Use of misoprostol for management of unsatisfactory colposcopy in the adolescent: a case report and review of the literature.

STUDY OBJECTIVE: To document the ability to use a prostaglandin analogue to achieve satisfactory colposcopy in a patient with cervical stenosis and unsatisfactory colposcopy. DESIGN: Case report. RESULTS: Satisfactory colposcopy was achieved by using 100mg of Misoprostol orally, administered the night before the planned colposcopic evaluation. CONCLUSION: In the presence of persistent atypia in an adolescent female with an unsatisfactory colposcopy, consider using a prostaglandin analogue for adequate evaluation of the endocervix, prior to proceeding with an ablative or excisional therapy.

Immature ovarian teratoma in an adolescent: a case report and review of the literature.

BACKGROUND: Benign cystic teratomas are relatively common tumors in reproductive age women, but can occur at any age. While the incidence of malignant elements in a teratoma is low (approximately 1-2%), the survival of patients with immature teratoma is poor. Definitive diagnosis is mandatory. CASE: We describe a case of a 13-year-old African American female, gravida 0, presenting with a large pelvic mass, determined to be a benign cystic teratoma by intra-operative frozen section. However, due to the size of the tumor and the preponderance of neural elements we performed a full surgical staging procedure (excluding hysterectomy and complete removal of adnexa). The final pathology report revealed foci of immature neural tissue, with a final diagnosis of an immature cystic teratoma Stage Ia. CONCLUSION: Foci of immature neural elements can be readily missed on frozen section, especially with a large tumor. Full surgical staging at the time of initial laparotomy is justified when encountering an apparently mature cystic teratoma with a preponderance of neural elements on frozen section.

Didelphic uterus and obstructed hemivagina with renal agenesis: case report and review of the literature.

Congenital disorders of development are more common than previously reported and the correct diagnosis is frequently missed leading to suboptimal treatment. Eight cases of uterus didelphys with obstructed hemivagina referred to the Gynecology service at Baylor College of Medicine over a 2-year period were reviewed. Initial presenting symptoms and signs were followed by an incorrect diagnosis by the referring physician 100% of the time. MRI, the most sensitive imaging modality for congenital anomalies (Kublik, RA: Female pelvis. Eur Radiol 1999; 9:1715), was utilized in only 50% of the cases. In this group of patients, hematocolpos and pyocolpos were discovered in equal numbers upon exploration. Ipsilateral renal anomalies were present 100% of the time, while coexisting contralateral anomalies were present 50% of the time. Resection of the vaginal septum was required for abatement of symptoms in all cases presented here. Laparoscopy provided additional information beyond radiologic tests regarding pelvic and urological anatomy. In two cases, resection of the ipsilateral uterine horn was required. These cases demonstrate the difficulty in diagnosis, heterogeneity in presentation, and need for expertise not only in this rare congenital anomaly but also all the other disorders of development of the female genital tract.

Vaginoscopic resection for rhabdomyosarcoma of the vagina: a case report and review of the literature.

Rhabdomyosarcoma is the most common soft-tissue sarcoma found in children. Genitourinary sites comprise 20% of the primary location of these tumors. A polypoid form of the embryonal type of rhabdomyosarcoma, sarcoma botyroides, is often found in girls under age 5. These tumors are usually localized to the anterior vaginal wall. Their superficial location and clinical symptoms lead to early diagnosis, and these tumors are therefore considered to be the easiest to treat and most likely to be cured. In the past 30 years we have seen a shift in treatment from radical surgery to conservative surgery with chemotherapy and radiation, with improved survival and preservation of normal anatomy and improved postoperative body imagery. Conservative excision in the past has been performed by sharp curettage of the anterior vaginal wall. We present a case of a 2-yr-old child with a RMS of the vagina for which we utilized vaginoscopy not only to determine the extent of the tumor but also for precise resection using a bipolar electrode with normal saline as the distension medium.

Endometrial balloon ablation as a therapy for intractable uterine bleeding in an adolescent.

STUDY OBJECTIVE: To evaluate the use of a minimally invasive global endometrial ablation technique in the management of life-threatening bleeding unresponsive to hormonal treatment. RESULTS: Immediate cessation of bleeding with recovery of normal hematologic profile. CONCLUSIONS: Endometrial ablation by global balloon ablation may be considered an alternative to hysterectomy in life-threatening hemorrhage in the adolescent patient who is unresponsive to hormonal therapy.

Continuous subcutaneous terbutaline pump therapy for premature labor: safety and efficacy.

To assess the usefulness of a continuous subcutaneous pump infusion of terbutaline for long-term tocolysis, we used this modality in 13 patients in whom other tocolytic regimens had failed. The mean (+/- standard deviation) maternal age was 29.9 +/- 3.8 years. The study population included 10 singleton gestations, two sets of triplets, and one twin pregnancy. In three cases, the terbutaline pump was thought to have been successful (duration of pump therapy, 52.7 +/- 20.9 days; gestational age at delivery, 37.1 +/- 1.3 weeks), whereas in six cases marginal success was achieved (duration, 42.2 +/- 27.7 days; gestational age at delivery, 33.8 +/- 2.6 weeks). In the remaining four patients, pump therapy was discontinued after 2 to 23 days because of maternal complications. In contrast to previous reports, we achieved only limited success with the subcutaneous terbutaline pump in the small number of patients studied.

Favorable outcome after treatment with amantadine and ribavirin in a pregnancy complicated by influenza pneumonia. A case report.

The moderate impairment of cell-mediated immunity that occurs in pregnancy justifies concern when a pregnant woman develops influenza. We treated a woman for influenza pneumonia with respiratory failure at 33 weeks' gestation with oral amantadine and ribavirin inhalation therapy in conjunction with evacuation of the uterus and delivery.