Practical Handbook of Prescriptions and Medications for Obstetrics and Gynecology

Author: Yang Yuebo et al. / Country:
Publisher:
Publishing Date: 2004-07-01
Features: Section 3: Genital Tuberculosis refers to inflammation of the female genital organs caused by Mycobacterium tuberculosis, also known as tuberculous pelvic inflammatory disease. It is more common in women aged 20–40, but can also occur in postmenopausal elderly women. The incidence of genital tuberculosis has been increasing in recent years. [Key Diagnostic Points] 1. Patients often have primary infertility, oligomenorrhea or amenorrhea, chronic pelvic inflammatory disease that does not respond to treatment, a history of tuberculosis exposure, or have previously had pulmonary tuberculosis, pleurisy, or intestinal tuberculosis. These should be considered as possible signs of genital tuberculosis. 2. Symptoms of tuberculosis intoxication may include fatigue, weakness, low-grade fever, night sweats, poor appetite, and increased leukorrhea. 3. Lower abdominal pain. 4. Physical examination shows that most patients have no obvious signs. In more severe cases, if there is peritoneal tuberculosis, the abdomen may have a doughy or fluid-filled sensation. When encapsulated effusions form, cystic masses can be palpated, with unclear boundaries and immobility. Uterine mobility is restricted. Irregularly shaped masses can be palpated in the parametrium, with hard texture, uneven surface, nodular or papillary elevations, or calcified nodules. 5. Auxiliary examinations such as chest X-rays, hysterosalpingography, endometrial pathological biopsy, and laparoscopy can aid in diagnosis. 6. It is important to differentiate from chronic pelvic inflammatory disease, endometriosis, and ovarian tumors. [Treatment Principles] 1. Prevention: Enhance physical fitness, receive BCG vaccination, and actively prevent and treat pulmonary tuberculosis, lymphatic tuberculosis, and intestinal tuberculosis. 2. Supportive treatment: Acute patients need bed rest for at least 3 months. Chronic cases can engage in light work but should pay attention to balancing rest and activity, strengthen nutrition, and participate in appropriate physical exercise to enhance physical fitness. 3. Antitubercular drug therapy should follow the principles of early, combined, regular, appropriate dosage, and full course. In recent years, multiple antitubercular drugs have been used in combination therapy, shortening the course to 6–9 months. 4. Surgical treatment may be necessary if needed. [Prescription Medications] 1. Rifampin: 450–600 mg daily, taken once before breakfast. The main side effect is liver damage. Liver function should be checked before and during treatment, and medication should be stopped promptly if abnormalities are found. 2. Isoniazid: 300 mg daily, taken once. The main side effect is liver damage. Liver function should be checked before and during treatment, and medication should be stopped promptly if abnormalities are found. 3. Streptomycin: Intramuscular injection, once daily, 750 mg each time. Numbness in limbs, tinnitus, and severe cases may lead to deafness. Elderly women should use with caution. 4. Ethambutol: Oral, 500–750 mg daily. The main side effect is retrobulbar neuritis, which is more likely to occur with high doses. Stopping medication early can lead to recovery. 5. Pyrazinamide: 1.5 g daily, divided into 3 doses. The main side effect is liver damage, and hyperuricemia, joint pain, and gastrointestinal reactions may also occur. Treatment Plan: Currently, short-course drug therapy is recommended, with the first 2–3 months using intensive treatment and the following 4–6 months using intermittent therapy. ① Combine streptomycin, pyrazinamide, isoniazid, and rifampin for 2 months, then continue with isoniazid and rifampin for the next 4 months; or continue with isoniazid, rifampin, and ethambutol for the next 4 months. ② Combine streptomycin, pyrazinamide, isoniazid, and rifampin for 2 months, then use isoniazid, rifampin, and ethambutol three times a week for 6 months. ③ Take isoniazid, rifampin, ethambutol, and streptomycin orally for 2 months, then use isoniazid and rifampin three times a week for 4 months. These regimens can be selected based on the condition.
Chapter 5: Vulvar Tumors, Section Vulvar Benign Tumors
I. Leiomyoma [Key Diagnostic Points] 1. Derived from vulvar smooth muscle, hair follicle arrector pili muscle, or vascular smooth muscle. Most commonly occurs in the labia majora, clitoris, or labia minora. 2. Appears as a pedunculated or projecting mass with hard texture and smooth surface. 3. Under the microscope, smooth muscle cells are arranged in bundles, intersecting with collagen fibers or forming whorled structures, often accompanied by degenerative changes. [Treatment Principles] Local excision or tumor enucleation.
II. Fibroma [Key Diagnostic Points] 1. More common in women of reproductive age, may cause symptoms of dragging or pain, and may be accompanied by urinary dysfunction and sexual intercourse difficulties. 2. Most commonly occurs in the labia majora, usually solitary. 3. The tumor is generally small to medium-sized and pedunculated. Initially, it appears as a hard subcutaneous nodule, which can then enlarge to form a pedunculated, hard solid mass with possible ulcers and necrosis on the surface. 4. The cut surface shows dense, grayish-white fibrous structure. Under the microscope, it shows wavy or interwoven collagen bundles and fibroblasts. 5. If degenerative changes occur, the tumor may soften. Malignant transformation is rare. [Treatment Principles] Surgical treatment. [Prescription Medications] If infection or ulcers are present, adjunctive drug therapy is used. 1. For infection: 10% erythromycin ointment 10 g. Apply locally twice daily; 10% tetracycline ointment 10 g, apply locally twice daily; 10% chlortetracycline ointment 10 g, apply locally twice daily. 2. For ulcers: 5% urea ointment 10 g, apply locally twice daily; 2% pseudomonal acid 5 g, apply locally twice daily. [Precautions] During surgery, the tumor should be excised at the base, and the tissue specimen should be sent for pathological examination. If malignancy is confirmed, a more extensive vulvar resection should be performed.
III. Lipoma [Key Diagnostic Points] 1. Derived from adipose tissue in the labia majora or mons pubis, usually located in the subcutaneous tissue. 2. The tumor grows slowly, appearing as a round, lobulated, or pedunculated mass of varying sizes. Small tumors generally cause no discomfort, but larger tumors may cause difficulty walking or sexual intercourse difficulties. 3. The tumor has clear boundaries with a capsule, and the cut surface is yellow, similar to normal adipose tissue. 4. Under the microscope, mature adipocytes are mixed with fibrous tissue and blood vessels. [Treatment Principles] Surgical excision.
IV. Papilloma [Key Diagnostic Points] 1. More common in elderly women, with an onset age typically between 40 and 70. The lesion grows slowly and may be asymptomatic. Symptoms of itching or pain may occur if infection or ulcers are present. 2%–3% have a tendency to malignant transformation. 2. Can be solitary or multiple, commonly occurring in the labia majora, mons pubis, clitoris, or perianal area. The surface shows multiple small papillary elevations covered with oily substances, resembling fingers, projecting from the skin surface, with sizes ranging from several millimeters to several centimeters. 3. Under the microscope, it shows a loose fibrous matrix with proliferated squamous epithelium covering it. Epithelial thickening is mainly due to the stratum spinosum and basal epidermal layer.