Genital prolapse during pregnancy

A case is presented of genital prolapse occurring during pregnancy in a patient with multiple congenital urogenital defects. The etiologies are hypothesized to be a congenitally defective pelvis and hormonally mediated connective tissue changes in pregnancy. The procidentia was treated with a vaginal hysterectomy, anterior and posterior colporrhaphy and sarcrospinous fixation. Pudendal nerve injury as a rare complication of sacrospinous fixation is discussed.     

Genital herpes

As well as being painful and distressing to women who contract the virus, genital herpes can pose danger to a fetus. Women with this condition require prompt and sensitive care.     

Urethral prolapse in girls

A sensitive method for the quantitative determination of piperazine is described. The method is precise and responds linearly from 25 g to 500 mug and above of the material. The procedure is based on the formation of a complex of piperazine with reineckate in neutral or acid medium. The complex can be separated by centrifugation. It is then dissolved in acetone and estimated at 530 nm in a colorimeter. Piperazine present in trichloroacetic acid extractrs of biological samples can also be estimated by this method.     

Digestion in the newborn

Although the various aspects of digestion in the newborn have been studied for decades, we still lack quantitative information about the contribution of individual enzymes to the overall process. The information to date indicates that in spite of immaturity of many of the classical digestive mechanisms of the adult, the infant uses a number of compensatory systems to achieve adequate digestion of nutrients (Fig. 1). Thus, whereas in the infant gastric proteolysis is probably extremely limited, intestinal protein digestion is adequate. Although starch supplements are better tolerated in breast-fed infants, because of the compensation provided by human milk amylase, the infant is able to digest lactose and short-chain glucose polymers with endogenous brush border enzymes. Fat digestion is markedly aided by gastric lipase and, in breast-fed infants, the bile salt-dependent lipase of human milk. Thus, in the infant, gastric lipolysis is quantitatively much more significant than in adults. The absorption of human milk whey proteins (and probably also cow milk proteins) is probably associated more with the highly glycosylated form of these proteins than with immaturity of neonatal digestive enzymes.     

Genital ulcer infections in the female patient and the vaginitides

This article discusses genital ulcers caused by sexually transmitted diseases in female patients, and the etiology, morphology of the ulcerations, diagnostic work-up, and current treatment. The article also discusses patients with a vaginal discharge, laboratory work-up, diagnoses, and treatment.     

Mucous prolapse of the urethra

Urethral prolapse represent a rare cause of urological consultation. Frequent in older women, it also happens in under 10-year-old little girls with a racial predominance. For most cases, medical treatment and follow-up are sufficient, but failure of these or possible complications may necessitate a surgical correction. Circumferential excision and muco-mucous suture are effective treatments with very few complications. About four case-reports, we are reviewing here the literature and discussing etiopathogenic mechanisms and therapeutic options for this disease.     

Genital manifestation of filariasis

'Natural' antibodies are generally believed to possess solely 2H-2L immunoglobulin structure. They have many disulphide bonds, the structural importance of which is not yet understood. However, some natural heterohaemagglutinins in the sera of some lower vertebrates (eel, shark, perhaps also trout and toad) are subunit proteins; the subunits are held together not by disulphide bonds but solely by non-covalent interactions like animal lectins. The relevance of these findings for immunophylogeny is discussed.     

Genital herpes complicating pregnancy

The seroprevalence of herpes simplex virus type 2 (HSV-2) infections among reproductive-aged women in the United States in prevalent. This article discusses HSV and how it effects the pregnant women and neonates. Management of the disease is reviewed, and recommendations for management of HSV during pregnancy are given.     

Sacrospinous colpopexy in the management of uterovaginal prolapse

The tet(M) genes were characterized from 84 isolates of 10 different bacterial species isolated from the periodontal pockets of 16 patients with periodontal disease. A 740 bp polymerase chain reaction product from the hypervariable region of the tet(M) structural gene was cleaved with the restriction enzymes AluI and HinfI. Three different restriction patterns were identified for each of the two enzymes. By DNA sequencing, using a direct solid-phase automated sequencing method, the isolates could be grouped into 3 different clusters of tet(M) subtypes. The internal DNA homology within each subtype was 98-100%; the homology between clusters was 89-94%. Two different subtypes were identified in 9 of 10 bacterial species, and the remaining species had 3 different subtypes. One of the subtypes (M3) was seen mainly in the anaerobic isolates. This subtype was different from all earlier sequenced structural tet(M) genes present in the Genbank. Most patients had two different subtypes of tet(M), and a third subtype was seen in the 3 patients who exhibited the greatest variety of tetracycline-resistant bacterial species. It appears that the presence of one subtype of the tet(M) gene within a patient or bacterial species does not prevent the acquisition of another subtype of the same gene. This study identified a new subtype of the tet(M) gene and grouped it into 3 distinct yet highly homologous genetic subtypes.     

Paediatric rectal prolapse in Rwanda

During the 1994 crisis in Rwanda, a high incidence of full-thickness rectal prolapse was noted among the refugee children in the south-west of the country. The prolapses arose as a result of acute diarrhoeal illness superimposed on malnutrition and worm infestation. We used a modification of the Thiersch wire technique in 40 of these cases during two months working in a refugee camp. A catgut pursestring was tied around the anal margin under local, regional or general anaesthesia. This was effective in achieving short-term control of full-thickness prolapse until the underlying illness was corrected. Under the circumstances, no formal follow-up could be arranged; however, no complications were reported and only one patient presented with recurrence.     

Intraventricular haemorrhage in the newborn

Coagulation studies were performed on 128 babies who were premature or who had respiratory distress syndrome (RDS). Forty-four babies were found to have abnormal coagulation parameters. Twenty-one were treated with plasma coagulation factors II, VII, IX and X (PPSB), and of these six died from intraventricular haemorrhage (IVH). Twenty-two did not have PPSB treatment and four died from IVH. In 84 babies in whom coagulation studies gave normal results only one baby died from IVH. The combination of RDS and abnormal coagulation produced a high-risk group to IVH and treatment with PPSB did not reduce the incidence of IVH. It is postulated that prevention of IVH lies in early and effective treatment of RDS.