Journal of pediatric and adolescent gynecology
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J Pediatr Adolesc Gynecol · Jun 2003
Case ReportsImpetigo herpetiformis unresponsive to therapy in a pregnant adolescent.
Impetigo herpetiformis is a rare pustular disorder affecting mainly pregnant women. We report a 16-yr-old adolescent primigravida, who presented with impetigo herpetiformis at 27 weeks gestation. ⋯ Because of the deteriorating condition of the patient, an early delivery decision was made. Her symptoms resolved after delivery, and at day 20 postpartum her skin lesions were completely resolved.
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J Pediatr Adolesc Gynecol · Jun 2003
ReviewManagement of adolescent chronic pelvic pain from endometriosis: a pain center perspective.
To review the options for the treatment of chronic pelvic pain in adolescents with endometriosis. ⋯ An individualized, multidisciplinary approach may be effective in improving overall outcome in patients with chronic pelvic pain in reducing pain and normalizing function.
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J Pediatr Adolesc Gynecol · Feb 2003
Identification of symptoms that indicate a pelvic examination is necessary to exclude PID in adolescent women.
Diagnosis of chlamydia, gonorrhea, and vaginitis is now possible in adolescents using urine testing and vaginal swabs obtained by care provider or patient. However, a complete pelvic examination is necessary to diagnose pelvic inflammatory disease (PID). It is thus important to identify patients who might have pelvic inflammatory disease to assure complete gynecologic assessment of genitourinary symptoms. ⋯ This study identified two symptoms reported in the medical history (lower abdominal pain and dyspareunia) that were associated with a clinical diagnosis of pelvic inflammatory disease. If lack of these two symptoms was used as a criterion for omitting a pelvic examination, more than one third of the patients in this study could have been evaluated for cervical and vaginal infections with urine and directly obtained vaginal swabs. Although some of these patients might have required a pelvic examination to exclude other causes of abnormal vaginal bleeding, at least 30% of the total sample could have been evaluated without a speculum and bimanual examination. If further studies support these findings, patients with symptoms suggestive of uncomplicated genitourinary infection (e.g., vaginal discharge, vaginal pruritus, or dysuria) who deny lower abdominal pain and dyspareunia can be evaluated with urine and vaginal samples in place of a speculum and bimanual examination.
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J Pediatr Adolesc Gynecol · Aug 2002
Premenarchal vaginal discharge: findings of procedures to rule out foreign bodies.
Vaginal discharge in children is a common gynecologic complaint and may be resistant to symptomatic and/or antibiotic treatment. In recurrent or unresponsive patients, an evaluation to rule out a foreign body is traditionally recommended. The objective of this study is to review cases of vaginal discharge referred to our institution and assess outcome and diagnosis in those who required irrigation or vaginoscopy to rule out a foreign body.A retrospective chart review was performed on all premenarchal girls identified through the University of Michigan Pediatric and Adolescent Gynecology Clinic database who were seen for evaluation of vaginal discharge between June 1996 and December 2001. The records were reviewed for age, length of time of discharge, aspects of discharge, procedures done to rule out foreign bodies, and findings of such procedures. ⋯ Foreign bodies as a cause of persistent vaginal discharge in a tertiary care referral clinic were identified in 4 of 41 girls (9.8%) and 7 of 27 procedures (25.9%). One child had recurrent foreign bodies removed during 4 of 5 procedures for discharge. In children with persistent vaginal discharge, vaginal irrigation was feasible in older children (average age 7.7 yr). However, no foreign bodies were removed by irrigation that had not already been visually identified prior to the procedure. Exam under anesthesia and vaginoscopy allowed the identification of foreign bodies, and it facilitated the diagnosis of other unusual conditions.
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J Pediatr Adolesc Gynecol · Jun 2002
Case ReportsVaginal adhesions caused by Stevens-Johnson syndrome.
Stevens-Johnson syndrome is a rare, life-threatening condition characterized by epidermal necrosis and involvement of the mucosal surfaces. We report a case of Stevens-Johnson syndrome with vaginal involvement in an 11-yr-old girl who was treated conservatively in the acute stage of the disease. After recovery from the profound systemic upset, she underwent vaginoscopy, which demonstrated some adhesions, which were divided. We recommend that all patients with Stevens-Johnson syndrome with vaginal involvement undergo routine follow-up to evaluate possible adhesions.