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The Effects of Lichen Sclerosus and Its Treatments on Sexuality: Case Report

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Open Journal of Obstetrics and gynecology 2019年第6期9卷 755-763页

作者： Janete Vettorazzi Edimárlei gonsales Valério Amanda Vilaverde Perez Mariana Sbaraini Luciana Segat Daniela Vanessa Vetori fernanda Santos grossi Valentino Antonio Magno Postgraduation Program in Health Sciences: gynecology and Obstetrics Universidade Federal do Rio Grande do Sul (UFRGS). Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil Department of gynecology and Obstetrics Faculty of Medicine (FAMED) UFRGS Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil FAMED UFRGS Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil Service of Obstetrics and gynecology Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos Santa Cecília Porto Alegre RS Brazil

Lichen sclerosus is a chronic and autoimmune dermatitis that develops in the anogenital region. It is related to genital alterations with repercussions in sexuality. We present a case of a 60-year-old woman who had several chronic diseases and had been diagnosed with vulvar lichen sclerosus for 20 years, with no response to multiple treatments (topical corticosteroids, immunomodulators). She was submitted to vulvectomy;however, it leads to worsening of her condition, presenting obliterated and fibrosed clitoris, atrophic vaginal lips, and anal and vulvar fissures. She remained with dyspareunia, decreased sexual desire and difficulty in orgasm. She underwent sexual therapy, adjustment of antidepressant medication and made intercalated use of topical corticosteroids, topical testosterone and vaginal moisturizers, with partial improvement. From this case we can conclude that, although vulvectomy can be related to some degree of improvement in patients with lichen sclerosus, serious complications can occur.

关键词： Lichen Sclerosus Dyspareunia Corticosteroids Vulvectomy

Impact of Selective vs Routine Midline Episiotomy and Lacerations of the anal Sphincter

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Open Journal of Obstetrics and gynecology 2019年第6期9卷 794-810页

作者： Samanta Schneider Amanda Vilaverde Perez Nadine Morais da Silva Charles Francisco Ferreira fernanda Santos grossi Mariana Sbaraini Sérgio H. Martins-Costa Janete Vettorazzi Edimárlei gonsales Valério PostgraduationProgram in Health Sciences Gynecology and Obstetrics Faculty of Medicine (FAMED Universida de Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brasil School of Medicine (FAMED) Universidade Federal do Rio Grande do Sul Porto Alegre Brasil Department of gynecology and Obstetrics Faculty of Medicine (FAMED) Universida de Federal do Rio Grande do Sul Porto Alegre Brasil

Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.

关键词： Restrictive Episiotomy Third-Degree Perineal Laceration Fourth-Degree Perineal Laceration Obstetric anal Sphincter Tear

Prevalence of anal human papillomavirus infection in patients with human immunodeficiency virus infection:A systematic review

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World Journal of Clinical Infectious Diseases 2021年第3期11卷 38-48页

作者： Cinara Dourado Pereira Correia Santos Caio Caires Brandão fernanda Santos Mota Isis Souza Ferreira Caline Novais Teixeira Oliveira Cláudio Lima Souza Fabrício Freire de Melo Márcio Vasconcelos Oliveira Instituto Multidisciplinar em Saúde Universidade Federal da BahiaVitória da Conquista 45029-094BahiaBrazil Medical School Faculdade Santo AgostinhoVitória da Conquista 45028-100BahiaBrazil

BACKgROUND Human papillomavirus(HPV)is one of the most common sexually transmitted viruses *** To analyze the prevalence of HPV infection in human immunodeficiency virus(HIV)-positive patients and the risk factors associated with this infection through a review of studies published in the period from January 2010 to April *** A total of 384 articles were initially identified in our searches,of which ten were selected according to previously defined eligibility *** anal intercourse,absence of condom use,multiple partners,other specific sexual and life habits,and HIV infection are among the risk factors associated with anal HPV *** In general,there is a higher prevalence of anal HPV infection among HIV-positive patients,mostly in individuals over 30 years old,those with multiple partners,those who had an early homosexual debut,and cigarette,alcohol,and drug users.

关键词： Human immunodeficiency virus anal human papillomavirus Risk factors Systematic review

International guideline on natural orifice specimen extraction surgery(NOSES)for colorectal cancer(2023 version)

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Holistic Integrative Oncology 2023年第1期2卷 93-100页

作者： Zheng Liu Xu guan Mingguang Zhang Xiyue Hu Ming Yang Junge Bai Jun Li Shaojun Yu Kefeng Ding Qingsi He Liang Kang Dan Ma Chuangang Fu Junhong Hu Ye Wei Donghui Sun gang Yu Songbing He Changyou Wang Yanwei gao guiyu Wang Hongliang Yao Jian Peng Yangchun Zheng Bo Jiang Taiyuan Li Zhiguo Xiong Xuejun Sun Zhenning Wang William Meng William Tzu-Liang Chen Ming-Yin Shen John H.Marks Charles A.Ternent Darcy DShaw Jim SKhan Petr Tsarkov Inna Tulina Sergey Efetov Joaquim Manuel da Costa Pereira fernanda Nogueira Ricardo Escalante Joel Leroy Avanish Saklani Audrius Dulskas Cuneyt Kayaalp Atsushi Nishimura Kay Uehara Woo-Yong Lee Sang-Hoo Kim Suk-Hwan Lee Xishan Wang Committee of Colorectal Cancer Society Chinese Anti-Cancer Association International NOSES Alliance Department of Colorectal Surgery National Cancer CenterNational Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100021China Department of Colorectal Surgery The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina Department of general Surgery Shandong University Qilu HospitalJinanShandongChina Department of Colorectal Surgery The Sixth Affiliated HospitalSun Yat-Sen UniversityGuangzhouChina Department of general Surgery Xinqiao HospitalThird Military Medical UniversityChongqingChina Department of gastrointestinal Surgery Shanghai East HospitalTongji University School of MedicineShanghaiChina Department of Anorectal Surgery First Affiliated HospitalZhengzhou UniversityZhengzhouHenanChina Department of general Surgery Zhongshan HospitalFudan UniversityShanghaiChina Department of gastric and Colorectal Surgery Jilin University First HospitalChangchunChina Department of general Surgery Qilu Hospital(Qingdao)Cheeloo College of MedicineShandong UniversityJinanChina Department of general Surgery the First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina Affiliated Hospital of North China University of Science and Technology TangshanHebeiChina Inner Mongolia Autonomous Region People’s Hospital HuhhotInner Mongolia Autonomous RegionChina Department of Colorectal Cancer Surgery the Second Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of general Surgery The Second Xiangya HospitalCentral South UniversityChangshaHunanChina Department of general Surgery Xiangya HospitalCentral South UniversityChangshaChina Department of gastrointestinal Surgery Sichuan Cancer HospitalChengduChina Department of Colorectal and anal Surgery Shanxi Cancer HospitalTaiyuanShanxiChina Department of general Surgery The First Affiliated Hospital of Nanchang UniversityNanchangChina Department of gastrointestinal Surgery Hubei Provincial Cancer Hosp

Purpose In recent years,natural orifice specimen extraction surgery(NOSES)has gained widespread attention as an alternative *** the safety and feasibility of NOSES have been well documented,many questions remain open for *** aim of this guideline is to provide more evidence for the promotion of *** This guideline has been prepared by the CACA Committee of Colorectal Cancer Society and the International NOSES Alliance,based on the latest *** The guideline on NOSES for colorectal cancer include the definition,classification,technology requirement,indications,technical difficulties and clinical *** The guideline provides a full introduction of the theoretical and technical aspects of NOSES for colorectal cancer which will beneficial to development of NOSES.

关键词： Colorectal cancer guideline Treatment Surgery Holistic integrative medicine Natural orifice specimen extraction surgery