Background Ehlers–Danlos syndrome type IV, the vascular type, results from mutations in the gene for type III procollagen (COL3A1). Affected patients are at risk for arterial, bowel, and uterine rupture, but the timing of these events, their frequency, and the course of the disease are not well documented. Methods We reviewed the clinical and family histories of and medical and surgical complications in 220 index patients with biochemically confirmed Ehlers–Danlos syndrome type IV and 199 of their affected relatives. We identified the underlying COL3A1 mutation in 135 index patients. Results Complications were rare in childhood; 25 percent of the index patients had a first complication by the age of 20 years, and more than 80 percent had had at least one complication by the age of 40. The calculated median survival of the entire cohort was 48 years. Most deaths resulted from arterial rupture. Bowel rupture, which often involved the sigmoid colon, accounted for about a quarter of complications but rarely l...

https://www.nejm.org/doi/pdf/10.1056/NEJM200003093421001

Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type.

/pdf/clinical-and-genetic-features-of-ehlers-danlos-syndrome-type-4fnompyk07.pdf

Clinical and genetic features of ehlers-danlos syndrome type iv, the vascular type

Background
Vaginal candidiasis (moniliasis or thrush) is a common and frequently distressing infection for many women. It is even more common in pregnancy. There is no evidence that thrush in pregnancy is harmful to the baby.

Objectives
The objective of this review was to assess the effects of different methods of treating vaginal candidiasis in pregnancy.

Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2001). We updated this search on 1 October 2009 and added the results to the awaiting classification section.

Selection criteria
Randomised trials of any treatment for vaginal candidiasis in pregnancy.

Data collection and analysis
Two reviewers assessed trial quality and extracted data.

Main results
Ten trials were included. Based on five trials, imidazole drugs were more effective than nystatin when treating vaginal candidiasis in pregnancy (odds ratio 0.21, 95% confidence interval 0.16 to 0.29). In turn, Nystatin was as effective as hydrargaphen in one trial (odds ratio 0.29, 95% confidence interval 0.05-1.84). A trial of clotrimazole was more effective than placebo (odds ratio 0.14, 95% confidence interval 0.06 to 0.31). Single dose treatment was no more or less effective than three or four days treatment. However, two trials involving 81 women, showed that treatment lasting for four days was less effective than treatment for seven days (odds ratio 11.7, 95% confidence interval 4.21 to 29.15). Based on two trials, treatment for seven days was no more or less effective than treatment for 14 days (odds ratio 0.41, 95% confidence interval 0.16 to 1.05). Terconazole was as effective as clotrimazole (odds ratio 1.41, 95% confidence interval 0.28- 7.10).

Authors' conclusions
Topical imidazole appears to be more effective than nystatin for treating symptomatic vaginal candidiasis in pregnancy. Treatments for seven days may be necessary in pregnancy rather than the shorter courses more commonly used in non-pregnant women.

[Note: The seven citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

Topical treatment for vaginal candidiasis (thrush) in pregnancy.

1 Introduction.- 1.1 Antimicrobial Therapy.- 1.2 Microbial Diseases of the Skin and Mucous Membranes.- 1.3 Antimicrobial Drugs for Local Application.- 2 Broad-Spectrum Antimicrobials for Local Application.- 2.1 Preliminary Remarks.- 2.2 Disinf ectants and Antiseptics.- 2.3 Antibiotics.- 2.4 Chemotherapeutic Agents.- 2.5 Imidazole Derivatives with Antimicrobial Action.- 2.5.1 General.- 2.5.2 Chlormidazole.- 2.5.3 Clotrimazole.- 2.5.4 Miconazole and Isoconazole.- 2.5.5 Econazole.- 2.5.6 Ketoconazole.- 2.5.7 Assessment of Imidazole Derivatives.- 3 Econazole.- 3.1 General.- 3.2 Chemical Structure.- 3.3 Physical Properties.- 3.4 Antimicrobial Spectrum.- 3.4.1 Antifungal Activity.- 3.4.2 Antibacterial Activity.- 3.4.3 Comparison of the Antimicrobial Activity of Econazole with Other Local Therapeutic Agents.- 3.4.4 Activity Against Protozoa (Trichomonads).- 4 General Microbiology of Imidazole Derivatives for Local Application.- 4.1 Preliminary Remarks.- 4.2 Modeof Action.- 4.2.1 Morphological Findings.- 4.2.2 Biochemical Effects.- 4.2.3 Sites of Action in the Cell.- 4.3 Resistance and Tolerance.- 4.4 Interactions with Other Compounds.- 4.4.1 Preliminary Remarks.- 4.4.2 Proteins.- 4.4.3 Lipids.- 4.4.4 Glucocorticoids.- 4.4.5 Antibacterial Substances.- 4.4.6 Antimycotic Substances.- 4.4.7 Antibacterial Substances and Glucocorticoids.- 4.4.8 Conclusions.- 4.5 Bioavailability Studies.- 5 Therapeutic Use of Imidazole Derivatives in Animals (Experimental Therapy).- 5.1 Local Application.- 5.2 Systemic Application.- 6 General Pharmacology of the Imidazole Derivatives in Man and Animals.- 6.1 Pharmacologic Properties (Apart from Antimicrobial Action) ...- 6.2 Absorption, Excretion, and Metabolism in Animals.- 6.2.1 Systemic Application.- 6.2.2 Local Application to the Skin and Mucous Membranes.- 6.3 Absorption, Excretion, and Metabolism in Man.- 6.3.1 Systemic Application.- 6.3.2 Local Application to the Outer Skin.- 6.3.3 Local Application to the Vaginal Epithelium.- 6.3.4 Conclusions.- 6.4 Sensitization.- 6.4.1 Preliminary Remarks.- 6.4.2 Animal Experiments in Systemic Sensitization.- 6.4.3 Animal Experiments in Local Sensitization.- 6.4.4 Sensitization in Man.- 6.5 Anaphylactoid Activity.- 7 Toxicology of the Imidazole Derivatives.- 7.1 Preliminary Remarks.- 7.2 SystemicToxicity.- 7.3 LocalToxicity.- 7.3.1 Skin and Mucous Membrane Tolerance in Animals.- 7.3.2 Photosensitizing Reactions.- 7.3.3 Skin and Mucous Membrane Tolerance in Man.- 8 Clinical Pharmacology of Topical Antimicrobials with Special Regard to the Imidazole Derivatives.- 8.1 Preliminary Remarks.- 8.2 Physical Properties.- 8.3 SkinTolerance.- 8.4 Sensitization.- 8.5 Photosensitizing Reactions.- 8.6 Interactions with Substances on the Skin Surface.- 8.7 Penetration and Absorption.- 8.8 Systemic Administration.- 8.9 Use in Veterinary Mediane and the Food Industry.- 8.10 Special Clinical Pharmacologic Considerations in the Local Application of Antimicrobials.- 8.10.1 General.- 8.10.2 Degree and Spectrum of Activity.- 8.10.3 Resistance and Tolerance.- 8.11 Clinical Pharmacology of the Preparation.- 8.11.1 General.- 8.11.2 Interactions.- 8.11.3 Combinationof Imidazole Derivatives and Glucocortoids ...- 9 Microbial Infections in Man.- 9.1 General.- 9.2 Increase in Microbial Infections of Body Surfaces.- 9.3 Saprophytes and Parasites on Body Surf aces.- 9.4 Mixed and Double Inf ections of Body Surf aces.- 10 Mycoses.- 10.1 Etiology of Mycoses.- 10.2 The Increase in Mycoses.- 10.2.1 General.- 10.2.2 Increase in Mycoses Due to Medications.- 10.2.3 Increase in Mycoses Due to Changes in Hygienic Habits and Modes of Social Behavior.- 10.2.4 Increase in Mycoses Due to Metabolie Disturbances.- 10.2.5 Increase in Mycoses Due to Physical Influences.- 10.3 Classification of Mycoses.- 10.4 Mycoses of the Skin and Mucous Membranes.- 10.4.1 General.- 10.4.2 Diagnosis of Skin and Mucous Membrane Mycoses.- 10.5 Mycoses of the Female Genitalia.- 10.6 Systemic Mycoses.- 10.7 General Principles in the Treatment of Mycoses.- 10.7.1 Systemic Treatment.- 10.7.2 Local Antimycotics.- 10.7.3 Treatment of Mucous Membrane Mycoses.- 11 Systemic Administration of Antimycotically Active Imidazole Derivatives in Man.- 12 Local Application of Antimycotically Active Imidazole Derivatives in Man.- 12.1 Application to the Outer Skin.- 12.2 Application to the Mucous Membranes.- 13 Combined Use of Imidazole Derivatives and Glucocortoids for the Local Treatment of Skin Diseases.- 13.1 Preliminary Remarks.- 13.2 Combination of Antibiotics with Glucocortoids.- 13.3 Salicylic Acid, Haloprogin, Clioquinol, Chlorquinaldol, and Triclosan.- 13.4 Imidazole Derivatives and Glucocortoids.- 13.5 Indications for the Combined Use of Imidazole Derivatives and Glucocorticoids.- 14 Assessment of Mycoses in Various Branches of Mediane.- 14.1 Dermatology.- 14.2 Gynecology.- 14.3 Pediatrics.- 14.4 Stomatology.- 14.5 Otolaryngology.- 14.6 Otorhinolaryngology.- 14.7 Proctology.- 14.8 Urology.- 14.9 Internal Mediane.- 14.10 Orthopedics.- 14.11 Surgery, Intensive Care, Anesthesiology.- 15 Concluding Remarks.- 16 References.- 17 Subject Index.

The treatment of mycosis with imidazole derivatives.

Objectives: This report wants to focus on the risk of severe prematurity in patients with the hypermobility type of the Ehlers-Danlos syndrome (EDS), a heritable disorder of connect

Preterm premature rupture of membranes in a patient with the hypermobility type of the Ehlers-Danlos syndrome. A case report.

Obstetrical problems in patients with Ehlers-Danlos syndrome type IV; a case report.

A new treatment of vaginal candidiasis: three-day treatment with econazole.

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Obstetrical problems in patients with Ehlers-Danlos syndrome type IV; a case report.

A new treatment of vaginal candidiasis: three-day treatment with econazole.