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Biomedical subjects

Hope K Haefner

Publications and source records attributed to Hope K Haefner.

At least 19 recordsLinked to original sources
PubMed2006

Erosive papulonodular dermatosis associated with topical benzocaine: a report of two cases and evidence that granuloma gluteale, pseudoverrucous papules, and Jacquet's erosive dermatitis are a disease spectrum.

Granuloma gluteale infantum/adultorum, pseudoverrucous papules, and Jacquet's erosive diaper dermatitis are fairly uncommon manifestations of irritant contact dermatitis historically thought to be distinct clinical entities. Here we report two informative cases of an erosive papulonodular dermatosis in the genital and suprapubic area associated with topical benzocaine. We review granuloma gluteale infantum, pseudoverrucous papules and nodules, and Jacquet's erosive diaper dermatitis, and propose that these disorders may all be variants of genitocrural irritant dermatitis.

Administration, Topical↗
PubMed2006

Reliability and validity of self-reported symptoms for predicting vulvodynia.

OBJECTIVE: To evaluate the reliability and validity of self-reported symptoms to predict vulvodynia, compared with examination-based confirmation. METHODS: Between August 5, 2004, and December 13, 2004, 1,046 members of the University of Michigan Women's Health Registry were surveyed regarding the presence of symptoms suggestive of vulvodynia. Diagnoses of vulvodynia and of control status based on survey responses were made, and a subset of these respondents was evaluated in the office. RESULTS: One thousand forty-six of 1,447 (72.3%) eligible women, aged 19 to 92 years, completed the survey. Seventy-nine (7.6%) of the survey respondents who reported ongoing vulvar pain lasting more than 3 months were predicted to have vulvodynia, while women reporting no current pain with intercourse and no history of prolonged vulvar pain were predicted to be controls (N = 543). Agreement between the history taken at the office and that reported on the survey was very good (reliability: Cohen's kappa = 0.86, 95% confidence interval 0.73-0.99). Of the 28 women predicted to have vulvodynia who were examined in the office, 27 (96.4%) were confirmed to have vulvodynia, and 28 of the 34 (82.4%) asymptomatic women examined did not have increased vulvar sensitivity (Cohen's kappa = 0.78, 95% confidence interval 0.64-0.92). CONCLUSION: Excellent reliability and validity of survey responses for predicting vulvodynia were demonstrated. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2006

Unusual location of vulvar basal cell carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) is a rare tumor of the vulva; it accounts for approximately 2% to 4% of vulvar cancer. CASE: A 73-year-old woman was referred because of a 2-cm ulcerative lesion on her perineum, near the anus. Punch biopsy showed BCC. She underwent wide local excision of tumor without any damage to the anal sphincter. The postoperative period was uneventful and the cosmetic results were good. CONCLUSIONS: BCC most commonly occurs in sun-exposed areas, but it may be seen in rare locations, such as in perineum. In our case, chronic irritation secondary to long-term chronic candidiasis in the presence of diabetes mellitus may have been contributory to the development of vulvar BCC.

Aged↗
PubMed2006

Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors.

OBJECTIVE: To determine the efficacy of tricyclic antidepressants (TCAs) as treatment for vulvodynia, and to identify demographic factors and pain characteristics associated with improvement. MATERIALS AND METHODS: Between January 2001 and April 2004, women diagnosed with vulvodynia were offered TCA therapy. The patients rated their worst recent pain on a 10-point scale at baseline and at follow-up; improvement was classified as at least 50% reduction in reported pain from baseline. RESULTS: Of 271 women diagnosed with vulvodynia, 209 (77.1%) were treated initially with a TCA (amitriptyline [n = 183], desipramine [n = 23], and other tricyclic medications [n = 3]). One hundred sixty-two (59.8%) of the women were followed up at a median period of 3.2 months after their initial visit, including 122 women who had started on a TCA. Of 83 women taking a TCA at the first follow-up, 49 (59.3%) improved by more than 50%, compared with 30 of 79 women not taking TCA at follow-up (improvement rate = 38.0%; p =.007; odds ratio = 2.35; 95% CI = 1.23-4.42). Multivariate analysis indicated that age, severity of pain, diagnosis (localized vs generalized vulvar pain), length of time with pain before treatment, age at menarche, use of oral contraceptives, and the number of previous pregnancies were not associated with the outcome; however, taking a TCA at the time of the first follow-up was strongly associated with improvement (p <.001; odds ratio = 4.23; 95% CI = 1.98-9.01). Repeated analysis including only those women prescribed with amitriptyline rather than any tricyclic revealed similar results. CONCLUSIONS: Women with vulvodynia who were prescribed a TCA in general (or amitriptyline, specifically) were more likely to have pain improvement compared with those women not taking these medications at follow-up. Randomized, controlled studies of TCAs versus other treatments are needed to clarify the overall effectiveness of these drugs.

Adult↗
PubMed2006

Home study course: fall 2006.

OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his/her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management, or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME ACCREDITATION: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ASCCP designates this education activity for a maximum of 1 American Medical Association Physician's Recognition Award Category I Credit. Physicians should only claim credit commensurate with the extent of their participation in the activity. The ASCCP also designates their educational activity for 1 Category 1 credit hour of the ASCCP's Program for Continuing Professional Development. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements. DISCLOSURES: The clinical history and images in the Home Study Course may represent an actual case, but not always. To improve educational quality, some gross, cytological, or histological images may come from photographic libraries. Good teaching cases are often difficult to obtain, and we encourage our readers to submit cases with high-quality images to the Home Study Course editor or executive editor to consider for publication.

Adult↗
PubMed2006

Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management.

Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population. Despite its high prevalence and associated distress, the etiology, diagnosis and clinical management of the disorder have not been clearly delineated. This "white paper" describes the findings and recommendations of a consensus conference panel based on a comprehensive review of the published literature on vulvodynia in addition to expert presentations on research findings and clinical management approaches. The consensus panel also identified key topics and issues forfurther research, including the role of inflammatory mechanisms and genetic factors and psychosexual contributors.

Biomedical Research↗
PubMed2005

The vulvodynia guideline.

OBJECTIVE: To provide a review of the literature and make known expert opinion regarding the treatment of vulvodynia. MATERIALS AND METHODS: Experts reviewed the existing literature to provide new definitions for vulvar pain and to describe treatments for this condition. RESULTS: Vulvodynia has been redefined by the International Society for the Study of Vulvovaginal Disease as vulvar discomfort in the absence of gross anatomic or neurologic findings. Classification is based further on whether the pain is generalized or localized and whether it is provoked, unprovoked, or both. Treatments described include general vulvar care, topical medications, oral medications, injectables, biofeedback and physical therapy, dietary changes with supplementations, acupuncture, hypnotherapy, and surgery. No one treatment is clearly the best for an individual patient. CONCLUSIONS: Vulvodynia has many possible treatments, but very few controlled trials have been performed to verify efficacy of these treatments. Provided are guidelines based largely on expert opinion to assist the patient and practitioner in dealing with this condition.

Administration, Oral↗
PubMed2005

Vulvar pain in women attending a general medical clinic in Accra, Ghana.

OBJECTIVE: To determine the prevalence of vulvar pain and pain related to sexual intercourse among women attending a general medical clinic in Accra, Ghana. STUDY DESIGN: A cross-sectional survey was performed. RESULTS: Forty-six women (22.8%) reported the presence of vulvar pain at the time of the study. There was significant association between the presence of vulvar pain and dissatisfaction with the quality of sexual activity (p < 0.001). There was no association between the presence of vulvar pain and the type of underwear used or the menstrual hygiene of the respondents. CONCLUSION: Vulvar pain with some relationship to sexual intercourse appears to be a significant problem among Ghanaian women.

Adolescent↗
PubMed2004

Teaching residents how to teach improves quality of clerkship.

OBJECTIVE: To evaluate the impact of a resident's teaching skills workshop on the ratings of the obstetrics and gynecology clerkship by third-year medical students. STUDY DESIGN: The 6-week obstetrics and gynecology clerkship at the University of Michigan is provided at 4 different sites including the University of Michigan Hospital. At the end of each rotation, medical students complete an evaluation form assessing various aspects of their learning experience, including the overall quality of clerkship. A workshop, "Teaching Residents How to Teach," was conducted at the University of Michigan Hospital, whereas the other 3 sites served as the control. Clerkship evaluations were compared before and after the workshop using Student t test. RESULTS: Students at the University of Michigan Hospital rated all items on the evaluation form higher after the teaching workshop. The overall quality of the clerkship at the University of Michigan Hospital improved ( P = .05), whereas the other sites remained stable. CONCLUSIONS: A "Teaching the Residents How to Teach" workshop improves the overall quality of the clerkship.

Clinical Clerkship↗
PubMed2004

Vulvar melanoma: a report of 20 cases and review of the literature.

BACKGROUND: Vulvar melanoma is the second most common vulvar malignancy and represents a significant women's health issue. OBJECTIVE: To report experience with 21 cases of vulvar melanoma in 20 patients and to review the literature about the condition. METHODS: Parameters retrospectively reviewed included age at diagnosis, family history of melanoma, location on the vulva, atypical nevi, Breslow depth, ulceration status, histologic pattern, presenting signs and symptoms, and the results of sentinel lymph node biopsy. Molecular characterization of the melanocortin type 1 receptor was performed in 1 patient. RESULTS: A family history of cutaneous melanoma was present in 15% of cases. The mean Breslow depth was 2.8 mm (range, 0.0-11.0 mm). Ten patients successfully underwent sentinel lymph node biopsy, results of which were positive in 2 (20%). Reported for the first time is that one patient had a germline mutation in the melanocortin type 1 receptor. CONCLUSION: Vulvar and cutaneous melanoma behave similarly despite their unique pathogeneses. Sentinel lymph node biopsy can be performed successfully for vulvar melanoma.

Adult↗
PubMed2004

Pain at the vulvar vestibule: a web-based survey.

OBJECTIVE: To assess the prevalence, characteristics, and ethnic distribution of pain in the vulvar vestibule among a national sample of women completing a web-based survey. METHODS: Female participants of the SurveySpot Internet research panel (Survey Sampling International) were invited via e-mail to respond to a web-based questionnaire on women's health issues. The frequency and characteristics of reported pain of the vulvar vestibule were assessed among 994 respondents, using univariate and multivariate analyses. RESULTS: Between May 24, 2002, and June 6, 2002, 730 non-African American women and 364 African American women responded to the invitation to participate, and 94.5% completed the survey. A history of pain at the vulvar vestibule was reported by 288 women (27.9%), with 80 (7.8% of the initial 1032) reporting pain within the past 6 months, 31 (3.0%) reporting pain that lasted 3 or more months, and 18 (1.7%) reporting vestibular pain lasting 3 or more months that occurred within the past 6 months. The prevalence of pain was similar in African American and non-African American women. CONCLUSIONS: The prevalence of pain at the vulvar vestibule is more common than previously estimated. The perception that vulvar pain is rare among African American women was not supported in this survey.

Journal Article↗
PubMed2004

Vulvar melanoma: review of diagnosis, staging, and therapy.

OBJECTIVES: To update, assimilate, and bridge the contemporary literature on vulvar and cutaneous melanoma regarding diagnosis, staging, and therapy to provide a useful clinical reference for managing and counseling for affected patients. MATERIALS AND METHODS: A computerized search for reports in the literature up to June 2003 was carried out using PubMed and MEDLINE databases. Multidisciplinary involvement was used in evaluating the available data and formulating conclusions. RESULTS: More than 300 reports were reviewed. Diagnosis, staging, and therapy aspects of vulvar melanoma are summarized. CONCLUSIONS: Vulvar melanoma represents a subtype of cutaneous melanoma, with similar prognostic and staging factors. The most recent American Joint Committee on Cancer staging system for cutaneous melanoma is applicable to vulvar melanoma. Sentinel lymph node biopsy is reliable for staging the regional lymph node basin for vulvar melanoma. Standardized documentation of clinical and histopathologic parameters is needed to standardize grouping of cases for future comparison studies.

Journal Article↗
PubMed2004

The bartholin gland cyst: past, present, and future.

Bartholin gland cysts account for 2% of all gynecologic visits per year. The treatment of Bartholin gland cysts has evolved from a complicated, bloody procedure requiring general anesthesia to, most recently, a simple puncture of the cyst and placement of a drain performed in the office. Although treatments for Bartholin gland cysts seem simple on the surface, recurrent cysts as well as diagnosing simple cysts versus abscesses versus malignant tumors can complicate treatment for this common problem. This article exams a history of the treatment of Bartholin gland cysts, including the use of the traditional treatments of excision, fistulization, marsupialization, as well as cauterization with carbon dioxide laser and silver nitrate. Modern variations are discussed, including the use of hydrodissection for excision, as well as the application of magnetic resonance imaging use in devising treatment for recurrent cysts.

Journal Article↗
PubMed2004

Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity.

OBJECTIVE: To assess both regional (vulvar) and overall (generalized) pain sensitivity in women with vulvodynia to determine whether both are increased, suggestive of altered central pain processing. METHODS: Seventeen patients (aged 18-60 years) with vulvodynia and 23 age-matched control subjects were included in this cross-sectional study. Pressure pain thresholds in the vulvar area were evaluated in 23 defined locations using a newly developed vulvodolorimeter. Peripheral pressure pain sensitivity was assessed by applying 1) continuously ascending pressures to 3 bilateral locations (thumb, deltoid, and shin), and 2) discrete pressure stimuli to the thumb using both an ascending and random sequence of varying pressures. RESULTS: Pain thresholds at all vulvar locations were lower in the women with vulvodynia than in pain-free control subjects. Similarly, peripheral pain thresholds were lower at the thumb in women with vulvodynia when obtained by discrete ascending or random staircase paradigms, as well as at the thumb, deltoid, and shin when tested by dolorimeter (P <.05). Findings were similar in both those with generalized vulvar dysesthesia and those with localized vestibulodynia. The quantitative results obtained with the vulvodolorimeter and with the more subjective cotton-tipped swab testing routinely used in diagnosis were strongly correlated. CONCLUSION: Women with vulvodynia displayed significantly increased pressure pain sensitivity in both the vulvar region and in peripheral body regions, suggesting a "central" component to the mechanisms mediating this disorder. Both the novel vulvodolorimeter and the thumb pressure stimulator may assist in future experimental tests of this and related hypotheses.

Adolescent↗
PubMed2004

Vulvar lichen sclerosus : pathophysiology and treatment.

Lichen sclerosus is a chronic disorder of the skin and mucosal surfaces, and is most commonly seen on the female genital skin. It also occurs on other areas of the body. Any age group may be affected, although it is seen more often in elderly women. The exact cause of lichen sclerosus is unknown. There have been reports of family members with lichen sclerosus; thus it may have a genetic link. There is also the possibility of an autoimmune connection. Currently, ultra-potent topical corticosteroids are the medical treatment of choice. Other treatments that have been utilized for this condition include testosterone, progesterone, tacrolimus, surgery, and phototherapy. Surgery should be reserved for symptomatic patients who fail to respond to multiple medical treatments, as there is a high recurrence rate following surgery. The risk of developing squamous cell carcinoma of the vulva approaches 5% in women with vulvar lichen sclerosus, and therefore close surveillance by the healthcare provider and patient is needed. This review discusses the history, clinical features, pathophysiology, and treatment of lichen sclerosus of the vulva, as well as pregnancy issues and sexual function in patients with this condition. In addition, problems specific to children with lichen sclerosus are reviewed.

Administration, Cutaneous↗