Adolescent and pediatric gynecology最新文献

A case of a 37/12-year-old infant with isosexual precocious puberty due to a granulosa cell tumor is presented, followed by a brief discussion of causes, diagnosis, and management of precocious puberty.

In both the medical literature and in the lay press, adolescent sexuality has received considerable attention as the problem of unintended pregnancy and, more recently, the rising rates of sexually transmitted diseases continue to exact a significant cost from increasing numbers of adolescents and from society. The potential management of these problems raises controversy, as concerns which relate not only to health, but also to lifestyle choice, frequently play a role in evolving discussions and public policies.

Escalating sexual involvement by younger and younger adolescents has resulted in an increased prevalence of sexually transmitted infections within this population. Because many of these infections may cause irreparable complications before diagnosis, and because the viral sexually transmitted diseases are incurable, the importance of primary prevention is becoming increasingly evident. A brief review of a number of programs in different western nations suggests that the focus on risk reduction through technology has not yet met the desired objectives, and the problems of unintended adolescent pregnancy and sexually transmitted diseases persist. Given the serious long-term consequences for the individual, as well as the cost to families and communities, management strategies which focus on the primary problematic behavior need to be further explored and the short- and long-term impact of all programs must be carefully evaluated.

Diagnosis of Mayer-von Rokitansky-Küster-Hauser syndrome can be made on the basis of the patient's history, physical examination, ultrasound examination, and hormonal assays. When intercourse is desired, laparoscopic creation of a neovagina or alternatively Frank's dilatation method or his modifications may be recommended. Two cases of laparoscopic creation of a neovagina according to the principles of Vecchietti are reported.

The nurse assumes a unique and critical role in the evaluation of children for sexual abuse. This paper outlines a particular approach to the nursing role encompassing both traditional nursing functions with family advocacy, child support, and counseling. Often the success of an evaluation depends on the nursing preparation of child and parent. Skill in developmental assessment, observation of parent-child interaction, and family support are essential. Nurses who work with abused children must be knowledgeable in psychosocial and developmental assessment techniques, a number of which are outlined here.

Three sisters were found to have pure gonadal dysgenesis. The diagnosis was confirmed by the finding of streak gonads and biopsy during laparotomy. Cytogenetic studies in a number of different tissues showed a normal male (46,XY) karyotype, none of which revealed signs of Turner syndrome. Histologically, no evidence of testicular differentiation was seen in any of the streak gonads examined. Hormonal studies, carried out in all three sisters, indicated elevated serum gonadotropin levels with normal female testosterone levels. Transmission of this disorder of testicular development by genes on the X chromosome or an autosome, as described in other genetic disorders of male development, is the most likely mode of inheritance.

Study Objective: To describe unusual features of vulvar hemangiomas which may mimic lesions caused by lichen sclerosus and sexual abuse.

Design and Participants: A case report of a 7-year-old child with unusual appearance of vulvar hemangiomas.

Setting: The patient was seen at the Pediatric and Adolescent Gynecology Clinic at the University of Tennessee, Memphis.

Interventions: Key Punch biopsies and CO₂ laser ablation of the vulvar lesions.

Results: All lesions were removed, resulting in complete relief of symptoms.

Conclusions: Capillary hemangiomas of the vulva may mimic findings and symptoms of lichen sclerosis or sexual abuse. Biopsy may be required to establish the correct diagnosis.