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Journal of Pediatric and Adolescent... Dec 2009Canada has licensed a human papilloma virus (HPV) vaccine for adolescent females, with the goal of decreasing the incidence of HPV infection and associated cervical...
STUDY OBJECTIVE
Canada has licensed a human papilloma virus (HPV) vaccine for adolescent females, with the goal of decreasing the incidence of HPV infection and associated cervical cancer. This study identifies the juvenile detainee population as a high-risk group for HPV infection and therefore an important target for primary prevention.
DESIGN
A retrospective chart review.
SETTING
Sundance Juvenile Detention Center, Kingston, Ontario, Canada.
PARTICIPANTS
Female detainees admitted between 2003 and 2006.
MAIN OUTCOME MEASURES
Papanicolaou (Pap) test results, sexually transmitted infection (STI) rates, and associated risk factors were collected from 119 charts.
RESULTS
Of 57 recorded Pap smears, 46 (80.7%) were normal, 5 (8.8%) were reported as atypical squamous cells of unknown significance, and 6 (10.5%) were reported as low-grade squamous intraepithelial lesion. Of the women tested, 4% were positive for gonorrhea, 10% for chlamydia, 32% for bacterial vaginosis, and 5% for trichomonas; none were positive for syphilis. Of the girls, (91) (77%) had negative HIV and hepatitis B tests, two girls were hepatitis-C-positive, three had clinical evidence of genital herpes, and one showed evidence of pelvic inflammatory disease. There were 75 (63%) girls who reported sexual activity; 87% of them used contraception or protection of some kind, albeit inconsistently. Of these young females, 12 (10%) had engaged in prostitution and 13 (11%) had allegedly been raped or sexually assaulted.
CONCLUSIONS
Female juvenile detainees in Kingston, Ontario, have higher rates of STIs, associated risk factors, and abnormal Pap tests than the general female adolescent population. This new information confirms that this population is at risk for HPV infection and subsequent cervical cancer.
Topics: Adolescent; Child; Contraception Behavior; Female; Humans; Ontario; Papanicolaou Test; Papillomavirus Infections; Prevalence; Prisoners; Retrospective Studies; Sexually Transmitted Diseases; Uterine Cervical Dysplasia; Vaginal Smears; Young Adult
PubMed: 19592281
DOI: 10.1016/j.jpag.2009.01.070 -
La Tunisie Medicale May 2008Adnexal torsion is the most frequent gynaecological emergency in children. It requires an early diagnosis and an urgent surgical treatment.
BACKGROUND
Adnexal torsion is the most frequent gynaecological emergency in children. It requires an early diagnosis and an urgent surgical treatment.
PURPOSE
to study the clinical, paraclinical and therapeutic aspect of adnexal torsion in paediatric population.
METHODS
This is a retrospective review of nine girls with the diagnosis of ovarian torsion observed over a 7 years period (January 1999 to December 2005).
RESULTS
The average age is 9 years (extreme 6 to 13 years). This pathology was located in 5 cases on the right side and in 3 cases on the left side; a case of bilateral torsion of poly-cystic ovary was encountered in a girl with down syndrome. Clinical presentation is made in all the cases by abdominal pains and vomiting. The disorders of the transit and the urinary signs are associated in 3 and 2 cases respectively, the clinical examination objectified a pelvic defense in all the cases and an abdominal mass in 2 cases. Pelvic ultra-sonography was made in 6 observations and give the diagnosis of torsion of the ovary in 4 cases, whereas it was doubtful in the 2 remaining cases when an ovarian mass was observed. In the 3 remaining cases, this examination was not performed since one the diagnosis of acute appendicitis was retained and the patient operated in emergency. All the children of our series were operated; in 1/3 of the cases we found a necrosis of the ovary. 4 cases out of 9 present a torsion on pathologic ovary (cyst, dysplasia), whereas in the 5 remaining cases, we noted a torsion on healthy ovary. 4 young girls have undergoes a annexectomy, of which one was bilateral. The evolution was favorable in all the cases.
CONCLUSION
Adnexal torsion is a surgical emergency that need an early diagnosis and management to preserve ovarian function in girls and Doppler sonography every must be done every time there is a pelvic pain without fever in girls
Topics: Adnexal Diseases; Adolescent; Child; Female; Humans; Retrospective Studies; Torsion Abnormality
PubMed: 19469302
DOI: No ID Found -
Transplantation Proceedings May 2009Sclerosing cholangitis is a chronic cholestatic liver disease of unknown etiology. Immunologic and genetic factors may be involved in the pathogenesis of the disease,...
BACKGROUND
Sclerosing cholangitis is a chronic cholestatic liver disease of unknown etiology. Immunologic and genetic factors may be involved in the pathogenesis of the disease, characterized by fibrosis involving bile ducts, which can progress to biliary cirrhosis and cholangiocarcinoma (8%-30%). Sclerosing cholangitis is frequently associated with inflammatory bowel diseases, especially ulcerative colitis (60%-80%), which may require a proctocolectomy with ileal pouch anal anastomosis if there is no response to therapy or the appearance of colonic carcinoma.
PATIENTS AND METHODS
Among 1629 liver recipients from 1990 to 2008, 47 (2.9%) had sclerosing cholangitis as the cause of cirrhosis. Forty two percent of these also had associated inflammatory bowel disease with 34% displaying ulcerative colitis. Eight patients died after liver transplantation (OLT) in the absence of recurrence of sclerosing cholangitis. Among the remaining 39 patients, 17 (43.6%) developed recurrent of sclerosing cholangitis; three required re-OLT, and among these three patients, one developed another recurrence. After OLT, ulcerative colitis persisted in an active state in eight patients, requiring proctocolectomy with ileal pouch-anal anastomosis for three patients (median time after OLT was 78.6 months).
RESULTS
One of the three patients who had proctocolectomy had an immediate complication, a pelvic hematoma, which required a surgical approach. One patient developed acute pouchitis 15 months after OLT, medically treated with antibiotics and corticoids. Histology of the colectomy specimen demonstrated colorectal cancer in two patients (pT3N0 and pT2N0) and high-grade dysplasia in the remaining subjects. All patients displayed a cure of their colonic disease (median follow-up 14 months) despite two patients developing recurrence of the liver disease.
CONCLUSION
Proctocolectomy with ileal pouch anal anastomosis is safe in patients who underwent OLT for sclerosing cholangitis in association with ulcerative colitis. If not surgically treated, patients may receive immunosuppression to prevent rejection and disease recurrence, avoiding at the same time the occurrence of "de novo" neoplasms. Mammalian target or rapamycin inhibitors may have an important role but this must be established with randomized controlled trials.
Topics: Cholangitis, Sclerosing; Colitis, Ulcerative; Humans; Liver Transplantation; Proctocolectomy, Restorative
PubMed: 19460568
DOI: 10.1016/j.transproceed.2009.03.027 -
Acta Dermato-venereologica 2008Schöpf-Schulz-Passarge syndrome is a rare ectodermal dysplasia, characterized chiefly by multiple eyelid apocrine hidrocystomas, palmo-plantar keratoderma, hypodontia,... (Review)
Review
Schöpf-Schulz-Passarge syndrome is a rare ectodermal dysplasia, characterized chiefly by multiple eyelid apocrine hidrocystomas, palmo-plantar keratoderma, hypodontia, hypotrichosis and nail dystrophy. The clinical spectrum and the most likely inheritance pattern(s) have not yet been completely defined. We report here on two, unrelated patients presenting with additional, previously unreported features, including hypoplastic nipples and optic atrophy. Both individuals were born to consanguineous parents, and one also has affected siblings. A literature review identified 23 additional cases. Multiple eyelid apocrine hidrocystomas, described in all of the cases, are the hallmark of this condition, although they usually appear in adulthood. The concomitant presence of eccrine syringofibroadenoma in most patients and of other adnexal skin tumours in 44% of affected subjects indicates that Schöpf-Schulz-Passarge is a genodermatosis with skin appendage neoplasms. However, the risk of skin and visceral malignancies is not increased. Pedigree study demonstrates that 9 of the 13 published familial cases may be explained by an autosomal recessive mutation, while the remaining pedigrees show apparent vertical transmission compatible with genetic heterogeneity. The benign disease course and advanced age at diagnosis could also suggest locus homogeneity for a recessive mutation with instances of pseudodominant inheritance.
Topics: Aged; Anodontia; Consanguinity; Ectodermal Dysplasia; Eyelid Neoplasms; Female; Hidrocystoma; Humans; Hypotrichosis; Keratoderma, Palmoplantar; Male; Nails, Malformed; Nipples; Optic Atrophy; Phenotype; Sweat Gland Neoplasms; Syndrome
PubMed: 19002348
DOI: 10.2340/00015555-0547 -
Archives of Gynecology and Obstetrics Jun 2008To present a unique case of a 63 year-old woman with coexistent adenocarcinoma of the ovary, endometrium, cervix and fallopian tube.
OBJECTIVE
To present a unique case of a 63 year-old woman with coexistent adenocarcinoma of the ovary, endometrium, cervix and fallopian tube.
MATERIALS AND METHODS
A case report from a tertiary health center.
RESULTS
A woman presenting with postmenopausal bleeding and abdominal distantion was assessed by endometrial biopsy and explorative surgery. The frozen section of the mass on the right adnex revealed malign mucinous carcinoma of the ovary. As usual, optimal debulking was performed as initial surgical staging procedure of ovarian cancer. The microscopic examination of the right ovary revealed a typical mucinous cystadenocarcinoma. Furthermore, the focal endometrial irregularity at the left uterine cornus turned out to be a well differentiated endometrial carcinoma of the endometrioid type with <1/3 myometrial invasion. The pale infiltrative lesion in the cervix also turned out to be an adenocarcinoma of the endocervical type with deep stromal invasion and areas of diffuse glandular dysplasia and in-situ glandular neoplasia at the periphery. Besides, several sections from the left fallopian tube uncovered diffuse dysplasia in the lining epithelium and a focus of adenocarcinoma with papillary and cribriform pattern.
DISCUSSION
When compared with patients having metastatic lesions, most synchronous female malignancies are accompanied with early stage and low-grade with a more favorable prognosis. However, there is paucity of data for the exact criterion to distinguish primary tumors from metastatic lesions. In such cases, the validity of immunohistochemical and cloning studies are not clear.
Topics: Adenocarcinoma; Endometrial Neoplasms; Fallopian Tube Neoplasms; Female; Humans; Middle Aged; Neoplasms, Multiple Primary; Ovarian Neoplasms; Uterine Cervical Neoplasms
PubMed: 18066567
DOI: 10.1007/s00404-007-0520-4 -
Diseases of the Colon and Rectum Jun 2007Inflammation, villous atrophy, colonic metaplasia, and dysplasia have been observed within the mucosa of ileal pelvic pouches after restorative proctocolectomy. This...
PURPOSE
Inflammation, villous atrophy, colonic metaplasia, and dysplasia have been observed within the mucosa of ileal pelvic pouches after restorative proctocolectomy. This study was designed to determine the prevalence of mucosal dysplasia in ileal pouch and any associated risk factors.
METHODS
Prospectively registered patients having restorative proctocolectomy were recruited. A cross-sectional study was performed using a questionnaire focusing on disease history, functional results, and pouchitis after surgery. Participants underwent screening endoscopic pouch examination using sigmoidoscopy. Mucosal biopsies were taken from six specific locations in the pouch from proximal ileal-pouch (inflow) to ileoanal anastomosis. All biopsies were performed under strict surveillance protocol regardless of patients' symptoms. Biopsies were interpreted by two pathologists unaware of each other's report.
RESULTS
A total of 138 patients completed the protocol. Colectomy specimens from restorative proctocolectomy showed chronic ulcerative colitis in 118 (85.6 percent), familial adenomatous polyposis in 10 (7.2 percent), Crohn's colitis in 2 (1.4 percent), and indeterminate colitis in 8 (5.8 percent) patients. Twenty-two patients (18.3 percent) had dysplasia and eight (6.7 percent) had invasive cancer found in colectomy specimens after restorative proctocolectomy. Median interval between proctocolectomy and pouch biopsy was 5.4 years. Inflammatory changes were present in a majority of specimens, but these did not correlate with clinical history of pouchitis. No villous atrophy was identified. Pouch biopsies from only one patient were indefinite for dysplasia. Subsequent biopsies were negative.
CONCLUSIONS
Clinical and microscopic evidence of ileal-pouch inflammation is common. Ileal-pouch mucosal dysplasia is uncommon, occurring in only 1 of 138 patients. Villous atrophy and colonic metaplasia were not observed in this series. Routine pouch surveillance with biopsies may not be warranted.
Topics: Adult; Aged; Biopsy; Colonic Pouches; Cross-Sectional Studies; Female; Humans; Ileum; Intestinal Diseases; Intestinal Mucosa; Male; Middle Aged; Pouchitis; Proctocolectomy, Restorative; Prospective Studies
PubMed: 17429711
DOI: 10.1007/s10350-007-0217-6 -
Journal of Clinical Oncology : Official... Apr 2007Serum CA-125 level is commonly used as indicator for ovarian cancer recurrence. However, its value for the prediction of neoplastic lesions is unknown. The aim of this...
PURPOSE
Serum CA-125 level is commonly used as indicator for ovarian cancer recurrence. However, its value for the prediction of neoplastic lesions is unknown. The aim of this study was to investigate whether CA-125 concentrations are indicative of adnexal dysplasia and cancer in women at hereditary high risk of ovarian/tubal cancer.
PATIENTS AND METHODS
CA-125 was obtained from 424 women at hereditary high risk of ovarian/tubal cancer attending the VU University Medical Center (Amsterdam, the Netherlands) between 1993 and 2005. Serum samples obtained at the second-to-last (n = 64) and last (n = 98) visit before surgery were tested in women who underwent adnexal surgery for diagnostic (n = 9) or prophylactic (n = 89) reasons. Serum samples obtained from 370 age-matched healthy women were used as controls.
RESULTS
Both the absolute value (P < .0001) and the serial change (P < .0001) of CA-125 were predictive for ovarian cancer (n = 8). For adnexal dysplasia (n = 23), the absolute value of CA-125 (P = .003) was predictive, but the serial change in CA-125 was not (P = .32). The odds ratio for adnexal dysplasia versus nondysplasia in the highest tertile (CA-125 levels 14 U/mL) compared with the lowest tertile (CA-125 < 10 U/mL) was 6 (95% CI, 1.32 to 36.66).
CONCLUSION
In patients at hereditary high risk for adnexal cancer, both the absolute value of serum CA-125 and the change in serial CA-125 are predictors for ovarian cancer. Remarkably, the absolute value of CA-125 is also predictive for adnexal dysplasia. CA-125 values should, therefore, be taken into account in the decision toward prophylactic bilateral salpingo-oophorectomy.
Topics: Adult; Biomarkers, Tumor; CA-125 Antigen; Case-Control Studies; Disease Progression; Early Diagnosis; Female; Genes, BRCA1; Genes, BRCA2; Genetic Predisposition to Disease; Humans; Logistic Models; Middle Aged; Neoplasm Recurrence, Local; Ovarian Neoplasms; Precancerous Conditions; Predictive Value of Tests; ROC Curve; Risk Factors; Statistics, Nonparametric
PubMed: 17416858
DOI: 10.1200/JCO.2006.06.7884 -
Journal of Veterinary Diagnostic... Nov 2006Epitheliogenesis imperfecta has been reported in several animal species, and its inheritance is suspected to be autosomal recessive. This term has been used to describe...
Epitheliogenesis imperfecta has been reported in several animal species, and its inheritance is suspected to be autosomal recessive. This term has been used to describe two different diseases, namely epidermolysis bullosa and aplasia cutis congenita, which are both grossly characterized by an absence of epidermis or mucosal epithelium and are most frequently reported on the distal limbs and oral cavity. Epitheliogenesis imperfecta has been described in swine, but the literature on the subject is scarce. To better characterize this condition, 70 piglets with congenital skin defects macroscopically compatible with epitheliogenesis imperfecta were examined. In all but 1 case, only 1 piglet per litter was affected. Of the affected piglets, 65 (93%) were male, suggesting a sex-related problem. More than half of the piglets had multiple skin lesions. All defects were located on the caudal half of the body, and none was found in the oral cavity. Most lesions were characterized by an absence of epidermis and part of the dermis and adnexae. Adnexal dysplasia was also observed at several sites, both with and without epitheliogenesis imperfecta, suggesting a developmental problem. Fluid-filled, congenital subcutaneous bullae were noted grossly on 7 piglets; their relationship, if any, with epitheliogenesis imperfecta remains unknown. As the term epitheliogenesis imperfecta has been used in cases of epidermolysis bullosa, the term aplasia cutis congenita seems to be more appropriate to describe these lesions in swine.
Topics: Animals; Animals, Newborn; Blister; Ectodermal Dysplasia; Female; Male; Sweat Glands; Swine; Swine Diseases
PubMed: 17121085
DOI: 10.1177/104063870601800608 -
Seminars in Liver Disease Feb 2006The prevalence of inflammatory bowel disease (IBD) in patients with PSC differs in various part of the world. Ulcerative colitis (UC) is most common, but 1 to 14% of all... (Review)
Review
The prevalence of inflammatory bowel disease (IBD) in patients with PSC differs in various part of the world. Ulcerative colitis (UC) is most common, but 1 to 14% of all primary sclerosing cholangitis (PSC) patients have Crohn disease with colonic involvement. Many PSC patients without clinical symptoms of IBD have colonoscopic and histological findings compatible with IBD, and the subclinical phase may last several years before onset of symptoms of active colitis. The characteristics of UC in patients with PSC are different from those in UC patients without PSC. The colitis is usually substantial, the clinical course of the colitis is quiescent, and rectal sparing is common. Moreover, PSC patients with UC have a higher risk of developing colorectal dysplasia/carcinoma than UC patients without PSC. In patients having an ileal pelvic pouch with ileal anal anastomosis, PSC is a risk factor for development of pouchitis. It is important that all PSC patients with UC are included in colonoscopic surveillance programs.
Topics: Cholangitis, Sclerosing; Colonic Neoplasms; Colonoscopy; Epidemiologic Studies; Humans; Inflammatory Bowel Diseases; Prevalence; Risk Factors
PubMed: 16496231
DOI: 10.1055/s-2006-933561 -
Pediatric Annals Oct 2005STIs are responsible for significant human suffering and carry significant economic costs. Strategies to control STIs, such as screening programs and condoms, have had... (Review)
Review
STIs are responsible for significant human suffering and carry significant economic costs. Strategies to control STIs, such as screening programs and condoms, have had limited success. Vaccines offer an additional method that is not coitally related and does not depend on consistent use. The HPV vaccine confers protection against the most common types causing cervical dysplasia. Mathematical modeling suggests that the HSV vaccine, given universally to all young women, should reduce genital and neonatal herpes in the population at large. Much work remains on vaccines for chlamydia and gonorrhea, but they offer the hope of preventing pelvic inflammatory disease and its sequelae. As these vaccines become licensed, their successful implementation will require the support of professional organizations, families, and providers.
Topics: Adolescent; Bacterial Vaccines; Chlamydia Infections; Chlamydia trachomatis; Humans; Papillomaviridae; Papillomavirus Infections; Sexually Transmitted Diseases; Simplexvirus; Viral Vaccines
PubMed: 16285635
DOI: 10.3928/0090-4481-20051001-14