Adolescent and pediatric gynecology最新文献

Adolescent and pediatric gynecologic oncology patients represent a subgroup of patients afflicted with malignancies in which significant improvement has been noted. In this article we discuss the specific factors which led to improvement in survival of these patients, but most importantly, how these improvements paralleled the improvements in quality-of-life issues for patients who only two decades ago were sentenced to a poor prognosis, a dismal outlook, and a miserable limited human existence.

A case report of a patient in whom transient elevation of androgens during early puberty, presumably physiologic, resulted in significant clitoral enlargement is presented. ACTH stimulation showed elevated A5 pathway steroids. The findings are consistent with partial 3-β-ol hydroxysteroid dehydrogenase deficiency. However, the condition resolved spontaneously following puberty.

Study Objective: Homelessness is a major complication to adolescent pregnancy. We hypothesized that homelessness was associated with an increased incidence of other psychosocial and health risk factors for young pregnant teens.

Design, Setting, Participants: We conducted a nationwide study of homeless young pregnant teens living in group residential facilities and of a control population of young pregnant teens living at home with their families. Clinical social workers involved in services for these patients were located by consulting a national directory of maternity homes and through contact with hospital-based social service departments randomly selected through long-distance telephone information. After a telephone conversation detailing the nature of the project, questionnaires were mailed to each social worker. They were to complete a questionnaire for each of the two youngest pregnant teens cared for at their facility in the previous 12 months. The data from the returned questionnaires were evaluated by chi-square analysis and Fisher's exact test.

Main Outcome Measures: We distributed 736 questionnaires and collected data on 509 subjects (278 homeless, 231 controls) from 191 cities throughout the United States. The return rates were 69.1% from each group. There were no significant differences between the two groups in median age (14 years), race (50 and 42% white, 32 and 39% black, 10 and 14% Hispanic), school grade level (8th), or dropout rates (19 and 18%).

Results: Findings included a greater likelihood for those in the homeless group to be under the guardianship of a social service agency (29 vs. 3%, p < .001), to be known to family court (54 vs. 13%, p < .001), to have been declared by the courts to be “a person in need of supervision” (43 vs. 7%, p < 0.001), and to have been convicted of a criminal offense (12 vs. 0%, p < .001). Homeless young pregnant teens were likely to have been victims of physical abuse (47 vs. 9%, p < .001), victims of sexual abuse (46 vs. 16%, p < .001), to have abused illicit drugs or alcohol (24 vs. 7%, p < .001), to have sold illicit drugs (3 vs. 0%, p < 0.01), to have exchanged sex for drugs (6 vs. 0%, p < .001), and to have exchanged sex for food and shelter (9 vs. 0%, p < .001).

Conclusions: Homelessness should alert prenatal care providers to the expected coexistence of numerous additional psychosocial and health risk factors in young pregnant teens.

Pregnancy causes a profound amount of respiratory stress on the body of the normal woman. For the woman with a chronic pulmonary disease such as pulmonary fibrosis (PF), pregnancy is not only a source of respiratory stress but can also be a life-threatening condition for both her and the unborn baby. We report an older adolescent with idiopathic pulmonary hemosiderosis (IPH) and PF who became pregnant and delivered a healthy infant. She is the first documented patient with this disease to suffer no exacerbations of her IPH during pregnancy. We also review potential respiratory problems, such as respiratory insufficiency and death, of both the mother and her unborn infant, which can occur in women with PF.

Study Objective: To assess the value of screening pregnant adolescents for gestational diabetes.

Design: Pregnant adolescents who attended the Teen Pregnancy Clinic at the University of Tennessee Medical Center at Knoxville were screened for gestational diabetes at 28.5 ± 2.5 weeks gestation using the 50-g, 1-hour glucose test. Those whose screening test result was ≥ 140 mg/dl underwent a 100-g, 3-hour glucose tolerance test. Demographic and perinatal data, including prepregnancy weight, weight gain, social habits, mode of delivery, birth weight, and neonatal complications were recorded.

Results: Of 437 women screened, 18 (4%) had abnormal results. All 18 underwent a 100-g, 3-hour glucose tolerance test, and none was diagnosed with gestational diabetes. There were no significant differences in the average screening test results among different age groups.

Conclusion: The low incidence of gestational diabetes in this population suggests that the likelihood of developing this disorder is significantly less for pregnant adolescents than for older gravidas. It may be more cost-effective to reserve diabetes screening for adolescent gravidas who have risk factors.

Two mentally disabled phenotypic females, 46,XY dysgonadal sisters from a consanguineous marriage are described. Low plasma testosterone levels and an inadequate response of plasma-testosterone to human chorionic gonadotrophin (hCG) stimulation were noted in both cases. Dysgenetic testes and remnants of the müllerian and wolffian ducts were identified at exploratory laparotomy. Mild mental retardation was also present in both cases. These data may suggest the specific role of genetic factors in the etiology of testicular dysgenesis.