Adolescent and pediatric gynecology最新文献

The finding of a voluminous tubular adenoma of the breast in a 16-year-old girl has led us to review the literature pertaining to this neoplasm. Tubular adenoma of the breast has an exceptionally low incidence in adolescents; this case is the second of two ever recorded in the literature in a nonpregnant girl. The prognosis of tubular adenoma is benign. The young patient was treated by surgical excision and followed for 5 years with neither recurrence nor breast-related problems. The neoforma-tion was excised, and the 5-year follow-up confirms the patient's health with no evidence of disease.

Study Objective: This study was undertaken to assess the impact of a monophasic and triphasic norethin-drone-containing oral contraceptive pill on reported side effects and compliance.

Design: Adolescents initiating oral contraceptive use were studied at baseline, 3 months and 12 months, to determine compliance and side effects associated with the use of two oral contraceptive pills.

Setting: A suburban private practice of adolescent medicine.

Participants: Ninety-nine sexually active adolescent and young adult women were sequentially entered into the study (49 initiating a monophasic pill and 50 a triphasic pill).

Outcome Measurements: Compliance with oral contraceptive use at 3 and 12 months was determined for adolescents and young adult women initiating the use of two oral contraceptive pills. Demographic data, sexual history, career goals, and concerns about use were collected before use. Compliance and side effects experienced were determined at 3 and 12 months.

Results: There was no significant difference in compliance in the use of the two oral contraceptives at 3 and 12 months of follow-up. At 3 months, there was no difference in reported side effects, but at 12 months, patients taking the triphasic norethindrone pill were more likely to experience breakthrough bleeding than those taking the monophasic pill (p = 0.001) and to change pills. Despite the common fear among adolescents of weight gain associated with oral contraceptive pill use, mean weight change at 3 months was not different between the two pills and was 0.59 and 0.55 kg for the monophasic and triphasic pill at 3 months and 1.00 kg and 1.24 kg for the monophasic and triphasic pills at 12 months. “Perceived” rather than actual weight gain led to discontinuation of the pill.

Conclusion: Adolescents experienced more side effects on the triphasic than the monophasic norethindrone-containing pill but compliance was the same. Weight issues and breakthrough bleeding need to be addressed in suburban practices.

Study Objective: To describe adolescents with Neisseria gonorrhoeae genital infections.

Design and Participants: The charts of all adolescents (12–22 years old) with N. gonorrhoeae genital infections were reviewed from September 1, 1989 to February 28, 1990. Patients were followed for 8–14 months from initial infection to determine the number of repeat N. gonorrhoeae and Chlamydia trachomatis infections.

Setting: The outpatient clinics of a pediatric hospital. The log books of the bacteriology laboratory at Children's Hospital, Boston were reviewed to determine all adolescents with N. gonorrhoeae infection visiting any clinic or the Emergency Ward.

Results and Conclusions: Ninety-six adolescents with 107 genital N. gonorrhoeae infections were seen in the initial 6-month interval. Compared with 29 males, the 67 females were less likely to be treated at the initial visit, were more likely to have counseling documented, to be rescreened at follow-up, to have more follow-up cultures in the 8 to 14-month interval, and to be followed for a longer duration. Twenty-three percent of patients had one or more additional gonococcal infections and 19% had further chlamydial genital infections over the short-term follow-up. Adolescents with N. gonorrhoeae infection should be considered at high risk for repeat infection and screened frequently for N. gonorrhoeae and C. trachomatis, as well as counseled about risk reduction.

The incidence of condylomata acuminata in children has increased dramatically.¹ Genital warts are associated with, but not specific for, sexual abuse and therefore present a dilemma for the physician. Clinicians frequently report presumed noncongenital cases to Child Protective Services (CPS) for further investigation. To determine the outcome of these cases, charts of 88 children with condylomata acuminata were reviewed. Sixty-four percent (56/88) of the children were referred to CPS for suspicion of child abuse or neglect; 26 of these 56 referrals were on the basis of genital warts alone. Sexual abuse was considered substantiated by CPS in 19% (5/26) of the children referred for warts alone. No consistent criteria seemed to lead to CPS substantiation of abuse. In the absence of other evidence of sexual abuse or neglect found on careful social, psychological, and medical evaluation, CPS referral is unlikely to be further able to differentiate abusive from nonabusive wart acquisition.

This review will focus on endogenous ovarian function in adolescent girls with Turner syndrome (TS); newer treatment modalities including the latest hormone replacement therapy using continuous low-dose transdermal 17β-estradiol for puberty induction; complications and sequelae in TS girls; and outlook for future fertility including in vitro fertilization and embryo transfer as well as the newer modalities such as gamete and zygote intrafallopian tube transfer using donated ova.

Study Objective: To evaluate the pregnancy management decisions made by adolescents who were found to be carrying fetuses with abnormalities.

Design: Adolescent women who were carrying fetuses with abnormalities detected in the second trimester of pregnancy were evaluated as to their decision to continue or terminate their pregnancies. The decision by these women to include parents, guardians, or partners in the counseling process was also evaluated.

Setting: The clinical offices of the Division of Reproductive Genetics, Department of Obstetrics and Gynecology, University of Tennessee, Memphis.

Participants: Twelve adolescent women (16 years old or younger) who were found to be carrying fetuses with abnormalities. All participants were between 14 and 20 weeks gestation.

Main Outcome Measures: Genetic counseling was provided to five women carrying fetuses with chromosome abnormalities (two trisomy 21, two 45,X, and one trisomy 13), four women with fetuses demonstrating malformations with normal chromosome complements, and three women carrying fetuses with neural tube defects (two spina bifida and one anencephaly).

Results: All 12 women elected to have a parent or guardian accompany them for genetic counseling following the detection of fetal abnormalities. In five cases the patient's partner attended the counseling session. All women elected to terminate their pregnancies.

Conclusion: Factors other than severity of the abnormality (e.g., desire to terminate the pregnancy irrespective of abnormality, stable and nurturing marital or family relationships, economic independence) may play important roles in the adolescents' decision to continue or terminate a pregnancy after detection of fetal abnormalities.