Foreign body as a cause vaginal discharge in childhood

Vaginal purulent discharge in children is mainly due to nonspecific enteric bacterial agents and specific agents such as group A beta-hemolytic streptococcus, hemophilus influenzae and staphylococcus aureus. Lack of protective effects of estrogen in vaginal mucosa is the main predisposing factor. Persistent or recurrent foul smelling and/or serosanguineous vaginal discharge, not responsive to medical therapy in most cases, might be caused by a missed vaginal foreign body We present a 7-year old girl because of persisting foul smelling, occasionally blood stained vaginal discharge for about 4 years despite a few courses of medical therapy by gynecologists. Ultrasonography didn't achieve to demonstrate the presence of the foreign body, but pelvic x-ray showed a radio-opaque body resembling a roll plaque. Vaginoscopy discovered a cap of eyebrow pencil in the upper vagina. This removed by forceps led to improvement of the disease. In a child presenting with vaginal discharge not responsive to hygienic measures and medical therapy, possibility of vaginal foreign body must be considered. Although MRI is the most proper technique for evaluation, sonography and/or x-ray are more available and helpful in most cases

Primary vesicoureteral reflux in Iranian children.

BACKGROUND: Experience with vesicoureteral reflux (VUR) differs in different centers and there are plenty of controversies. OBJECTIVE: The aim of this study was to evaluate the outcome of primary VUR complications and the rate of recurrence of UTI. METHODS: The medical charts of all infants and children with primary VUR who were followed up by two nephrologist were reviewed. During 19 years (1985 to 2004), 330 patients (271 females, 59 males) with 496 refluxing ureters were followed up as primary VUR. Results: The patients age at diagnosis was 54 days to 16 years (Mean: 4.1 years) and the mean duration of follow-up was 4.5 years. Urinary tract infection (UTI) was the presenting symptom in 95% and fever was recorded in 35% of cases. Frequencies of different grades of VUR at initial investigation were 10% 35% 30% 13% and 12% for grades I to V, respectively. Recurrence of UTI in VUR of grades I to V, were 22.2% 18.1% 20% 23.4% and 17.9% respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 55% improvement in 27.5%, no change in 12% and deterioration in 5.5% Complications such as chronic renal failure and hypertension were observed in 13 and 13 patients, respectively. Renal scarring was present in 52% of boys and 29% of girls. CONCLUSION: The present study indicates that symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR.