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Biomedical subjects

Paula J Adams Hillard

Publications and source records attributed to Paula J Adams Hillard.

At least 19 recordsLinked to original sources
PubMed2006

Vulvar ulcers in young females: a manifestation of aphthosis.

STUDY OBJECTIVE: To examine the etiology, clinical course, and outcomes of non-sexually transmitted vulvar ulcers in young females. DESIGN: A prospective cohort study of subjects referred to a tertiary center who had active vulvar ulcers and no evidence of sexually transmitted infections were evaluated with a structured clinical and laboratory protocol and followed with visits or telephone calls. RESULTS: Twenty eligible subjects had a mean age of 14 years (range 10-19), and five were premenarchal. Nineteen reported systemic symptoms such as fever, malaise, and headache. Most ulcers were >1cm in diameter (range 0.3-5 cm) and were located on the medial aspect of the labia minora. All viral, bacterial, and fungal cultures were negative. Serologic testing for Epstein-Barr virus (EBV) infection demonstrated 10 subjects with evidence of prior infection, two with acute infection, one indeterminate, and seven negative for infection. Two subjects had evidence of possible acute cytomegalovirus (CMV) infection. Other laboratory findings were nonspecific. The median duration of pain was 10 days (range 6-30), and 75% healed by 21 days. Follow up was available for 19 subjects (median 14 months). Seven experienced recurrent ulcers 2-16 months after the initial episode, and 10 had experienced oral aphthous ulcers. None met criteria for other etiologies of vulvar ulcers reported in the literature. CONCLUSIONS: No single infectious agent was identified as a cause of vulvar ulcers. Most cases were not temporally associated with either acute EBV or CMV infection. These ulcers are consistent with aphthous major or complex aphthosis that arise in response to acute illness.

Adolescent↗
PubMed2006

Adolescent menstrual health.

Attention to pubertal development and menstrual health is an important aspect of primary care for adolescents. Textbooks may not provide sufficient evidence-based guidance to facilitate the early detection of gynecologic disease states and conditions. Conversely, the typical guidelines for pubertal development may lead to over-evaluation of normal girls. Chaotically irregular and unpredictable bleeding is NOT the norm during adolescence. On the contrary, although many early menstrual cycles are anovulatory, most adolescents have menstrual cycles that fall within the parameters of 21-45 days. Adolescents with menstrual bleeding that is less frequent than every 45 days, is prolonged > 7 days, or is excessively heavy should be evaluated in order to detect conditions such as eating disorders, polycystic ovary syndrome, and von Willebrand disease. Clinicians who attend to adolescent menstrual cycles can help set the stage for future health.

Adolescent↗
PubMed2005

Overview of contraception.

The United States has the highest rates of adolescent pregnancy of any Western industrialized country. Addressing these high rates and preventing adolescent pregnancy are complicated tasks. This article addresses some of the issues involved with preventing adolescent pregnancy, focusing on contraception.

Abortion, Induced↗
PubMed2005

Oral contraceptives and the management of hyperandrogenism-polycystic ovary syndrome in adolescents.

Appropriate management of polycystic ovary syndrome in adolescents depends on recognizing the syndrome, which can have a variety of presenting complaints and must be differentiated from other causes of hyperandrogenism, as well as not dismissed as "normal adolescence." Oral contraceptives have long been considered the first line of treatment by obstetrician/gynecologists and have many advantages in treating the aspects of PCOS that are most bothersome to teens. Because of the potential risk for cardiovascular disease, early diagnosis and management may be helpful in minimizing the risk of the early metabolic correlates of adult disease.

Adolescent↗
PubMed2005

Menstrual disorders in the college age female.

College-age young women frequently experience a variety of menstrual-related complaints, including dysmenorrheal, menorrhagia, irregular menses, and menstrual-related mood changes. These problems deserve careful evaluation; they may reflect normal ovulatory menstrual symptoms or be suggestive of significant pathology that can have a major impact on future reproductive and general health. The menstrual cycle is a vital sign whose normalcy suggests an overall good health and whose abnormality requires evaluation. Eating disorders and the female athlete triad increase the risk of osteoporosis; polycystic ovary syndrome is associated with future cardiovascular risks. Diagnosis and management of these problems will not only improve a young woman's current health, sense of well-being, and overall quality of life but may also lower her risks for future disease and ill-health. This article addresses normal menstrual function, excessive bleeding, infrequent or absent menses, pain with menses, menstrual-related mood disorders, and recommendations about routine gynecologic examinations and evaluation.

Female↗
PubMed2005

Adnexal torsion in pediatric and adolescent girls.

PURPOSE OF REVIEW: This review provides timely information to assist in solving the diagnostic dilemma of adnexal or ovarian torsion. Knowledge and awareness of current literature is essential to help clinicians improve diagnostic accuracy and avoid potentially catastrophic consequences, including loss of ovarian tissue and function. RECENT FINDINGS: This article reviews recent evidence regarding radiologic tools used for efficient, timely diagnosis and management strategies for adnexal torsion, including detorsion. The role of oophoropexy in the pediatric and adolescent population is also reviewed. SUMMARY: The discussion reinforces the role of detorsion in lieu of oophorectomy or adnextomy in an effort to preserve reproductive capacity in a young population. Long-term follow-up, including reproductive outcomes, is needed to determine the role of oophoropexy.

Abdominal Pain↗
PubMed2005

Female genital mutilation.

PURPOSE OF REVIEW: The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation. RECENT FINDINGS: The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor. Additionally, as people continue to try to eliminate female genital mutilation through human rights campaigns and the legal system, they have also become increasingly aware that understanding the motives behind this traditional practice may be an avenue towards change. SUMMARY: The fundamental understanding of female genital mutilation will allow the clinician to address the emotional and physical needs of the children, girls, and women who have undergone this traditional practice or who are at risk for undergoing this practice. This understanding will allow the practitioner to individualize the history and physical examination, and to provide appropriate management with recognition and treatment of complications. Increased knowledge of the laws against female genital mutilation will allow the healthcare provider to educate and advise at-risk girls and women as well as their parents.

Adolescent↗
PubMed2005

Contraceptive behaviors in adolescents.

A wide range of factors influence adolescents' contraceptive behaviors, from personal characteristics to family context to social support to knowledge about and access to contraception. Improving knowledge about contraception and counseling about successful contraceptive use can be helpful in decreasing the remarkably high US rates of adolescent pregnancy. Encouraging the postponement of sexual activity until an individual adolescent is developmentally capable of participating in a mature, healthy, mutually respectful relationship that incorporates effective contraception clearly is a goal that most clinicians, parents, teachers, and other responsible adults can support. Contraceptive technologies that incorporate delivery systems that are "user-friendly" and long-acting also will help to further lower US adolescent pregnancy rates that, while improving, are currently among the highest in the world.

Abortion, Induced↗
PubMed2004

Unusual vulvar ulcerations in young adolescent females.

STUDY OBJECTIVE: To review a series of young female patients who presented to the Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, from July of 1996 to November of 2001 with new, unexplained vulvar ulcerations, in order to elucidate common factors. DESIGN: Retrospective case series. SETTING: Cincinnati Children's Hospital Medical Center and its satellite offices. PARTICIPANTS: Female patients who have never been sexually active or abused who presented with the diagnosis of vulvar ulcerations. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Description of clinical features. RESULTS: Nine patients who developed vulvar ulcerations and denied sexual contact or sexual abuse were identified. Eight of nine were premenarchal. All nine had negative Herpes Simplex Virus (HSV) cultures from the lesions, and three had negative HSV serology. Negative Epstein Barr virus (EBV) tests were documented in six patients. Lesions were recurrent in three patients. The diagnosis of Behcet's disease was considered in three patients. The remaining six patients had systemic complaints consistent with a viral syndrome at the time of the vulvar ulcerations, but no definite etiology could be documented. CONCLUSION: The rare finding of a vulvar ulcer in a sexually inexperienced patient can result in a diagnostic dilemma in the absence of signs of systemic illness such as Crohn's disease, Behcet's syndrome or EBV infection. These ulcers could be a local manifestation of a non-sexually transmitted systemic viral infection that has yet to be identified. The occurrence in premenarchal females suggests the possibility of mediating hormonal factors.

Adolescent↗
PubMed2003

Adolescent girls, the menstrual cycle, and bone health.

In adolescent girls, amenorrhea is sometimes viewed as a variant of normal; in fact, however, during the first gynecologic year, the 95th percentile for cycle length is 90 days. Although early menstrual cycles are frequently anovulatory and may be somewhat irregular, girls with menses coming less frequently than every 90 days may have significant pathology associated with hypoestrogenism. Hypoestrogenism is a known risk factor for the development of osteoporosis. Causes of oligomenorrhea and amenorrhea include the relatively common conditions of hyperandrogenism, eating disorders, and exercise-induced amenorrhea, as well as uncommon conditions such as pituitary tumor, gonadal dysgenesis, and premature ovarian failure. Even functional hypothalamic oligomenorrhea has been linked to reduced bone density. Attention to menstrual irregularity and the earlier diagnosis of conditions causing it may lead to interventions that will benefit life-long bone health.

Adolescent↗
PubMed2003

Sexually transmitted disease screening in teens.

Sexually transmitted diseases (STDs) impose a tremendous health burden on women, and adolescent females are the group at the highest risk. Universal annual screening of all women younger than 25 years of age has been a best practice recommendation since 1997. When implemented, such screening leads to a decrease in disease prevalence and of serious sequelae, such as pelvic inflammatory disease (PID). However, STD screening rates in actual clinical practice fail to approach recommendations. In this review, we summarize findings from recent surveys of providers and adolescents, discuss barriers to STD screening, and offer strategies for individual clinicians to improve STD screening rates in practice.

Adolescent↗
PubMed2002

Menstruation in young girls: a clinical perspective.

The ACOG has recommended that the initial visit to an obstetrician-gynecologist for health guidance, screening, and provision of preventive services should take place around age 13-15. At this visit, clinicians can provide guidance to young girls and their parents on adolescent physical development based on data that define parameters for normal pubertal development, menarche, and menstrual cyclicity, and address menstrual hygiene and emerging adolescent concerns. Adolescent menstrual cycles are initially variable, but this variability does not imply that there are no useful parameters for menstrual cyclicity. Data indicate that cycles typically range from 21 to 45 days, even in the first few gynecologic years. Individuals with cycles that vary widely from this norm may have significant pathology, most commonly hyperandrogenism or polycystic ovary syndrome. Controversy now exists regarding the lower limits for the onset of pubertal development in girls; data suggest that pubertal growth may be occurring earlier than had previously been described. The age of menarche has remained constant. Clinicians can furnish information about menstrual hygiene and menstrual protection and provide parental and teen guidance with printed patient education materials and suggested Web-based sources of information. The provision of anticipatory guidance and information to young girls and their parents can help ease the transition from childhood through puberty and a healthy adolescence.

Adolescent↗