preblastomatoses. These are all sorts of various diseases: intraepithelial vulvar neoplasias, Paget's disease, precancerous circumscript melanosis, malignant melanoma of the first Clark level, verrucous type of leukoplakia, vulvar dystrophy with atypia, giant Buschke-Lowenstein's condyloma and chronic skin damages. Vulvar dystrophy belongs to medical terminology since 1966 and includes a group of diseases known as leukoplakia and kraurosis, primary vulvar atrophy and hyperplastic vulvitis. According to classification from 1987 vulvar dystrophies are divided into: squamocellular hyperplasia, lichen sclerosus and other dermatoses. The term vulvar leukoplakia is not a special disease, but is used for a whole group of different lesions of white color due to leukoderma, vitiligo, chronic infections, benign tumors, dystrophies and even invasive carcinomas.

Female↗

Current etiopathogenetic views in vulvar cancer.

We considered 59 patients, from 19 to 79 years, treated for vulvar neoplastic pathology (32 of 59 had multiple squamous neoplasias of the anogenital region). It appeared that vulvar cancer is a disease of aged women and in particular between sixty and seventy years, while it isn't common under the age of thirty years. It is a hormone-independent pathology. 85% of vulvar malignant tumors is constituted by squamous cell carcinomas. The principal risk factors are: 1) chronic vulvitis (in particular Lichen sclerosus); 2) leucoplachia, 3) immunosuppression, 4) coitus in a young woman with different partners, multiple abortions, 5) HPV infection (mostly HPV type 6 and 16), 6) other genital carcinomas, 7) capacity to activate or not protoncogenes and to produce interferon, 8) tobacco smoking, 9) VIN.

Adult↗

[Enterobiasis in students from Ciudad Bolivar, Venezuela].

Enterobius vermicularis is a nematode with a peculiar biological cycle, thus requiring a special diagnostic technique. In order to determine the prevalence of E. vermicularis infection among schoolchildren in Ciudad Bolívar, Venezuela, 282 children aged 5-14 years old were evaluated between november 1995 and august 1996 by the Graham technique (three perianal swabs with adhesive cellulose tape). The prevalence of enterobiasis in the studied children was estimated 19.1% (54/282). There was no difference between sexes (P > 0.05), but there was a difference between ages (x2 = 13.8; 1.g. = 4), being the infection more frequent between 5 and 8 years. Symptoms were observed in 90.7% of the schoolchildren. Anal pruritus was the most common clinical finding (81.6%). Other less frequent manifestations were enuresis (28.6%) and vulvitis in girls (26.1%). This intestinal parasitosis occurs with high frequency among schoolchildren in Ciudad Bolívar with characteristic and identifiable symptoms in most cases. The Graham method must be used for its diagnosis. This test is not routinely performed in our laboratories unless specifically requested by the attending physician.

Adolescent↗