"Blooming too soon": A case of precocious puberty / Philippine Journal of Obstetrics and Gynecology

Precocious puberty is the onset of pubertal development at an earlier age than is expected based upon established normal standards. The cause of precocious puberty may range from a variant of normal development (eg. premature adrenarche or isolated premature thelarche) to pathologic conditions with significant risk of morbidity and even death (eg. malignant germ-cell tumor or astrocytoma). A case of an 18 month old female presenting with vaginal bleeding following a previously noted breast enlargement was described. Initial assessment based on the patient's history and physical examination is suggestive of precocious puberty. Hormonal studies indicated normal levels of FSH and LH, with an elevation in estradiol. Radiographic analysis showed a normal bone age. Cranial MRI revealed no abnormal masses. Sonographic evaluation showed bilateral cystic masses in the ovaries. A diagnosis of peripheral precocious puberty associated with functional ovarian cysts was made, and the patient was monitored for progression of pubertal development.

A profile of female in-patients with sexually transmitted diseases in a government psychiatric center

A study was done to describe sexually transmitted diseases among female psychiatric in-patients and to determine the psychiatric diagnosis of the female in-patients with sexually transmitted diseases at the National Center for Mental Health. In this study female in-patients with mental illness who underwent work-up for STD/HIV/AIDS were included. Deceased and discharged patients with STD/HIV were excluded from the study. Patients were given a set of questionnaires. Charts were also properly reviewed. The results showed that schizophrenic female patients with venereal warts were positive for VDRL and N. gonorrhea. The three patients positive for HIV had a psychiatric diagnosis of Mood Disorder and Schizophrenia. Most of the patients were formerly sex workers with the history of prohibited drug use. Strict surveillance and monitoring of female psychiatric patients is recommended.

Coxsackie viral myocarditis: a clinical and echocardiographic study.

Thirty two patients with acute onset of cardiac symptoms following an episode suggestive of viral infection, were studied. 11 patients had Coxsackie viral myocarditis. All had 4 fold rise of neutralising Coxsackie viral antibody titres on paired sera tested. Coxsackie B virus types 2 and 4 were commonly detected. Among the eleven patients, 8 presented with congestive heart failure, 2 with ventricular arrhythmias and one with chest pain and S3 gallop. All had ECG changes. Echocardiographic examination showed global left ventricular dysfunction in 7, regional wall motion abnormalities in 2 and normal left ventricular function in one. Serial echocardiographic examination showed progressive myocardial dysfunction in 3 and improvement in myocardial function in two patients. Two patients died during the follow up period. Echocardiography helped in assessing the course of patients with viral myocarditis.

Assessment of severity of aortic stenosis by continuous wave Doppler echocardiography.

Fifty consecutive patients with aortic stenosis were evaluated by continuous wave Doppler echocardiography for assessment of the transaortic gradient. The Doppler derived gradients were compared with the gradients measured at cardiac catheterisation. Excellent correlation was found between the Doppler and catheterisation findings for the maximum instantaneous gradient (r = 0.92) and the mean systolic gradient (r = 0.84). The maximum, midsystolic and late systolic Doppler gradients also showed a good correlation with the peak to peak catheter gradient. The maximum Doppler velocity however, showed overestimation of the peak to peak gradient in the presence of mild aortic stenosis (predictive accuracy 86%). The midsystolic Doppler velocity showed the highest predictive accuracy (94%) for the detection of severe aortic stenosis. No case of severe aortic stenosis was missed by Doppler using either the maximum or midsystolic Doppler velocity. These findings indicate that continuous wave Doppler ultrasound provides a reliable estimate of the gradient in patients with aortic stenosis.

Double chambered right ventricle with anomalous muscle bundles and false tendons in the left ventricle.

A patient with double chambered right ventricle, with anomalous muscle bundles and false tendons in the left ventricle, is described. This combination of anomalies may represent a failure of regression of foetal trabeculations.