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Menstrual Function and Pubertal Development in Congenital Cardiac Patients
Oral Presentations
164
CURRENT KNOWLEDGE AMONG PRIMARY CARE RESIDENT PHYSICIANS IN USING EMERGENCY CONTRACEPTION.Geon!e M. Veloudis. Jr.. DO.Shona C. Murray, MD. University ofKentuc旬， Lexington, KY. BACKGROUND:Emergency con甘aception isωed after unprotected intercourse 旭 m at臼mptωprevent an unwanted pregnancy. Emergency contraception has been largely under-utilized 旭this country. Potenti剖 間越ons for under-utilization of 也is form of pre伊ancy prevention could include lack of p前ient knowledge, lack of physician knowled阱， and reluctance ωprescribe b臼ed on 泊。甜on belief. 甘le p山pose of 曲is survey w臼to detennine physician knowled阱，op旭ion， and experience with emergency con甘aception.
ME凹ODS:
軒旭ary
care specialty hoωes個ff physicians at 也e University of Kentucky contraception (40.5% response ra妞， 81 out of 200). included family practice (駒，扭扭mal medicine (IM), pedia剖cs 伊D)， and obste出cs and gynecology (00) wi曲 的甘year of training being included. The attending faculty 旭Obstetrics and Gynecology were 叫so surveyed 訟a control (69% response ra妞，9 out of 13). The scored survey included ques討ons on knowledge and use of emergency contraception. An opinion que到on whether or not 曲ey believed emergency contraception was a fonn of abortion was asked, but not scored. RESULTS:Overall (including attending physicians), 29.6% of responders have pre此ribed emergency con叮叮epti側，7.4兮兮counsel their patien包 扭 曲e availability and proper 凶age ， and 36.2% believe it to be a fonn of ab。而on. 句Spe“ci泊f 白ic偈ally 砂y， 悶I 8.3 % of resident 切hlOU 凶 』尬se 臼st旭aff have pres鈴cr吋ibed emergency ∞ c。n甘齡e 句pμtωi 泊 。n 吼， 5.6% had counseled their patients 。∞ n 凶e 吼， 組d were surveyed
regarding 戶S峙。i個I
Speci泌的surveyed
泊8 3
。 o f油。吋。侃 n
either prescribing 。叮r ∞ c。m揖ling of emergency survey w自significantly different based on speci到ty of training (p
contraception.
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甘le av叮咚e 詞。re on 也e
MENSTRUAL FUNCTION AND PUBERTAL DEVELOP加IENTIN CONGENITAL CARDIAC PATIENTS.LisaA. Chi.Wayne H. Franklin , 恥血， Hugh D. Allen , MD , John Hayes , P hD, Barbara A. Cromer, MD , The Ohio State University and Children's Hospital , Columbus, OH. BACKGROUND:As the population of children with congenital heart disease moves into adulthood , an emerging cohort of adolescents with unique problems needs to be addressed. Th is study examines menstrual function and pubertal development of females visiting a pediatric cardiology clinic. METHODS:Female patients (N= 143) aged to to 28 (median age = 13.8 yrs.) completed a IO-question gynecologic history. Exclusionary criteria included any fonn of honnonal 甘eatment or concurrent diseases known to affect menstrual function. Control group comprised patients referred to the cardiology clinic and found not to have structural heart disease. Other pertinent clinical infonnation was recorded during chart review. Patients were divided into 3 groups: cyanotic (n=25), acyanotic (n=66), and no (n=52) heart disease (HD). Variables among 出e study groups were compared with ANOVA and Chi square analysis, and multiple regression was perfonned to assess their relationships to menstrual function and pubertal development. RESULTS:Women with a history off血， and especially those with a history of cyanotic f白， had a significantly later age at menarche compared to 出ose with no HD even while controlling for age and body mass index (B間 ) (mean age at menarche: HD 12.例 如 . vs no HD 12.10 yrs. , p< 0.01; cyanotic HD 13.6 yrs. vs no HD 12.1 yrs., p<0.005). Of I函，gynecologic age and B 間， HD accounted for the most variance in age at menarche (p<0.02). Patients with a history of cyanotic HD and gynecologic age> 3 yrs. were found to be 5 times more likely to have skipped at least one period within the past year as compared to those with acyanotic or no HD (p<0.05). Of the patients who were premenarcheal , significantly more girls with HD were at a prepubertal level of breast development despite no difference in chronologic age with the prepubertal control group (p<0.05). CONCLUSIONS:Women with heart disease may have delayed pubertal milestones , later menarche, and increased likelihood for amenorrhea than women without heart disease. Primary care providers must be aware of the special needs of this population
USE OF URINE LIGASE CHAIN REACTION TO IDENTIFY THE ASYMPTOMATIC ADOLESCENT FEMALE WITH CHLAMYDIA GENITOURINARY INFECTION. Tamara I Pottker , MD , Frank M Biro , MD , Shirley F Reising , PhD , Christopher A Von Volborth , MA , MT. Divisions of Emergency Medicine , Adolescent Medicine , and Infectious Diseases , Children's Hospital Medical Ctr. , Cincinnati , OH. BACKGROUND: Lig a s e chain reaction (LCR) is a diagnostic modality with excellent sensitivity for the detection of chlamydia. This study compared urine and endocervical LCR to chlamydia culture , and clinical performance characteristics between those with and without symptoms.METHOD: Patients (ages 13-21) were enrolled from an adolescent clinic (N = 317) and a pediatric emergency room (N = 62). Clinical history was collected prospectively , distinguishing between spontaneous and elicited symptoms. Endocervical specimens were obtained for chlamydia culture , LCR , and slide for confirmation by DFA. Sensitivity and specificity for each of the methods were calculated , and tests results compared by symptom status.RESULTS: Mean age was 16.6 yrs (± 1.9). The majority of the patients were African-American (N = 275 , 72.6%). The total number of those positive by culture was 10.8% , endocervical LCR 14.5% , and urine LCR 12.7%. The sensitivity and specificity of each test follow: culture 72.2 and 99.7; endocervical LCR 92.5 and 98.6; and urine LCR 84.6 and 98.9. A total of 147 (38.8%) patients were asymptomatic; among these , 112 urine LCR were performed , with chlamydia prevalence of 15 % and urine LCR sensitivity 82.4%.CONCLUSIONS: Both urine and endocervical LCR have superior sensitivity with similar specificity t 。 chlamydia culture. The prevalence among asymptomatic adolescent females was 15% , and urine LCR detected the majority of asymptomatic infections (82%). In this study , 32% of infections occurred among the asymptomatic. Previous studies have documented the likelihood of transmitting an STD (gonorrhea) is greater among the asymptomatic than the symptomatic. Urine LCR is a potentially effective tool to help eliminate the burden of infection among adolescents.
DOXYCYCLINE SCLEROTHERAPY OF A SY加lPTOMATIC PARAVAGINAL MESONEPHRIC DUCT REMNANT.Robert Cooke. MD.Shona Murray， 齡的， University of Kentuc旬， Lexington, KY. BACKGROUND:A Gartner's duct cyst associated wi曲a vaginal ectopic ureter is a rarely reported fmding in the literature. Treatments for 曲is anomaly include observation or surgical excision when symptomatic. SclerotherapγIS 企'equently 凶ed 扭 曲e management of recurrent pleural effusions. One au曲。r has described the use of tetracycline sclerotherapy to successfully treat vaginal and vulvar Gartner's duct cysts. O叮objective was to evaluate 曲e effectiveness of doxycycline sclerotherapy in 血e treatment ofa symptomatic Gartner's duct cyst associated with a vaginal ectopic ureter. CASE: A 17 year old nulligravid white female was refe甘ed for evaluation of a congenital gynecologic anom叫y and a heavy vaginal discharge. She had been evaluated previously for gross hematuria and was found to have a bicornuate u脂rus and congeni個l absence of the right kidney. Cyωscopic evaluation had revealed an ectopic right ureter 曲at opened into a right paravaginal cavity. At laparotomy 也e ectopic ure臼rw臼ligated at the bladder, however, the paravaginal cavity could not be approached abdominally. 甘le p訂avaginal mass was then explored, but not excised, via a vaginal approach. 甘le patient subsequently experienced heavy vaginalleaking of a serous fluid 企om 曲e ostomy 曲 at had been created vaginally. 甘le drainage was sufficiently heavy to require continuous use of incontinencepads and to interfere with normal 也i1y activities. At 曲is point she was referred to our care. A Technetium-labeled Dimercaptosuccinic Acid (DMSA) renal scintigram demonstrated 曲e absence of functional renal tissue around 曲e paravaginal cav旬， and communication to the bladder was ruled out by a fIstulogram. 甘lis anomaly was believed to represent a Gartner's duct cyst 曲at had previously been communicating wi曲the bladder via an ectopic vaginal ureter. To avoid further surgical intervention. the symptomatic cavity w趟 出en treated medically with doxycycline sclerotherapy. One gram of doxycycline was mixed wi曲100 cc of normal saline 個d 20 cc of I% lidocaine to provide topical 組自由es旭. 甘lis solution was then infused into 曲e paravaginal cavity via a hysterosalpingogram catheter where it remained for 1-2 hours on three separate occasions over a 3 mon也period. 甘冒e patient noted a marked reduction in the amount of leaking from 出e paravaginalcavity, and did not experience any side effects or complicatio
164
CURRENT KNOWLEDGE AMONG PRIMARY CARE RESIDENT PHYSICIANS IN USING EMERGENCY CONTRACEPTION.Geon!e M. Veloudis. Jr.. DO.Shona C. Murray, MD. University ofKentuc旬， Lexington, KY. BACKGROUND:Emergency con甘aception isωed after unprotected intercourse 旭 m at臼mptωprevent an unwanted pregnancy. Emergency contraception has been largely under-utilized 旭this country. Potenti剖 間越ons for under-utilization of 也is form of pre伊ancy prevention could include lack of p前ient knowledge, lack of physician knowled阱， and reluctance ωprescribe b臼ed on 泊。甜on belief. 甘le p山pose of 曲is survey w臼to detennine physician knowled阱，op旭ion， and experience with emergency con甘aception.
ME凹ODS:
軒旭ary
care specialty hoωes個ff physicians at 也e University of Kentucky contraception (40.5% response ra妞， 81 out of 200). included family practice (駒，扭扭mal medicine (IM), pedia剖cs 伊D)， and obste出cs and gynecology (00) wi曲 的甘year of training being included. The attending faculty 旭Obstetrics and Gynecology were 叫so surveyed 訟a control (69% response ra妞，9 out of 13). The scored survey included ques討ons on knowledge and use of emergency contraception. An opinion que到on whether or not 曲ey believed emergency contraception was a fonn of abortion was asked, but not scored. RESULTS:Overall (including attending physicians), 29.6% of responders have pre此ribed emergency con叮叮epti側，7.4兮兮counsel their patien包 扭 曲e availability and proper 凶age ， and 36.2% believe it to be a fonn of ab。而on. 句Spe“ci泊f 白ic偈ally 砂y， 悶I 8.3 % of resident 切hlOU 凶 』尬se 臼st旭aff have pres鈴cr吋ibed emergency ∞ c。n甘齡e 句pμtωi 泊 。n 吼， 5.6% had counseled their patients 。∞ n 凶e 吼， 組d were surveyed
regarding 戶S峙。i個I
Speci泌的surveyed
泊8 3
。 o f油。吋。侃 n
either prescribing 。叮r ∞ c。m揖ling of emergency survey w自significantly different based on speci到ty of training (p
contraception.
句 a，ppe缸tω 。e缸 能 eet
甘le av叮咚e 詞。re on 也e
MENSTRUAL FUNCTION AND PUBERTAL DEVELOP加IENTIN CONGENITAL CARDIAC PATIENTS.LisaA. Chi.Wayne H. Franklin , 恥血， Hugh D. Allen , MD , John Hayes , P hD, Barbara A. Cromer, MD , The Ohio State University and Children's Hospital , Columbus, OH. BACKGROUND:As the population of children with congenital heart disease moves into adulthood , an emerging cohort of adolescents with unique problems needs to be addressed. Th is study examines menstrual function and pubertal development of females visiting a pediatric cardiology clinic. METHODS:Female patients (N= 143) aged to to 28 (median age = 13.8 yrs.) completed a IO-question gynecologic history. Exclusionary criteria included any fonn of honnonal 甘eatment or concurrent diseases known to affect menstrual function. Control group comprised patients referred to the cardiology clinic and found not to have structural heart disease. Other pertinent clinical infonnation was recorded during chart review. Patients were divided into 3 groups: cyanotic (n=25), acyanotic (n=66), and no (n=52) heart disease (HD). Variables among 出e study groups were compared with ANOVA and Chi square analysis, and multiple regression was perfonned to assess their relationships to menstrual function and pubertal development. RESULTS:Women with a history off血， and especially those with a history of cyanotic f白， had a significantly later age at menarche compared to 出ose with no HD even while controlling for age and body mass index (B間 ) (mean age at menarche: HD 12.例 如 . vs no HD 12.10 yrs. , p< 0.01; cyanotic HD 13.6 yrs. vs no HD 12.1 yrs., p<0.005). Of I函，gynecologic age and B 間， HD accounted for the most variance in age at menarche (p<0.02). Patients with a history of cyanotic HD and gynecologic age> 3 yrs. were found to be 5 times more likely to have skipped at least one period within the past year as compared to those with acyanotic or no HD (p<0.05). Of the patients who were premenarcheal , significantly more girls with HD were at a prepubertal level of breast development despite no difference in chronologic age with the prepubertal control group (p<0.05). CONCLUSIONS:Women with heart disease may have delayed pubertal milestones , later menarche, and increased likelihood for amenorrhea than women without heart disease. Primary care providers must be aware of the special needs of this population
USE OF URINE LIGASE CHAIN REACTION TO IDENTIFY THE ASYMPTOMATIC ADOLESCENT FEMALE WITH CHLAMYDIA GENITOURINARY INFECTION. Tamara I Pottker , MD , Frank M Biro , MD , Shirley F Reising , PhD , Christopher A Von Volborth , MA , MT. Divisions of Emergency Medicine , Adolescent Medicine , and Infectious Diseases , Children's Hospital Medical Ctr. , Cincinnati , OH. BACKGROUND: Lig a s e chain reaction (LCR) is a diagnostic modality with excellent sensitivity for the detection of chlamydia. This study compared urine and endocervical LCR to chlamydia culture , and clinical performance characteristics between those with and without symptoms.METHOD: Patients (ages 13-21) were enrolled from an adolescent clinic (N = 317) and a pediatric emergency room (N = 62). Clinical history was collected prospectively , distinguishing between spontaneous and elicited symptoms. Endocervical specimens were obtained for chlamydia culture , LCR , and slide for confirmation by DFA. Sensitivity and specificity for each of the methods were calculated , and tests results compared by symptom status.RESULTS: Mean age was 16.6 yrs (± 1.9). The majority of the patients were African-American (N = 275 , 72.6%). The total number of those positive by culture was 10.8% , endocervical LCR 14.5% , and urine LCR 12.7%. The sensitivity and specificity of each test follow: culture 72.2 and 99.7; endocervical LCR 92.5 and 98.6; and urine LCR 84.6 and 98.9. A total of 147 (38.8%) patients were asymptomatic; among these , 112 urine LCR were performed , with chlamydia prevalence of 15 % and urine LCR sensitivity 82.4%.CONCLUSIONS: Both urine and endocervical LCR have superior sensitivity with similar specificity t 。 chlamydia culture. The prevalence among asymptomatic adolescent females was 15% , and urine LCR detected the majority of asymptomatic infections (82%). In this study , 32% of infections occurred among the asymptomatic. Previous studies have documented the likelihood of transmitting an STD (gonorrhea) is greater among the asymptomatic than the symptomatic. Urine LCR is a potentially effective tool to help eliminate the burden of infection among adolescents.
DOXYCYCLINE SCLEROTHERAPY OF A SY加lPTOMATIC PARAVAGINAL MESONEPHRIC DUCT REMNANT.Robert Cooke. MD.Shona Murray， 齡的， University of Kentuc旬， Lexington, KY. BACKGROUND:A Gartner's duct cyst associated wi曲a vaginal ectopic ureter is a rarely reported fmding in the literature. Treatments for 曲is anomaly include observation or surgical excision when symptomatic. SclerotherapγIS 企'equently 凶ed 扭 曲e management of recurrent pleural effusions. One au曲。r has described the use of tetracycline sclerotherapy to successfully treat vaginal and vulvar Gartner's duct cysts. O叮objective was to evaluate 曲e effectiveness of doxycycline sclerotherapy in 血e treatment ofa symptomatic Gartner's duct cyst associated with a vaginal ectopic ureter. CASE: A 17 year old nulligravid white female was refe甘ed for evaluation of a congenital gynecologic anom叫y and a heavy vaginal discharge. She had been evaluated previously for gross hematuria and was found to have a bicornuate u脂rus and congeni個l absence of the right kidney. Cyωscopic evaluation had revealed an ectopic right ureter 曲at opened into a right paravaginal cavity. At laparotomy 也e ectopic ure臼rw臼ligated at the bladder, however, the paravaginal cavity could not be approached abdominally. 甘le p訂avaginal mass was then explored, but not excised, via a vaginal approach. 甘le patient subsequently experienced heavy vaginalleaking of a serous fluid 企om 曲e ostomy 曲 at had been created vaginally. 甘le drainage was sufficiently heavy to require continuous use of incontinencepads and to interfere with normal 也i1y activities. At 曲is point she was referred to our care. A Technetium-labeled Dimercaptosuccinic Acid (DMSA) renal scintigram demonstrated 曲e absence of functional renal tissue around 曲e paravaginal cav旬， and communication to the bladder was ruled out by a fIstulogram. 甘lis anomaly was believed to represent a Gartner's duct cyst 曲at had previously been communicating wi曲the bladder via an ectopic vaginal ureter. To avoid further surgical intervention. the symptomatic cavity w趟 出en treated medically with doxycycline sclerotherapy. One gram of doxycycline was mixed wi曲100 cc of normal saline 個d 20 cc of I% lidocaine to provide topical 組自由es旭. 甘lis solution was then infused into 曲e paravaginal cavity via a hysterosalpingogram catheter where it remained for 1-2 hours on three separate occasions over a 3 mon也period. 甘冒e patient noted a marked reduction in the amount of leaking from 出e paravaginalcavity, and did not experience any side effects or complicatio