Biomedical subjects

S C Marinoff

Publications and source records attributed to S C Marinoff.

12 recordsLinked to original sources

PubMed1993

Intralesional alpha interferon. Cost-effective therapy for vulvar vestibulitis syndrome.

The cost-effectiveness of two treatment strategies for vulvar vestibulitis syndrome (VVS) was compared. Our prospective study consisted of 55 patients with human papillomavirus (HPV)- and non-HPV-associated VVS of at least 6 months' duration treated with intralesional recombinant alpha interferon injections, followed by surgery for nonresponders and responders compared with a hypothetical model of surgery alone. The setting was a private-practice multispecialty center for vulvovaginal disorders. Improvement was defined by patients' subjective evaluation of change in the level of introital dyspareunia and the ability to have sexual relations and objective evidence of change in the degree of erythema and tenderness to touch within the vestibule. Statistical analyses of the overall probability of improvement, overall costs and the cost per patient treated were done. Twenty-seven (49%) of 55 patients treated with alpha interferon had substantial or partial improvement. Of the 28 (51%) who did not improve following alpha interferon, 19 elected to have surgery. Surgery resulted in substantial improvement in 84% of the patients and partial improvement in 11%. Statistical analysis comparing the group treated with alpha interferon (some of whom went to surgery with the hypothetical model of surgical treatment alone) showed significant cost-saving in the group first treated with alpha interferon. At the level of effectiveness achieved in this study, intralesional alpha interferon as a first choice in the treatment of VVS is cost-effective.

Adult↗

PubMed1992

General principles in the diagnosis and treatment of vulvar diseases.

There are several major considerations that compel us to regard the vulva in a special way. Its surface epithelium encompasses a range from mucosa, to keratinized glabrous skin, to keratinized, hair-bearing skin. It thus needs to be approached from the point of view of a dermatologist who has an interest in sexually transmitted diseases and mucosal pathology. Dermatologists have long dealt with another mucosal surface, the mouth, and there are numerous similarities between the two--witness several important orogenital syndromes. The vulva serves both sexual and obstetric functions, so disorders in this area naturally fall in the purview of the obstetrician-gynecologist. What we have attempted to do is to put forth a guide for evaluation and treatment of these patients that is essentially a combination of both approaches. In the authors' experience, we have learned a great deal from each other. We have learned to take a history, examine a patient, and eventually treat her with a combination of dermatologic and gynecologic modalities. If the dermatologist reading this article has become familiar with gynecologic techniques, and the gynecologist with dermatologic techniques, and they have learned when to apply each, we have accomplished our aim.

Diagnosis, Differential↗

PubMed1992

Vulvar vestibulitis syndrome.

VVS is currently recognized as one of the leading causes of vulvodynia or chronic vulvar pain. Its cause is unknown, and it is defined by a constellation of signs and symptoms confined to the vulvar vestibule. Hence, there is introital or entry dyspareunia, vestibular erythema of varying degrees, and localized tenderness confined to the vulvar vestibule. It has been found to be associated with subclinical HPV infection; chronic, recurrent candidiasis; and persistent alteration of vaginal pH secretion, and therapy for some of these conditions sometimes leads to amelioration of the symptoms associated with vulvar vestibulitis. The majority of cases, however, are still idiopathic. The more chronic and severe cases are frequently helped by a surgical procedure that results in excision of most of the vestibule and advancement of the vaginal epithelium. Some of the milder cases are known to remit spontaneously, so conservative, supportive management is of the utmost importance.

Chronic Disease↗

PubMed1991

Vulvar vestibulitis syndrome: an overview.

Vulvar vestibulitis syndrome is a constellation of symptoms and findings involving and limited to the vulvar vestibule that consists of: (1) severe pain on vestibular touch to attempted vaginal entry, (2) tenderness to pressure localized within the vulvar vestibule, and (3) physical findings confined to vulvar erythema of various degrees. Histopathologic findings are consistent with a chronic, nonspecific inflammatory response that is occasionally associated with metaplasia of the minor vestibular glands. The cause is likely multifactorial, and to date the syndrome has been seen in association with subclinical human papillomavirus, chronic recurrent candidiasis, chronic recurrent bacterial vaginosis, chronic alteration of vaginal pH, and the use of chemical and destructive therapeutic agents. Therapy is directed at elimination of these symptoms. When symptoms are unrelieved, a surgical approach consisting of vestibulectomy with vaginal advancement has a high rate of success.

Chronic Disease↗

PubMed1991

Pudendal neuralgia.

We call attention to a group of patients with chronic vulvar burning (vulvodynia), who do not have apparent infections or easily discernible abnormal physical findings, but who on simple sensory testing have allodynia, hyperalgesia, hyperpathia, and hypoesthesia in varying permutations within the areas innervated by the pudendal nerve. We propose that pudendal neuralgia (pain along the pudendal nerve) is one of the causes of idiopathic vulvodynia. In those patients in whom a neurologic, metabolic, infectious, traumatic, or malignant cause for neuralgia is not found, medical management with tricyclic antidepressants, antiepileptic agents, or both may prove helpful. Awareness of this entity will lead to earlier diagnosis, treatment, and reassurance of patients with chronic vulvar burning.

Acyclovir↗

PubMed1988

Association of human papillomavirus with vulvodynia and the vulvar vestibulitis syndrome.

Seven women presenting with longstanding introital dyspareunia and burning in the vulvar area were demonstrated, with DNA hybridization techniques, to harbor human papillomavirus (HPV). Three of the seven had intermittent, culture-negative dysuria coincident with the vulvar complaints. All the patients had mild to marked erythema of the openings of the minor vestibular glands, with exquisite tenderness on palpation with a cotton-tipped applicator. A regular histologic examination was equivocal for evidence of HPV infection in four of the seven cases. The clinical picture prior to acetic acid application exhibited three variations: (1) smooth epithelial surfaces devoid of papillations; (2) patchy papillations of the vestibular and adjacent structures; and (3) florid, fine papillomatosis of the vestibule and adjacent structures. We propose that HPV infection is one of the causes of vulvodynia and the vulvar vestibulitis syndrome.

Adult↗

PubMed1986

Hypersensitivity to vaginal candidiasis or treatment vehicles in the pathogenesis of minor vestibular gland syndrome.

Minor vestibular gland syndrome is a specific clinical entity found in young women with a previous history of vaginal candidiasis. The criteria for diagnosis include introital dyspareunia, absence of active infection, erythema around orifices of the minor vestibular glands and exquisite tenderness to point palpation with a cotton-tipped applicator over these glandular openings. The histopathology shows a mixed inflammatory infiltrate in the subepithelium as well as around the glands. The etiology of this clinical syndrome is unknown. It is unlikely that a delayed hypersensitivity reaction to Candida is the cause. It is also unlikely that an irritant or allergic reaction to Monistat-7 vaginal cream or the vehicles in other vaginal creams contributes to this problem.

Adult↗

PubMed1972