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Endothelial dysfunction (impaired vasodilation, prothrombotic, proinflammatory and prooxidant states) is involved in the development of cardiovascular diseases (atherosclerosis, hypertension, heart failure, stroke) and vascular complications of diabetes mellitus. Reduced production of endothelium-derived relaxing factors, increased release of endothelium-derived constricting factors, prothrombotic molecules and inflammatory mediators, upregulation of growth factors and adhesion molecules play a crucial role in the development and progression of endothelial dysfunction. Phytochemicals belonging to different chemical classes (alkaloids, flavonoids, isoflavonoids, phenolic acids, terpenoids) were reported to prevent and/or reverse endothelial dysfunction in different experimental models. Many of them showed a multitarget activity which is a great advantage in tackling endothelial dysfunction and thereby, they may serve as lead compounds for novel drug development. Salvianolic acid B, caffeic, chlorogenic, ferulic and rosmarinic acids, resveratrol, luteolin are only some examples of phytochemicals modulating multiple mechanisms associated with endothelial dysfunction. Obviously, extensive clinical trials are needed to confirm the efficacy of phytochemicals in improving endothelial function and also their safety. In addition, formulation strategies to enhance bioavailability and afford an endothelium-targeted delivery should be explored.

Background: Vaginal masses are an uncommon finding in well-woman gynecologic examinations. The differential diagnosis includes cysts, leiomyomata, ectopic ureteroceles, infected granuloma, and malignancy. Case: A 74-year-old woman with a history of mantle cell lymphoma was referred for vaginal prolapse. Examination revealed a vaginal mass, with MRI confirming 3 masses. Fine needle aspiration confirmed metastatic mantle cell lymphoma which later regressed with radiation therapy. Conclusion: Although vaginal masses are often rare and incidental findings during routine gynecologic examinations, a comprehensive differential diagnosis is required to avoid delays in treatment. Fine needle aspiration should be included as part of the arsenal of diagnostic tools because of its low cost and the ease with which it can be performed in a clinical setting.

To estimate whether prophylactic antibiotics at the time of repair of third- or fourth-degree perineal tears after vaginal delivery prevent wound infection and breakdown.This was a prospective, randomized, placebo-controlled study. Patients who sustained third- or fourth-degree perineal tears after a vaginal delivery were recruited for the study. Each patient was given a single intravenous dose of a second-generation cephalosporin (cefotetan or cefoxitin) or placebo before repair of third- or fourth-degree perineal tears. Obstetricians and patients were blinded to study drug. The perineum was inspected for evidence of infection or breakdown at discharge from the hospital and at 2 weeks postpartum. Primary end points were gross disruption or purulent discharge at site of perineal repair by 2 weeks postpartum.One hundred forty-seven patients were recruited for the study. Of these, 83 patients received placebo and 64 patients received antibiotics. Forty patients (27.2%) did not return for their 2-week appointment. Of the patients seen at 2 weeks postpartum, 4 of 49 (8.2%) patients who received antibiotics and 14 of 58 (24.1%) patients who received placebo developed a perineal wound complication (P=.037). There were no differences between groups in parity, incidence of diabetes, operative delivery, or third-degree compared with fourth-degree lacerations.By 2 weeks postpartum, patients who received prophylactic antibiotics at the time of third- or fourth-degree laceration repair had a lower rate of perineal wound complications than patients who received placebo.ClinicalTrials.gov, www.clincaltrials.gov, NCT00186082.I.