RESUMEN
BACKGROUND: Several organs may be damaged by strangulation by hair or strings that cause ischemia and necrosis. There have been sporadic case reports of such events. Injuries to the hands, feet, and fingers, as well as penile(1-5) and clitoral injuries(6-8) have been reported. CASES: Three cases of labia minor strangulation by hair are described. A review of the relevant literature is included. CONCLUSIONS: Pediatricians, gynecologists, and family physicians must be aware of labial tourniquet syndrome. If the diagnosis is missed or remains without immediate attention, the hair or string may cause necrosis and the resulting amputation of the vital body part.
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Enfermedades de los Genitales Femeninos/etiología , Genitales Femeninos/patología , Cabello , Adolescente , Niño , Constricción Patológica , Femenino , Enfermedades de los Genitales Femeninos/patología , Humanos , Perineo/patología , SíndromeRESUMEN
INTRODUCTION: Increasing awareness and medical studies of sexual dysfunction (SD) unveil the multi-dimensional nature of SD and the need for a multidisciplinary treatment approach. PURPOSE: To describe the psychosexual contribution to the multidisciplinary model for the assessment and treatment of SD. METHODS: The psychosexual contribution will be demonstrated by 4 case reports and data of subjects applying for sex therapy during 2004-8. OUTCOMES: A total of 822 women (age 35 +/- 12.0 years) and 813 men (age 38 +/- 13.2 years) applied for sex therapy; 44% were referred by a physician, 37% found information on the internet or in other media resources. The most frequent SDs in women were: hypoactive sexual desire disorder (HSDD] (29.7%), sexual pain (28.5%) and anorgasmia (20.9%); and in men: erectile dysfunction (44.2%), premature ejaculation (24.5%) and HSDD (17.5%). Co-morbid relationship distress was found in 217 of the cases (26.5%). CONCLUSIONS: Subjects, referred by a physician or on their own initiation, present a variety of SDs, stemming from a combination of physical, psychological and interpersonal contributing factors. The presenting sexual problem is frequently the tip of the iceberg of hidden psychological problems, relationship distress or partner's SD. The overall goal of treatment is increased pleasure and satisfaction, rather than achieving a perfect genital response. Therefore, successful treatment outcome depends on multi-professional assessment and successful resolution of the issues that accompany the sexual complaint, sharing the process with patients and their partners.
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Disfunciones Sexuales Fisiológicas/terapia , Disfunciones Sexuales Psicológicas/terapia , Adulto , Eyaculación/fisiología , Disfunción Eréctil/terapia , Femenino , Humanos , Libido/fisiología , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Relaciones Profesional-Paciente , Adulto JovenRESUMEN
AIM: To investigate the behavior and association of serum sex-steroids and serum CD40 ligand in patients undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). DESIGN: Prospective, observational study. SETTING: The IVF unit of an academic medical center. PATIENTS AND METHODS: Blood was drawn three times during the COH cycle from 17 patients undergoing the long gonadotropin-releasing hormone-analog protocol: (i) day on which adequate suppression was obtained (Day-S); (ii) day of or prior to administration of human chorionic gonadotropin (Day-hCG); and (iii) day of ovum pick-up (Day-OPU). Levels of sex steroids and serum CD40 ligand were compared among the three time points. RESULTS: During gonadotropin treatment, serum ovarian sex steroids (estradiol, progesterone, free testosterone and androstenedione) significantly increased while CD40 ligand levels nonsignificantly decreased. After hCG administration, there was a significant increase in the levels of serum CD40 ligand, ovarian androgens, and progesterone, with a significant decrease in estradiol levels. No correlations were observed between CD40 ligand and ovarian sex-steroid levels or other treatment variables. CONCLUSION: The administration of hCG leads to activation of systemic inflammation, as reflected by CD40 ligand levels. This, in turn, may lead to the development of ovarian hyperstimulation syndrome via several mechanisms, including an increase in several angiogenic factors.
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Ligando de CD40/sangre , Síndrome de Hiperestimulación Ovárica/etiología , Inducción de la Ovulación , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Adulto , Femenino , Hormonas Esteroides Gonadales/sangre , Humanos , Síndrome de Respuesta Inflamatoria Sistémica/sangreRESUMEN
Topoisomerase II-alpha (Topo II-alpha) is a nuclear enzyme. Its expression rises rapidly at the end of the S to G2/M phase and falls after the mitotic process ends. We have studied the immunohistochemical expression of Topo II-alpha in breast cancer and its correlation with the menopausal state, tumor type, size, lymph node metastases, stage, and estrogen and progesterone positivity. Histological sections from 50 breast cancers were immunohistochemically stained for Topo II-alpha. The percent of positive cells at the area of highest staining was recorded as Topo index. The correlation between the course of disease, survival and Topo II-alpha index was statistically significant, p<0.001. High-grade tumors showed higher Topo II-alpha levels, than those of intermediate and low-grade, p<0.01. A significant association was found between estrogen receptors positivity and Topo II-alpha, p<0.05. A higher Topo II-alpha index indicates higher probability for recurrence of the disease and overall survival. Therefore, Topo II-alpha expression has a prognostic value in breast carcinoma.
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Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/enzimología , ADN-Topoisomerasas de Tipo II/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Antígenos de Neoplasias/metabolismo , Biomarcadores de Tumor , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/enzimología , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/enzimología , Proteínas de Unión al ADN , Femenino , Humanos , Técnicas para Inmunoenzimas , Metástasis Linfática/diagnóstico , Menopausia , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/enzimología , Estadificación de Neoplasias , Pronóstico , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: The possible problems of an adolescent breast include a large spectrum of phenomena such as changes which may cause aesthetic problems, infectious diseases and in rare cases, malignant tumors. Young adolescents and their mothers tend to consult with a gynecologist usually due to developmental abnormalities of the growing breast such as asymmetry of the breast, agenesis or hypoplasia of one breast. Cysts and tumors are usually worrisome and warrant attention and precise diagnosis. PURPOSE: The aim of this paper is to review the recent studies and data concerning breast diseases in adolescents and to summarize by presenting symptoms, diagnostic procedures and the most up-to-date treatment modalities. METHOD: A comprehensive and updated literature review. RESULTS AND CONCLUSIONS: A large variety of abnormal phenomena in the breast during adolescence have been described. Abnormal breast development in adolescents may present themselves as an aesthetic problem only, but other symptoms such as breast tumors or cysts may arouse suspicion of malignancy of the breast. These findings may be the initiative for the first clinical visit to a gynecologist, initiated by the patient herself or by her parent. Malignancy of the breast in adolescence is very rare, especially when there are no risk factors such as family history or previous X-ray radiation to the breast region. In any case, detailed medical history should be recorded and meticulous physical examination performed in order to rule out any breast pathology that may necessitate prompt treatment. Usually, breast problems in adolescents are benign disorders and only require follow-up without additional treatment. In any aesthetic problem or developmental abnormality, surgery should be postponed until the breast has completed the adolescent stage.