[Vulvodynia - Diagnostics and Management Strategies]

Vulvodynia - Diagnostics and Management Strategies Abstract. Vulvodynia is characterized by chronic, idiopathic vulvar pain lasting for at least three months. After exclusion of other, specific diseases associated with vulvar pain, which can be treated accordingly, realistic therapy goals for this chronic disease should be defined. The therapy concept is multimodal, interdisciplinary as well as individualized and includes the combination of general recommendations with physiotherapeutic and psychotherapeutic measures. Pharmacological therapy, which is indispensable, is carried out off-label and includes the topical and/or systemic use of various substances and substance combinations. Surgical measures may be regarded as a possible option, especially in women with therapy-resistant and provocable vulvodynia. Alternative therapy options such as acupuncture, hypnosis and transcutaneous electrical nerve stimulation are also worth investigating.

[Etiology, Diagnosis, and Management of Female Bladder Outlet Obstruction]

Etiology, Diagnosis, and Management of Female Bladder Outlet Obstruction Abstract. Bladder outlet obstruction affects up to every fourth woman. This condition is causing difficulties to void. Patients complain about frequency, an urge to void, or they describe the feeling of post-void residual urine. Increased post-void residual urine or a pathological micturition pattern with increased pressure or pathological flow curves are suggestive for a bladder outlet obstruction. Common causes are genital organ prolapse, previous incontinence surgery, or dysfunctional voiding. Correspondingly, the underlying etiology is determining therapy: surgical correction of the pelvic organ prolapse usually eliminates the obstructive situation; a tightly placed incontinence sling should be loosened or incised, while dysfunctional disorders can be well addressed by pelvic floor rehabilitation.

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Zusammenfassung. Die Kolposkopie ist ein wichtiges Instrument in der Früherkennung des Zervixkarzinoms. Die Kombination von Zytologie und Kolposkopie bleibt unabhängig von der Möglichkeit der HPV-Typenbestimmung zurzeit die akkurateste Methode, hochgradige intrazervikale Läsionen der Portio zu detektieren. Dank der Kolposkopie kann die zytologische Diagnose bestätigt oder revidiert, die Grösse und Lokalisation des dysplastischen Befundes erfasst und die notwendige Therapie sowie Nachsorge eingeleitet werden. Die HPV-Bestimmung sagt wohl etwas über das onkogene Potenzial des HPV aus, nicht jedoch, ob eine Dysplasie vorliegt, die über Jahre in ein Karzinom übergehen kann. Kolposkopisch abnorme Befunde der Ektozervix werden mit einer Knipsbiopsie histologisch abgeklärt, intrazervikale Befunde mittels einer endozervikalen Kürettage und eines tiefen Zytobrushes.

[Burning Vulva: Significance of Surgery in Inflammatory and Precancerous Vulvar Pathologies]

Vuval pathologies manifested by allodynia and burning sensations can be due to infection, inflammatory dermatoses or other causes. Infective as well as certain inflammatory diseases, e.g. drug eruptions, allergic eczemas, irritative dermatitis/vulvitis, Behcet's Syndrome and pemphigus/pemphigoid usually respond well to conservative treatment. The category of inflammatory diseases also contains pathologies that in certain circumstances do require a surgical intervention, e.g. Lichen ruber planus/Lichen sclerosus, Condyloma, scars, premalignant lesions (VIN, genital M. Paget) and cancer. Vulodynia also can cause some stinging to the vulvar skin. The surgical aspects relating to the treatment of the benign and premalignant pathologies indicated above are mentioned in this mini-review.

Expression of neuroserpin, an inhibitor of tissue plasminogen activator, in the developing and adult nervous system of the mouse

Neuroserpin is a serine protease inhibitor of the serpin family that has been identified as an axonally secreted glycoprotein in neuronal cultures of chicken dorsal root ganglia. To obtain an indication for possible functions of neuroserpin, we analyzed its expression in the developing and the adult CNS of the mouse. In the adult CNS, neuroserpin was most strongly expressed in the neocortex, the hippocampal formation, the olfactory bulb, and the amygdala. In contrast, most thalamic nuclei, the caudate putamen, and the cerebellar granule cells were devoid of neuroserpin mRNA. During embryonic development, neuroserpin mRNA was not detectable in neuroepithelia, but it was expressed in the differentiating fields of most CNS regions concurrent with their appearance. In the cerebellum, the granule cells and a subgroup of Purkinje cells were neuroserpin-positive during postnatal development. As a further step toward the elucidation of neuroserpin function, we performed a study to identify potential target proteases. In vitro, neuroserpin formed SDS-stable complexes and inhibited the amidolytic activity of tissue plasminogen activator, urokinase, and plasmin. In contrast, no complex formation with or inhibition of thrombin was found. Expression pattern and inhibitory specificity implicate neuroserpin as a candidate regulator of plasminogen activators, which have been suggested to participate in the modulation or reorganization of synaptic connections in the adult. During development, neuroserpin may attenuate extracellular proteolysis related to processes such as neuronal migration, axogenesis, or the formation of mature synaptic connections.