The Vulvodynia Guideline
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The Leucoplakic Vulva: Premalignant Determinants C
Henry Ford Hospital Medical Journal Volume 11 | Number 3 Article 3 9-1963 The Leucoplakic Vulva: Premalignant Determinants C. Paul Hodgkinson Roy B. P. Patton M. A. Ayers Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Hodgkinson, C. Paul; Patton, Roy B. P.; and Ayers, M. A. (1963) "The Leucoplakic Vulva: Premalignant Determinants," Henry Ford Hospital Medical Bulletin : Vol. 11 : No. 3 , 279-287. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol11/iss3/3 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. For more information, please contact [email protected]. Henry Ford Hosp. Med. Bull. Vol. 11, September, 1963 THE LEUCOPLAKIC VULVA Premalignant Determinants C. PAUL HODGKINSON, M.D.,* ROY B. P. PATTON, M.D., AND M. A. AYERS, M.D.* IN A PAPER proposing to discuss the leucoplakic vulva and any predisposing ten dency it may have to the development of squamous cell carcinoma, the term "pre malignant" has presumptuous connotations. This is presumptuous because it implies that more is known about cancer and its mode of development than can be supported by facts. What happens in the cell prior to the stage of carcinoma-in-situ is a burning and unsolved question in cancer research. How to detect and appraise the parameters of malignant potential is the essence of meaning connoted by the word "premalignant". -
Baclofen Overdose D
Postgraduate Medical Journal (February 1980) 56, 108-109 Postgrad Med J: first published as 10.1136/pgmj.56.652.108 on 1 February 1980. Downloaded from Baclofen overdose D. J. LIPSCOMB* T. J. MEREDITHt M.B.. M.R.C.P. M.A., M.R.C.P. *Department of Medicine, Peterborough District Hospital, Peterborough PE3 6DA, and tPoisons Unit, Guy's Hospital, London SE] 9RT Summary Case report A 57-year-old woman suffering from multiple sclerosis A 51-year-old woman, who had suffered from took an estimated 1500 mg of baclofen. She became multiple sclerosis for 15 years, was prescribed baclo- deeply unconscious with generalized flaccid muscle fen 40 mg daily as part of her treatment for spastic paralysis and absent tendon reflexes. Toxicological paraplegia. One morning, she was found lying in analysis confirmed the presence of baclofen together bed unconscious and was admitted to hospital. with small amounts of paracetamol and glutethimide. Information given by her husband suggested that an Supportive therapy, including assisted ventilation for overdose of baclofen (consisting of 152 10-mg 3 days, led to complete recovery; anticonvulsant tablets) had been taken about 2 5 hr before being drugs were necessary for the treatment of grand mal found unconscious. On arrival in hospital 90 min fits. The clinical features and treatment of baclofen later, she was deeply unconscious and unresponsive overdose are discussed. to painful stimuli. Respiration was depressed and the cough reflex was absent. She was intubated without Introduction resistance and ventilated; gastric lavage was per-Protected by copyright. Baclofen (Lioresal, Ciba) is widely used in the formed but no tablets were returned in the lavage treatment of muscle spasticity. -
Dyspareunia: an Integrated Approach to Assessment and Diagnosis
PROBLEMS IN FAMILY PRACTICE Dyspareunia: An Integrated Approach to Assessment and Diagnosis Genell Sandberg, PhD, and Randal P. Quevillon, PhD Seattle, Washington, and Vermillion, South Dakota Dyspareunia, or painful intercourse, is frequently referred to as the most common female sexual dysfunction. It can occur singly or be manifested in combination with other psychosexual disorders. Diagnosis of dyspareunia is appropriate in cases in which the experience of pain is persistent and severe. There has been little agreement concerning the origin of dyspareunia. Or ganic conditions and psychological variables have alternately been pre sented as major factors in causality. There is a presumed high incidence of physical disease associated with dyspareunia when compared with other female sexual dysfunctions. In the majority of cases, however, organic fac tors are thought to be rare in contrast with sexual issues and interpersonal or intrapsychic difficulties as a cause of continuing problems. The finding of an organic basis for dyspareunia does not rule out emotional or psychogenic causes. Thorough and extensive gynecologic and psycholog ical evaluation is essential in cases of dyspareunia. The etiology of dys pareunia should be viewed on a continuum from primarily physical to primar ily psychological with many women falling in the middle area. recurrent pattern of genital pain during or im Dyspareunia and vaginismus are undeniably linked, A mediately after coitus is the basis for the diagnosis and repeated dyspareunia is likely to result in vaginis of dyspareunia.1 The Diagnostic and Statistical Man mus, as vaginismus may be the causative factor in ual of Mental Disorders (DSM-III)2 has included dys dyspareunia.6-7 The difference between vaginismus pareunia under the classification of psychosexual dis and dyspareunia is that intromission is generally pain orders. -
The National Drugs List
^ ^ ^ ^ ^[ ^ The National Drugs List Of Syrian Arab Republic Sexth Edition 2006 ! " # "$ % &'() " # * +$, -. / & 0 /+12 3 4" 5 "$ . "$ 67"5,) 0 " /! !2 4? @ % 88 9 3: " # "$ ;+<=2 – G# H H2 I) – 6( – 65 : A B C "5 : , D )* . J!* HK"3 H"$ T ) 4 B K<) +$ LMA N O 3 4P<B &Q / RS ) H< C4VH /430 / 1988 V W* < C A GQ ") 4V / 1000 / C4VH /820 / 2001 V XX K<# C ,V /500 / 1992 V "!X V /946 / 2004 V Z < C V /914 / 2003 V ) < ] +$, [2 / ,) @# @ S%Q2 J"= [ &<\ @ +$ LMA 1 O \ . S X '( ^ & M_ `AB @ &' 3 4" + @ V= 4 )\ " : N " # "$ 6 ) G" 3Q + a C G /<"B d3: C K7 e , fM 4 Q b"$ " < $\ c"7: 5) G . HHH3Q J # Hg ' V"h 6< G* H5 !" # $%" & $' ,* ( )* + 2 ا اوا ادو +% 5 j 2 i1 6 B J' 6<X " 6"[ i2 "$ "< * i3 10 6 i4 11 6! ^ i5 13 6<X "!# * i6 15 7 G!, 6 - k 24"$d dl ?K V *4V h 63[46 ' i8 19 Adl 20 "( 2 i9 20 G Q) 6 i10 20 a 6 m[, 6 i11 21 ?K V $n i12 21 "% * i13 23 b+ 6 i14 23 oe C * i15 24 !, 2 6\ i16 25 C V pq * i17 26 ( S 6) 1, ++ &"r i19 3 +% 27 G 6 ""% i19 28 ^ Ks 2 i20 31 % Ks 2 i21 32 s * i22 35 " " * i23 37 "$ * i24 38 6" i25 39 V t h Gu* v!* 2 i26 39 ( 2 i27 40 B w< Ks 2 i28 40 d C &"r i29 42 "' 6 i30 42 " * i31 42 ":< * i32 5 ./ 0" -33 4 : ANAESTHETICS $ 1 2 -1 :GENERAL ANAESTHETICS AND OXYGEN 4 $1 2 2- ATRACURIUM BESYLATE DROPERIDOL ETHER FENTANYL HALOTHANE ISOFLURANE KETAMINE HCL NITROUS OXIDE OXYGEN PROPOFOL REMIFENTANIL SEVOFLURANE SUFENTANIL THIOPENTAL :LOCAL ANAESTHETICS !67$1 2 -5 AMYLEINE HCL=AMYLOCAINE ARTICAINE BENZOCAINE BUPIVACAINE CINCHOCAINE LIDOCAINE MEPIVACAINE OXETHAZAINE PRAMOXINE PRILOCAINE PREOPERATIVE MEDICATION & SEDATION FOR 9*: ;< " 2 -8 : : SHORT -TERM PROCEDURES ATROPINE DIAZEPAM INJ. -
Pelvic Inflammatory Disease (PID) PELVIC INFLAMMATORY DISEASE (PID)
Clinical Prevention Services Provincial STI Services 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel : 604.707.5600 Fax: 604.707.5604 www.bccdc.ca BCCDC Non-certified Practice Decision Support Tool Pelvic Inflammatory Disease (PID) PELVIC INFLAMMATORY DISEASE (PID) SCOPE RNs (including certified practice RNs) must refer to a physician (MD) or nurse practitioner (NP) for all clients who present with suspected PID as defined by pelvic tenderness and lower abdominal pain during the bimanual exam. ETIOLOGY Pelvic inflammatory disease (PID) is an infection of the upper genital tract that involves any combination of the uterus, endometrium, ovaries, fallopian tubes, pelvic peritoneum and adjacent tissues. PID consists of ascending infection from the lower-to-upper genital tract. Prompt diagnosis and treatment is essential to prevent long-term sequelae. Most cases of PID can be categorized as sexually transmitted and are associated with more than one organism or condition, including: Bacterial: Chlamydia trachomatis (CT) Neisseria gonorrhoeae (GC) Trichomonas vaginalis Mycoplasma genitalium bacterial vaginosis (BV)-related organisms (e.g., G. vaginalis) enteric bacteria (e.g., E. coli) (rare; more common in post-menopausal people) PID may be associated with no specific identifiable pathogen. EPIDEMIOLOGY PID is a significant public health problem. Up to 2/3 of cases go unrecognized, and under reporting is common. There are approximately 100,000 cases of symptomatic PID annually in Canada; however, PID is not a reportable infection so, exact -
The Use of Intravenous Baclofen As Therapy for the Γ-Hydroxybutyric Acid Withdrawal Syndrome
Research Article Remedy Open Access Published: 12 Jun, 2017 The Use of Intravenous Baclofen as Therapy for the γ-hydroxybutyric Acid Withdrawal Syndrome Marc Sabbe1*, Francis Desmet1 and Sabrina Dewinter2 1Department of Emergency Medicine, University Hospitals, Catholic University of Leuven, Belgium 2Department of Pharmacy, University Hospitals, Catholic University of Leuven, Belgium Abstract Introduction: In this case series with three patients, we introduced baclofen, a γ-aminobutyric acid type B(GABA-B) receptor agonist, for treatment of the γ-hydroxybutyric acid (GHB) withdrawal syndrome. Materials and Methods: Single center case series performed on three patientswith a GHB withdrawal syndrome. They initially received massive doses of benzodiazepines, without sufficient effect. Two patients also received an unsuccessful continuous dexmedetomidine drip. In all patients, intravenous baclofen was started, with an intravenous loading dose between 0.5 and 2 milligrams (mg) to achieve a therapeutic level. Thereafter a continuous intravenous dose between 0.5 and 1 mg per hour for 12 h was administered to maintain a steady state. After that, baclofen was substituted orally with a daily oral dose varying between 20 mg and 40 mg which could be downgraded and stopped over the next days. They all continued to receive a standard benzodiazepine regimen during the baclofen trial. Results and Discussion: Main outcome measurements were the degree of withdrawal symptoms and the need for benzodiazepines during baclofen treatment. In all patients, a significant reduction of the GHB withdrawal syndrome was noted. A standard daily regimen of baseline benzodiazepine dosing between 40 mg and 80 mg diazepam was sufficient. Adverse effects of baclofen use were absent. -
3-Year Results of Transvaginal Cystocele Repair with Transobturator Four-Arm Mesh: a Prospective Study of 105 Patients
Arab Journal of Urology (2014) 12, 275–284 Arab Journal of Urology (Official Journal of the Arab Association of Urology) www.sciencedirect.com ORIGINAL ARTICLE 3-year results of transvaginal cystocele repair with transobturator four-arm mesh: A prospective study of 105 patients Moez Kdous *, Fethi Zhioua Department of Obstetrics and Gynecology, Aziza Othmana Hospital, Tunis, Tunisia Received 27 January 2014, Received in revised form 1 May 2014, Accepted 24 September 2014 Available online 11 November 2014 KEYWORDS Abstract Objectives: To evaluate the long-term efficacy and safety of transobtura- tor four-arm mesh for treating cystoceles. Genital prolapse; Patients and methods: In this prospective study, 105 patients had a cystocele cor- Cystocele; rected between January 2004 and December 2008. All patients had a symptomatic Transvaginal mesh; cystocele of stage P2 according to the Baden–Walker halfway stratification. We Polypropylene mesh used only the transobturator four-arm mesh kit (SurgimeshÒ, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. ABBREVIATIONS The patients’ characteristics and surgical variables were recorded prospectively. The VAS, visual analogue anatomical outcome, as measured by a physical examination and postoperative scale; stratification of prolapse, and functional outcome, as assessed by a questionnaire TOT, transobturator derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic tape; Floor Impact Questionnaire and the Pelvic Organ Prolapse–Urinary Incontinence- TVT, tension-free Sexual Questionnaire, were considered as the primary outcome measures. Peri- vaginal tape; and postoperative complications constituted the secondary outcome measures. TAPF, tendinous arch Results: At 36 months after surgery the anatomical success rate (stage 0 or 1) was of the pelvic fascia; 93%. -
Hygroscopicity of Pharmaceutical Crystals
HYGROSCOPICITY OF PHARMACEUTICAL CRYSTALS A DISSERTATION SUBMITTED TO THE FACULTY OF GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY DABING CHEN IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY RAJ SURYANARAYANAN (ADVISER) JANUARY, 2009 © Dabing Chen, January / 2009 ACKNOWLEDGEMENTS I am very grateful to my thesis advisor, Prof. Raj Suryanarayanan, for his constant guidance, support, and encouragement throughout my research. Without his help, the completion of this thesis would be impossible. His friendship and advices are precious to my professional and personal growth and will help me overcome many difficulties in my future career. I would like to take the opportunity to thank Prof. David J.W. Grant, who was my advisor during the first three years in graduate school and led me into the research area of physical pharmacy. It was my great honor to have worked for him, and he will always live as a role model in my life. Many thanks to Dr. Zheng Jane Li at Boehringer Ingelheim Pharmaceuticals (BI) for her invaluable advice as an industrial mentor and also for agreeing to serve on my committee. I sincerely appreciate her helpful discussions, revision of the manuscripts, and supervision of my research. I also want to thank her for providing me the internship opportunity at BI. I thank Dr. Timothy S. Wiedmann and Dr. Theodore P. Labuza for serving on my committee and for critically reviewing my thesis. I also want to thank Dr. Timothy S. Wiedmann for allowing me the use of the HPLC instruments in his lab and also for his advice as the Director of Graduate Studies. -
GABA Receptors
D Reviews • BIOTREND Reviews • BIOTREND Reviews • BIOTREND Reviews • BIOTREND Reviews Review No.7 / 1-2011 GABA receptors Wolfgang Froestl , CNS & Chemistry Expert, AC Immune SA, PSE Building B - EPFL, CH-1015 Lausanne, Phone: +41 21 693 91 43, FAX: +41 21 693 91 20, E-mail: [email protected] GABA Activation of the GABA A receptor leads to an influx of chloride GABA ( -aminobutyric acid; Figure 1) is the most important and ions and to a hyperpolarization of the membrane. 16 subunits with γ most abundant inhibitory neurotransmitter in the mammalian molecular weights between 50 and 65 kD have been identified brain 1,2 , where it was first discovered in 1950 3-5 . It is a small achiral so far, 6 subunits, 3 subunits, 3 subunits, and the , , α β γ δ ε θ molecule with molecular weight of 103 g/mol and high water solu - and subunits 8,9 . π bility. At 25°C one gram of water can dissolve 1.3 grams of GABA. 2 Such a hydrophilic molecule (log P = -2.13, PSA = 63.3 Å ) cannot In the meantime all GABA A receptor binding sites have been eluci - cross the blood brain barrier. It is produced in the brain by decarb- dated in great detail. The GABA site is located at the interface oxylation of L-glutamic acid by the enzyme glutamic acid decarb- between and subunits. Benzodiazepines interact with subunit α β oxylase (GAD, EC 4.1.1.15). It is a neutral amino acid with pK = combinations ( ) ( ) , which is the most abundant combi - 1 α1 2 β2 2 γ2 4.23 and pK = 10.43. -
Vaginitis and Abnormal Vaginal Bleeding
UCSF Family Medicine Board Review 2013 Vaginitis and Abnormal • There are no relevant financial relationships with any commercial Vaginal Bleeding interests to disclose Michael Policar, MD, MPH Professor of Ob, Gyn, and Repro Sciences UCSF School of Medicine [email protected] Vulvovaginal Symptoms: CDC 2010: Trichomoniasis Differential Diagnosis Screening and Testing Category Condition • Screening indications – Infections Vaginal trichomoniasis (VT) HIV positive women: annually – Bacterial vaginosis (BV) Consider if “at risk”: new/multiple sex partners, history of STI, inconsistent condom use, sex work, IDU Vulvovaginal candidiasis (VVC) • Newer assays Skin Conditions Fungal vulvitis (candida, tinea) – Rapid antigen test: sensitivity, specificity vs. wet mount Contact dermatitis (irritant, allergic) – Aptima TMA T. vaginalis Analyte Specific Reagent (ASR) Vulvar dermatoses (LS, LP, LSC) • Other testing situations – Vulvar intraepithelial neoplasia (VIN) Suspect trich but NaCl slide neg culture or newer assays – Psychogenic Physiologic, psychogenic Pap with trich confirm if low risk • Consider retesting 3 months after treatment Trichomoniasis: Laboratory Tests CDC 2010: Vaginal Trichomoniasis Treatment Test Sensitivity Specificity Cost Comment Aptima TMA +4 (98%) +3 (98%) $$$ NAAT (like GC/Ct) • Recommended regimen Culture +3 (83%) +4 (100%) $$$ Not in most labs – Metronidazole 2 grams PO single dose Point of care – Tinidazole 2 grams PO single dose •Affirm VP III +3 +4 $$$ DNA probe • Alternative regimen (preferred for HIV infected -
NVA Research Update E- Newsletter September – October – November 2016
NVA Research Update E- Newsletter September – October – November 2016 www.nva.org __________________________ Vulvodynia The Vulvar Pain Assessment Questionnaire inventory. Dargie E, Holden RR, Pukall CF. Pain. 2016 Aug 1. https://www.ncbi.nlm.nih.gov/pubmed/27780177 Millions suffer from chronic vulvar pain (ie, vulvodynia). Vulvodynia represents the intersection of 2 difficult subjects for health care professionals to tackle: sexuality and chronic pain. Those with chronic vulvar pain are often uncomfortable seeking help, and many who do so fail to receive proper diagnoses. The current research developed a multidimensional assessment questionnaire, the Vulvar Pain Assessment Questionnaire (VPAQ) inventory, to assist in the assessment and diagnosis of those with vulvar pain. A large pool of items was created to capture pain characteristics, emotional/cognitive functioning, physical functioning, coping skills, and partner factors. The item pool was subsequently administered online to 288 participants with chronic vulvar pain. Of those, 248 participants also completed previously established questionnaires that were used to evaluate the convergent and discriminant validity of the VPAQ. Exploratory factor analyses of the item pool established 6 primary scales: Pain Severity, Emotional Response, Cognitive Response, and Interference with Life, Sexual Function, and Self-Stimulation/Penetration. A brief screening version accompanies a more detailed version. In addition, 3 supplementary scales address pain quality characteristics, coping skills, and the impact on one's romantic relationship. When relationships among VPAQ scales and previously researched scales were examined, evidence of convergent and discriminant validity was observed. These patterns of findings are consistent with the literature on the multidimensional nature of vulvodynia. The VPAQ can be used for assessment, diagnosis, treatment formulation, and treatment monitoring. -
Localised Provoked Vestibulodynia (Vulvodynia): Assessment and Management
FOCUS Localised provoked vestibulodynia (vulvodynia): assessment and management Helen Henzell, Karen Berzins Background hronic vulvar pain (pain lasting more than 3–6 months, but often years) is common. It is estimated to affect 4–8% of Vulvodynia is a chronic vulvar pain condition. Localised C women at any one time and 10–20% in their lifetime.1–3 provoked vestibulodynia (LPV) is the most common subset Little attention has been paid to the teaching of this condition of vulvodynia, the hallmark symptom being pain on vaginal so medical practitioners may not recognise the symptoms, and penetration. Young women are predominantly affected. LPV diagnosis is often delayed.2 Community awareness is low, but is a hidden condition that often results in distress and shame, increasing with media attention. Women can be confused by the is frequently unrecognised, and women usually see a number symptoms and not know how to discuss vulvar pain. The onus is of health professionals before being diagnosed, which adds to on medical practitioners to enquire about vulvar pain, particularly their distress and confusion. pain with sex, when taking a sexual or reproductive health history. Objective Vulvodynia The aim of this article is to inform health providers about the Vulvodynia is defined by the International Society for the Study assessment and management of LPV. of Vulvovaginal Disease (ISSVD) as ‘chronic vulvar discomfort, most often described as burning pain, occurring in the absence Discussion of relevant findings or a specific, clinically identifiable, neurologic 4 Diagnosis is based on history. Examination is used to support disorder’. It is diagnosed when other causes of vulvar pain have the diagnosis.