Unusual primary location of the malignant melanoma, the cervico-vaginal region: 3 cases and literature review

Introduction: Malignant melanoma (MM) represents 1% of all cancers and has an incidence of 3% - 7% in the female genital tract, the majority of cases being reported in the vulva. The cervico-vaginal region is an unsual primary location of the malignant mela-noma. Case report: The clinical and morphologic findings of 3 MM patients with cervico-vaginal tumours mimicking cervical polyp in third case. Histologically, the neoplasia was formed by nodules of broad cytoplasmic cells with poorly defined borders with pleomorphic nuclei with prominent nucleolae. Tumor cells were positive for S-100 protein, Melan A, HMB 45 and CD117. The authors discuss three cases of cervico-vaginal melanoma and analyze clinical and prognostic aspects of this disease. Conclusion: Primary MM of the cervix should be considered in the differential diagnosis of cervical malignancies. Early diagnosis is essential in order to warrant a better prognosis, although there are no cases of cure described.

Prevalence, Associated Risk Factors and Maternal Outcomes of Lower Genital Tract Injuries in the Bamenda Regional Hospital

BACKGROUND: Tears of the genital tract are lesions resulting from the breakage of the continuity of the lower genital tract during childbirth. These injuries are associated with high maternal morbidity or mortality if severe, poorly managed or delayed in repair. It is a frequent complication of vaginal delivery. This study was aimed at determining the prevalence, demographic characteristics, risk factors, patterns and the t-term maternal outcomes of lower genital tract injuries in the labour room and the post-natal ward of the Bamenda Regional Hospital. METHODS: This was a hospital-based cross-sectional study of women managed for genital tract injuries following vaginal birth in the Bamenda Regional Hospital (BRH) from March 2019 to July 2019. A non-probabilistic, consecutive and exhaustive sampling technique was used to select participants (sample size estimated at 237). Among those selected were women who had a vaginal birth. However, the researchers’ interest was particularly centered on the women who had genital tract injuries. Data was collected using a pretested questionnaire and analyzed using the SPSS version 22 software. RESULTS: In total, 310 participants were included in this study. The mean age of the participants was 26.1 years (SD = 5.2), while the median age was 25 years (interquartile range = 22 - 29). Of the 310 participants included in the study, 128 developed a birth tract injury giving a prevalence of 41.3% (95% CI, 35.8 - 47.0). The most common type of injury was spontaneous tears (33.9%), the majority of which were perineal (30.6%) compared to episiotomies (7.4%). Most perineal tears were first degree tears (23.2%) followed by second-degree tears (6.8%). Third-degree perineal tears were rare (0.6%). We did not have any cases of fourth-degree perineal tears. We also encountered a few cases of cervical tears (0.6%). The factors associated with birth tract injury were assessed using bivariate and multiple logistic regression analysis. On bivariate analysis, being an adolescent parturient (OR = 2.8, 95% CI: 1.4 - 5.7, p = 0.005), single (OR = 1.78, 95% CI, 1.04 - 3.03, p = 0.034), having a history of birth tract injury (OR = 1.69, 95% CI, 1.01 - 2.95, p = 0.042), a duration of active phase of labour (OR = 2.1, 95% CI, 1.3 - 3.3, p = 0.002), being a primipara (OR = 2.8, 95% CI, 1.0 - 8.4, p = 0.045), inducing labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), augmenting labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), birthweight of 4000 g or more (OR = 3.0, 95% CI, 1.3 - 7.4, p < 0.015), and foetal head circumference greater than 36 cm (OR = 3.3, 95% CI, 1.5 - 7.9, p = 0.005) were statistically significantly associated with birth tract injuries. The majority of the blood loss post-partum was between 200 and 500 cc. Only one participant had a blood loss of 500 cc and above. Also, the severity of genital pain lasting beyond 24 hours postpartum was mostly less than 5/10 (50.6%) followed by genital pains > 7/10 (41.7%). The prevalence of infection of the injury was (1.6%) and no maternal death from injury was recorded. CONCLUSION: The prevalence of lower genital tract injuries in the Bamenda Regional hospital is high. First-degree tears were the most common followed by episiotomies. The perineal outcome in the BRH is poor and should be improved upon.

健康奶牛产道内正常菌群的研究

本试验从山东省不同奶牛场筛选出60头健康状况良好的奶牛，按试验要求分三组，第一组为20头8～15月龄的未配种的青年奶牛，第二组为20头处于干奶期（围产期）的奶牛，第三组为20头产后一个月的奶牛。采用常规细菌培养、分离、鉴定的方法从产道分离到细菌150株，其中乳酸杆菌46（30．70／4）株、表皮葡萄球菌39（26％）株、无乳链球菌21（14％）株、大肠杆菌23（15．3％）株、芽孢杆菌8（5．3％）株、棒状杆菌5（3．3％）株、念珠菌8（5．3％）株。比较结果显示，乳酸杆菌为正常奶牛产道内的主要寄生菌，其次是表皮葡萄球菌、无乳链球菌和大肠杆菌。但是未配青年奶牛的阴道内，乳酸杆菌的分离率并不高。试验发现，奶牛阴道内的寄生菌一般为2～3种。

青少年梗阻性阴道发育畸形的MR影像表现

目的探讨青少年梗阻性阴道发育畸形(OVA)的MRI影像表现特点,分析MRI在该发育畸形术前诊断中的作用。方法回顾性分析18例OVA患者的MRI影像表现,并将MRI诊断结果与术前超声及术中发现进行对比分析。结果本研究纳入的OVA患者MRI表现包括梗阻的直接和间接征象、伴发的其他生殖道或生殖道外畸形及相关并发症等。MRI对阴道发育畸形的诊断与手术发现完全吻合;超声正确诊断4例(22.22%),阴性诊断6例(33.33%),不确定诊断8例(44.44%)。青少年OVA主要分为阴道下段闭锁、先天性无阴道及阴道斜隔综合征3种,手术方式各异。4例阴道下段闭锁行阴道下段成形术;10例先天性无阴道,由于患者均合并宫体和/或宫颈畸形,行子宫切除术;4例阴道斜隔综合征行阴道斜隔切除术,其中1例并发盆腔脓肿,行盆腔脓肿引流术,1例并发产后胎盘植入行相应治疗。结论 MRI能准确评估青少年OVA的梗阻位置、阴道畸形类型及相关合并症、并发症。

复发性流产患者生殖道菌群特征的初步研究

目的:分析和比较正常早孕女性和复发性流产(recurrent spontaneous abortion,RSA)患者的生殖道菌群特征。方法:选取2021年3—9月在我院拟行清宫术的37例RSA患者为RSA组,同期拟行人工流产术的25例正常早孕女性为正常早孕组。对其阴道分泌物及子宫蜕膜组织进行16S rRNA测序,比较2组阴道和宫腔菌群的特征及差异。结果:与正常早孕女性相比,RSA患者阴道菌群多样性显著增多(P<0.05),个体间菌群结构相似度较低,但优势菌未改变,仍为乳杆菌属,而乳杆菌属丰度显著降低(P<0.05),且加德纳菌属、普雷沃菌属、巨型球菌属、李斯特菌属和厌氧球菌属丰度显著增加(P<0.05);RSA患者宫腔菌群多样性及个体间菌群结构相似度无显著变化(P>0.05),但优势菌种发生改变,正常早孕女性宫腔优势菌种为卷曲乳杆菌,RSA患者宫腔优势菌种为惰性乳杆菌,RSA患者宫腔菌群中两歧双歧杆菌和不能培养的不动杆菌丰度显著减少(P<0.05),而拟杆菌属、大肠埃希菌/志贺菌属和瘤胃菌属团显著增加(P<0.05)结论:正常的阴道和宫腔存在微生物菌群,宫腔比阴道的菌群多样性更高,但宫腔优势菌丰度较低。阴道细菌的上行定植可能与宫腔菌群的形成存在一定的相关性。而宫腔特有菌群的存在,尤其是宫腔优势菌种的改变和致病菌的出现,可能与RSA的发生相关。

产道深部血肿的临床分析

目的:探讨产道深部血肿的临床处理方法。方法:回顾性分析1996年1月~2004年12月我科收治的产道深部血肿32例(含外院转入12例)的临床资料。结果:后窟窿及侧窟窿血肿12例,坐骨直肠窝血肿9例、膀胱侧窝血肿9例(左7例、右2例)、阔韧带血肿2例,我院产道深部血肿发生率1·86‰,绝大多数发生于不恰当的产程处理、阴道助产的初产妇,血肿2h内发现者12例(37·50%),失血量最多达3200ml。根据血肿大小、位置、局部特点、有无继续出血倾向,结合患者全身状况综合考虑处理措施。结论:产道深部血肿临床不少见,早期易被忽视,处理棘手,应引起临床重视和加强预防。

重视中国女性生殖道感染及阴道微生态诊治

女性生殖道感染是感染性疾病的重要部分，目前已成为全球性的重大社会及公共卫生问题。近年的研究表明，女性生殖道感染与肿瘤的发生、不孕不育、异位妊娠、胎膜早破、早产等均密切相关，而几乎所有的生殖道感染都伴随着女性生殖道微环境的改变。阴道微生态检测系统的开发及下生殖道炎症诊断平台的应用，为准确治疗女性生殖道感染提供可能。故女性生殖道感染及阴道微生态的规范化检验也得到了相关领域专家学者越来越多的重视。

国际人类微生物组最新研究进展——第五届国际人类微生物组联盟学术会议纪要

国际人类微生物组联盟（IHMC）于2008年在德国海德堡正式成立，汇聚了美国、法国、德国、中国、日本等国家和地区国际顶级的微生物学研究者，以解析人类共生微生物与健康关系为目标，旨在推动各国微生物学家在人体微生态领域的国际研究合作。IHMC学术会议每一年半举行一次，已在中国深圳、加拿大渥太华、法国巴黎和中国杭州举办了四届。第五届IHMC学术会议于2015年3月31日至4月2日在卢森堡举行。本次大会由我国感染微生态领域著名专家李兰娟院士担任大会主席，参加大会的中国微生态研究学者共计80余人，是历届会议中我国参会代表人数最多的一次。第五届IHMC学术会议以“微生态与人类健康和疾病研究的未来发展方向”为主题，全面深刻地揭示了微生物组与人类健康和疾病的关系，并详细介绍了目前微生物组研究领域的最新方法和技术。本刊特邀请李兰娟院士，对本次大会的主要内容进行整理和总结，以便让广大读者了解国际最新、最顶尖、最有价值的微生态学研究成果。感谢浙江大学医学院附属第一医院秦楠、王保红、姚航平、陈春雷、鲁海峰、吕龙贤、陈云波、李昂、谢天胜、凌宗欣等老师协助整理本次会议纪要!

小尾寒羊生殖道的组织学结构研究

为了了解小尾寒羊生殖道的组织学结构特点,试验以小尾寒羊的阴道、子宫及输卵管为材料,通过制作石蜡切片和进行H.E.染色,镜下观察阴道、子宫及输卵管各部位的组织学结构特点,测定各部位肌层厚度及内膜厚度并进行统计分析。结果表明:小尾寒羊阴道黏膜形成皱襞,黏膜上皮为复层扁平上皮细胞;子宫体黏膜上皮为单层柱状上皮细胞或假复层柱状上皮细胞,子宫颈上皮为单层柱状上皮细胞,其间可见少量杯状细胞和管状腺;输卵管黏膜上皮为单层柱状上皮细胞。小尾寒羊生殖道不同部位的肌层厚度与内膜厚度存在一定差异,其中子宫体的肌层厚度最厚,为781.7μm;输卵管伞部的肌层厚度最薄,为10.2μm;阴道的内膜厚度最厚,为20.2μm;输卵管峡部的内膜厚度最薄,为8.5μm。说明小尾寒羊自身独特的生殖道组织结构可能是其繁殖能力强的原因之一。