Dysfunctional uterine bleeding as an early sign of polycystic ovary syndrome during adolescence.

Excessive uterine bleeding during the early years after menarche can be worrisome to the girl and her parents. The most prevalent diagnosis set is Dysfunctional uterine bleeding (DUB), after thorough examination and exclusion of other causes of abnormal uterine bleeding. The aim of this article was to review our knowledge and share our experience as tertiary reference center of pediatric-adolescent gynecology in Greece. We conducted a review of current literature using Pubmed and MedLine as our primary databases, as well as providing commentary considering work up, treatment and follow-up of our DUB patients. Insufficient progesterone production and subsequent abnormal shedding of the endometrium appears to orchestrate the pathophysiology of DUB in adolescence. Hypothalamic-pituitary-ovarian (HPO) axis immaturity right after menarche, is usually the most plausible cause. Nevertheless, it is necessary to exclude other, possibly even life-threatening causes. Complete work up including physical examination, laboratory and imaging studies (complete blood count, b-HCG, hormonal levels and ultrasonography) is needed, and appropriate treatment with combined oral contraceptives is administered accordingly. Although menstrual disorders are very common in early adolescence, a severe episode of DUB should always be thoroughly attended by any physician. Follow-up should be offered in all young patients due to high incidence of recurrence or subsequent development of endocrine disorders such as Polycystic Ovary Syndrome (PCOS).

Isolated sigmoid colon metastasis from a primary fallopian tube carcinoma: a case report.

Isolated metastasis of primary fallopian tube carcinoma (PFTC) is extremely rare. We describe a case of a 41-year-old asymptomatic woman who was referred three years after the initial treatment for PFTC due to elevated sertum CA-125 levels. The abdominal and pelvic CT scans revealed a pelvic mass near the top of the vaginal vault. On surgery, a sigmoid colon tumour was found and a sigmoidectomy was performed. On histopathology the tumour involved the bowel wall from serosa to submucosa, without involvement of the underlying mucosa. Immunohistochemical staining was positive for cytokeratin 7 and negative for cytokeratin 20, and the tumour was determined to be a metastatic müllerian neoplasm, consistent with the initial PFTC. Although this is the first reported case of colon metastasis of PFTC, the possibility of such an unusual site of metastasis should be kept in mind, as PFTC may recur as isolated bowel lesions even in the absence of peritoneal disease.

Colposcopically directed biopsy findings in the young female.

STUDY OBJECTIVE: To evaluate the colposcopic findings of cervical alterations in the young sexually active female. DESIGN, SETTING, PARTICIPANTS: Colposcopic examination and follow-up of 51 young sexually active females aged 15-20 yr was conducted due to abnormal cytology or a suspicious abnormality of the cervix. The study was conducted at the Colposcopy Units of the 1(st) and 2(nd) Departments of Obstetrics and Gynecology, University of Athens, Greece. ONTERVENTIONS: Colposcopic examination, LEEP, conization. MEAN OUTCOME MEASURES: Biopsy, human papillomavirus (HPV) typing. RESULTS: Colposcopic examinations were within normal limits in 8 of 51 (15.7%) cases. Cervical alterations were related to HPV infection in 14 cases (27.4%), to cervical intraepithelial neoplasia (CIN) I in 15 (29.4%) cases, to CIN II in 13 (25.5%) cases, and to CIN III in 1 (2.0%) case. Of all CIN I cases, 8 of 15 (53.3%) were HPV positive, and HPV type 11, 16, 18, 31, 33, and 11& 16 were found. In CIN II cases, 5 of 13 (38.4%) were HPV positive, and HPV type 11, 16, 18, and 11 & 31 were found. In the CIN III case, only HPV type 16 was found. CONCLUSIONS: Our findings strongly confirm the necessity of obtaining cervicovaginal smears on all sexually active gynecologic and obstetric teenage patients. Colposcopy plays a major role in the evaluation of the cervix and in the treatment that should be given for any individual CIN lesion.

Laparoscopic gonadectomy in a patient with testicular feminization syndrome.

A laparoscopic technique is reported as an operative approach for gonadectomy in a case of testicular feminization syndrome. A 17-year-old phenotypic female presented with primary amenorrhea and was evaluated through a diagnostic protocol that included clinical, cytogenetic, and hormonal examinations. The findings supported the diagnosis of testicular feminization syndrome. The left gonad was found at the internal opening of the inguinal canal and removed laparoscopically. No gonad was found at the contralateral side. No complications occurred during the operation and the patient left the hospital the same day. A long-term hormonal replacement treatment was initiated postoperatively.

Non-Hodgkin's ovarian lymphoma during adolescence: report of two cases.

STUDY OBJECTIVE: To present two cases of non-Hodgkin's ovarian lymphoma during adolescence. DESIGN: Follow up of the patients. Report of diagnostic and therapeutic approaches. SETTING: Division of Pediatric and Adolescent Gynecology and Corrective Gynecological Surgery, University of Athens (Athens, Greece). INTERVENTIONS: Laparotomy and chemotherapy. RESULTS AND MAIN OUTCOME: Three- and five-year survival rates. CONCLUSIONS: Ovarian lymphoma constitutes a rare entity with guarded prognosis. Selective surgery and chemotherapy constitute the treatment of choice.

Vulvovaginitis during childhood and adolescence.

STUDY OBJECTIVE: To evaluate cases of vulvovaginitis treated in our institutions. DESIGN: Follow-up of 1,778 cases of vulvovaginitis to investigate the prevalence of various pathogens involved in the disease. SETTING: Divisions of pediatric and adolescent gynecology, university hospitals of Crete and Athens, Greece. PARTICIPANTS: Girls 1-18 years old seen at the clinics of the above institutions. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Vaginal culture, cytology, and vaginoscopy. RESULTS: Vulvovaginitis was encountered in 61.8% of the gynecological problems seen during childhood and adolescence. Infections were usually located in both the vulva and the vagina (56.9%). The main symptoms were vaginal discharge (53%), erythema (33%), and pruritus (27%). Candida spp (23.0%), beta-hemolytic Streptococci group B (15.0%), and Enterococci spp (10.0%) were the most frequent pathogens involved in the disease. CONCLUSIONS: Vulvovaginitis is a common disease during childhood and adolescence. Effective treatment, reassurance, and appropriate consultation based on the prevention of relapses are the most important steps for the management of the disease.

Sexuality: sexual activity and contraception during adolescence.

Adolescent sexual activity is increasing. Premature sexual intercourse results in high figures of adolescent pregnancy and abortion, as well as in increased risk of sexually transmitted diseases (STDs). Lack of information on the prevention of STDs and poor hygiene in both boys and girls are also main reasons for increased morbidity because of STDs during adolescence. Contraceptive behaviour during adolescence varies between countries and communities. It seems, however, that the condom and oral contraceptives (OC) are popular contraceptive methods. Ineffective methods such as periodic abstinence, coitus interruptus, and withdrawal before ejaculation are in use. On the other hand, compliance of adolescents on contraception is poor. The above are additional causes for increasing rates of adolescent pregnancies. Countries providing sexual education programs in schools present lower rates of pregnancy and abortion. Adolescent pregnancy is safe if a careful follow up is accepted by the teenager. A significant number of homeless youth are homosexuals or lesbian adolescents. Most of them are at high risk for HIV infection, AIDS, and STDs. It is concluded that sexual education programs are absolutely necessary to offer adolescents the knowledge on the complications of premature sexual activity, as well as prevention of the undesired pregnancy and STDs.

Bacteriologic aspects of pelvic inflammatory disease in gynecologic patients.

The bacteriology of acute pelvic inflammatory disease (PID) was studied in 65 women. Endometrial, endocervical and vaginal cuff cultures were taken. In some cases blood cultures and cultures from the cul-de-sac or pelvic abscess were also obtained. Mixed organisms (aerobes and anaerobes) were the most common isolates from the endometrial, endocervical or vaginal cuff cultures, present in 40%. Neiseria gonorrhoeae was isolated in 8 (12.30%) endocervical specimens. Anaerobes were the most common bacteria recovered from cul-de-sac aspirates, pelvic abscesses and blood cultures. The combination of gentamicin, penicillin and metronidazole was the most common antibiotic scheme used. However, other antibiotics as cefoxitin and clindamycin were also used according to the sensitivity test. These data support the polymicrobial etiology of the disease and suggest: (1) the high incidence of anaerobic or mixed infections, and (2) the relatively low incidence of gonococcus in the studied cases.

Bacteriology of amniotic fluid.

The incidence of aerobic and anaerobic bacteria in the amniotic fluid and the cervix of 101 healthy parturients, with intact membranes, was studied. Pharynx, urine and umbilical cord of the newborns were also examined for the same pathogens. Although positive cultures from the cervix were found in 41.58% of the cases, the contamination of the amniotic fluid was only 1.98%. Our results support the view of the antibacterial activity of amniotic fluid.