Pediatric and adolescent gynecology for the primary care pediatrician.

This review represents the author's personal style of practice in a new and evolving field, where the standard academic framework is still in its infancy. When there is no prior established practice to follow, good clinical care needs to come from listening very carefully to patients and empirically judging appropriate treatment by actual outcomes. The information provided here that is not cited represents 14 years of careful clinical listening and observation, as well as public health training in maternal and child care and epidemiology.

A clinical pathway for pelvic inflammatory disease for use on an inpatient service.

Objective: (1) To create a guideline to improve care of adolescent patients diagnosed with pelvic inflammatory disease (PID); (2) to promote cost-effective, consistent care while minimizing delays and ensuring timely and appropriate use of laboratory tests and other interventions; and (3) to describe the process of the development and the implementation of a clinical pathway for PID.

Methods: The study involved the creation and piloting of a multidisciplinary, collaborative clinical pathway for uncomplicated PID on an inpatient service, and the development of a standardized form for analysis of demographics and variances from the pathway. The setting was an inpatient adolescent service at a children's hospital in an urban setting.

Histologic correlates of vulvar human papillomavirus infection in children and young adults.

Two clinically important issues in the treatment of vulvar wartlike lesions are the histologic criteria for the recognition of human papilloma virus (HPV)-related lesions and the exclusion of lesions derived from cutaneous rather than genital HPV types. We analyzed a series of 70 biopsies from the vulva or distal vagina of 57 children and 13 young adults for HPV nucleic acids by polymerase chain reaction (PCR) amplification and typed the isolates following isotope labeling and restriction digestion (restriction fragment length polymorphism [RFLP] analysis). Lesions were classified as condyloma, suggestive of condyloma (papillary/verrucous architecture without koilocytotic atypia), or nonspecific epithelial alterations.

Congenital anomalies of the female reproductive tract.

External and internal anomalies can result from enzyme or chromosome defects, and prenatal drug exposure. Major new developments in this field include better understanding of the genetics of enzymatic defects, laparoscopic and hysteroscopic modifications of older procedures, the advent of magnetic resonance imaging for diagnosis, and better understanding of the psychosocial impact and timing of therapy.

Müllerian aplasia associated with maternal deficiency of galactose-1-phosphate uridyl transferase.

The activity and electrophoretic pattern of galactose-1-phosphate uridyl transferase (transferase), a key enzyme in galactose metabolism, were analyzed in four patients with Müllerian aplasia (Rokitansky-Küster-Hauser syndrome) and their mothers. Mothers of two of the patients had genetic variations of their transferase enzymes with activities below the normal range. Affected daughters from these two mothers also had genetic variations of the transferase enzyme.