Combined vesicovaginal-ureterovaginal fistulas associated with a vaginal foreign body

Article Abstract:

Vesicovaginal fistulas (abnormal openings between the bladder and vagina) most commonly develop after gynecologic surgery; however, such a fistula can develop in association with a foreign body in the vagina. The case report of a 52-year-old woman with a foul-smelling vaginal discharge is presented. The vaginal walls were inflamed and hardened, and a malignancy was suspected. A mass, lying against the rectum, was discovered; two weeks later, the patient became increasingly incontinent of urine. A small vesicovaginal fistula was detected. The mass was identified with computed tomography (an X-ray of the soft tissues). Further examination led to the surgical removal of a clear plastic cap, the type found on aerosol deodorants. It had apparently been in place for some time. After recovery from the inflammation, the patient underwent surgery to repair the fistula. Complications developed, including continued leakage of urine. An additional fistula between the ureter and the vagina (ureterovaginal fistula) was discovered and repaired. Because ureterovaginal fistulas are rarely associated with foreign objects, it is possible that the patient's ureterovaginal fistula was congenital. In this case, the patient may have used the deodorant cap as a treatment for incontinence, rather than for sexual stimulation (a more common reason why a foreign body is found in the vagina). (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Diagnosis, Surgery, Fistula, Vesico-vaginal, Vesicovaginal fistula

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Invasive group A streptococcal infections

Article Abstract:

An increase in the incidence of serious group A streptococcal infections may be due to the introduction of a more virulent strain. These infections include toxic shock syndrome and necrotizing fasciitis, which is commonly called 'flesh-eating bacteria'. The same bacteria can cause a mild case of strep throat and scientists are not sure why the bacteria can turn deadly. Researchers have been unable to find a single strain responsible for most cases of invasive infection. Young children and the elderly have the highest risk, indicating that an impaired immune system may be a risk factor.

Editorial, Streptococcal infections, Demographic aspects, Streptococcus pyogenes

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