Adolescent and pediatric gynecology最新文献

Study Objective: A multicentric European study was undertaken by the International Federation of Pediatric and Adolescent Gynecology, to compile information on sexual activity during adolescence.

Setting and Participants: Eleven countries contributed to the study. The following data were collected: Age of first sexual intercourse, and adolescent pregnancy and abortion rates, as well as contraceptive methods used during adolescence.

Results: It was found that boys start sexual intercourse earlier than girls with girls starting sexual intercourse after the age of 16. No significant differences were found among European countries for adolescent pregnancy rate. A reduction of adolescent pregnancy rate was reported from Finland, Germany, Greece, Italy, and the United Kingdom during the years 1985 through 1989. An increase in the abortion rate was recorded for Denmark, Finland, Hungary, and Italy during the same period. Oral contraceptives were the most popular contraceptive method in many European countries.

Conclusions: Sexual education programs must be initiated in countries that have not yet approved them in schools. Further multicentric data must be collected to harmonize the use of the same birth control methods during adolescence. The need for consultation on adolescent sexuality matters in European countries as well as the prevention of complications arising from premature sexual relations must also be stressed.

The study objective was to develop a laparoscopic technique for oophoropexy with the marking of both ovaries with titanium clips so as to be able to calculate the radiation dosage to each ovary. We propose a laparoscopic approach to oophoropexy for patients with medulloblastoma planning for craniospinal radiation. Therapeutic radiation dose exposure to the pexed and nonpexed ovaries is calculated. A surgical outpatient laparoscopic procedure for oophoropexy is described. It was determined that if the pexed ovary is moved 1 cm outside of a megavoltage radiation beam, then the dosage of radiation to the ovary is reduced to approximately 9% of the prescription dose (300 cGy), whereas if the pexed ovary is moved 2 cm outside of a megavoltage radiation beam, then the dosage of radiation is reduced to less than 5% (180 cGy). This new laparoscopic oophoropexy procedure can be performed as an outpatient before craniospinal irradiation in order to increase the chances for the preservation of gonadal steroid production and fertility in girls.

The objective of this study was to determine, by survey, the prevalence of negative attitudes toward rape victims among police officers at the Memphis Police Academy. A total of 510 police officers completed surveys that included negative statements about rape victims. A total of 482 officers completed the pretest, and 495 completed the posttest. Intervention included a follow-up lecture in which appropriate attitudes toward rape victims were reemphasized. The presence of negative attitudes was the main outcome measure. A high level of negative attitudes was noted in the pretest, with positive responses ranging from 43 to 73%. After the session, there was no significant difference in the acceptance rates of these same negative myths, with acceptance rates ranging from 51 to 77%. There were minimal differences between the acceptance rates for the various questions, with the training changing those preconceived ideas in less than 10% of respondents. Some negative myths were affected by the gender or seniority of the responding officer. The study documents the high prevalence of negative attitudes toward rape victims among police officers. Physicians should be aware of the existence of such attitudes. To offset potential negative attitudes, the physician in his or her medical report should use terminology that emphasizes that the patient is a victim of a crime.

The measurement of serum concentrations of Δ4- and Δ5-steroid hormones after intravenous adrenocorticotropic hormone stimulation in a 4-month-old infant female pseudohermaphrodite, who had been exposed to danazol in the first 20 weeks of gestation, showed normal 17-hydroxyprogesterone and compound S (11-deoxycortisol) but elevated 17-hydroxypregnenolone. Thus, protracted postnatal inhibition of adrenal 3β-hydroxysteroid dehydrogenase activity may occur after in utero exposure to danazol.

The objective of this study was to compare the sensitivities and specificities of two molecular techniques, polymerase chain reaction (Amplicor) and DNA hybridization probe (Gen-Probe PACE II), for the detection of Chlamydia trachomatis in cervical specimens. A total of 378 cervical specimens were collected from 189 female adolescent patients and tested with either Amplicor or Gen-Probe PACE II. Sociodemographic data and sexually transmitted disease risk behavior were also collected from patient charts and analyzed. The population comprised young adolescents (mean age 17.7) who were sexually active (77.1% had one or more partners in the last 3 months) with a relatively long duration of sexual activity (mean 2.8 years). The prevalence rates of cervical C. trachomatis infection diagnosed by Amplicor and Gen-Probe PACE II were 7.9 and 9.0%, respectively. Patients testing positive for C. trachomatis had a significant percentage of Pap smears with inflammatory results (p < 0.005). After initial testing, Amplicor had a sensitivity of 82.4% and a specificity of 93.3%, whereas Gen-Probe PACE II had a sensitivity of 99.4% and a specificity of 98.3%. After discrepant analysis, Amplicor and Gen-Probe PACE II had an equal sensitivity of 93.7%; the specificities were 100 and 98.8%, respectively. However, Gen-Probe PACE II had a 1% false-positive rate. Both Amplicor and Gen-Probe PACE II are highly sensitive. However, Amplicor is more specific and can be used as a confirmatory test. Either test for C. trachomatis may be indicated in patients with abnormal Pap smears.

The detection of ovarian cysts in the neonate, child, and adolescent has markedly increased with the widespread use of ultrasonography. The previous dogma that any ovarian lesion detected before puberty mandates surgical exploration is no longer valid. Observation of the asymptomatic and mildly symptomatic cyst is now required before proceeding to surgery. The physiology of the ovary from intrauterine development through puberty is discussed. Current literature is reviewed to provide a rationale to the proposed treatment protocols of ovarian cysts in utero, in childhood, and in adolescence.