We report a case of burning vulvar pain accompanied by erythema responding to an oral combination of a benzodiazepine and a beta blocker. The positive response to two medication classes used in the treatment of erythromelalgia supports the possibility of a localized manifestation of this disorder in the genital region.

Steroid induced skin atrophy is the most frequent and perhaps most important cutaneous side effect of topical glucocorticoid therapy. To date, it has not been described in vulvar skin. We describe a patient with significant vulvar skin atrophy following prolonged steroid application to treat vulvar dermatitis. The extensive atrophy in the perineum resulted in secondary ‘webbing’ and partial obstruction of genital hiatus and superimposed dyspareunia. Prolonged topical steroids may result in atrophic changes in vulvar skin. Therefore, further research in clinical correlates of steroid-induced atrophy in the vulvar region is warranted.

No abstract

After interfacial dissection and downward reflection of the temporalis muscle, a frontotemporal craniotomy and a zygomatic arch osteotomy were performed. The MA was identified easily 1 to 2 cm inferior to crista infratemporalis. Then, from the junction of sutura sphenosquamosa and crista infratemporalis, the dura of the temporal lobe was separated from the temporal fossa and elevated. Foramen rotundum was identified, and 2 to 3 mm lateral to the foramen rotundum, a hole was created in sphenoid bone extradurally. After that, the radial artery graft was passed through the hole inside the dura. Then, after opening the carotid and sylvian cisternas and exposing the MCA and its trunks, the graft is brought to reach the M2 segment of MCA.Results: We have found that the calibers of MA, radial artery, and M2 segment of proximal MCA match well, and as the mean caliber of these arteries was over 2 mm, such a bypass will provide sufficient blood flow.Conclusion: When a higher blood flow is needed or the caliber of STA is inadequate, MA-to-proximal MCA bypass using a short arterial graft will be a good alternative to STA-MCA bypass or ECCA-to-proximal MCA bypasses using long venous grafts.