Claire Templeman

Noninflammatory ovarian masses in girls and young women.

Objective We reviewed the presentation, treatment, and pathologic diagnoses of girls and young women less than 21 years old with noninflammatory ovarian masses that required surgery and established whether treatment had changed over time. Methods We retrospectively reviewed charts of all girls and young women under 21 years old with International Classification of Diseases, 9th Revision (ICD-9) codes specific for noninflammatory ovarian masses treated at our institution from June 1980 to July 1998 (n = 140). Results The median age at surgery was 15 years (range 2 days–21 years). Ovarian cysts occurred in 57.9% (81 of 140) of patients, benign tumors (including mature cystic teratomas) in 30% (42 of 140), malignant tumors in 7.9% (11 of 104), and torsed but normal ovaries in 4.3% (six of 140) of the study sample. Patients older than 15 years were more likely to have ovarian cysts and benign tumors than younger patients (P = .019). There were no malignancies among girls with neonatal cysts. The incidence of ovarian torsion was 17.8% (25 of 140). Patients with ovarian cysts, mature cystic teratomas, and normal ovaries were more likely to have torsion than those with other benign or malignant tumors (P < .001). Operative approach and surgical procedure were compared before and after July 1, 1989. Laparoscopy was performed more commonly after July 1, 1989 (P = .009). However, patient age (P < .001) rather than time of surgery (P = .83) was the most important predictive factor in a multivariate analysis for use of laparoscopy. In addition, multivariate analysis revealed that patient age (P = .02) rather than time of surgery (P = .79) was also predictive of surgeon type (gynecologist or pediatric surgeon). Conclusion The most frequent cause of an ovarian mass requiring surgery in a girl or young woman under 21 years of age is an ovarian cyst, which justifies consideration of a laparoscopic approach. Patient age rather than time of surgery predicted operative approach and surgeon type. Caution should be exercised in patients over age 12 months with a complex mass on ultrasound and clinical evidence of hormonal activity, as these masses are usually malignant.

Postpartum contraceptive use among adolescent mothers

Objective To compare the incidence of repeat pregnancy and method continuation rate at 12 months postpartum in young women who chose either depot medroxyprogesterone acetate or oral contraceptives (OCs) as contraception. Methods We conducted a prospective cohort study of 122 postpartum women younger than 18 years of age who delivered between January 8, 1997 and December 31, 1997. Patients choosing depot medroxyprogesterone acetate (n = 76) and OCs (n = 46) were accrued for 12 months and were followed-up for a minimum of 12 months. Main outcome measures were median contraceptive method continuation and the incidence of repeat pregnancy at 12 months postpartum. Results There was no difference in mean age at delivery (P = .47), parity (P = .84), or gravidity (P = .78) between depot medroxyprogesterone acetate and OC users. At 12 months postpartum, 27.4% of OC users and 55.3% of depot medroxyprogesterone acetate users were still using contraception. Median time to contraceptive discontinuation was longer for those choosing depot medroxyprogesterone acetate compared with OCs (17.8 vs 7.4 months, respectively, P = .002). The overall incidence of repeat pregnancy at 12 months postpartum was 10.6%. Among OC and depot medroxyprogesterone acetate users, respectively, 24% and 2.6% became pregnant again, producing a relative risk (RR) of 9.09 (95% confidence interval [CI] 2.1, 39.2) for repeat pregnancy among OC users. The mean time to repeat pregnancy (this was reported instead of the median time whenever the pregnancy rate had not reached 50% at the end of the follow-up period) was longer for depot medroxyprogesterone acetate compared with OC users (17.1 months vs 13.2 months, respectively, P < .001). Conclusion Adolescent mothers using depot medroxyprogesterone acetate injection for contraception have a higher method continuation rate and a lower incidence of repeat pregnancy at 12 months postpartum than those selecting OCs during the same period.

Breast disorders in the pediatric and adolescent patient

Despite the wide range of breast abnormalities that affect patients in the pediatric and adolescent populations, some conclusions can be drawn. Breast self-examination in the adolescent population is controversial but is recommended for girls who carry the BRCA1 or BRCA2 gene beginning at age 18 to 21 years. All girls with a disorder of breast size or symmetry should be given the opportunity of consultation with a plastic surgeon to discuss reconstructive options. Ultrasound is the most appropriate initial investigation in any adolescent patient with a breast mass owing to the dense nature of breast tissue in this age group. Although it is extremely rare in this population, breast cancer must always be included in the differential diagnosis of a breast mass, particularly in the patient with a prior history of childhood malignancy or chest irradiation.

Use of laparoscopically mobilized peritoneum in the creation of a neovagina

OBJECTIVE To present an alternative technique for the creation of a neovagina. DESIGN Case study. SETTING Academic university gynecology clinic. PATIENT(S) A patient diagnosed with müllerian agenesis. INTERVENTION(S) Laparoscopically assisted creation of a neovagina by using peritoneum. MAIN OUTCOME MEASURE(S) Patient morbidity and satisfactory intercourse. RESULT(S) The patient underwent the procedure satisfactorily and was discharged within 24 hours. She had no perioperative or postoperative complications, and she became satisfactorily sexually active. CONCLUSION(S) The use of laparoscopically mobilized peritoneum in the creation of a neovagina provided the patient with a functional vagina, allowing satisfactory intercourse.

Vaginal agenesis: an opinion on the surgical management.

The management of vaginal agenesis-Mayer-Rokitanksy-Kuster-Hauser syndrome-has always been a controversial topic. Initially, the arguments centered on whether to do surgery or try passive dilation as well as at what age to intervene. As surgical techniques have recently become refined, the question is, if surgery is selected, what type of tissue should one use (bowel vs. skin graft) and, if skin graft, from what area to select. Now we are faced with new surgical techniques from the realm of pelviscopy and ask the question: Is one of these better than the other, and is this approach superior to previously established surgical techniques? Drs. Claire Templeman and S. Paige Hertweck from the University of Louisville School of Medicine, Department of Obstetrics and Gynecology here present a concise discussion of these diverse issues.

Depomedroxyprogesterone acetate use and weight gain among adolescents

We wish to report the results of a chart review of adolescents using depomedroxyprogesterone (DMPA) for contraception. The specific aims of this study were to examine weight-gain patterns and time to amenorrhea between two groups of adolescent girls receiving differing dosing regimes of DMPA. (excerpt)

Clinical pediatric and adolescent gynecology

Clinical pediatric and adolescent gynecology / , Clinical pediatric and adolescent gynecology / , کتابخانه دیجیتال جندی شاپور اهواز

Laparoscopic Management of Neonatal Ovarian Cysts

A laparoscopic approach was used in four infants with antenatally diagnosed ovarian cysts requiring surgical intervention. Operating time ranged from 60 to 90 minutes, there were no intraoperative or postoperative complications, and all infants were discharged within 23 hours after surgery. If performed by experienced practitioners, microendoscopy is an alternative to laparotomy in neonates requiring surgical intervention for ovarian cysts.

A new technique for the creation of a neovagina

Background: There are many described reconstructive techniques for vaginal agenesis including vaginal dilators, skin covered molds, sigmoid grafts, vulval and large muscle flaps all of which aim to produce a vagina of normal axis, secretory capacity and length. We report the laparoscopic approach to Davydovs operation which utilizes peritoneum to line the newly dissected vesicorectal space. Methods: A case report detailing preoperative evaluation, surgical technique and outcome.Results: There were no intraoperative or immediate postoperative complications. The patient was discharged from hospital within 23 hours of surgery. Six month follow up revealed a vagina 7-8 cm in length, lined with squamous epithelium. The patient reports satisfactory sexual intercourse.Conclusion: This technique provides a satisfactory option for the surgical management of vaginal agenesis.

Advanced Surgical Techniques in the Pediatric and Adolescent Patient

What makes pediatric and adolescent gynecology an exciting specialty is that while many of the everyday cases we see are straightforward we also have a high proportion of challenging and exciting conditions that we treat. These cases can be quite difficult not just because of the diminutive size of our patients but also because of the sometimes stunning complexity of the abnormal pathology especially congenital abnormalities. So today we would like to focus on three major areas of interest reviewing our current surgical approaches and especially the impact of newer minimally invasive techniques. The three areas would be the management of ovarian masses; current approaches toward endometriosis pelvic pain and related conditions; and the latest techniques for the surgical correction of congenital abnormalities. (excerpt)