A Rare Dermatologic Disease in Pregnancy: Rosacea Fulminans- Case Report and Review of the Literature

BACKGROUND: Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. The pathways that lead to the development of rosacea are not well understood. The relationship of pyoderma faciale (also known as rosacea fulminans) to rosacea also is uncertain. We aimed to write this article with the aim of showing how a pregnant patient who has been aggravated by the degree of lesions on the face during the first trimester of pregnancy is treated and to show what is in the literature in this issue.CASE REPORT: A 22-year-old woman complained of painful erythema, papules and pustules on the face. She had fever and malaise during the sixth week of her first pregnancy and a history of the mild eruption and seborrhea before her pregnancy with flaring over the preceding 4 weeks. Dermatologic examination revealed red erythema of all involved facial areas; the lesions consisted of papules, pustules and nodules. The case was diagnosed as rosacea fulminans (pyoderma faciale) by these findings. In the literature, there are some effective therapeutic options such as retinoids, tetracyclines, antiandrogenic contraceptives, and dapsone and these were not used because they are contraindicated in pregnancy. Amoxicillin-clavulanic acid 1 gr/day, wet compresses, and a fusidic acid cream were started. After the activity of the disease had been suppressed for 10 days, antibiotic was stopped, and the other treatment options were applied topically for the next month. One month after cessation of treatment, the lesions had disappeared with only mild erythema remaining. There was minimally flushing on the face and no telangiectasia.CONCLUSION: In conclusion, there is no substantial evidence as to the mechanism by which pregnancy may trigger this conditioner whether the gender of the fetus influences the development of rosacea fulminans, but is generally accepted that hormonal changes in pregnancy play an important role. The pathogenesis of rosacea fulminans remains uncertain, but it is obvious that the further basic and clinical research is required to optimise the management of this rare facial dermatosis

Contraception counselling during gynecology visit — does a questionnaire help?

Objectives: Women are at risk of unplanned pregnancy and inappropriate choice of contraception if not given effectivecontraception counselling. We aimed to understand the contraceptive needs of women, improve effective contraceptioncounselling promoting modern contraception methods during gynecology outpatient visit using a contraception counsellingquestionnaire.Material and methods: All reproductive-age women over 18 were given Contraception Counselling Project Form to fill inwhile in the waiting room. The form consisted of 15 questions evaluating patients’ characteristics and contraceptive methodused. Physicians evaluated these forms during the examination and an appropriate method was chosen. Forms of pregnant,postmenopausal and sexually inactive patients as well as forms with more than one answer missing were excluded.Results: 778 questionnaires were accepted for evaluation. 340 women (43.8%) used modern contraception, 112 (14.4%)used interrupted coitus, 3 (0.4%) used calendar method. 738 women could be given adequate contraception counsellingby the physicians. 215 women among 323 women (66.5%) who did not use modern contraception and did not desirepregnancy, were convinced to use modern contraception and 103 (91.9%) among 112 women who used interruptedcoitus for contraception were convinced to use modern contraception. There was a significant relationship between age,education, working state, parity, number and type of delivery, previous OCP usage, resources of contraception and thepreferred contraception method.Conclusions: More than half the women preferred to use modern contraception methods by means of contraceptioncounselling questionnaire. Women’s backgrounds significantly affected their choice of contraception method

Operative Hysteroscopy Versus Levonorgestrel-Releasing Intrauterine System (LNG-IUS) Insertion: A Prospective Observational Study on the Effect of Surgical and Medical Treatments on Sexual Functions in Women With Abnormal Uterine Bleeding

Background This study aims to evaluate the effect of operative hysteroscopy and levonorgestrel-releasing intrauterine system (LNG-IUS) insertion for abnormal uterine bleeding on sexual function and, if it improves sexual function, to examine differences in sexual function between women undergoing hysteroscopy and women using LNG-IUS.Methods Ninety women aged between 25 and 52 enrolled in the study. Participants were divided into two groups, including 45 operative hysteroscopy patients and 45 LNG-IUS patients. All patients completed the Female Sexual Function Index (FSFI) questionnaire pre-treatment and after three months post-treatment. Pre-and post-treatment FSFI scores were compared both within and between groups.Results The mean FSFI scores at three months following both treatments were significantly higher than baseline in both groups (p<0.05). When the two groups were compared, no significant difference was observed between baseline and three-month post-treatment differences in FSFI scores except for the pain domain. In the pain domain of the FSFI questionnaire, a more significant improvement was found in the LNG -IUS inserted group compared to the operative hysteroscopy group.Conclusion Patients had improvement in sexual functions after both operative hysteroscopy and LNG -IUS insertion treatment. No significant difference was observed in hysteroscopy and LNG-IUS patients after both treatments in terms of sexual function according to scores calculated by FSFI, except for the pain domain. Significant improvement was observed in the pain domain of the FSFI for the LNG -IUS inserted group compared to the operative hysteroscopy group, thus demonstrating a significant effect and improvement for dyspareunia and chronic pelvic pain complaint in the LNG-IUS inserted group

Management of Menstrual and Gynecologic Concerns in Girls with Special Needs

For girls with physical and developmental disabilities and their families/caregivers, puberty and menstruation can present significant problems such as vulnerability, abuse risk, unintended pregnancies, difficulties with managing menstrual hygiene, abnormal uterine bleeding, dysmenorrhea, behavioral difficulties/mood concerns or changes in seizure pattern. Healthcare providers may have an important and positive impact for both the adolescents and their families/caregivers during this stage of life. Whether menstrual manipulation is indicated should be decided after a detailed history is taken from both the patient and the caregivers to determine the impact of current problems on quality of life. It should be explained that complete amenorrhea is difficult to achieve and realistic expectations should be addressed. The goals for the management of menstrual concerns should be a reduction in the amount and total days of menstrual flow, reduction of menstrual pain and suppression of ovulatory or cyclic symptoms, depending on each individual patient's needs. Advantages and disadvantages of available treatment methods should also be discussed

Sentinel lymph node biopsy for the staging of anal melanoma: Report of two cases

Primary melanoma of the anal region is a rare pathological entity and its prognosis is generally poor. The aim of this report is to demonstrate the feasibility of the sentinel lymph node (SLN) procedure with combined technique in patients with anal melanoma. We report of two cases with anal melanoma that had wide local excision of the primary lesion and was referred for further evaluation. After diagnostic metastatic work-up, SLN procedure consisted of a combination of preoperative lymphoscintigraphy with technetium-99m nanocolloid injected around the tumor, and intraoperative detection of SLN with gamma probe (combined technique) was performed. In addition, patent blue dye was injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. In the first case, SLN identified both inguinal and iliac lymph node basins, both of which were histologically negative on both frozen and paraffin sections. In the other case, SLN removed from the inguinal lymph node basin showed micrometastasis by paraffin section. In both cases SLN procedure with combined technique was performed sufficiently without significant complications. Consequently, we suggest that SLN procedure with combined technique is also a useful technique in malignant melanomas similar to other anal canal cancers

Complete labial fusion causing urinary retention in a postmenopausal woman

Labial fusion or labial adhesion can rarely be encountered postmenopausal and may be diagnosed in advanced stages especially in sexually inactive women. It may be a rare cause of voiding dysfunction or urinary retention. We present a case of a postmenopausal woman presenting with urinary retention due to complete labial fusion. The patient was treated both with topical estrogen and surgical separation of labial fusion. No recurrences developed after the procedure. Topical estrogen treatment may not resolve adhesions in postmenopausal women and invasive procedures may be necessary to resolve urinary retention

Contraception counselling during gynecology visit - does a questionnaire help?

Objectives: Women are at risk of unplanned pregnancy and inappropriate choice of contraception if not given effective contraception counselling. We aimed to understand the contraceptive needs of women, improve effective contraception counselling promoting modern contraception methods during gynecology outpatient visit using a contraception counselling questionnaire

Effects of estrous cycle stage and transport temperature of ovaries on in vitro maturation of canine oocytes

Unlike other domestic animals, in vitro maturation (IVM) of canine oocytes still has limited success. The present study investigated the effects of estrous cycle stage and transport temperature of ovaries on in vitro maturation of canine oocytes. The donor bitches were categorized into three groups based on stage of estrus cycle: follicular (proestrus or estrous), luteal (diestrus) and anestrus. One ovary of each pair collected from 39 mature bitches was transported in Phosphate Buffer Saline (PBS) at 4 degrees C while the other was transported at 37 degrees C. A total of 1138 Grade I COCs obtained from all ovaries were grouped and matured in modified synthetic oviduct fluid (mSOF) supplemented with follicle stimulating hormone (FSH), luteinizing hormone (LH), essential and non-essential amino acids at 38.5 degrees C in a humidified 5% CO2, 5% O-2, and 90% N-2 atmosphere for 72 h. The nuclear maturation rates were evaluated by aceto-orcein staining

Efficacy of a New Crosslinked Hyaluronan Gel in the Prevention of Intrauterine Adhesions

Background and Objectives: The authors sought to assess the effect of the use of a new crosslinked hyaluronan (NCH) gel on the prevention of intrauterine adhesions (IUAs) in women underwent curettage in the second trimester

Improvement in quality of life and pain scores after laparoscopic management of deep endometriosis: a retrospective cohort study

Purpose This is a retrospective cohort study that evaluates the postoperative pain findings of a consecutive series of laparoscopic surgeries for deep endometriosis (DE). Methods This multi-center retrospective cohort study was carried out in university hospitals (Istanbul, Turkey). Sixty-five patients diagnosed through bimanual gynecologic examination, gynecologic ultrasound or magnetic resonance imaging-confirmed endometrioma and DE together; who underwent a laparoscopic surgery between 2013 and 2019 by a team of gynecologists, colorectal surgeons, and a urologist were retrospectively evaluated. The data were collected in a specific database and analyzed for postoperative pain outcomes through a comparison with preoperative symptoms scored using a visual analogue score (VAS), and the British Society of Gynecologic Endoscopy (BSGE) pelvic pain questionnaire. Results Sixty-five patients who met the criteria were included. The mean age of all patients was 35.0 +/- 6.3 (range 22-50) years. The mean operative time was 121.3 +/- 50.2 (range, 60-270) minutes. Preoperative and postoperative comparison of VAS scores for dysmenorrhea (8.57 vs. 2.91), dyspareunia (6.62 vs. 1.66), dyschezia (7.46 vs. 2.43), dysuria (5.67 vs. 1.34), chronic pelvic pain (4.11 vs. 1.22), and BSGE score (40.98 vs. 11.00) showed significantly reduced pain scores, respectively (p < 0.01). Conclusion Laparoscopic management of DE is a valid treatment option in terms of reduced postoperative pain and increased quality of life according to pain score outcomes. To have more robust conclusions, a prospective cohort study with a larger sample size which evaluates patients who had segmental bowel resection and those who did not have segmental bowel resection is necessary