Biomedical subjects
Publications and source records attributed to E G Friedrich.
One thousand forty-three patients made 2,750 visits to the Vulvar Clinic at the Milwaukee County Medical Complex from July, 1970, to July, 1978. This experience is analyzed and the various diseases are grouped in order of frequency. The results shed light on those vulvar problems most likely to be encountered in general office practice and point the way toward future areas of research.
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Psychosomatic vulvovaginitis is a real clinical entity that should be suspected in any patient whose vaginal complaints do not correlate with the physical findings. Such patients have usually seen multiple physicians, are "allergic" to most vaginal medications, and exhibit signs of emotional lability. In many cases, psychiatric evaluation and therapy can be of great benefit.
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The clinical staging of malignant disease is necessary before initiating nonsurgical therapy. Unfortunately, such staging does not help answer critical questions about the course and natural history of the cancerous process. Answers to these questions are crucial to the planning of future therapeutic programs. A postoperative staging system, amenable to computer analysis, that can be retrospectively applied to a large series of invasive squamous cell carcinomas of the vulva is presented. A review of the experience of a large oncologic service at the University of Buenos Aires, which used this new classification system, shows the system's applicability. Such a system could, in time, provide answers to many questions concerning invasive squamous cell carcinoma of the vulva.
Because the underlying causes are so varied, vulvar pruritus must be understood as a symptom and not as a disease entity in itself. Successful treatment depends on proper identification of the underlying disorder.
A urethral prolapse occurring in an 80-year-old woman was successfully treated with cryosurgery. The procedure was painless and accomplished without loss of urethral length and without subsequent stricture.
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The use of photodynamic dye and light inactivation for the treatment of genital herpes simplex virus infections has been associated with the risk of potential oncogenesis. Sixteen patients treated with neutral red and fluorescent light for documented herpetic infections were studied at intervals ranging from 9 to 52 months following treatment. Four patients treated with other modalities were included in the study. Biopsies of the treated areas were obtained, and 3925 tissue sections were examined. Mild atypical epithelial changes were focally present in most specimens regardless of therapy. Histologically identifiable premalignant change could not be demonstrated.
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Ten patients with vulvovaginal and cervical herpesvirus infections were treated with a regimen of external and intravaginal povidone-iodine preparations. In all but 1 case, the expected duration of symptoms and healing time were shortened. The response of cervical lesions was especially remarkable. The findings of this pilot study warrant further controlled clinical investigation.
Hypercalcemia associated with nonmetastatic malignancy has been reported most frequently with lung or kidney tumors, while among gynecologic malignancies, the ovary has been the most common primary site. The pertinent clinicopathologic features of 2 cases of nonmetastatic vulvar carcinoma producing hypercalcemia are described in the present report. Including 3 previously reported cases, the vulva is seen to be the second most common site in the female genital tract for production of this paraendocrine syndrome. The clinician should be aware of the association of hypercalcemia and mental confusion with bulky vulvar tumors, so that surgery will not needlessly be delayed in a futile attempt to correct the hypercalcemia medically,
Vulvar Paget's disease is an intraepithelial change which is locally recurrent and has minimal if any propensity to invasion. Its major significance lies in the frequency with which concomitant carcinomas are discovered in association with the vulvar skin lesion. Adenocarcinoma of the vulvar apocrine glands is the most commonly associated tumor. Another apocrine adenocarcinoma, carcinoma of the breast, either antecedent or concomitant, is the second most frequently associated tumor, having been noted in 14 cases of vulvar Paget's disease. A case report illustrating this association is presented, and the importance of preoperative breast screening procedures in all patients with vulvar Paget's disease is demonstrated.
The cytologic appearance of Paget's disease of the vulva is described, noting the similarity in appearance of the cells to those seen in Paget's disease of the nipple. The relation of this disease state to mammary involvement is emphasized by the fact that three of the five cases presenting had either a current or past history of breast ductal carcinoma or hyperplasia.