Asymptomatic Girls Research Articles

Assessment of the diagnostic value of serum ceruloplasmin for Wilson\u2019s disease in children

BackgroundSerum ceruloplasmin is one of the major diagnostic parameters for Wilson’s disease (WD). Age and gender difference of serum ceruloplasmin remain controversy. This study aims to assess diagnostic value of serum ceruloplasmin level for WD in children up to age of 15 years.MethodsSerum ceruloplasmin levels were measured in 317 WD patients, 21 heterozygotes, 372 healthy control children and 154 non-WD patients with other liver diseases. Receiver operating characteristic (ROC) curve was used to determine the diagnostic accuracy of serum ceruloplasmin for WD in children.ResultsAmong healthy controls, serum ceruloplasmin level was slightly low in the infants younger than 6 months, and then maintained from 26 to 33 mg/dl after age of 6 months. A total of 8.1% of healthy children had levels of serum ceruloplasmin < 20 mg/dL. Serum ceruloplasmin level was 5.7 ± 4.7 mg/dl in WD patients, and 25.6 ± 5.9 mg/dl in heterozygous carriers. Only 1.9% of WD patients had serum ceruloplasmin levels > 20 mg/dL. Serum ceruloplasmin levels had gender difference, being higher in healthy boys than healthy girls, and higher in asymptomatic WD boys than asymptomatic WD girls (p < 0.01, p < 0.05). Serum ceruloplasmin levels also presented genotypic difference. WD patients with R778L homozygotes exhibited lower levels of serum ceruloplasmin than the patients without R778L (p < 0.05). The ROC curve revealed that serum ceruloplasmin level, at a cutoff value of 16.8 mg/dL, had the highest AUC value (0.990) with a sensitivity of 95.9% and a specificity of 93.6%.ConclusionsSerum ceruloplasmin is one of sensitive diagnostic biomarkers for WD in children. Gender and genotypic difference of serum ceruloplasmin level should be considered. The cutoff value of serum ceruloplasmin level < 16.8 mg/dL may provide the highest accuracy for diagnosis of WD in children.

Non-invasive bladder function measures in healthy, asymptomatic female children and adolescents: A systematic review and meta-analysis

Lower urinary tract symptoms (LUTS) are common in children and adolescents. Non-invasive tests evaluating bladder function are generally preferred over invasive tests, yet few studies have explored the range of normative values for these tests in healthy, asymptomatic children. To define normative reference ranges for non-invasive tests of bladder function in healthy, asymptomatic girls and adolescents. A comprehensive search strategy was performed in seven electronic databases through October 2019. English-language studies reporting data on voiding frequency, voided and postvoid residual volumes (PVR) and uroflowmetry results in healthy, asymptomatic girls (mean age≥5 years) were included. Two independent reviewers performed study review, data extraction, and quality assessment. Overall mean estimates and 95% confidence intervals for each bladder function parameter were calculated using random effects models, and 95% normative reference values were estimated. Ten studies met eligibility criteria for the meta-analysis (n=2143 girls, age range: 3-18). Mean estimates of maximum voided volume and PVR were 233.4ml (95% CI 204.3-262.6; n=1 study) and 8.6ml (95% CI 4.8-12.4; n=2 studies) respectively. Pooled mean estimates for uroflowmetry parameters were: 21.5ml/s (95% CI 20.5-2.5) for maximum flow rate (n=6 studies), 12.5ml/s (95% CI 11.2-13.8) for mean flow rate (n=6 studies), 6.8s (95% CI 4.4-9.3) for time to maximum flow (n=3 studies), 15.7s (95% CI 13.0-18.5) for flow time (n=3 studies), and 198.7ml (95% CI 154.2-234.2) for voided volume (n=9 studies). No studies reported estimates of voiding frequency. Between-study heterogeneity was high (89.0-99.6%). Although we were able to calculate pooled mean estimates for several parameters, the small number of included studies and the wide age ranges of participants preclude generalization of reference values to all healthy girls. Further research is needed to determine normative reference values within specific age groups.

Underlying diseases in sporadic presentation of high creatine kinase levels in girls

BackgroundPersistent creatine kinase (CK) elevation can occur due to various conditions. Identifying the causes of hyperCKemia is crucial for enabling appropriate follow-up and care. Girls with elevated CK levels may be carriers of Duchenne/Becker muscular dystrophy (DMD/BMD), making diagnosis more difficult than that in boys. This study aimed to elucidate the underlying causes of high CK levels in girls. MethodsFourteen girls (seven symptomatic, seven asymptomatic) with persistently elevated CK levels but without a family history of muscle diseases were referred to our hospital between April 2014 and August 2018. Muscle biopsy and/or genetic analysis were conducted for diagnoses. ResultsAmong the symptomatic girls, six (85.7%) had muscular dystrophy (five DMD/BMD carriers, and one sarcoglycanopathy [limb-girdle muscular dystrophy: LGMDR4]), and one had dermatomyositis. Among the asymptomatic girls, four (57.1%) had muscular dystrophy (three DMD/BMD carriers, and one calpainopathy [LGMDR1]), and three were undiagnosed. ConclusionOur results indicate that muscular dystrophy, including DMD/BMD carriers, must be considered in girls with highperCKemia regardless of symptoms presentation, and in symptomatic girls with dermatomyositis. Investigations in girls with hyperCKemia should be performed under proper ethical considerations. Further research is necessary to develop a diagnostic strategy for girls with hyperCKemia.

Trunk Growth in Early-Onset Idiopathic Scoliosis Measured With Biplanar Radiography

Study DesignCross-sectional and longitudinal retrospective study. ObjectivesTo measure thoracic dimensions and volume during growth in early-onset idiopathic scoliosis (EOIS) patients and to compare them to a population of asymptomatic adults and to the previous literature. Summary of Background DataData on trunk growth for scoliotic children between 6 and 14 years of age is sparse in the literature. MethodsThirty-six patients (29 girls and 7 boys, between 3 and 14 years old, average Cobb angle 33°±15°) were included, all with a minimum two-year follow-up. Sixty-one asymptomatic girls and 54 asymptomatic adults were included as control groups. All subjects underwent biplanar radiography and 3D reconstruction of the spine, pelvis, and rib cage. EOIS patients repeated their radiologic examination every six months. Cobb angle, rib cage volume, anteroposterior and transverse diameters, thoracic index, thoracic perimeter, pelvic incidence, and T1–T12 and T1–S1 distance were calculated. Reproducibility of measurement was assessed. ResultsMeasurement reliability in such young patients was comparable to previous studies in adolescents and adults. Geometrical parameters of EOIS patients increased linearly with age. For instance, rib cage volume in girls with EOIS increased from 2200 cm3 at six to seven years of age to 4100 cm3 at 13–14 years (65% of adult values, 294 cm3/y). Comparison with asymptomatic girls showed that EOIS could affect growth spurt. Longitudinal analysis on a cohort of six girls who had a follow-up of six years confirmed the cross-sectional data. ConclusionsIn this longitudinal and cross-sectional study, trunk growth between 3 and 14 years of age was characterized, for the first time, with biplanar radiography and 3D reconstruction. The results can be useful to estimate patient growth and thus have potential application in the surgical planning of EOIS patients. Level of EvidenceLevel II, retrospective study.

Consensus recommendations for diagnosis, management and treatment of Fabry disease in paediatric patients.

Fabry disease (FD), a rare X‐linked disease, can be treated with bi‐monthly infusion of enzyme replacement therapy (ERT) to replace deficient α‐galactosidase A (AGAL‐A). ERT reduces symptoms, improves quality of life (QoL), and improves clinical signs and biochemical markers. ERT initiation in childhood could slow or stop progressive organ damage. Preventative treatment of FD from childhood is thought to avoid organ damage in later life, prompting a French expert working group to collaborate and produce recommendations for treating and monitoring children with FD. Organ involvement should be assessed by age 5 for asymptomatic boys (age 12‐15 for asymptomatic girls), and immediately for children diagnosed via symptoms. The renal, cardiac, nervous and gastrointestinal systems should be assessed, as well as bone, skin, eyes, hearing, and QoL. The plasma biomarker globotriaosylsphingosine is also useful. ERT should be considered for symptomatic boys and girls with neuropathic pain, pathological albuminuria (≥3 mg/mmol creatinine), severe GI involvement and abdominal pain or cardiac involvement. ERT should be considered for asymptomatic boys from the age of 7. Organ involvement should be treated as needed. Early diagnosis and management of FD represents a promising strategy to reduce organ damage, morbidity and premature mortality in adulthood.

Labial adhesion - diagnostics and treatment.

Labial adhesion is relatively common, but the condition is little known among doctors and parents. The article assesses treatment in the specialist health service. The treatment and course are assessed in 105 girls in the age group 0 – 15 years who were referred to St. Olavs Hospital in the period 2004 – 14. The majority of the girls (n = 63) were treated topically with oestrogen cream. In 26 of 51 girls (51 %) for whom the final result is known, the adhesion opened after one treatment. When 1 – 4 oestrogen treatments were administered, the introitus had opened completely in two out of three (65 %). Fewer than half of those who received supplementary surgical treatment achieved permanent opening. Treatment for labial adhesion had a limited effect in this study. As the literature suggests that the condition results in few symptoms and resolves spontaneously in virtually all girls in puberty, no compelling medical reason exists for opening the adhesion in asymptomatic girls. It is important that doctors are aware of the condition in order to prevent misdiagnosis and to provide parents with adequate information. For parents it is important to know that spontaneous resolution may result in soreness and dysuria. Knowledge of the condition can most likely prevent unnecessary worry.

Sexually transmitted diseases in symptomatic and asymptomatic Thai women and girls: a study from Bangkok and nearby

Background: Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus (HPV) infections among women and girls may be symptomatic or asymptomatic. Objectives: To survey and identify C. trachomatis, N. gonorrhoeae, and HPV infections in symptomatic and asymptomatic women and girls in Bangkok and surrounding neighborhoods using molecular techniques, evaluate the use of doxycycline treatment for clinically symptomatic patients infected with C. trachomatis, and identify possible genetic mutations associated with persistence and/or drug resistance. Method: We enrolled 150 women and girls with inflamed urogenital tracts and 134 asymptomatic controls, both without a history of HIV infection or cervical cancer in this prospective study. Genomic DNAs were extracted, and C. trachomatis, N. gonorrhoeae, and HPV infections were detected using established PCR primers and protocols. PCR controls included no confirmatory template controls or human β-globin. Patients infected with C. trachomatis were treated with doxycycline and re-examined after treatment. C. trachomatis major outer membrane (ompA) and tryptophan synthesis A (trpA) genes were sequenced to identify possible genetic mutations associated with persistence and/or drug resistance. Results: C. trachomatis, N. gonorrhoeae, and HPV were detected in 22%, 6%, and 48% of symptomatic, and in 3%, 16%, and 10% of asymptomatic women and girls, respectively. Coinfection with C. trachomatis and HPV were frequent in the 15-34 year age group, and associated with upper urogenital tract symptoms. Doxycycline was not considered effective for C. trachomatis infection. Several nonconserved amino acid changes were detected in C. trachomatis ompA and trpA. Conclusion: We found different distributions of these pathogens among symptomatic and asymptomatic patients. We also found doxycycline treatment failures, and mutated trpA supported persistent C. trachomatis infections.

The Auto-Amputated Adnexa: A Review of Findings in a Pediatric Population

Study ObjectiveTo quantify our experience and that of the literature with diagnosis and management of the auto-amputated adnexa in a pediatric population. DesignCase series and literature review. SettingTertiary care medical center. ParticipantsCase series of pediatric patients (<18 years of age) with surgically documented adnexal auto-amputation collected from our medical center and the literature. InterventionsNone. Main Outcome MeasureAuto-amputated adnexa. ResultsIn addition to the 3 cases discussed from our institution, 91 cases of auto-amputated adnexa were identified in the literature dating back to 1943, for a total of 94 cases. Forty-nine percent (46/94) of the cases involved girls in a pediatric population (<18 years of age). Of these, the majority (n = 26) were identified in a subgroup of girls who were diagnosed with an adnexal cyst by antenatal ultrasound. Most of these neonates were asymptomatic at birth or had a palpable abdominal mass (n = 6) and at the time of surgical exploration were found to have an auto-amputated adnexa. 34 out of 46 cases were analyzed in detail. The right adnexa were involved in 56% of the cases. The most common presenting complaint verbalized by the older girls was pain; however, 8 cases were identified in asymptomatic girls undergoing unrelated diagnostic testing. ConclusionThe auto-amputated adnexa is a rare finding in the pediatric population, but it must be considered as a possible explanation for the incidental finding of absence of the fallopian tube or ovary in the subgroup of patients who undergo surgery for any reason. Patients with an antecedent history of pelvic pain either chronic or intermittent in nature may be diagnosed with torsion or less frequently auto-amputation of the adnexa. A fetal “pelvic mass” or “ovarian cyst” may predispose the adnexa to torsion and subsequent auto-amputation either in-utero or post-delivery. Many of these antenatally diagnosed cysts and even subsequent auto-amputations are completely asymptomatic, however, and do not compromise fertility assuming the contralateral adnexa are normal. Thus expectant management is appropriate for small (less than 4 cm), asymptomatic simple cysts and even suspected auto-amputated adnexa in an asymptomatic patient.

The role of negative urgency and expectancies in problem drinking and disordered eating: testing a model of comorbidity in pathological and at-risk samples.

The aim of this study was to test hypotheses derived from a model that explains both the comorbidity of problem drinking and eating disorder symptoms and the difference in risk process between the two disorders. In Study One, the authors examined four personality constructs typically associated with rash action (sensation seeking, lack of planning, lack of persistence, and negative urgency) and disorder-specific expectancies in samples of women with eating disorders, substance dependence disorders, comorbid conditions, and no symptoms (N = 104). Negative urgency, the tendency to act rashly when distressed, differentiated the disordered groups from the control group. In contrast, learned expectancies differentiated among clinical groups. Women with eating disorders endorsed high levels of eating and dieting expectancies and women with substance use disorders endorsed high levels of alcohol expectancies, while comorbid women endorsed high levels of both. In Study Two, this pattern of findings was replicated in a sample of fifth grade girls (N = 905). Girls who had engaged in binge eating, alcohol use, or both had higher levels of negative urgency than asymptomatic girls, and the pattern of outcome expectancy endorsement was disorder specific. Negative urgency may represent a general, personality influence on both eating disordered behaviors and symptoms of alcohol dependence, which, when combined with learned, behavior-specific expectancies, leads to specific addictive behavior patterns.

Microbiological aspects of vulvovaginitis in prepubertal girls

This study aimed to establish the vaginal introitus microbial flora in girls with and without symptoms of vulvovaginitis, and to present the distribution of isolated microorganisms by age groups in girls with vulvovaginitis. We enrolled 500 girls with vulvovaginitis symptoms, aged 2-12 years, referred by their pediatricians for microbiological examination of the vaginal introitus swabs, and 30 age-matched asymptomatic girls. Similar microbial flora was isolated in both groups, but the symptomatic girls had significantly more common positive microbiological findings compared to controls (p < 0.001). In symptomatic girls, the following pathogenic bacteria were isolated: Streptococcus pyogenes (4.2%), Haemophilus influenzae (0.4%), and Staphylococcus aureus (5.8%). Bacteria of fecal origin were found in vaginal introitus swabs in 33.8% of cases, most commonly Proteus mirabilis (14.4%), Enterococcus faecalis (12.2%), and Escherichia coli (7.0%). The finding of fecal flora was more common compared to controls, reaching a statistical significance (p < 0.05), as well as in girls aged up to 6 years (p < 0.001). Candida species were found in 2.4% of girls with vulvovaginitis symptoms. The microbial ecosystem in girls with clinical signs of vulvovaginitis is complex and variable, and the presence of a microorganism does not necessarily imply that it is the cause of infection. The diagnosis of vulvovaginitis in prepubertal girls requires a complex and comprehensive approach, and microbiological findings should be interpreted in the context of clinical findings.

An irreducible inguinal hernia in a girl

A 5-week-old girl (born a terme) was referred to our hospital with an irreducible right inguinal mass. This had been present for 1 day. On examination, a non-reducible, mildly painful swelling was present in the right groin. An ultrasound scan was performed to be informed about the content and to exclude other diagnoses (e.g. Nuck’s cyst and lymphadenitis) and showed the uterus, both fallopian tubes and both ovaries contained in the sac. If an ovary is seen in the hernial sac, during ultrasonography, visualisation of the uterus should also be performed. Absence of a uterus should warrant further investigations, e.g. to exclude androgen insensitivity syndrome. On exploration the following day, the uterus and one fallopian tube with the corresponding ovary was identified (see Fig. 1). The other fallopian tube and ovary had been reduced spontaneously. The patient recovered uneventfully after hernial sac resection. Fig. 1 Hernial sac presented with visible ovary The presence of an ovary in the hernial sac is reported to be 4–30% [1] in asymptomatic girls and up to 82–100% [1–3] in case of an incarcerated hernia. Strangulation of the ovary is present in 7–27% [1] of the patients with incarcerated inguinal hernia. If the inguinal hernia is symptomatic, an emergency operation should be performed.

Phenotype-genotype Correlation in Potential Female Carriers of X-linked Developmental Cataract (Nance-Horan Syndrome)

Purpose: To correlate clinical examination with underlying genotype in asymptomatic females who are potential carriers of X-linked developmental cataract (Nance-Horan syndrome).Methods: An ophthalmologist blind to the pedigree performed comprehensive ophthalmic examination for 16 available family members (two affected and six asymptomatic females, five affected and three asymptomatic males). Facial features were also noted. Venous blood was collected for sequencing of the gene NHS.Results: All seven affected family members had congenital or infantile cataract and facial dysmorphism (long face, bulbous nose, abnormal dentition). The six asymptomatic females ranged in age from 4–35 years old. Four had posterior Y-suture centered lens opacities; these four also exhibited the facial dysmorphism of the seven affected family members. The fifth asymptomatic girl had scattered fine punctate lens opacities (not centered on the Y-suture) while the sixth had clear lenses, and neither exhibited the facial dysmorphism. A novel NHS mutation (p.Lys744AsnfsX15 [c.2232delG]) was found in the seven patients with congenital or infantile cataract. This mutation was also present in the four asymptomatic girls with Y-centered lens opacities but not in the other two asymptomatic girls or in the three asymptomatic males (who had clear lenses).Conclusions: Lens opacities centered around the posterior Y-suture in the context of certain facial features were sensitive and specific clinical signs of carrier status for NHS mutation in asymptomatic females. Lens opacities that did not have this characteristic morphology in a suspected female carrier were not a carrier sign, even in the context of her affected family members.

Cytology role in healthy sexual life promotion of adolescent users of Centro de Atendimento a Jovens de Coimbra

Adolescents usually have risky sexual behaviors which can result in an unwanted pregnancy and/or in transmission of sexually transmitted infections (STIs). Medical consultation can provide adequate and early sexual information. Medical surveillance and pelvic examination are essential for a healthy sexual life. Despite the availability of two vaccines against the major oncogenic types of human papilloma virus, the main agent of cervical cancer, performance of cytology is still needed. The purpose of this study was to characterize the group of adolescents/young adults who made their first cytology during 2005 and 2006 and determine the results of gynecological observation and first cytology. This is a retrospective study of users of Centro de Atendimento a Jovens (CAJ) of Centro de Saúde de Celas de Coimbra, who made their first cytology in 2005 and 2006. Clinical data were analyzed to determine the following parameters: demographic data, habits, sexual parameters, gynecological observation, symptoms, first and subsequent cytology results and consultations dropout rate until January 2009. During these two years, 172 first cytologies were performed. At first consultation in CAJ, the average age was 19 years old (15-24). At first intercourse, which occurred on average at 17,5 years old (13-21), 75,6% of girls used condom, 4,6% only pill and 16,3% did not use any contraceptive method. The mean number of sexual partners at first consultation was 1,6. The majority needed to take emergency pill (43/54). Gynecological observation was abnormal in 50,6% of cases, but only 10% reported symptoms. First cytology was performed, on average, three years after first intercourse, and was normal in 149 cases, unsatisfactory for evaluation in one case and abnormal in 22 (eight bacterial vaginosis, six with signs of inflammation, six candidiasis and two low grade intraepithelial lesions). Fifty nine per cent of adolescents made, at least, once more cytology. Three more cases of low grade intraepithelial lesions were detected. Dropout rate of consultations was 17%. In adolescence, isolated pill use increases the risk of transmission of STIs. Not using any contraceptive method may be related to the increasing use of emergency contraceptive pills. Abnormal gynecological examination may be present in asymptomatic girls. Dysplastic lesions (which are increasing in adolescence) have the same course of adulthood, supporting the need for screening and continuity of follow-up in young people.

Vaginal and endocervical microorganisms in symptomatic and asymptomatic non-pregnant females: risk factors and rates of occurrence

Physiological or non-physiological factors may affect the vaginal flora. The occurrence of genital microorganisms in non-pregnant females of all ages was studied, as were the risk factors associated with each microorganism. A retrospective analysis of vaginal and endocervical cultures and wet smears from 27,172 non-pregnant women, between 1996 to 2005, was performed taking into consideration clinical and socio-demographic characteristics. No microorganisms were observed in 55.7% of the individuals studied and 44.3% had positive cultures. There was no microbiological aetiology in 49% of women with genital symptoms. Poor hygiene, chemical irritants, sexual behaviour, vaginal blood, birth control type, and/or the lack of an oestrogen effect may have caused the symptoms. The highest occurrence of Gram-negative bacteria (p<0.01), mainly Escherichia coli, was observed in prepubescent girls. The highest occurrence of Candida species (p<0.01) was in women of childbearing age, and of Gram-positive bacteria (p<0.01) in menopausal women. Adolescents, particularly asymptomatic girls, carried more frequently Ureaplasma urealyticum and Chlamydia trachomatis (p<0.01). Hormonal contraception and consistent condom use was protective against bacterial vaginosis and U. urealyticum colonization. Users of intrauterine devices had an increased risk of bacterial vaginosis or of contracting U. urealyticum, Mycoplasma hominis and Candida species. Genital complaints were an independent indicator of Candida species, Gram-negative and Gram-positive bacteria, Trichomonas vaginalis and bacterial vaginosis.Chlamydia trachomatis infections were often asymptomatic. It is concluded that the hormonal milieu and non-physiological factors are major determinants of the vaginal flora. If diagnosis of genital infections is based on symptoms alone and not on culture results, it may be erroneous. Sexual abuse should be investigated when a child presents with a sexually transmitted disease.

Child Sexual Abuse Examination: Is There a Need for Routine Screening for N gonorrhoeae and C trachomatis?

Purpose To determine the yield of routine vaginal cultures for Neisseria gonorrhoeae and Chlamydia trachomatis from girls evaluated following sexual abuse. Methods Retrospective chart review evaluating results of cultures that were obtained from 2008 prepubertal girls seen within 72 hours following an assault over two periods of 3 years each. Results It was found that only 16 (0.8%) of cultures were positive for either gonorrhea or chlamydia. All but one of the prepubertal girls who had positive vaginal cultures for sexually transmitted disease had signs of acute vulvovaginitis. Conclusion Routine vaginal cultures in asymptomatic pre-pubertal girls have a very low yield. Prospective studies are required to change current protocols for the evaluation of child victims of sexual abuse.

Child Sexual Abuse Examination: Is There a Need for Routine Screening for N. gonorrhoeae?

PurposeTo determine the yield of routine vaginal cultures for Neisseria gonorrhoeae from asymptomatic girls following sexual abuse. MethodsCultures were obtained from 865 prepubertal girls seen within 72 hours following an assault. Adult females (2743), age 18 or older, who were treated according to the same protocol constitute the control group. Data were analyzed using chi square analysis and comparison of proportions. ResultsIt was found that 165 (4.6%) cultures were positive for N. gonorrhoeae. Of the 2743 adults, 153 were positive (5.6%) compared with 12 of the 865 prepubertal girls (1.4%). The differences are statistically significant. All 12 prepubertal children who had positive vaginal cultures for N. gonorrhoeae revealed that they had signs of acute vulvovaginitis. ConclusionRoutine vaginal cultures in asymptomatic prepubertal girls may not be indicated as part of the initial evaluation.

Urethral prolapse: an often misdiagnosed cause of urogenital bleeding in girls.

Urethral prolapse is an uncommon disorder in girls, usually presenting as "vaginal" bleeding. This retrospective chart review focuses on the high rate of misdiagnosis of urethral prolapse and describes treatment modalities based on 24 patients seen at a major children's hospital during an 11-year span. Their mean age was 4.9 years. The initial diagnosis, made by the referring pediatrician or emergency physician, was correct in only five girls (21%). Twenty children presented with urogenital bleeding. Operative correction was employed as initial treatment in 16 girls, with one recurrence. The remaining eight children were treated nonoperatively. Of these, five showed no improvement and underwent surgical repair. Although most children eventually require resection of the prolapsed urethral mucosa, nonoperative treatment is appropriate for asymptomatic girls with a mild degree of urethral prolapse. Increased physician awareness of urethral prolapse is desirable to enhance early recognition and to avoid unnecessary examinations and parental concern.

Vaginal discharge as an indicator of gonorrhea and chlamydia infection in girls under 12 years old

Cultures for sexually transmitted diseases (STDs) are frequently obtained as part of an evaluation for alleged sexual abuse, but the prevalence of STDs in abused children is very low. Furthermore, STDs in children may not be identified if the clinician does not maintain a high index of suspicion in the symptomatic child. A retrospective review was done to study the symptoms and presenting complaints of girls under 12 with gonorrhea and chlamydia infections and to examine the prevalence of STDs in asymptomatic girls. The charts of 622 patients were reviewed. All patients were females under 12, Tanner I or II, who were initially seen for evaluation of sexual abuse or who were diagnosed with an STD. During the study period, 28 girls were found to have STDs. Twenty-two of these girls had vaginal gonorrhea; vaginal chlamydia was diagnosed in eight. Twenty-three of the 28 girls (82%) with an STD were initially seen and cultured for a chief complaint of vaginal discharge. Of the 581 patients who were cultured for evaluation of abuse, only five STDs were diagnosed (0.7%). All 22 girls with gonorrhea had a vaginal discharge on examination. Of the eight girls with chlamydia, two also had vaginal gonorrhea. Of the six who had chlamydia without gonorrhea, asymptomatic infection was common; four gave histories of discharge but only one had a discharge on examination. Our review indicates that girls under 12 who present for evaluation of vaginal discharge may have an STD and should be cultured for gonorrhea and chlamydia whether or not sexual abuse is suspected.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth of airways and air spaces in teenagers is related to sex but not to symptoms

To determine growth patterns of the lung and airways in adolescents, we analyzed maximal expiratory flow-volume curves, closing capacity, and residual volume. They were obtained every 6 mo for up to 7 yr in 430 boys and 125 girls (11-19 yr), of whom 143 boys and 36 girls were classified as symptomatic; symptoms were most often minor and limited to childhood. Development of flows vs. volumes was used to investigate growth of the airways relative to lung size. A model of isotropic growth of the airways and air spaces (J. Appl. Physiol. 65: 822-828, 1988) was modified for increasing elastic recoil pressure with growth. Growth of airways relative to volume occurred faster in teenage boys than in teenage girls and was compatible with isotropic growth in 92% of asymptomatic boys and in 44% of asymptomatic girls: dysanaptic growth in teenage girls seems to be a normal phenomenon and not a unique characteristic of symptomatic subjects. Subjects with respiratory symptoms in childhood and/or adolescence have lower flows for a given lung size and airway closure at a greater lung volume when they enter adulthood. However, no difference in patterns of lung growth was observed in association with the presence of respiratory symptoms.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Pre- and Postoperative Echocardiography Findings in Three Unusual Cases

Diagnosis of anomalous left coronary artery from the pulmonary artery was prospectively established by color Doppler echocardiography in three patients. In two asymptomatic girls, aged 10 years and 5 years respectively, referred for evaluation of a murmur with normal ECG and chest X ray, two-dimensional and pulsed-Doppler examination showed no intracardiac abnormalities. Color flow mapping detected flow in a dilated right coronary artery and left coronary artery to pulmonary artery shunting. Color guided pulsed-Doppler examination permitted further evaluation of coronary flow. Another child had a dilated cardiomyopathy with an echo-dense anterolateral papillary muscle and mitral insufficiency. Postoperative echoes after subclavian to left coronary artery anastomosis and ligation of the left coronary artery at its origin showed residual high-velocity shunting resulting in reoperation in one case and a moderate supravalvular pulmonic stenosis in another. These findings further emphasize the benefit of color Doppler echocardiography in the pre- and postoperative evaluation of anomalous left coronary artery. (ECHOCARDIOGRAPHY, Volume 8, September 1991)