Himen imperforado y hematocolpos por retención urinaria y dolor abdominal: reporte de un caso clínico / Imperforate hymen and hematocolpos as a cause of urinary retention and abdominal pain: A clinical case report

Resumen ANTECEDENTES: El himen imperforado es una malformación congénita del aparato genital femenino, con incidencia de 0.1%. El desarrollo del himen ocurre con la proliferación de los senos bulbo-vaginales y estos se perforan de forma normal antes o después del nacimiento. Al llegar a la adolescencia, la mayoría de los casos suelen manifestar: amenorrea, dolor pélvico, retención urinaria, o los tres. CASO CLÍNICO: Paciente de 12 años, llevada al servicio de Urgencias debido a dolor abdominal intenso y retención urinaria. Primero se estableció el diagnóstico de quiste gigante de ovario; sin embargo, la laparotomía exploradora no evidenció alteraciones ováricas. Mediante estudios de imagen y la exploración física detallada se estableció el diagnóstico de hematocolpos e himen imperforado. Se decidió efectuar la himenoplastia, con lo que se resolvió el cuadro clínico. CONCLUSIONES: El himen imperforado puede causar retención urinaria y dolor abdominal; por tanto, la manifestación de estos síntomas debe considerarse en el diagnóstico diferencial de pacientes adolescentes.

Abstract BACKGROUND: Imperforate hymen is an uncommon congenital malformation of the genital tract, its incidence is 0.1%. Physiologically the development of the hymen occurs for the proliferation of the sinovaginal bulbs, they usually will perforate before or after born. The majority of cases will show clinical manifestations when patient reach puberty, the most common are pelvic pain, amenorrhea and urinary retention. CLINICAL CASE: This is a 12-year-old adolescent patient who went to the emergency department for severe abdominal pain and urinary retention. Initially, the patient was diagnosed with a giant ovarian cyst and a laparotomy was performed without finding ovarian pathology. However, through imaging studies and a more detailed physical examination, the diagnosis of hematocolpos and imperforate hymen was reached. The patient was subsequently subjected to hymenoplasty, which resolved the condition. CONCLUSIONS: The presence of imperforate hymen can cause urinary retention and abdominal pain. It should be suspected in adolescent patients.

Reconstruction of disrupted anterior cruciate ligament in adolescent patients / 中国微创外科杂志

Objective To summarize the experience of anterior cruciate ligament (ACL) reconstruction in teenager patients by bone-tendon-bone method under arthroscope. Methods A total of 23 teenagers with disrupted ACL, who were treated by bone-tendon-bone reconstruction in the Joint Diseases Hospital of New York from 1996 to 2000, were reviewed. The clinical results were measured by using Lysholm and International Knee Documentation Committee (IKDC) scoring systems. Results The patients were followed for 26～63 months, mean 37 months. The mean Lysholm score was 94 points, 21 patients returning to their pre-injury normal knee functions.According to IKDC system, normal knee functions were obtained in 18 cases (78.3%), improved functions in 3 (13.0%), and poor in 2 (8.7%). There were no patients complaining instability in follow-up. Conclusions Bone-tendon-bone reconstruction is also suited to adolescent patients with disrupted ACL. Special attention should be paid to the bone plug and the interface screw fixation in operation.

Development and validation of a screening questionnaire for detection of adolescent psychiatric problems in primary care

BACKGROUND: Because of many physical, psychological, and social stresses, adolescence is a vulnerable period to psychiatric disorders. But in Korea, there is actually not enough time for primary care physicians to screen such patients during ordinary medical interviews. Therefore this research was done to develop and validate a brief screening questionnaire for the detection of adolescent patients with psychiatric problems. METHODS: Three family physicians in charge of their own adolescent clinics developed a five-item questionnaire for screening adolescents with psychiatric problems by reviewing related literature with consultation by a psychiatrist. After performing a pretest and gathering second opinions from other psychiatrists and nurse-teachers, final questionnaire was redeveloped. Verification of its reliability by using test-retest method and internal consistency by calculating Cronbach's alpha coefficient was done. Also inspection of its validity by comparing the scores of psychiatric patient group to normal group was done. And finally the discrimination point was obtained. RESULTS: For reliability Kappa value of new questionnaires ranged from 0.33 to 0.63. One item was dropped because of its negative influence to the internal consistency and the discrimination power. With the four final items, we estimated the validity for distinguishing psychiatric patients from the normal group by calculating the sensitivity and specificity of each cutting point of scores. For the each cutting point 1, 2, and 3, sensitivity was 85%, 75%, 40%, respectively, and specificity was 27%, 62%, 84%, respectively. We considered score 1 as the best cutting point because the purpose of the questionnaire was screening rather than diagnosis. CONCLUSION: A brief four-item screening questionnaire(SAPPO. Screening method of Adolescent Psychiatric Problems in Outpatient clinic) was developed and its reliability and validity was estimated.