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Nakhleh-Francis Y, Awad-Igbaria Y, Sakas R, Bang S, Abu-Ata S, Palzur E, Lowenstein L, Bornstein J. Exploring Localized Provoked Vulvodynia: Insights from Animal Model Research. Int J Mol Sci 2024; 25:4261. [PMID: 38673846 PMCID: PMC11050705 DOI: 10.3390/ijms25084261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Provoked vulvodynia represents a challenging chronic pain condition, characterized by its multifactorial origins. The inherent complexities of human-based studies have necessitated the use of animal models to enrich our understanding of vulvodynia's pathophysiology. This review aims to provide an exhaustive examination of the various animal models employed in this research domain. A comprehensive search was conducted on PubMed, utilizing keywords such as "vulvodynia", "chronic vulvar pain", "vulvodynia induction", and "animal models of vulvodynia" to identify pertinent studies. The search yielded three primary animal models for vulvodynia: inflammation-induced, allergy-induced, and hormone-induced. Additionally, six agents capable of triggering the condition through diverse pathways were identified, including factors contributing to hyperinnervation, mast cell proliferation, involvement of other immune cells, inflammatory cytokines, and neurotransmitters. This review systematically outlines the various animal models developed to study the pathogenesis of provoked vulvodynia. Understanding these models is crucial for the exploration of preventative measures, the development of novel treatments, and the overall advancement of research within the field.
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Affiliation(s)
- Yara Nakhleh-Francis
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya 2210001, Israel; (S.B.); (L.L.); (J.B.)
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Yaseen Awad-Igbaria
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Reem Sakas
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Sarina Bang
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya 2210001, Israel; (S.B.); (L.L.); (J.B.)
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Saher Abu-Ata
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Eilam Palzur
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya 2210001, Israel; (S.B.); (L.L.); (J.B.)
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya 2210001, Israel; (S.B.); (L.L.); (J.B.)
- Research Institute of Galilee Medical Center, Nahariya 2210001, Israel; (Y.A.-I.); (R.S.); (S.A.-A.); (E.P.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
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Awad-Igbaria Y, Abu-Ata S, Nakhleh-Francis Y, Lowenstein L, Ginat K, Bornstein J, Palzur E, Shamir A. Exploring venlafaxine effects on chronic vulvar pain: Changes in mood and pain regulation networks. Neuropharmacology 2024; 243:109788. [PMID: 37984764 DOI: 10.1016/j.neuropharm.2023.109788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
The etiology of idiopathic pain conditions, such as Provoked vulvodynia (PV), is multifactorial. The efficiency of venlafaxine, serotonin-noradrenaline reuptake inhibitor (SNRIs) in modulating vulvar pain led to the hypothesis that PV might involve central mechanisms. Here, we investigate whether vulvar pain is associated with gene-expression changes in mood, stress and pain systems, including amygdala (Amg), medial prefrontal cortex (mPFC), and periaqueductal gray matter (PAG). Additionally, we examined the analgesic and anxiolytic effects of venlafaxine. We found that the development of chronic vulvar pain in an animal model of PV is associated by overexpression of genes related to neuronal-activity and neuroinflammation in the Amg, mPFC, and PAG. Additionally, changes in the expression of GABA and serotonin synthesis, and reuptake were noted in the Amg and mPFC. Unsurprisingly, anxiety-like behavior and emotional-disorder were observed in rats with chronic vulvar pain. Nevertheless, treatment with venlafaxine (37.5 mg/kg) for one month significantly improves the vulvar hypersensitivity, as well as reduces the anxiety level. More critically, the long-term gene expression adaptation in serotonin receptor and synthesis, GABA synthesis, neuroplasticity, and neuroinflammation in the Amg, mPFC, and PAG, were modulated by venlafaxine in rats with vulvar pain. Our findings suggest that vulvar hypersensitivity induced by inflammation might associated with gene expression changes in brain areas that are involved in mood, stress and pain regulation. These changes probably play a role in central sensitization, and anxiety. Strikingly, enhancing the activity of serotonin and noradrenaline via venlafaxine treatment in rats with vulvar pain induces analgesic and anxiolytic effects.
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Affiliation(s)
- Yaseen Awad-Igbaria
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Research Institute of Galilee Medical Center, Nahariya, Israel.
| | - Saher Abu-Ata
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Research Institute of Galilee Medical Center, Nahariya, Israel
| | - Yara Nakhleh-Francis
- Research Institute of Galilee Medical Center, Nahariya, Israel; Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Lior Lowenstein
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Research Institute of Galilee Medical Center, Nahariya, Israel; Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Karen Ginat
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel
| | - Jacob Bornstein
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Research Institute of Galilee Medical Center, Nahariya, Israel
| | - Eilam Palzur
- Research Institute of Galilee Medical Center, Nahariya, Israel
| | - Alon Shamir
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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Bornstein J. More Steps Forward for the Journal of Lower Genital Tract Disease. J Low Genit Tract Dis 2024; 28:1-2. [PMID: 37728387 DOI: 10.1097/lgt.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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Sacinti KG, Razeghian H, Awad-Igbaria Y, Lima-Silva J, Palzur E, Vieira-Baptista P, Verstraelen H, Bornstein J. Is Vulvodynia Associated With an Altered Vaginal Microbiota?: A Systematic Review. J Low Genit Tract Dis 2024; 28:64-72. [PMID: 37963335 DOI: 10.1097/lgt.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Vulvodynia is defined as vulvar pain of at least 3 months' duration, without clear identifiable cause, which may have potential associated factors. It can have a significant impact on women's quality of life due to a combination of physical pain, emotional distress, and limited treatment options. Despite affecting a considerable number of women worldwide, the causes and underlying mechanisms of vulvodynia remain poorly understood. Given the recognized association of the vaginal microbiota with various gynecologic disorders, there has been growing interest in exploring the potential role of the vaginal microbiota in the etiology of vulvodynia. This systematic review aims to evaluate the current literature on the association between the vaginal microbiota and vulvodynia. MATERIAL AND METHODS A systematic search of multiple databases, including PubMed, Scopus, Web of Science, Cochrane Library, and Ovid MEDLINE, was conducted to identify relevant peer-reviewed studies up to May 12, 2023. The following search terms were used across these databases: "vulvodynia," "vestibulodynia," "vulvar vestibulitis," "microbiome," "microbiota," and "flora." RESULTS A total of 8 case-control studies were included, the quality of which was assessed using the Newcastle-Ottawa Scale. Data extraction and synthesis were performed using a standardized protocol. In most studies, no major differences were found between the vaginal bacterial composition of women with vulvodynia and that of controls. No specific bacterial taxa were consistently associated with vulvodynia. The relationship between vaginal microbiota diversity and vulvodynia remains to be fully understood. CONCLUSIONS The role of vaginal microbiota in vulvodynia, if any, remains unclear. Because of the cross-sectional nature of the included studies, it is not possible to make any causal inferences. Further research, using larger and more diverse study populations and advanced sequencing techniques, is necessary to gain a better understanding of the potential relationship between the vaginal microbiota and vulvodynia.
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Affiliation(s)
| | | | | | - Joana Lima-Silva
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Eilam Palzur
- The Research Institute of Galilee Medical Center, Galilee Medical Center, Nahariya, Israel
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Sharon A, Aiob A, Kais M, Apel-Sarid L, Tendler R, Dourleshter G, Bornstein J. Detection and dissection of sentinel nodes in endometrial endometrioid cancer with indocyanine green using PinPoint laparoscopy: Analysis of the learning curve. Eur J Obstet Gynecol Reprod Biol 2024; 292:91-96. [PMID: 37988798 DOI: 10.1016/j.ejogrb.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Early-stage endometrial endometrioid adenocarcinoma is managed through laparoscopic total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Detection of positive nodes is rare, and lymphadenectomy may involve complications. Pelvic sentinel lymph node dissection can prevent complete dissection. Herein, we evaluated the learning curve of sentinel lymph node dissection using indocyanine green. STUDY DESIGN All surgeries for endometrial endometrioid adenocarcinoma were performed laparoscopically with indocyanine green to detect sentinel nodes. The primary outcome was the ability to identify and resect sentinel lymph nodes on each side. The secondary outcome was correspondence between the frozen section histology of the nodes with the final histology. RESULTS Among 31 patients with endometrial endometrioid adenocarcinoma treated between October 2018 and August 2020, 29 who underwent laparoscopy using indocyanine green were enrolled. Complete lymphadenectomy was performed in 16 patients. Failure to recognize sentinel nodes on right and left sides occurred in 10.34% and 0% of cases, respectively. The median number of recognized and dissected sentinel nodes was 1 on both sides (range 0-5). One patient had a lymph node positive for malignancy on histology (3.45%) on both sides. There were 13 and 14 cases of negative frozen sections on the right and left sides, respectively, and 1 case of a positive frozen section with positive whole pelvic lymph nodes. CONCLUSION Sentinel node dissection using indocyanine green in endometrial endometrioid adenocarcinoma has a distinct learning curve; however, it is practical and achievable for skilled surgeons.
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Affiliation(s)
- Avishalom Sharon
- Department of Gynecology and Obstetrics, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ala Aiob
- Department of Gynecology and Obstetrics, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Mohammad Kais
- Department of Gynecology and Obstetrics, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Liat Apel-Sarid
- Department of Pathology, Galilee Medical Center, Nahariya, Israel
| | - Renee Tendler
- Department of Gynecology and Obstetrics, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Grigory Dourleshter
- Department of Gynecology and Obstetrics, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jacob Bornstein
- Department of Gynecology and Obstetrics, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Yin W, Egawa N, Zheng K, Griffin H, Tian P, Aiyenuro A, Bornstein J, Doorbar J. HPV E6 inhibits E6AP to regulate epithelial homeostasis by modulating keratinocyte differentiation commitment and YAP1 activation. PLoS Pathog 2023; 19:e1011464. [PMID: 37379354 DOI: 10.1371/journal.ppat.1011464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Human papillomaviruses (HPV) cause persistent infections by modulating epithelial homeostasis in cells of the infected basal layer. Using FUCCI and cell-cell competition assays, we have identifed regulatory roles for E6AP and NHERF1, which are the primary HPV11 E6 cellular targets, as well as being targets of the high-risk E6 proteins, in processes governing epithelial homeostasis (i.e. cell density, cell cycle entry, commitment to differentiation and basal layer delamination). Depletion of E6AP, or expression of HPV11 or 16E6 increased keratinocyte cell density and cell cycle activity, and delayed the onset of differentiation; phenotypes which were conspicuously present in HPV11 and 16 infected patient tissue. In line with proposed E6 functions, in HPV11 condyloma tissue, E6AP and NHERF1 were significantly reduced when compared to uninfected epithelium. In experimental systems, loss of HPV11 E6/E6AP binding abolished 11E6's homeostasis regulatory functions, while loss of E6/NHERF1 binding reduced the cell density threshold at which differentiation was triggered. By contrast, a NHERF1-binding mutant of 16E6 was not compromised in its homeostasis functions, while E6AP appeared essential. RNA sequencing revealed similar transcriptional profiles in both 11 and 16E6-expressing cells and E6AP-/- cells, with YAP target genes induced, and keratinocyte differentiation genes being downregulated. HPV11 E6-mediated Yap activation was observed in 2D and 3D (organotypic raft) cell culture systems and HPV-infected lesions, with both NHERF1, which is a regulator of the Hippo and Wnt pathways, and E6AP, playing an important role. As the conserved binding partner of Alpha group HPV E6 proteins, the precise role of E6AP in modulating keratinocyte phenotype and associated signalling pathways has not previously been defined. Our study suggests a model in which the preserved functions of the low and high-risk Alpha E6 proteins modulate epithelial homeostasis via E6AP activity, and lead to alteration of multiple downstream pathways, including those involving NHERF1 and YAP.
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Affiliation(s)
- Wen Yin
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Nagayasu Egawa
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Ke Zheng
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Heather Griffin
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Pu Tian
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Ademola Aiyenuro
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Jacob Bornstein
- Gynecologist & Obstetrician, Colposcopy, Azrieli Faculty of Medicine of Bar-Ilan University, and Galilee Medical Center-Nahariya
| | - John Doorbar
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
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Sharon A, Zidane M, Aiob A, Apel-Sarid L, Bornstein J. Nonelectric shaving of endometrial polyp by hysteroscopy - A new technique to eliminate thermal damage. Eur J Obstet Gynecol Reprod Biol 2023; 285:170-174. [PMID: 37146506 DOI: 10.1016/j.ejogrb.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To present a new technique for complete endometrial polypectomy, using the bipolar loop hysteroscope, but without the activation of electrical energy, and follow its efficiency and safety for the patient. STUDY DESIGN This is a prospective descriptive study conducted at a university hospital. Forty four patients were recruited to the study according to an intra uterine polyp diagnosed by transvaginal ultrasound (TVS). Out of them 25 really had an endometrial polyp which was inspected by hysteroscopy. Eighteen were at menopause age and seven in their reproductive age. The hysteroscopic removal of the endometrial polyp was performed using the operative loop resectoscope without using electricity, meaning by cold loop. We called this unique technique SHEPH: Shaving of Endometrial Polyp by Hysteroscopy. RESULTS The range age was 21-77 years old. All patients with apparently endometrial polyp, underwent a complete removal of the polyp which could be directly seen through hysteroscopy. No bleeding was seen in all cases. The other nineteen patients had normal uterine cavity, so a biopsy was taken according to the indication. The specimen from all cases were sent to histological evaluation. An endometrial polyp was histologically confirmed in all cases who underwent the SHEPH technique, while fragments of an endometrial polyp was revealed by histology in six cases from the group that had normal uterine cavity. No complications were noted for the short and long periods. CONCLUSIONS Nonelectric Shaving of Endometrial Polyp by Hysteroscopy (SHEPH technique) is a safe and effective procedure which allows the surgeon to achieve a complete endometrial polypectomy but without using electrical energy within the body of the patient. The technique which is easy to learn, is new and unique by eliminate thermal damage in a very common gynecologic indication.
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Affiliation(s)
- Avishalom Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel.
| | - Muhammad Zidane
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel
| | - Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel
| | - Liat Apel-Sarid
- Department of Pathology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel
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Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, Chargari C, Cruickshank M, Erzeneoglu E, Gallio N, Gultekin M, Heller D, Joura E, Kyrgiou M, Madić T, Planchamp F, Regauer S, Reich O, Esat Temiz B, Woelber L, Zodzika J, Stockdale C. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus Statement on the Management of Vaginal Intraepithelial Neoplasia. J Low Genit Tract Dis 2023; 27:131-145. [PMID: 36951985 PMCID: PMC10026974 DOI: 10.1097/lgt.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
ABSTRACT The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vaginal intraepithelial neoplasia (VaIN). The management of VaIN varies according to the grade of the lesion: VaIN 1 (low grade vaginal squamous intraepithelial lesions (SIL)) can be subjected to follow-up, while VaIN 2-3 (high-grade vaginal SIL) should be treated. Treatment needs individualization according to the patient's characteristics, disease extension and previous therapeutic procedures. Surgical excision is the mainstay of treatment and should be performed if invasion cannot be excluded. Total vaginectomy is used only in highly selected cases of extensive and persistent disease. Carbon dioxide (CO2) laser may be used as both an ablation method and an excisional one. Reported cure rates after laser excision and laser ablation are similar. Topical agents are useful for persistent, multifocal lesions or for patients who cannot undergo surgical treatment. Imiquimod was associated with the lowest recurrence rate, highest human papillomavirus (HPV) clearance, and can be considered the best topical approach. Trichloroacetic acid and 5-fluorouracil are historical options and should be discouraged. For VaIN after hysterectomy for cervical intraepithelial neoplasia (CIN) 3, laser vaporization and topical agents are not the best options, since they cannot reach epithelium buried in the vaginal scar. In these cases surgical options are preferable. Brachytherapy has a high overall success rate but due to late side effects should be reserved for poor surgical candidates, having multifocal disease, and with failed prior treatments. VaIN tends to recur and ensuring patient adherence to close follow-up visits is of the utmost importance. The first evaluation should be performed at 6 months with cytology and an HPV test during 2 years and annually thereafter. The implementation of vaccination against HPV infection is expected to contribute to the prevention of VaIN and thus cancer of the vagina. The effects of treatment can have an impact on quality of life and result in psychological and psychosexual issues which should be addressed. Patients with VaIN need clear and up-to-date information on a range of treatment options including risks and benefits, as well as the need for follow-up and the risk of recurrence.
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Affiliation(s)
- Vesna Kesic
- Medical Faculty, University of Belgrade, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Lower Genital Tract Unit Centro Hospitalar de São João, Porto, Portugal
- Hospital Lusiadas, Porto, Portugal
| | | | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Maggie Cruickshank
- Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria Kyrgiou
- Surgery and Cancer - West London Gynecological Cancer Center, IRDB, Department of Gut, Metabolism & Reproduction-Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Healthcare NHS Trust, Queen Charlotte's & Chelsea Hospital West London Gynaecological Cancer Centre, London, United Kingdom
| | - Tatjana Madić
- Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Sigrid Regauer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Bilal Esat Temiz
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
- Dysplasia Center Hamburg; Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņ,š University, Riga, Latvia
| | - Colleen Stockdale
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA
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Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, Chargari C, Cruickshank M, Erzeneoglu E, Gallio N, Gultekin M, Heller D, Joura E, Kyrgiou M, Madić T, Planchamp F, Regauer S, Reich O, Esat Temiz B, Woelber L, Zodzika J, Stockdale C. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia. Int J Gynecol Cancer 2023; 33:446-461. [PMID: 36958755 PMCID: PMC10086489 DOI: 10.1136/ijgc-2022-004213] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vaginal intraepithelial neoplasia (VaIN). The management of VaIN varies according to the grade of the lesion: VaIN 1 (low grade vaginal squamous intraepithelial lesions (SIL)) can be subjected to follow-up, while VaIN 2-3 (high-grade vaginal SIL) should be treated. Treatment needs individualization according to the patient's characteristics, disease extension and previous therapeutic procedures. Surgical excision is the mainstay of treatment and should be performed if invasion cannot be excluded. Total vaginectomy is used only in highly selected cases of extensive and persistent disease. Carbon dioxide (CO2) laser may be used as both an ablation method and an excisional one. Reported cure rates after laser excision and laser ablation are similar. Topical agents are useful for persistent, multifocal lesions or for patients who cannot undergo surgical treatment. Imiquimod was associated with the lowest recurrence rate, highest human papillomavirus (HPV) clearance, and can be considered the best topical approach. Trichloroacetic acid and 5-fluorouracil are historical options and should be discouraged. For VaIN after hysterectomy for cervical intraepithelial neoplasia (CIN) 3, laser vaporization and topical agents are not the best options, since they cannot reach epithelium buried in the vaginal scar. In these cases surgical options are preferable. Brachytherapy has a high overall success rate but due to late side effects should be reserved for poor surgical candidates, having multifocal disease, and with failed prior treatments. VaIN tends to recur and ensuring patient adherence to close follow-up visits is of the utmost importance. The first evaluation should be performed at 6 months with cytology and an HPV test during 2 years and annually thereafter. The implementation of vaccination against HPV infection is expected to contribute to the prevention of VaIN and thus cancer of the vagina. The effects of treatment can have an impact on quality of life and result in psychological and psychosexual issues which should be addressed. Patients with VaIN need clear and up-to-date information on a range of treatment options including risks and benefits, as well as the need for follow-up and the risk of recurrence.
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Affiliation(s)
- Vesna Kesic
- Medical Faculty, University of Belgrade, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Lower Genital Tract Unit Centro Hospitalar de São João, Porto, Portugal
- Hospital Lusiadas, Porto, Portugal
| | | | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Maggie Cruickshank
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Debra Heller
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria Kyrgiou
- Surgery and Cancer - West London Gynecological Cancer Center, IRDB, Department of Gut, Metabolism & Reproduction-Surgery & Cancer, Imperial College London, London, UK
- Imperial Healthcare NHS Trust, Queen Charlotte's & Chelsea Hospital West London Gynaecological Cancer Centre, London, UK
| | - Tatjana Madić
- Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Sigrid Regauer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Bilal Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
- Dysplasia Center Hamburg; Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņš University, Riga, Latvia
| | - Colleen Stockdale
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa, USA
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10
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Leron E, Riches A, Neuman M, Erez O, Bornstein J. The Light-weight Mid-urethral Sling Implant for Female Stress Urinary Incontinence Treatment: A One-Year Postoperative Follow-up Study. Isr Med Assoc J 2023; 25:52-58. [PMID: 36718738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Serasis® (Serag-Wiessner KG, Naila, Germany) is a light-weight mid-urethral sling for treating stress urinary incontinence (SUI). Its insertion is considered less traumatic than other mid-urethral slings. OBJECTIVES To define postoperative outcomes following Serasis implantation. To compare the efficacy and complication rates of the implant to those of other common techniques. METHODS Our retrospective study evaluated patients who underwent Serasis mid-urethral sling surgery for SUI. Data were collected from medical records prior to and at the time of surgery and by telephonic interview for postoperative pain and complications. Follow-up of patients was performed for up to one year postoperatively. Patients rated pain or discomfort according to the Visual Analogue Scale (VAS). The primary outcome was the development of early postoperative pain during the first month after surgery. Secondary outcomes were relief of SUI symptoms, groin pain or discomfort, and other postoperative complications up to 12 months after surgery. RESULTS The study cohort included 50 consecutive patients aged 31 to 68 years. All patients underwent Serasis implantation procedures by a single surgeon and completed interviews. In total, 35 patients underwent concomitant anterior colporrhaphy. In the immediate postoperative period and at one month after the procedure, complaints were mild. No complaints were recorded during the 12-month follow-up period. Overall, 90% and 92% of the patients were free of SUI symptoms at one month and 12 months after surgery, respectively. CONCLUSIONS Serasis mid-urethral sling is safe, effective, and associated with mild postoperative pain and a low incidence of complications.
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Affiliation(s)
- Elad Leron
- Departments of Obstetrics and Gynecology B, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Anthony Riches
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Menahem Neuman
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Offer Erez
- Departments of Obstetrics and Gynecology D, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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11
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Feldstein O, Gali‐Zamir H, Schejter E, Feinberg T, Yehuda‐Shnaidman E, Bornstein J, Levy T. High-risk HPV testing vs liquid-based cytology for cervical cancer screening among 25- to 30-year-old women: A historical cohort study. Acta Obstet Gynecol Scand 2022; 102:226-233. [PMID: 36478537 PMCID: PMC9889323 DOI: 10.1111/aogs.14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION High-risk human papilloma virus (hrHPV) DNA testing is more sensitive than cytology screening, achieving greater protection against cervical cancer. Controversy exists regarding the preferred screening method for women 25-30 years of age. At this age, infection with HPV is common and usually transient. Consequently, hrHPV screening in this age group is fraught with high false-positive screening results, leading to more colposcopies and unnecessary treatments with the potential for harm. In the present study, we aimed to compare the results of two screening methods in relation to high-grade cervical intraepithelial lesion detection rate in the young age group of 25-30 years. MATERIAL AND METHODS Retrospective information on cervical cytology, hrHPV testing, colposcopy referrals and histologic results, from one screening round, were retrieved from the Maccabi HealthCare Health Maintenance Organization centralized database during the study period from March 1, 2017 to April 1, 2019 for 25- to 30-year-old women. Screening with hrHPV testing for types 16, 18 and 12 other hrHPV types was compared with the conventional PAP liquid-based cytology (LBC) test. Odds ratio (OR) of detection with 95% confidence interval (CI) was calculated for cervical intraepithelial neoplasia (CIN) grade 3 or higher (CIN 3+). RESULTS During the study period, 42 244 women 25-30 years old underwent cervical cancer screening; of them, 20 997 were screened with LBC between March 1, 2017 and March 1, 2018 and compared with 21 247 who were screened with hrHPV between April 1, 2018 and April 1, 2019. Testing for hrHPV resulted in a higher colposcopy referral rate compared with primary LBC screening: 9.8% vs 7.8%, respectively; (OR 1.28; 95% CI 1.2-1.37; p < 0.001). Screening with hrHPV led to significantly higher detection of CIN 3+ lesions (OR 1.4; 95% CI 1.2-1.6; p < 0.001) compared with LBC. HPV infections with non-16/18 hrHPV (other hrHPV) were the most prevalent (84.8%). CONCLUSIONS In women 25-30 years old, primary hrHPV screening was associated with a higher detection rate of CIN 3+ compared with cytology screening and should be considered for primary screening in this age group.
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Affiliation(s)
- Ohad Feldstein
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWolfson Medical Center and Sackler Faculty of MedicineTel Aviv UniversityHolonIsrael
| | - Hadar Gali‐Zamir
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWolfson Medical Center and Sackler Faculty of MedicineTel Aviv UniversityHolonIsrael
| | | | | | | | - Jacob Bornstein
- Department of Obstetrics and GynecologyGalilee Medical Center and Azrieli Faculty of MedicineBar Ilan UniversityIsrael
| | - Tally Levy
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWolfson Medical Center and Sackler Faculty of MedicineTel Aviv UniversityHolonIsrael
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12
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Awad-Igbaria Y, Palzur E, Nasser M, Vieira-Baptista P, Bornstein J. Changes in the Vaginal Microbiota of Women With Secondary Localized Provoked Vulvodynia. J Low Genit Tract Dis 2022; 26:339-344. [PMID: 35943448 DOI: 10.1097/lgt.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The etiology of localized provoked vulvodynia (LPV) remains unknown, but observations suggest the involvement of the vaginal microbiota. We examined the vaginal microbiota of women with LPV and healthy controls, upon after a low-oxalate diet (LOD). MATERIALS AND METHODS A total of 9 women diagnosed with secondary LPV and 21 healthy controls were recruited from the Galilee Medical Center in Israel and subjected to prospective evaluations of their vaginal microbiota. Total DNA was extracted from vaginal discharge samples provided before and after following LOD for 3 weeks and was then subjected to 16S sequencing. Data obtained were then used to evaluate α and β diversity, identify differentially abundant bacterial taxa in LPV, and determine their impact on the metabolism. RESULTS These evaluations revealed decreased diversity in the vaginal microbiota of women with LPV and identified the Ochrobactrum genus and Pseudomonadaceae family as indicators for LPV. In addition, we identified 23 differentially expressed bacterial metabolic pathways between the LPV and control samples and revealed that LOD could induce changes in the β diversity of LPV vaginal microbiomes, which was further supported by some degree of pain reduction in patients. CONCLUSIONS Localized provoked vulvodynia and LOD were associated with shifts in the vaginal microbiota. However, the impact of these changes on the development of LPV requires additional studies with a larger cohort.
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Affiliation(s)
| | - Eilam Palzur
- The Research Institute of Galilee Medical Center, Nahariya, Israel
| | - Manal Nasser
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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13
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Vieira-Baptista P, Lima-Silva J, Preti M, Sousa C, Caiano F, Stockdale CK, Bornstein J. Vaginal Leptothrix: An Innocent Bystander? Microorganisms 2022; 10:microorganisms10081645. [PMID: 36014063 PMCID: PMC9415594 DOI: 10.3390/microorganisms10081645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Leptothrix are long bacteria of rare occurrence; although these bacteria have been implicated in causing vaginal symptoms identical to candidiasis, studies on prevalence and effect on overall vaginal health are lacking. In this study, we evaluated data of women referred to a private clinic for treating vulvovaginal symptoms (n = 1847) and reassessed data of our previous and ongoing studies (n = 1773). The overall rate of leptothrix was 2.8% (102/3620), and the mean age of affected women was 38.8 ± 10.65 years (range 18−76). The majority of the women with leptothrix had normal vaginal flora (63.7% [65/102]). Leptothrix was associated with a higher risk of candidiasis (relative risk (RR) 1.90, 95% confidence interval (CI) 1.1600–3.1013; p = 0.010) and a lower risk of bacterial vaginosis (RR 0.55, 95% CI, 0.3221–0.9398; p = 0.029) and cytolytic vaginosis (RR 0.11, 95% CI, 0.0294–0.4643; p = 0.002). No cases of trichomoniasis were observed. Human immunodeficiency virus infection increased the risk of leptothrix (RR 3.0, 95% CI, 1.6335–5.7245; p = 0.000). Among the women evaluated for vulvovaginal symptoms, 2.4% (45/1847) had leptothrix, and in 26.7% (12/45), leptothrix was considered the causative entity. This study suggests that leptothrix occurrence is rare; it remains unresolved if it can be a cause of vulvar symptoms.
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Affiliation(s)
- Pedro Vieira-Baptista
- Hospital Lusíadas Porto, 4050-115 Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, 4200-319 Porto, Portugal
- Correspondence: (P.V.-B.); (J.B.)
| | - Joana Lima-Silva
- Hospital Lusíadas Porto, 4050-115 Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, 4200-319 Porto, Portugal
| | - Mario Preti
- Department of Surgical Sciences, University of Torino, 10124 Turin, Italy
| | | | | | - Colleen K. Stockdale
- Department of Obstetrics & Gynecology, University Iowa Healthcare, Iowa City, IA 52242, USA
| | - Jacob Bornstein
- Galilee Medical Center, and Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
- Correspondence: (P.V.-B.); (J.B.)
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14
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Kyrgiou M, Athanasiou A, Arbyn M, Lax SF, Raspollini MR, Nieminen P, Carcopino X, Bornstein J, Gultekin M, Paraskevaidis E. Terminology for cone dimensions after local conservative treatment for cervical intraepithelial neoplasia and early invasive cervical cancer: 2022 consensus recommendations from ESGO, EFC, IFCPC, and ESP. Lancet Oncol 2022; 23:e385-e392. [DOI: 10.1016/s1470-2045(22)00191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
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15
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Awad-Igbaria Y, Dadon S, Shamir A, Livoff A, Shlapobersky M, Bornstein J, Palzur E. Characterization of Early Inflammatory Events Leading to Provoked Vulvodynia Development in Rats. J Inflamm Res 2022; 15:3901-3923. [PMID: 35845089 PMCID: PMC9286136 DOI: 10.2147/jir.s367193] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Provoked vulvodynia (PV) is the main cause of vulvar pain and dyspareunia. The etiology of PV has not yet been elucidated. However, PV is associated with a history of recurrent inflammation, and its often accompanied by increases in the numbers of mast cells (MCs) and sensory hyperinnervation in the vulva. Therefore, this study aimed to examine the role of MCs and the early inflammatory events in the development of chronic vulvar pain in a rat model of PV. Methods Mechanical and thermal vulvar sensitivity was measured for 5 months following zymosan vulvar challenges. Vulvar changes in glutamate and nerve growth factor (NGF) were analyzed using ELISA. Immunofluorescence (IF) staining of the vulvar section after 20, 81, and 160 days of the zymosan challenge were performed to test MCs accumulation, hyperinnervation, and expression of pain channels (transient receptor potential vanilloid/ankyrin-1-TRPV1 & TRPA1) in vulvar neurons. Changes in the development of vulvar pain were evaluated following the administration of the MCs stabilizer ketotifen fumarate (KF) during zymosan vulvar challenges. Results Zymosan-challenged rats developed significant mechanical and thermal vulvar sensitivity that persisted for over 160 days after the zymosan challenge. During inflammation, increased local concentrations of NGF and glutamate and a robust increase in MCs degranulation were observed in zymosan-challenged rats. In addition, zymosan-challenged rats displayed sensory hyperinnervation and an increase in the expression of TRPV1 and TRPA1. Treatment with KF attenuated the upregulated level of NGF during inflammation, modulated the neuronal modifications, reduced MCs accumulation, and enhanced mechanical hypersensitivity after repeated inflammation challenges. Conclusion The present findings suggest that vulvar hypersensitivity is mediated by MCs accumulation, nerve growth, and neuromodulation of TRPV1 and TRPA1. Hence, KF treatment during the critical period of inflammation contributes to preventing chronic vulvar pain development.
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Affiliation(s)
- Yaseen Awad-Igbaria
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,The Research Institute of Galilee Medical Center, Nahariya, Israel
| | - Shilo Dadon
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,The Research Institute of Galilee Medical Center, Nahariya, Israel
| | - Alon Shamir
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Alejandro Livoff
- Pathology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Mark Shlapobersky
- Pathology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Jacob Bornstein
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,The Research Institute of Galilee Medical Center, Nahariya, Israel
| | - Eilam Palzur
- The Research Institute of Galilee Medical Center, Nahariya, Israel
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Preti M, Joura E, Vieira-Baptista P, Van Beurden M, Bevilacqua F, Bleeker MCG, Bornstein J, Carcopino X, Chargari C, Cruickshank ME, Erzeneoglu BE, Gallio N, Heller D, Kesic V, Reich O, Stockdale CK, Esat Temiz B, Woelber L, Planchamp F, Zodzika J, Querleu D, Gultekin M. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) consensus statements on pre-invasive vulvar lesions. Int J Gynecol Cancer 2022; 32:830-845. [PMID: 35728950 PMCID: PMC9279839 DOI: 10.1136/ijgc-2021-003262] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget's disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).
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Affiliation(s)
- Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Pedro Vieira-Baptista
- Hospital Lusiadas Porto, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Marc Van Beurden
- Centre for Gynecological Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Maaike C G Bleeker
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris, France
| | | | - Bilal Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Debra Heller
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vesna Kesic
- Department of Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Colleen K Stockdale
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa, USA
| | - Bilal Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
- Dysplasia Center Hamburg, Jerusalem Hospital, Hamburg, Germany
| | | | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņš university, Riga, Latvia
| | - Denis Querleu
- Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Aiob A, Naskovica K, Amdur Zilberfarb I, Sharon A, Bornstein J, Lowenstein L. Changes in diagnostic sensitivity, incidence and presentation of complete and partial hydatidiform mole over the years. Eur J Obstet Gynecol Reprod Biol 2022; 274:136-141. [PMID: 35640442 DOI: 10.1016/j.ejogrb.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/04/2022] [Accepted: 05/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Molar pregnancy is the most common type of gestational trophoblastic disease. Several recent reports have described changes in the clinical representation, the incidence and the diagnostic sensitivity of molar pregnancy. These changes could be due to widespread use of transvaginal ultrasound and beta-hCG testing in the management of routine first-trimester investigations. STUDY DESIGN This is a retrospective study of 144 women diagnosed with partial or complete mole at a regional medical center during 2007-2020. Incidence, demographics, clinical features and diagnostic sensitivity were compared between 2007 and 2014 and 2015-2020, and attempts were made to understand the bases of the changes between the time periods. RESULTS Sixty-two moles were diagnosed during 2007-2014 and 82 during 2015-2020. The proportions of complete moles in the respective periods were 65% (40) and 18% (15). From the earlier to the later period, the incidence and proportion of complete moles decreased, and of partial moles, increased. The median gestational age at diagnosis of molar pregnancy was 9.3 weeks. In the later period, women presented less frequently with vaginal bleeding, though this remained the most common presenting symptom. The proportion of women who underwent surgical evacuation of the uterus due to suspected molar pregnancy decreased, as did the proportion of moles that was suspected in ultrasound evaluation (P < 0.001). CONCLUSION The proportion of complete moles decreased between the periods examined. Gestational age at diagnosis was similar to data from 1994 to 2013. Some typical presenting symptoms of molar pregnancy decreased. However, earlier diagnosis of missed abortion can miss diagnoses of molar pregnancy.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Cente, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Karina Naskovica
- Department of Obstetrics and Gynecology, Galilee Medical Cente, Israel
| | | | - Avishalom Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Cente, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Cente, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Frank Wolf M, Ben-Nun M, Sgayer I, Shnaider O, Aiob A, Odeh M, Bornstein J. The association between acute lower abdominal pain over a previous caesarean scar and uterine rupture. J OBSTET GYNAECOL 2022; 42:1169-1173. [PMID: 35152819 DOI: 10.1080/01443615.2022.2027896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pregnant women with previous caesarean delivery might suffer from acute lower abdominal pain located at the site of previous caesarean scar (CS). The association between this complaint and uterine rupture (UR) is not fully understood. Therefore, we aimed to examine the risk of UR in women with acute persistent abdominal pain (APAP) over a previous CS and to investigate all the women with UR, with or without APAP and with or without previous CS, in order to determine risk factors, clinical presentation and management. We performed a retrospective analysis on two study groups: women who had APAP over previous CS and women who had UR. We found an incidence of UR in patients with APAP over the previous CS was 0.7%; which doubled the total UR rate among women with previous caesarean in our medical centre (0.35%). Forty percent of the women with APAP over a previous CS had preterm delivery. Twenty percent of the cases of UR occurred in preterm weeks. To conclude, APAP over a previous CS is associated with a doubled risk of UR. Considering this symptom as a preliminary sign of UR might lead to elevated rate of iatrogenic preterm deliveries.Impact statementWhat is already known on this subject? Women with UR may present with abdominal pain which may vary from non-specific mild discomfort to severe acute abdominal pain. Additionally, these women may suffer from acute persistent abdominal pain (APAP) located over the previous caesarean scar. The clinical significance of APAP in these women has not been fully investigated.What do the results of this study add? Lower abdominal pain located at the site of previous CS is associated with a doubled risk of UR. Considering this complaint as a major sign of UR might lead to an elevated rate of iatrogenic preterm deliveries.What are the implications of these findings for clinical practice and/or further research? Further studies are needed to explore whether women with a single complaint of APAP over CS could be managed expectantly and even offered a trial of labour after caesarean delivery (CD).
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Affiliation(s)
- Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maayan Ben-Nun
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Oleg Shnaider
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Alaa Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Preti M, Joura E, Vieira-Baptista P, Van Beurden M, Bevilacqua F, Bleeker MCG, Bornstein J, Carcopino X, Chargari C, Cruickshank ME, Erzeneoglu BE, Gallio N, Heller D, Kesic V, Reich O, Stockdale CK, Temiz BE, Woelber L, Planchamp F, Zodzika J, Querleu D, Gultekin M. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) Consensus Statements on Pre-invasive Vulvar Lesions. J Low Genit Tract Dis 2022; 26:229-244. [PMID: 35763611 PMCID: PMC9232287 DOI: 10.1097/lgt.0000000000000683] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget's disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).
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Affiliation(s)
- Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer; Center, Medical University of Vienna, Vienna, Austria
| | - Pedro Vieira-Baptista
- Hospital Lusiadas Porto, Porto, Portugal; Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Marc Van Beurden
- Centre for Gynecological Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Maaike C. G. Bleeker
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Cyrus Chargari
- Radiation Therapy, Gustave Roussy Cancer Campus, Paris, France
| | - Margaret E. Cruickshank
- Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Bilal Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | - Vesna Kesic
- Department of Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Bilal Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Dysplasia Center Hamburg, Jerusalem Hospital, Hamburg, Germany
| | | | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņš university, Riga, Latvia
| | - Denis Querleu
- Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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20
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Vieira-Baptista P, Pérez-López FR, López-Baena MT, Stockdale CK, Preti M, Bornstein J. Risk of Development of Vulvar Cancer in Women With Lichen Sclerosus or Lichen Planus: A Systematic Review. J Low Genit Tract Dis 2022; 26:250-257. [PMID: 35285455 DOI: 10.1097/lgt.0000000000000673] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vulvar lichen sclerosus (VLS) and possibly vulvar lichen planus (VLP) are associated with an increased vulvar cancer (VC) risk. We analyzed the risk of VC and its precursors after a diagnosis of VLS or VLP. MATERIALS AND METHODS A search was performed to identify articles describing the development of vulvar neoplasia in women with VLS or VLP. This systematic review was registered with the PROSPERO database. RESULTS Fourteen studies on VLS included 14,030 women without a history of vulvar neoplasia. Vulvar cancer, differentiated vulvar intraepithelial neoplasia (dVIN), and vulvar high-grade squamous intraepithelial lesion occurred in 2.2% (314/14,030), 1.2% (50/4,175), and 0.4% (2/460), respectively. Considering women with previous or current VC, the rate was 4.0% (580/14,372). In one study, dVIN preceded VC in 52.0% of the cases. Progression of dVIN to VC was 18.1% (2/11).The risk was significantly higher in the first 1-3 years after a biopsy of VLS and with advancing age; it significantly decreased with ultrapotent topical steroid use.For the 14,268 women with VLP (8 studies), the rates of VC, dVIN, and vulvar high-grade squamous intraepithelial lesion were 0.3% (38/14,268), 2.5% (17/689), and 1.4% (10/711), respectively. CONCLUSIONS Vulvar lichen sclerosus is associated with an increased risk of VC, especially in the presence of dVIN and with advancing age. Ultrapotent topical steroids seem to reduce this risk. An increased risk of developing VC has been suggested for VLP. Hence, treatment and regular life-long follow-up should be offered to women with VLS or VLP.
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Affiliation(s)
| | | | | | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Mario Preti
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Jacob Bornstein
- Research Institute of the Azrieli Faculty of Medicine, Bar-Ilan University, Galilee Medical Center, Safed, Israel
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21
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Carmiel Haggai M, Sgayer I, Bornstein J, Odeh M, Lowenstein L, Frank Wolf M. Liver stiffness and steatosis in preeclampsia as shown by transient elastography-a prospective cohort study. Am J Obstet Gynecol 2022; 227:515.e1-515.e9. [PMID: 35500613 DOI: 10.1016/j.ajog.2022.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Preeclampsia is a multisystem disorder and the leading cause of severe morbidity and death in pregnancy. Liver involvement in preeclampsia ranges from elevated liver enzyme levels to hepatic infarction or rupture. Endothelial dysfunction leads to changes in blood flow and congestion and may be involved in the pathophysiology of preeclampsia. Changes in splanchnic blood flow and portal congestion can lead to altered liver stiffness. Transient elastography is a noninvasive, ultrasound-based technique that measures organ stiffness and steatosis and is therefore widely used in clinical hepatology. Previous studies reported elevated liver stiffness and liver steatosis, as measured by transient elastography, in women with preeclampsia. OBJECTIVE This study followed changes in liver stiffness and steatosis, as measured by transient elastography, from the antepartum period to 1-week postpartum among women with preeclampsia compared with healthy controls and evaluated the association between preeclampsia severity and transient elastography results. STUDY DESIGN This prospective cohort study was conducted from 2017 through 2021. The study group comprised women with preeclampsia, and the control group comprised healthy pregnant women hospitalized for other reasons. All the participants underwent transient elastography either on diagnosis of preeclampsia (study group) or on hospital admission (control group) and again in the postpartum period. Liver stiffness measurements are expressed in kilopascals (kPa) in the range of 2.5 to 75 kPa, and liver steatosis is expressed by controlled attenuation parameter in the range of 100 to 400 dB/m. RESULTS The study group comprised 36 women and the control group 37. Liver stiffness scores were significantly elevated in the study when compared with the control group, both in the antepartum period (P<.001) and the postpartum period (P=.025). Liver stiffness scores decreased significantly after delivery in the study and control groups (P<.001 and P=.002, respectively). Liver steatosis scores were higher in the study group than in the control group both in the antepartum and postpartum periods (P<.001 and P<.02, respectively). In the multivariable analysis, the diagnosis of preeclampsia correlated with higher antepartum liver stiffness scores (P=.005). For the study group, postpartum liver stiffness and liver steatosis scores were increased among those with vs those without severe features of preeclampsia (P=.03 and P=.04, respectively) CONCLUSION: Reductions in liver stiffness and steatosis from the antepartum to the postpartum period were documented in both the preeclampsia and control groups. However, both these measures were higher in the preeclampsia group and correlated with preeclampsia severity. Larger studies may be able to determine whether transient elastography can predict the severity of preeclampsia or other related metabolic conditions that correlate with chronic hypertension.
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22
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Aiob A, Naskovica K, Zilberfarb IA, Sharon A, Bornstein J, Lowenstein L. Complete blood count parameters, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in hydatidiform mole versus missed abortion. EUR J GYNAECOL ONCOL 2022. [DOI: 10.31083/j.ejgo4302023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Bornstein J. Inauguration Editorial. J Low Genit Tract Dis 2022; 26:105. [PMID: 35220344 DOI: 10.1097/lgt.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Wolf MF, Sgayer I, Yaron L, Shnaider O, Odeh M, Bornstein J, Carmiel M. Intrahepatic cholestasis of pregnancy - prevalence and ethnic distribution in northern Israel. Ginekol Pol 2022:VM/OJS/J/75333. [PMID: 35072239 DOI: 10.5603/gp.a2021.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution. OBJECTIVES Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity. MATERIAL AND METHODS Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (≥ 10 μmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity. RESULTS The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007). A higher rate of preeclampsia was found in the severe (BA ≥ 40 μmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018). CONCLUSIONS The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients.
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Affiliation(s)
- Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel.
| | - Liat Yaron
- Liver disease Unit, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Oleg Shnaider
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Michal Carmiel
- Liver disease Unit, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Israel
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25
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Albuquerque A, Stockdale CK, Heller D, Bornstein J, Roberts JM, Preti M, Poynten IM, Vieira-Baptista P. Vulvar High-Grade Squamous Intraepithelial Lesions and Cancer as a Risk Factor for Anal Cancer: A Review. J Low Genit Tract Dis 2022; 26:32-37. [PMID: 34670242 DOI: 10.1097/lgt.0000000000000631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Anal squamous cell carcinoma (ASCC) has a higher incidence described in certain groups, namely, in women with vulvar high-grade squamous intraepithelial lesions (vHSILs) and/or human papillomavirus squamous cell carcinoma (VSCC). This review describes terminology, vHSIL, and VSCC in their association with ASCC and the published recommendations for early detection of this cancer in these women. MATERIALS AND METHODS A narrative review was conducted by the authors on vHSIL and VSCC as risk factors for ASCC. RESULTS The ASCC and VSCC incidence are increasing. Women with vHSIL and/or VSCC can present with ASCC at diagnosis, being one of the highest-risk groups. Suspicious symptoms include rectal bleeding, pain, and a sensation of an anal mass. Digital anorectal examination can help detect early ASCC. Sensitivity of anal cytology in women with vHSIL and VSCC seems low, with the exception of immunosuppressed women with genital neoplasia (cervix, vagina, and vulva). There are still insufficient data on high-resolution anoscopy in women with vHSIL and/or VSCC as a screening method. CONCLUSIONS Clinicians need be aware that women with vHSIL and VSCC comprise one of the highest-risk groups for ASCC. Inquiring suggestive symptoms of ASCC and a digital anorectal examination can help in the early detection of this type of cancer.
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Affiliation(s)
- Andreia Albuquerque
- CINTESIS-Center for Health Technology and Services Research, Medical Research Center, University of Porto, Porto, Portugal
| | | | | | - Jacob Bornstein
- Bar Ilan University and Galilee Medical Center, Nahariya, Israel
| | | | - Mario Preti
- Department of Surgical Science University of Torino, Torino, Italy
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Sgayer I, Haggai MC, Bornstein J, Odeh M, Lowenstein L, Wolf M. Liver stiffness in preeclampsia as shown by transient elastography. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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27
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Petros P, Swash M, Bornstein J. A Review of Chronic Pelvic Pain in Women. JAMA 2021; 326:2207. [PMID: 34874426 DOI: 10.1001/jama.2021.17983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter Petros
- School of Mechanical and Mathematical Engineering, University of Western Australia, Perth, Australia
| | - Michael Swash
- Barts and the London School of Medicine, London, England
| | - Jacob Bornstein
- Azrieli Faculty of Medicine, Bar Ilan University, Nahariya, Israel
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28
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Lavie G, Kais M, Tendler R, Marwan O, Bornstein J, Sharon A. Rate of hourly change in serum beta-human chorionic gonadotropin levels in ectopic pregnancy can predict the success of treatment with single-dose methotrexate: A retrospective observational study. Eur J Obstet Gynecol Reprod Biol 2021; 265:39-43. [PMID: 34418695 DOI: 10.1016/j.ejogrb.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether the success of treatment with single-dose methotrexate (SD MTX) for ectopic pregnancy can be predicted using the rate of change in serum β-human chorionic gonadotropin (β-hCG) level. STUDY DESIGN This was a retrospective observational study conducted at a tertiary referral centre. The study population included women who underwent treatment with SD-MTX for ectopic pregnancy. We analysed data of 119 women treated with SD-MTX for ectopic pregnancy at the Galilee Medical Centre between 2012 and 2016. Success was defined as a <15% decrease in β-hCG level between days 4 and 7, with no need for a second dose of MTX or surgical intervention. The dynamics of serum β-hCG levels before treatment were considered as the main outcomes. RESULTS SD-MTX administration was successful in 77 (65%) patients. The average baseline β-hCG level was significantly lower in women with successful outcomes than in those without successful outcomes (763.1 vs. 1429.63 mIU/L, respectively, p < 0.0048). The hourly change in β-hCG level was significantly lower in those with successful outcomes than in those without successful outcomes (0.38 vs. 5.73 mIU/mL, respectively, p < 0.0023). The percentage change in β-hCG level was 13.1%, which was not significantly different between the groups (p < 0.133). At serum β-hCG level < 946 mIU/mL and sac size < 2.55 cm, the treatment was successful in 88% of women. CONCLUSIONS We propose a predictive model of hourly change in β-hCG to achieve successful treatment using SD-MTX in ectopic pregnancy based on objective and measurable criteria.
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Affiliation(s)
- G Lavie
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of medicine, Bar-Ilan University, Safed, Israel
| | - M Kais
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of medicine, Bar-Ilan University, Safed, Israel
| | - R Tendler
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of medicine, Bar-Ilan University, Safed, Israel
| | - O Marwan
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of medicine, Bar-Ilan University, Safed, Israel
| | - J Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of medicine, Bar-Ilan University, Safed, Israel.
| | - A Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of medicine, Bar-Ilan University, Safed, Israel
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29
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Levor O, Neuman M, Bornstein J. Outcomes of a fixed skeletonised mini mesh implant for pelvic organ prolapse repair with uterine preservation. J OBSTET GYNAECOL 2021; 42:490-493. [PMID: 34167432 DOI: 10.1080/01443615.2021.1916808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mesh repair of pelvic organ prolapse (POP) is complicated, causing erosions, postoperative pain and surgical failure. We hypothesised that reducing the mesh size and fixating it would result in significant cure rates and reduce complication rates. Here, we present the effectiveness of mini mesh implants in POP reconstruction. Sixty women who underwent repair of stage III and IV apical prolapse with cystocele or rectocele using skeletonised mesh implant Seratom PA MR MN® were evaluated. Anatomical outcomes were assessed using modified POP-quantification (POP-Q) staging and functional outcomes were self-reported by patients - one and three months post-operatively. Apical support with anterior and/or posterior colporrhaphy was performed, resulting in 96.6% success rate. Follow-up conducted one and three months post-operatively revealed significant improvement on the modified POP-Q (p < .001) and no complaints of dyspareunia. Para-vesicular fixation using a skeletonised mini mesh implant is feasible and effective in POP repair and has low surgical complication risk.Impact StatementWhat is already known on this subject? Mesh repair for pelvic organ prolapse (POP) is currently under scrutiny as it may result in erosions, postoperative pain, and surgical failure.What do the results of this study add? The use of an apical support with mini-mesh implants resulted in a 96.6% (58/60) success rate and excellent outcomes at 1- and 3-month follow-up.What are the implications of these findings for clinical practice and/or further research? Reconstruction using skeletonised and fixated mini-mesh implants may be safe and effective for POP treatment.
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Affiliation(s)
- Omri Levor
- Azrielli Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Menahem Neuman
- Assuta Medical Centers, Tel Aviv and Rishon LeZion, Nahariya, Israel
| | - Jacob Bornstein
- Azrielli Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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30
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Abed R, Neuman M, Bornstein J. Outcomes of Retropubic Sub-Mid-Urethral Sling Procedure for Recurrent Stress Urinary Incontinence After Primary Surgical Failure in Women. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Reem Abed
- Department of Obsetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Menahem Neuman
- Department of Obsetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Jacob Bornstein
- Department of Obsetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Schonfeld M, Petros P, Bornstein J. Mechanically Supporting Uterosacral Ligaments for the Relief of Provoked Vulvodynia: A Randomized Pilot Trial. J Pain Res 2021; 14:1281-1288. [PMID: 34040432 PMCID: PMC8141612 DOI: 10.2147/jpr.s296613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/01/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose Provoked vulvodynia (PV) is the most common cause of vulvar pain and dyspareunia. Although its etiology is unknown, it has been associated with musculoskeletal dysfunction. The inability of the lax uterosacral ligaments (USLs) to support the adjoining T11/L2 and S2-4 nerve plexuses is considered to cause PV. This study aimed to determine whether providing mechanical support to the USLs would improve PV. Patients and Methods PV patients were randomly divided into two groups. The participants in each group underwent sham manipulation (inserting a wide swab in the vagina without applying pressure) and trial manipulation (supporting the posterior fornix with a wide swab sufficiently broad to mechanically support the USLs). This was a cross-over trial, and the participants alternated between the sham and trial manipulation. Using a 0-10 visual analog pain scale (VAS), PV-associated pain levels experienced by participants were recorded during each manipulation, and the results were compared with baseline levels. Results The pain level significantly reduced with USL support compared with the baseline value and the sham manipulation pain level (P = 0.003). Pain during sham manipulation was not significantly different from that recorded at baseline. The average reduction in pain with USL support was 18.4% ± 2.2%. The manipulation order did not affect changes in the pain level during trial manipulation (P = 0.512). Conclusion Applying mechanical support to the posterior fornix temporarily alleviates provoked vulvar pain in some women.
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Affiliation(s)
- Matan Schonfeld
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Peter Petros
- University of Western Australia School of Mechanical and Chemical Engineering, Perth, WA, Australia
| | - Jacob Bornstein
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Tietel M, Shema-Didi L, Roth R, Wolf MF, Bornstein J. Compliance with a new quality standard regarding administration of prophylactic antibiotics before cesarean section. J Matern Fetal Neonatal Med 2021; 35:6243-6249. [PMID: 33899640 DOI: 10.1080/14767058.2021.1910659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Administering prophylactic antibiotics before cesarean section (CS) decreases postpartum infections significantly. They should be administered within 60 min prior to CS. In 2014 the Israeli Ministry of Health introduced the administration of pre-operative antibiotic prophylaxis for CS as a quality criterion. This was immediately adopted by the Galilee Medical Center (GMC). This study aimed to examine the compliance to this quality standard in the GMC under 3 criteria: the type of antibiotics, timing of administration, and use of one dose only. STUDY DESIGN Data of women who underwent CS from the day of introducing the new quality standard on January 1, 2014, to July 31, 2015, were retrospectively analyzed. RESULTS The study included 1790 women who delivered by elective (24.4%) or emergency CS. In general, the medical staff's compliance to this quality standard was 90.9; 95.6% of the patients received the correct antibiotic, 94.6% had it within 65 min before surgery to 5 min after it, and 100% received it in less than 24 h. There was an increase in the overall compliance rate with time (logistic regression, p = .001). During the day shift, 60.4% of CS were emergency surgeries while during the on-call shift (evening and night) almost all (99%) of the CS were emergencies (p < .001, 2-sided). In morning shift's emergency CS, only 4.1% of the cases were not given prophylactic antibiotics as against 7.8% in the on-call shift (p = .005). CONCLUSION Over a period of 18 months, the compliance to the new quality standard of administering prophylactic antibiotics before CS was 90.9%. It was particularly high in the subgroup of elective CS during the morning shift. This high compliance rate may be attributed to the introduction of clear guidelines and assignment of a specific team member, the anesthesiologist, to administer the medication.Key pointsCompliance rate to the guideline was 90.9%.Compliance was better in the morning shift.Compliance was better for elective cesarean section.Compliance was not affected by time.
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Affiliation(s)
- Michal Tietel
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | | | - Ruti Roth
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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Sgayer I, Naskovica K, Abu Shaqara R, Odeh M, Bornstein J, Frank Wolf M. Early planned labor induction vs expectant management in late preterm pre-labor rupture of membranes: maternal and neonatal outcomes. Ginekol Pol 2021; 92:498-504. [PMID: 33844257 DOI: 10.5603/gp.a2021.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To compare expectant management with early planned labor induction in pregnancies complicated by late preterm pre-labor rupture of membranes (PPROM). MATERIAL AND METHODS A retrospective file review was conducted in a single tertiary center from January 2015 to Sep-tember 2019. Singleton pregnancies complicated by late PPROM at 34-36 completed weeks of gestation were enrolled. We compared maternal and neonatal complications between expectant management and early planned labor induction. RESULTS We retrospectively assigned 41 women to the expectant management group and 39 to the early planned labor induction group. No difference was found in the mode of delivery between the groups. Women in the expectant manage-ment group had a longer antepartum hospital stay compared with the induction group (median of three versus one day, p < 0.01). Neonates were delivered at a more advanced gestational age in the expectant management group compared with that in the induction group (35 5/7 versus 35 2/7 weeks, p < 0.01). In the induction group, 74.4% of the neonates were admitted to the intensive care unit (ICU), and 66.7% received antibiotics compared with 51.2% of neonates admitted to ICU and 29.3% receiving antibiotics in the expectant management group (p = 0.04 and p < 0.01, respectively). CONCLUSIONS In pregnancies complicated by late PPROM, early labor induction was associated with a shorter antepartum maternal hospital stay but a higher neonatal ICU admission rate and more frequent antibiotic administration than expect-ant management. We consider expectant management to be an acceptable alternative to early labor induction in PPROM.
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Affiliation(s)
- Inshirah Sgayer
- The Azrieli faculty of Medicine, Bar-Ilan University, Safed, Israel. .,Galilee Medical Center, Nahariya, Israel.
| | | | | | - Marwan Odeh
- The Azrieli faculty of Medicine, Bar-Ilan University, Safed, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Jacob Bornstein
- The Azrieli faculty of Medicine, Bar-Ilan University, Safed, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Maya Frank Wolf
- The Azrieli faculty of Medicine, Bar-Ilan University, Safed, Israel.,Galilee Medical Center, Nahariya, Israel
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Aiob A, Naskovica K, Sharon A, Bornstein J. A possible association between hydatidiform mole and the COVID-19 pandemic: A retrospective cohort study. Gynecol Oncol 2021; 161:454-457. [PMID: 33712273 PMCID: PMC7934616 DOI: 10.1016/j.ygyno.2021.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/27/2021] [Indexed: 11/25/2022]
Abstract
Objective To confirm an increase in the number of women with molar pregnancy during the COVID-19 pandemic. Methods In this retrospective cohort study, all patients with complete or partial mole diagnosed at our institution between January 1, 2010 and October 31, 2020, were included. To verify whether there was an increase in the incidence of hydatidiform mole (HM) and deliveries in 2020, the incidences for each year from January 2010 to October 2020 were recorded. In addition, we identified all women who were diagnosed with HM from January to October 2020, and compared them with a control group who underwent uterine evacuation for missed abortion of a singleton pregnancy during the same period. We also documented the time taken to diagnose missed abortion or molar pregnancy to check if a delay in diagnosis can explain the increase in HM incidence. Results Between 2016 and 2019, there was a statistically significant increase in the incidence of molar pregnancy. A further increase occurred in 2020 (odds ratio = 2.071). The mean gestational age of the embryo at the time of diagnosis was smaller in the HM group than in the missed abortion group (6.3 ± 1.67–7.4 ± 2.4, one-sided P = 0.034), meaning that it took more time (days) to diagnose molar pregnancy than missed abortion (22.38 ± 10.32 vs. 15.83 ± 7.83 days, P = 0.012). Conclusion There was a significant increase in the incidence of molar pregnancy during the COVID-19 pandemic, possibly because of the delay in receiving medical care. We recommend providing gynecological primary care services during a crisis, such as a pandemic.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Karina Naskovica
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Avishalom Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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Jahshan-Doukhy O, Bornstein J. Long-Term Efficacy of Physical Therapy for Localized Provoked Vulvodynia. Int J Womens Health 2021; 13:161-168. [PMID: 33603495 PMCID: PMC7882794 DOI: 10.2147/ijwh.s297389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/23/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The origin of provoked vulvodynia (PV), the main cause of entry dyspareunia, remains unclear, and the treatment is empiric. In this study, we aimed to investigate the long-term effects of physical therapy on PV in subjects using questionnaire concerning PV symptoms immediately after physical therapy and at least 10 years later. Patients and Methods This study included a total of 24 women diagnosed with PV and referred by their primary physicians to Maccabi Physical Therapy Clinic for pelvic floor rehabilitation between 2004 and 2008. Criteria such as pain relief, sexual functioning, and treatment satisfaction were assessed. Results The average pain scores of the 24 participants reduced significantly after therapy, and 42% had no pain between treatment and the time of survey. Eighty-three percent did not undergo additional treatment after the initial physical therapy and reported high or very extremely high levels of pain reduction following treatment. Multiple regression analysis found that onset type of PV and age were not associated with the treatment outcome (p = 1.0). Conclusion Physical therapy is an effective long-term treatment for primary or secondary PV, resulting in pain reduction and improved sexual function.
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Affiliation(s)
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Weinberg M, Sar-Shalom Nahshon C, Feferkorn I, Bornstein J. Evaluation of human papilloma virus in semen as a risk factor for low sperm quality and poor in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 2021; 113:955-969.e4. [PMID: 32386620 DOI: 10.1016/j.fertnstert.2020.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze the effect of human papilloma virus (HPV) sperm infection on sperm parameters and in vitro fertilization (IVF) outcomes. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENTS Men with HPV sperm infection and couples undergoing IVF. INTERVENTIONS Searches were conducted in the following databases: Medline(R), PubMed, Embase, Web of Science, Scopos, and the Cochrane Library. We included studies examining sperm parameters and IVF results in patients with and without HPV sperm infection. MAIN OUTCOME MEASURES Sperm analysis (concertation, count, volume, motility, morphology), according to the World Health Organization manual, pregnancy rate (PR), and miscarriage rate (MR). RESULTS Sixteen studies were included in this meta-analysis. The presence of HPV had a significant association with impaired sperm parameters in terms of concentration (mean difference [MD] -4.48, 95% confidence interval [CI] - 6.12 to -2.83), motility (MD -11.71, 95% CI - 16.15 to -7.26), and morphology (MD -2.44, 95% CI - 4.08 to -0.79. A review of the literature regarding ART outcomes showed an association between HPV infection and decreased PR, and an even stronger association between HPV infection and increased MR. CONCLUSION Our meta-analysis shows a negative effect of HPV on sperm concentration, motility, and morphology. Further subgroup and categorical analysis confirmed the clinical significance of impaired sperm motility in HPV-infected sperm, although the sperm count and morphology must be carefully analyzed. The studies reviewed reported lower PR and increased MR in couples with HPV-infected sperm. As most studies had a moderate risk of bias, these observations warrant further large, well-designed studies before introducing clinical management recommendations. PROSPERO REGISTRATION NUMBER CRD42019127419.
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Affiliation(s)
- May Weinberg
- Department of Obstetrics and Gynecology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| | - Chen Sar-Shalom Nahshon
- Division of Reproductive Endocrinology - IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Haifa, Israel.
| | - Ido Feferkorn
- Division of Reproductive Endocrinology - IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Haifa, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
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Bornstein J, Roux S, Kjeld Petersen L, Huang LM, Dobson SR, Pitisuttithum P, Diez-Domingo J, Schilling A, Ariffin H, Tytus R, Rupp R, Senders S, Engel E, Ferris D, Kim YJ, Tae Kim Y, Kurugol Z, Bautista O, Nolan KM, Sankaranarayanan S, Saah A, Luxembourg A. Three-Year Follow-up of 2-Dose Versus 3-Dose HPV Vaccine. Pediatrics 2021; 147:peds.2019-4035. [PMID: 33386332 DOI: 10.1542/peds.2019-4035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Human papillomavirus (HPV) antibody responses to the 9-valent human papillomavirus (9vHPV) vaccine among girls and boys (aged 9-14 years) receiving 2-dose regimens (months 0, 6 or 0, 12) were noninferior to a 3-dose regimen (months 0, 2, 6) in young women (aged 16-26 years) 4 weeks after last vaccination in an international, randomized, open-label trial (NCT01984697). We assessed response durability through month 36. METHODS Girls received 2 (months 0 and 6 [0, 6]: n = 301; months 0 and 12 [0, 12]: n = 151) or 3 doses (months 0,2, and 6 [0, 2, 6]: n = 301); boys received 2 doses ([0, 6]: n = 301; [0, 12]: n = 150); and young women received 3 doses ([0, 2, 6]: n = 314) of 9vHPV vaccine. Anti-HPV geometric mean titers (GMTs) were assessed by competitive Luminex immunoassay (cLIA) and immunoglobulin G-Luminex immunoassay (IgG-LIA) through month 36. RESULTS Anti-HPV GMTs were highest 1 month after the last 9vHPV vaccine regimen dose, decreased sharply during the subsequent 12 months, and then decreased more slowly. GMTs 2 to 2.5 years after the last regimen dose in girls and boys given 2 doses were generally similar to or greater than GMTs in young women given 3 doses. Across HPV types, most boys and girls who received 2 doses (cLIA: 81%-100%; IgG-LIA: 91%-100%) and young women who received 3 doses (cLIA: 78%-98%; IgG-LIA: 91%-100%) remained seropositive 2 to 2.5 years after the last regimen dose. CONCLUSIONS Antibody responses persisted through 2 to 2.5 years after the last dose of a 2-dose 9vHPV vaccine regimen in girls and boys. In girls and boys, antibody responses generated by 2 doses administered 6 to 12 months apart may be sufficient to induce high-level protective efficacy through at least 2 years after the second dose.
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Affiliation(s)
- Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Surita Roux
- Synexus Clinical Research SA, Somerset West, Cape Town, South Africa
| | - Lone Kjeld Petersen
- Open Patient Data Explorative Network and Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei City, Taiwan
| | - Simon R Dobson
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Javier Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research of Valencia Region - Public Health, Valencia, Spain
| | - Andrea Schilling
- Department of Obstetrics and Gynecology, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Hany Ariffin
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Richard Tytus
- Hamilton Medical Research Group, Hamilton, Ontario, Canada
| | - Richard Rupp
- The University of Texas Medical Branch, Galveston, Texas
| | | | - Eli Engel
- Bayview Research Group, Valley Village, California
| | - Daron Ferris
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Zafer Kurugol
- Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey; and
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Braester A, Bornstein J, Zverev A, Kukuyev Y, Stemer G, Barhoum M. Reassessment of Venous Thromboembolism Risk and Prophylaxis in Postdelivery Period of Healthy Women. Am J Med Sci 2020; 360:604-606. [DOI: 10.1016/j.amjms.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/10/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
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Solt I, Frank Wolf M, Michlin R, Farajun Y, Ophir E, Bornstein J. Intrauterine bacterial growth in elective and non-elective caesarean sections. J OBSTET GYNAECOL 2020; 41:733-738. [PMID: 33045855 DOI: 10.1080/01443615.2020.1789959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We assessed intrauterine bacterial growth for elective and non-elective caesarean sections (CSs). Aerobic uterine cultures were obtained from the uterine cavity immediately following placental removal from 1376 patients who underwent CS in one center during one year. About 13.8% (115/832) of elective CS were positive vs. 55.9% (304/544) of non-elective CS (p < .001). Of non-elective CSs, 28.6% (56/196) of those without ruptured membranes (ROM) were positive vs. 71.3% (248/348) with ROM (p < .001). Mean birth weight and 1-minute Apgar scores were significantly lower in women with positive cultures, elective and non-elective, than negative cultures. A higher percentage of women with positive uterine cultures presented with postpartum endometritis (p < .05). Intrauterine bacteria in elective CSs demonstrate that the uterine cavity is not sterile. Non-elective CS, particularly after membrane rupture, is a significant risk factor for positive uterine culture. Positive uterine culture is associated with lower birth weight, lower one-minute Apgar score and postpartum endometritis.Impact statementWhat is already known on this subject? Postpartum endometritis is a leading cause of postpartum febrile morbidity. Caesarean sections, in particular non-elective cesareans, are an important risk factor for the development of postpartum endometritis. Controversy exists concerning the sterility of the placenta and uterus. The diagnosis of endometritis is based mainly on clinical findings and does not necessitate bacterial isolation from the uterine cavity. Positive culture at caesarean section has been associated with positive postoperative culture and yet, currently, professional organisations do not recommend the routine sampling of intrauterine cultures during caesarean section.What do the results of this study add? Since positive uterine culture rate was higher in non-elective CSs and associated with lower birth weight and 1-minute Apgar score and postoperative endometritis, obtaining uterine culture in those cases might be of clinical value.What are the implications of these findings for clinical practice and/or further research? Obtaining routine intrauterine cultures during non-elective caesarean sections might be useful for detecting significant pathogens and tailoring antibiotic treatment in postpartum endometritis. Further studies are necessary in order to determine the impact of obtaining intrauterine cultures during caesarean sections, particularly non-elective cesareans.
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Affiliation(s)
- Ido Solt
- Division of Maternal-Fetal Medicine Service, Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Rosa Michlin
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Yaniv Farajun
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Ella Ophir
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Odeh M, Karwani R, Schnaider O, Wolf M, Bornstein J. Dehiscence of cesarean section scar during pregnancy and delivery - risk factors. Ginekol Pol 2020; 91:539-543. [PMID: 33030734 DOI: 10.5603/gp.2020.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We wanted to identify risk factors for dehiscence of cesarean section (CS) scars in patients undergoing repeated cesarean section. MATERIAL AND METHODS This was a retrospective case-control study over a 3-year period in our medical center (2011-2014), comparing women who had repeated CS without complications and women diagnosed with dehiscence. Data were collected from medical records and the groups were compared for demographic and obstetrical data. RESULTS Dehiscence was identified in 27 women, while 54 women without dehiscence were the control group. Statistically significant differences were found in the need for augmentation, the number of previous cesarean sections, cesarean section in the active phase of labor and length of hospitalization. DISCUSSION The need for augmentation of labor, CS in the nonactive stage and more than one cesarean section, all increased the risk of dehiscence. There was no association between dehiscence and scar pain, time elapsed since the previous cesarean section, the method of wound closure or fever.
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Affiliation(s)
- Marwan Odeh
- Galilee Medical Center, Nahariya, Israel. .,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Rawan Karwani
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Oleg Schnaider
- Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Wolf
- Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Shahar D, Bornstein S, Bornstein J. Cervical traction suture technique during large loop excision of the transformation zone increases complete lesion excision. J Gynecol Obstet Hum Reprod 2020; 50:101904. [PMID: 32942052 DOI: 10.1016/j.jogoh.2020.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE A surgical technique was developed in the past by our group to reduce the rate of inadvertent complications. It was then seemed that it also increased the rate of complete lesion excision. The objective of the study was to evaluate the effectiveness of a cervical traction suture technique in increasing the prevalence of complete lesion excisions and reducing the incidence of unintended injuries to adjacent tissues during large loop excision of the transformation zone (LLETZ). BASIC PROCEDURES A retrospective cohort study, including all consecutive patients who underwent LLETZ between January 2016 and June 2018, at the outpatient Colposcopy clinic of a general hospital in Galilee Medical Center. We divided patients into two groups based on whether their LLETZ utilized the cervical traction suture technique. We compared these two groups using an independent-samples t test, and we compared the study-specific proportions to those reported in the literature using the proportion test. MAIN FINDINGS A total of 66 patients were included in the analysis; 33 had undergone LLETZ with a traction suture, and 33 had undergone LLETZ without a traction suture. The prevalence of complete lesion excision was 93.3 % among patients undergoing LLETZ with a traction suture and 72.7 % among those without a traction suture (p = 0.04). The incidence of unintentional injuries to adjacent organs was 12.1 % in women with a traction suture and 18.2 % in women without a traction suture (p = 0.73). PRINCIPAL CONCLUSIONS Using a cervical traction suture along with LLETZ can increase the rate of complete lesion excision and may reduce the prevalence of unintended injuries.
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Affiliation(s)
- Dor Shahar
- Department of Obstetrics & Gynecology, Galilee Medical Center and Bar-Ilan University Faculty of Medicine, Nahariya, Israel
| | | | - Jacob Bornstein
- Department of Obstetrics & Gynecology, Galilee Medical Center and Bar-Ilan University Faculty of Medicine, Nahariya, Israel.
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Shatkin Hamish N, Wolf M, Tendler R, Sharon A, Bornstein J, Odeh M. Early prediction of methotrexate treatment outcome in tubal ectopic pregnancy based on days 0 and 4 human chorionic gonadotropin levels. J Obstet Gynaecol Res 2020; 46:1104-1109. [PMID: 32406562 DOI: 10.1111/jog.14259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/03/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022]
Abstract
AIM Methotrexate (MTX) is an efficient treatment for ectopic pregnancy, used according to 'single-dose' protocol. Treatment success is evaluated on days 4 and 7 after dose administration, and defined as a decline of ≥15% in beta-human chorionic gonadotropin (β-hCG) levels, with a positive predictive value of 93%. A decrease on day 4 β-hCG levels was determined to be a good predictor for treatment success. We retrospectively examined changes in β-hCG levels between days 0 and 4 after MTX treatment as an early predictor for treatment outcome. METHODS The 'success group' consisted of patients with resolved ectopic pregnancy after a single MTX dose and 'failure group' included patients who required additional MTX doses or underwent surgery after the first dose. For each group, demographic and pregnancy data were analyzed as well as initial (admission day), days 0, 4 and 7 β-hCG levels. RESULTS Of 159 women included in the study, MTX treatment was successful in 117 patients (73.6%) while 42 patients (26.4%) were defined as treatment failure. In the success group, most patients (58.9%) demonstrated a decrease in β-hCG values between days 0 and 4 as opposed to the failure group in which an increase in β-hCG values was observed (76.2%). Decrease of >18% in β-hCG levels was predictive of treatment success (positive predictive value 92%). Increase in β-hCG values is less predictive of treatment failure with positive predictive value of 54%. CONCLUSION Differences in β-hCG levels between days 0 and 4 may serve as an early predictor for treatment outcome.
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Affiliation(s)
- Noy Shatkin Hamish
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Rene Tendler
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Avishalom Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Wolf MF, Sgayer I, Miron D, Krencel A, Sheffer VF, Idriss SS, Sammour RN, Peleg D, Shachar IB, Rechnitzer H, Bornstein J. A novel extended prophylactic antibiotic regimen in preterm pre-labor rupture of membranes: A randomized trial. Int J Infect Dis 2020; 96:254-259. [PMID: 32407901 DOI: 10.1016/j.ijid.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Prophylactic antibiotic use in preterm pre-labor rupture of membranes (PPROM) is associated with a significant reduction in intra-amniotic infection and improved neonatal outcome. However, data is insufficient to determine the optimal antibiotic regimen. Considering the rise in Escherichia coli and Klebsiella pneumonia early-onset sepsis rate and the emergence of ampicillin resistance, our aim is to compare the efficiency of two antibiotic regimens in prolonging pregnancy and reducing infectious morbidity. DESIGN This multicenter randomized unblinded controlled prospective trial compared two antibiotic prophylactic protocols in PPROM: ampicillin + roxithromycin vs. cefuroxime + roxithromycin in 84 women with PPROM, from 12/2015-12/2019. RESULTS The median latency period was significantly longer (p = 0.039) in the cefuroxime + roxithromycin group (4.63 [0.59-50.18] days) than in the ampicillin + roxithromycin group (2.3 [0.15-58.3] days). Neonatal admission to neonatal intensive care unit rate, hospitalization length, neonatal respiratory distress syndrome, neonatal fever, and need for respiratory support or mechanical ventilation, were similar between the groups. K. pneumonia cultures were significantly more frequent in the ampicillin + roxithromycin group. None of the cultures were group B Streptococcus positive. CONCLUSIONS To prolong latency period and reduce gram-negative early-onset sepsis, cefuroxime + roxithromycin is recommended as the first-line protocol in PPROM. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02819570.
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Affiliation(s)
- Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Israel.
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Dan Miron
- Department of Pediatrics A, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Amir Krencel
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Vered Fleisher Sheffer
- Azrieli Faculty of Medicine, Bar Ilan University, Israel; Neonatal Intensive Care Unit, Galilee Medical Center, Nahariya, Israel
| | - Suraya Saied Idriss
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Israel; Technion - Israel Institute of Technology, Israel
| | - Rami N Sammour
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Israel; Technion - Israel Institute of Technology, Israel
| | - David Peleg
- Azrieli Faculty of Medicine, Bar Ilan University, Israel; Department of Obstetrics and Gynecology, Ziv Medical Center, Safed, Israel
| | - Inbar Ben Shachar
- Azrieli Faculty of Medicine, Bar Ilan University, Israel; Department of Obstetrics and Gynecology, Ziv Medical Center, Safed, Israel
| | - Hagai Rechnitzer
- Azrieli Faculty of Medicine, Bar Ilan University, Israel; Clinical Microbiology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Israel
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Sgayer I, Gur T, Glikman D, Rechnitzer H, Bornstein J, Wolf MF. Routine uterine culture swab during cesarean section and its clinical correlations: A retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2020; 249:42-46. [PMID: 32348949 DOI: 10.1016/j.ejogrb.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cesarean sections, particularly non-elective cesareans, are an important risk factor for the development of postpartum endometritis, a leading cause of postpartum febrile morbidity. We evaluated the yield of obtaining routine intrauterine culture during elective and non-elective cesarean sections, in the prevention and management of postpartum endometritis. STUDY DESIGN A retrospective comparative study investigating the distribution of uterine cultures obtained immediately after fetus and placenta delivery during cesarean sections performed in a single tertiary hospital during 2017. True pathogenic bacteria were included in the study analysis and considered as positive results, while other contaminant bacteria were excluded. RESULTS Positive uterine cultures were identified in 10.7 % (88/821) of cesarean sections, with no significant difference in prevalence between elective and non-elective cesareans. Escherichia coli (E.coli), isolated in 40.9 % of the positive cultures of all women, was the most common organism in non-elective cesareans vs. Group B Streptococcus (GBS) in elective cesareans. Higher rate of positive cultures was found in term vs. preterm cesareans (17.5 % vs 10.5 %, respectively, p-value = 0.04). E.coli was the most frequent pathogen reported in both women with intact membranes or premature rupture of membranes (46.3 % and 47.3 % respectively). Eight women (9.1 %) with positive cultures presented with postpartum fever; all had undergone non-elective cesarean section. In one-third of these cases the empirical antibiotic treatment was adjusted according to the uterine culture results and susceptibility testing results. CONCLUSIONS Obtaining routine intrauterine cultures during non-elective cesarean sections might be useful for detecting significant pathogens and tailoring the antibiotic treatment in postpartum endometritis.
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Tomer Gur
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Daniel Glikman
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hagai Rechnitzer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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45
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Miller H, Martens MG, Guilfoil D, Kessary-Shoham H, Ayers C, Ukazu A, Bachmann G, Bornstein J. 424: AmnioTectTM– Detecting PROM using a specially designed panty liner. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leron E, Toukan M, Schwarzman P, Mastrolia SA, Bornstein J. Long-term outcome (5-10 years) after non absorbable mesh insertion compared to partially absorbable mesh insertion for anterior vaginal wall prolapse repair. Int Braz J Urol 2019; 45:1180-1185. [PMID: 31808406 PMCID: PMC6909865 DOI: 10.1590/s1677-5538.ibju.2019.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/19/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: To evaluate long-term (5-10 years) outcomes of Minimally Invasive Surgical (MIS) kit insertion with Prolift® (non-absorbable) mesh compared to the use of Prolift M® (partially absorbable), for anterior vaginal wall prolapse repair. Study design: In this retrospective study we compared women undergoing MIS kit Prolift® insertion (n=90) vs. Prolift M® insertion (n=79) for anterior vaginal wall prolapse repair between 2006 and 2012 at our Institution. A number of 169 women fulfilled the inclusion criteria and were included in the study. Results: During the study period 128 women (76%) completed full follow-up; of them 58 (73%) following MIS kit Prolift® insertion, and 70 (88%) following MIS kit ProliftM® insertion. There was no significant difference between the Prolift® and Prolift M® regarding parity (3.04 vs. 2.88, p=0.506), presence of hypertension (24.1% vs. 39.1%, p=0.088), diabetes mellitus (3.4% vs. 11.6%, p=0.109), or urinary stress incontinence (39.7% vs. 47.1%, p=0.475). All participants had been diagnosed with POP grade 3 or 4 before the procedure. No significant complications during the procedure or postoperative period were identified in the study groups. The follow-up period was at least five years in duration for both groups. Both groups were comparable according to questionnaires focused on function and satisfaction. Conclusion: Patients undergoing MIS kit Prolift® and Prolift M® insertion for anterior vaginal wall prolapse repair had comparable early and late postoperative outcomes. No differences in patient's function and satisfaction between the two groups were identified. According to our findings, there is no superiority to either of the two studied mesh devices.
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Affiliation(s)
- Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Mona Toukan
- Department of Obstetrics and Gynecology, Galilee University Medical Center, Bar Ilan University, Nahariya, Israel
| | - Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Ospedale dei Bambini "Vittore Buzzi", University of Milano, Milano, Italy
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee University Medical Center, Bar Ilan University, Nahariya, Israel
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Bornstein S, Bornstein J. [THE NEW CONSENSUS TERMINOLOGY OF CHRONIC VULVAR PAIN AND VULVODYNIA]. Harefuah 2019; 158:812-816. [PMID: 31823537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We review the process of establishing the new terminology of persistent vulvar pain and vulvodynia. Three international scientific societies: the International Society for the Study of Vulvovaginal Disease - ISSVD, the International Society for The Study of Women's Sexual Health - ISSWSH, and the International Pelvic Pain Society - IPPS, prepared a consensus terminology of vulvar pain and vulvodynia. This terminology includes the definition of vulvodynia, descriptors of the clinical presentation of vulvodynia, and evidence-based data on the possible causes of vulvodynia. The controversy behind the introduction of the possible causes of vulvodynia, a condition which was considered an idiopathic condition, is revealed. The inclusion of these possible causes has changed the paradigm enabling tailoring treatment.
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Affiliation(s)
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center and the Azrieli Faculty of Medicine of Bar-Ilan University in the Galilee, Nahariya
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48
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Kuperman AA, Zimmerman A, Hamadia S, Ziv O, Gurevich V, Fichtman B, Gavert N, Straussman R, Rechnitzer H, Barzilay M, Shvalb S, Bornstein J, Ben‐Shachar I, Yagel S, Haviv I, Koren O. Deep microbial analysis of multiple placentas shows no evidence for a placental microbiome. BJOG 2019; 127:159-169. [DOI: 10.1111/1471-0528.15896] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 01/23/2023]
Affiliation(s)
- AA Kuperman
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
- Galilee Medical Center Nahariya Israel
| | | | | | - O Ziv
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
| | - V Gurevich
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
| | - B Fichtman
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
| | - N Gavert
- Department of Molecular Cell Biology Weizmann Institute of Science Rehovot Israel
| | - R Straussman
- Department of Molecular Cell Biology Weizmann Institute of Science Rehovot Israel
| | | | | | - S Shvalb
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
- Ziv Medical Center Safed Israel
| | - J Bornstein
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
- Galilee Medical Center Nahariya Israel
| | - I Ben‐Shachar
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
- Ziv Medical Center Safed Israel
| | - S Yagel
- Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - I Haviv
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
| | - O Koren
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
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49
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Pérez-López FR, Bueno-Notivol J, Hernandez AV, Vieira-Baptista P, Preti M, Bornstein J. Systematic review and meta-analysis of the effects of treatment modalities for vestibulodynia in women. EUR J CONTRACEP REPR 2019; 24:337-346. [PMID: 31364893 DOI: 10.1080/13625187.2019.1643835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To quantify the effects of available treatments of vestibulodynia. Methods: Systematic review of randomised controlled trials (RCTs) in six search engines until December 2018, comparing any intervention vs. placebo or sham in women with vestibulodynia. Primary outcome was dyspareunia assessed with visual analogue (VAS) or numeric rating (NRS) scales. Secondary outcomes were daily vestibular symptoms (DVS), McGill Pain Questionnaire (MPQ) and Index of Sexual Satisfaction (ISS). Effects were described as mean differences (MDs) with their 95% confidence intervals (CIs). Traditional and frequentist network meta-analyses (NMA) were performed using random effect models. Results: Four RCTs (n = 275) were included evaluating vaginal cream of conjugated oestrogens, oral desipramine with or without topical lidocaine, topical lidocaine, laser therapy and transcranial direct current. In traditional MA, interventions did not reduce dyspareunia (MD = 0.08; 95%CI = -0.49 to 0.64), DVS (MD = -0.04; 95%CI = -0.31 to 0.24; 4 interventions), or MPQ (MD = -0.17; 95%CI = -2.16 to 1.81; 4 interventions). ISS was significantly improved (MD = -5.14; 95%CI = -9.52 to -0.75). In NMA, oral desipramine with or without lidocaine significantly improved ISS vs. other treatments. Conclusions: Several existing interventions were not associated with improvements in vestibulodynia. There only was improvement of sexual function with oral desipramine with or without lidocaine.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine , Zaragoza , Spain.,Red de Investigacion de Ginecologia, Obstetricia y Reproduccion, Instituto Aragonés de Investigaciones Sanitarias , Zaragoza , Spain
| | | | - Adrian V Hernandez
- Hartford Hospital Evidence-Based Practice Center, University of Connecticut , Hartford , CT , USA.,Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL) , Lima , Peru
| | - Pedro Vieira-Baptista
- Department of Obstetrics and Gynecology, Hospital Lusíadas Porto , Porto , Portugal.,Lower Genital Tract Unit, Centro Hospitalar de São João , Porto , Portugal
| | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino , Torino , Italy
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar Ilan University , Safed , Israel
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50
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Solt I, Frank Wolf M, Ben-Haroush S, Kaminskyi S, Ophir E, Bornstein J. Foley catheter versus cervical double balloon for labor induction: a prospective randomized study. J Matern Fetal Neonatal Med 2019; 34:1034-1041. [PMID: 31185762 DOI: 10.1080/14767058.2019.1623776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Cervical ripening by mechanical methods enhances labor induction success. We compared Cervical Ripening Double Balloon catheter (CRDB) to Foley catheter. STUDY DESIGN This prospective blind study randomized 85 nulliparas and 95 multiparas to labor induction by either Foley catheter or CRDB. Primary outcomes were Bishop score increment, time from catheter withdrawal to delivery, and cesarean section rate. RESULTS In multiparas, mean Bishop score increment between pre- and post-catheter was significantly higher in the CRDB catheter than in the Foley group (4.4 ± 1.9 and 3.4 ± 2.0, respectively, p = .02). Mean interval from catheter withdrawal to delivery was shorter in the CRDB catheter (14.6 ± 12.3 and 8.6 ± 5.4) than in the Foley catheter group (22.6 ± 27.2 and 13.9 ± 17.7), in both nulliparas and multiparas (p = .05 and p = .03, respectively). In nulliparas, no statistically significant differences were found in mean Bishop score increment between the two catheters, but cesarean section rate was higher in the Foley group than the CRDB group (46.5% and 20%, respectively, p = .02). CONCLUSION Bishop score increment by CRDB catheter is more effective than induction by Foley catheter in multiparas. CRDB catheter is associated with decreased time to delivery in both nulliparas and multiparas and a lower cesarean section rate in nulliparas. ClinicalTrials.gov Identifier: NCT00501033.
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Affiliation(s)
- Ido Solt
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shani Ben-Haroush
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Svetlana Kaminskyi
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Ella Ophir
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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