The document discusses the development of the female reproductive system from embryological development through adulthood. It covers stages from the neonatal period through puberty and adolescence, describing the anatomical changes that occur at each stage. The focus is on providing guidance for evaluating and examining pediatric and adolescent patients, including what to assess, techniques to use, and important considerations for each age group.
Gynecologic diseases in childhood are common. This review is intended to enable careful and sound management of pediatric patients as the initial assessment is paramount to proper management.
Overview normal physiological development; skeletal growth, maturation of the reproductive tract, development secondary sexual characteristics, CNS maturation, personality and psychology of the female adolescent.
Gynecologic diseases in childhood are common. This review is intended to enable careful and sound management of pediatric patients as the initial assessment is paramount to proper management.
Overview normal physiological development; skeletal growth, maturation of the reproductive tract, development secondary sexual characteristics, CNS maturation, personality and psychology of the female adolescent.
Alcances de la Ginecología Pediátrica en el INSNJorge Corimanya
El Servicio de Ginecología del INSN Lima Perú, fue fundado en Enero de 1995, con la finalidad de atender la frecuente patología ginecológica y obstétrica de niñas y adolescentes.
Alcances de la Ginecología Pediátrica en el INSNJorge Corimanya
El Servicio de Ginecología del INSN Lima Perú, fue fundado en Enero de 1995, con la finalidad de atender la frecuente patología ginecológica y obstétrica de niñas y adolescentes.
This presentation consist brief introduction about the IVF (In-vitro fertilization) in humans.
There are more than 15 slides which gives you basic study about the history of IVF, causes of IVF, basic steps involved in IVF process, ethical issues and etc.
Hope it will help you and make you easy to understand the IVF.
abruption. This is when the placenta partly or completely peels away from the inner wall of the uterus before delivery. With placental abruption, the developing baby might not get enough oxygen and nutrients. The pregnant person might have back or stomach pain and bleeding from the vagina. Placental abruption can lead to an emergency in which a baby needs to be delivered early.
Placenta previa. This condition happens when the placenta partly or totally covers the cervix. Placenta previa is more common early in pregnancy. It might get better on its own as the uterus grows.
Placenta previa can cause serious vaginal bleeding during pregnancy or delivery. Treatment depends on various factors. They include the amount of bleeding, whether bleeding stops, how far along the pregnancy is and the placenta's position. If placenta previa continues late into the pregnancy, a healthcare professional likely will recommend a C-section.
Placenta accreta. Most often, the placenta separates from the wall of the uterus after childbirth. With placenta accreta, part or all of the placenta stays firmly attached to the uterus. This condition happens when the blood vessels and other parts of the placenta grow into the uterine wall. This can cause serious blood loss during delivery.
Sometimes, the placenta invades well into the muscles of the uterus or grows through the uterine wall. If this happens, a healthcare professional likely will recommend a C-section followed by surgery to remove the uterus. This is called a C-hysterectomy.
The placenta is attached to the wall of the uterus. Most often, it attaches to the top, side, front or back of the uterus. Rarely, it might attach in the lower area of the uterus. When this happens, the placenta may block the passage that connects the uterus to the vagina, called the cervix. If the placenta is near the opening of the cervix, it's known as a low-lying placenta. If it partly or totally covers the opening of the cervix, it causes a condition called placenta previa.
What affects the health of the placenta?
Various factors can affect the health of the placenta, including:
Age of the pregnant person. Some conditions that affect the placenta are more common in older people, especially after age 40.
Water breaking before labor. During pregnancy, the developing baby is surrounded and cushioned by a fluid-filled layer of tissue called the amniotic sac. If the sac leaks or breaks before labor starts, it's known as the water breaking. This raises the risk of problems with the placenta.
High blood pressure. This condition can cause less blood to reach the placenta.
Being pregnant with twins or other multiples. Being pregnant with more than one baby might raise the risk of some conditions related to the placenta.
Blood-clotting conditions. Typically, blood hardens into a clump to help control bleeding from cuts. This process is called clotting. Sometimes, blood clots form inside the body and lead to medical problems. Conditions that ca
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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1. The General Principles of Gynecologic Evaluation and
Management of Pediatric and Adolescent Patients
Dr.Süleyman Engin Akhan
Dept. Of Obst.&Gyn.
2. Gonadal Differantiation
At approximately 5 th week of gestation the paired gonads are in the form
of gonadal ridges overlying the mesonephros.
The migration of primordial cells to this gonadal ridge starts at around 4-6
th weeks of gestation.
Gonads are “ bipotent” at the 6 th gestational week. It may be
differentiated to a ovary or a testes.
The testes development is an active process and it depends on “SRY
region” which is found in the short arm of Y chromosome. In the absence
of “SRY” , gonads become differentiated as on ovary.
3. The ovarian differentiation of a bipotent gonad in a XX embryo takes
place at around 8-9 gestational weeks.
At this stage germ cells get proliferated by rapid mitotic multiplication and
reaching 5-7 millon oogonia by 20 weeks.
After this stage follicle maturation and degeneration start. There are 1-2
million primordial follicle at birth.
The development of anterior pituitary takes place 4-5 weeks of gestation.
The hypothalamic-hyophyseal portal circulation becomes functional at 12
th gestational week.
FSH levels peak at 20- 23 gestational week.
4.
5. ♀Reproduktif Sistemin Embriyolojik Gelişimi
1. Development of pituitary gland
2. Migration of primordial germ
cells originate in the endoderm
of the yolk sac
3. Development of sex cords,
gonads and mullerian ducts
4. Sex determination
5. Development of ovaries and
genital ducts
6. Formation of broad
ligament
1.Trimester 2. Trimester 3. Trimester
2
1
3
4
5
6
72.Gün dişi farklılaşma
6. Genital Organ Farklılaşmasının Temeli
Sertoli Cells
AMH
Leading to regression
of mullerian ducts
Leydig Cells
Testosterone
Ensuring the continuity
of wolffian ducts
5--reductase
DHT
Development and virilization
of the external genitalia
7. The Uterus and Cervix During The Intrauterin and
Neonatal Period
There are both wolfian ducts ( mesonephric canal) and mullerian ducts
(paramesonephric canal) in the embryo till the 8 th week of gestation and
this period is known as bipotent period. At the 12 th gestational week one
of these disappears.
Differentiation is determined by the effect of antimullerian hormone (AMH)
secreted from Sertoli cells and testosteron secreted from Leydig cells.
If there is no AMH, the uterus, fallopian tubes and upper 1/3 of vagina
develop from mullerian canal.
8. Fusion of mullerian canal get
completed at 10 th gestational week,
canalization of uterine cavity and
development of cervical canal and
vagina is completed at 22 th week of
gestation.
At 20 th gestational week uterine
cavity is lined with endometrium and
original squamocolumnar junction
occurs.
9. In the neonatal period, breast tissue and uterus are under the effect of
placental oestrogen-progesteron and gonadotropins. Vaginal mucosa
and endometrium also proliferate under this effect.
Cervix-corpus ratio is 1/3. Vaginal pH’s asidic. Physiologic eversion
can be seen at the cervix.
Microscopic or macroscopic vaginal bleeding may be seen after birth
because of withdrawal of hormones and it may last 7- 10 days.
The vaginal bleeding seen after 15th postpartum day is always
pathologic.
Changes occuring because of placental and maternal origined
hormones encompass a period of 2 years.
10. Ovaries at the neonatal period
FSH and LH levels are high during neonatal period. FSH level
further increases during infancy.
FSH levels are high at 6 - l2 moths and at the same period
follicles respond to this elevated FSH-LH levels.
That is why the MOST FREQUENT abdominal mass in girls is
ovarian cysts till the age of 1.
11. Genital Organs and Ovaries During the Childhood Period
Childhood period is a period of
genital and hormonal silence.
Gonadotroph cells controlling
hypothalamo-hypophyseal system
are sensitive to the negative feed-
back effect of oestrogen 10- 15
times more compared to adult
period.
The mucosa of vaginal introitus is
pink and wet. Clitoris is small and
is about 5 cm in length. There are
a few rugae.
12. Genital Organs and Ovaries During the Childhood Period
Genital organs are susceptible to traumas and infections because of low
oestrogen levels.
Vaginal pH is notr or slightly alkaline and it has a mixed bacterial flora.
There are multipl follicles during childhood period. Number of follicle
decreases gradually. Ovaries expand their volumes with increasing age and
descent into minor pelvis.
İt is possible to see big follicles at this stage and it does not need any surgical
intervention or biopsy.
13. Stages Of a Women Life
1. Neonatal period (postpartum first
28 days)
2. Childhood period (till at the age
of 8)
3. Prepuberty and puberty period
(between the ages of 8 – l2)
4. Adolescence period (between the
ages 12 - 20)
5. Sexual maturity period(between
the ages of 18-50)
6. Climacterium and senium (after
the age of 50)
14. Gynecologic examination in pediatric patients
Basically, pediatric gynecological examination is very
simple,
Key points before the gynecological history and
examination :
Ensure that the child calm and cooperative
Gynecologist with confidence
Give confidence to the family
Parents or someone who they trust should support
children during examination
15. Gyneacologic Examination and Evaluation
Basic conditions for physical examination of the pediatric patient:
1. Time
2. Patience
3. Communication ability
4. Communication with family
5. Assistance (Educated nurse. staff )
6. Equipment
7. Good team work (Pediatry, Microbiology, Pediatric
surgery,Urology)
16. The history
The most important thing is to achieve incorporation of the
child. The history should be taken first from the child,
thenafter, you can talk to the parents.
İnterviewing with just parents may cause serious
incofidentiality problems.
History should be specifically focused on the main complain.
17. In the case of vulvovaginitis, it should be asked when the the symptoms
have begun and if there is any antibiotic use or urinary system anomaly
(such as VUR).
In the presence of vaginal bleeding, signs of puberty, growth curve of the
child, hormonal medication use history should be questioned thoroughly. In
both vulvovaginitis and vaginal bleeding conditions, doctor should ask
whether she is masturbating.
The possibility of foreign body should be remembered in the presence of
both vaginal discharge and bleeding.
18. Gyneacologic Examination
Those must be certainly evaluated in a girl’s gyneacologic
examination: Height- weight, head- neck, thoraks, heart,
abdomen, breast
An exact gyneacologic examination:
1.Inspection of external genital organs
2. Visualization of the vagina and cervix
3.Rectoabdominal palpation
19. Gynecologic examination of the newborn
Labia minora can be thick, protruding and stick out beyond labia
majora according tomaternal estrogenization.
Labia majora is pink and covered by physiological vaginal
discharge
Apparent estrogenization findings are present in the first 6-8 weeks
after birth
It can be hard to see vaginal
orifice and a urethral catheter
can be needed.
Vaginal length is approximately
4 cm.
20. Gynecologic examination of the child
What should be evaluated : Height-weight , head-neck, chest-
heart-abdomen-breast
Inspection of breasts is very important. Especially, color of the
areola should be carefully checked.
When there is Tanner stage I or II breast development with
dark brown areola, hormone use should be questioned.
21. The instruments and position used
Mother’s help is important, the
child should be kept in the frog
position.
Otoscope and lenses can also
used during inspection.
Another important inspection
instrument is mirror
The child should discover the
instruments to feel safe.
22. Inspection of external genital organs:
1. Pubic hair
2. Size of the clitoris
3. Anatomy of hymen
4. Signs of oestrogenisation in vagina and hymen
5. Perineal hygene .
In a prepubertal girl, clitoris is 3-4 mm in length and 2-3 mm in width.
Shape of hymen should be noted.
23. To inspect hymen and vagina:
Hands are placed to the perineum and
labium drawn up and sideways.
Labium majora is moved forward.
When the child coughs, a significant
part of vagina can be seen.
Labium should not move laterally
since it causes pain
24. Physical examination of vagina and cervix in Child
Above 2 year-age,vagina and
cervix are perfectly visualised in
knee-elbow position.
In the same position, otoscope
can be easily used.
Other visualisation merthods of
mentioned organs are
vaginoscope and hysteroscope.
25. Taking Vaginal Culture from Child
One of the most important points in vaginal examination is
sampling discharge, especially vaginal culture in the case of
sexual abuse.
Vaginal sample can be obtained by culture swabs. Swab is
inserted into the vagina witout touching hymen while the
child is coughing.
Anterior labial foldlarda kalın beyaz bir madde bulunur.
Buna smegma adı verilir ve lökore ile karıştırılmaması
gerekir.
26. In case of sexual assault, sampling is made by vaginal
washing with the help of an injector and serum set or
feeding tube.
Pokorny is a sampling made with 1 ml of SF through a 4
inch iv catheter placed in to no:12 bladdder catheter.
28. Obtaining material is followed by rectoabdominal examination.
Bimanual examination is performed by placing thumb on abdomen
and other finger in rectum.
Only cervix and vagina are palpable in rectovaginal examination. In
newborn period,uterus, under oestrogen effect, may be palpated as a
large mass.
Varies are located higher than in adulthood, therefore, palpation is
pathological.
Finally, as little finger is taken out of rectum, vagina is squeezed so
that a polypoid tumor can be detected.
Rektoabdominal Examination
30. The stages of adolescence
Early period: 12-14 years
Period of pubertal growth and menstruation.
They start separating from the family and interpret the family
according to their own values
Middle period: 15-17 years
They start creating their moral values and begin to make choices.
They interpret the rights and wrongs in their own again.
They begin to take risks in their relationship.
They care about their appearance and health more than before.
They argue with their parents.
Late period: 18-21 years
Formal thought is developed. They begin to consider possible
outcomes and consequences of actions.
They accept the parent's value and can even become a parent.
31. Development of the adolescent brain
The brain's remote control is the
prefrontal cortex, a section of the
brain that weighs outcomes, forms
judgments and controls impulses and
emotions. This section of the brain
also helps people understand one
another.
The prefrontal cortex is immature in
teenagers when compared to adults; it
may not fully develop until mid-20s.
(Kotulak, Randal 2004)
32. An area of the teenager's brain
that is fairly well-developed
early on is the nucleus
accumbens, or the area of
the brain that seeks pleasure and
reward.
In imaging results that
compared brain activity when
the subject received a small,
medium or large reward,
teenagers exhibited exaggerated
responses to medium and large
rewards compared to children
and adults. (Nature 442, 865-867, 2006)
33.
34. During adolescence,
The reward system is over reactive.
Nucleus accumbens is well developed and
dopaminergic activity is extremely high.
The neurobiologic system does not need to de-
activate the frontal cortex and the prefrontal
cortex, because they are already immature.
35. Psychologic State of Adolescence
Not a child anymore, but a sexual object. Potential sexual
partner for the opposite sex.
Reproductive functions are possible.
Body is fully developed, however psychologic state is not
mature yet.
The most important thing is that he/she does not have
control mechanisms for the instinctual behavior
The body is ready for reproduction and sexuality;
however the mind is not.
37. Transition from childhood to adulthood involves
becoming ‘Me’ instead of ‘Us’
It is important to emphasize the differences with
parents. The situation of the parents changes.
Has own opinions, interests, and moral values. From
US to ME: becoming a female or male
38. Gynecoogic examnination for
adolecents
Gynecologic examination of an adolescent cannot be
routine examination.
Three main objectives of the examination:
We ensure the right ambience and establish a
relationship based on trust with young girl who can
have deep emotional problems about sex, fertility or
puberty.
Clinically evaluate
Diagnosis and treatment
39. The clinician should spare enough time and take a
careful history, preferably also from parents. It is
important to listen and observe the patient
carefully.
Cultural values of the patient and the parents need
to be taken into account but treatment regulation
cannot be made carelessly without examination.
40. İmportant points
According to western literature: Adolescents should be
examined alone after 13 years old.
Istanbul University Faculty of Medicine Adolescent
Outpatient Service : We usually get history and examine
alone after 15-16 years old.
We should ask the adolescent whether she is sexually active
alone ve define the meaning of being sexually active.
41. What should be evaluated : Height-weight , head-neck, chest-
heart-abdomen-breast
Inspection of breasts is very important. It’s especially important
for the patients with primary or secondary amenorrhea.
42. Inspection of vulva and vagina
(Plast. Reconstr. Surg. 122: 1780, 2008.)
43. Our patient MK;
17 years old, height:1.62, weight: 43.
Reason for admission: oligomenorrhea. Age at menarche:13
She had used oral contraceptives for 1 year and she stopped
taking it 2 months ago. She hasn't had menstruation for 2
months.
Hormone profile: LH slightly ↓; FSH ↓; E2 ↓; P ↓. There is no
another feature.
Mild hirsutism, especially around neck; PCO like appearance
on ultrasound but do not meet Rotterdam Criteria.
Diagnosis: Anorexia nervosa
44. There is no significant difference between gynecological
examination of children and adolescents who are virgin. We
can use very small and thin speculums if necessary. After
examination, we should discuss the findings and treatment
options with the parents.
Pap smears are required for the patients who are sexually
active and talk the patient first about findings then you can
give the family the information with the patient's permission
and make a plan of treatment.
It is also absolutely necessary to give the patient some
information about birth control methods.
45. Diagnostic imaging methods -I-
ULTRASONOGRAPHY
Abdominal ultrasound is very efficient for
the pediatric patients. A good image can
be obtained by reason of thin
subcutaneous fat tissue before puberty.
When there is a suspicion of early puberty
abdominal ultrasound is also efficient to
rule out ovarian pathology.
Transrectal ultrasound is also performed
to follow-up of patients who were
diagnosed with cancer and operated or in
the presence of suspicion of malignancy
after 12 years old.
46. Diagnostic imaging methods -II-
MR
MR can be performed in
the presence of suggestive
symptoms of sarcoma
botryoides or suspicion of
adnexal mass for the
pediatric patients.
In the presence of
suggestive symptoms of
Mullerian anomaly for the
48. Vaginoscopy in Pediatric Patients
The main indication for
vaginoscopy in pediatric patients is
bloody vaginal discharge.
We are using office hysteroscopy
for this purpose.
I always prefere to take the mother
in the operating room !!
The procedure is so simple.
49. The most common pathology in
pediatric patient with vaginal
discharge or bleeding is foreign
body.
8 years old girl with vaginal
bleeding and examine by pediatric
endocrinology because of puberty
precox.
There is no stigmata for the
puberty precox
Hormonal profile is normal
50. Vaginoscopy should not be postponed in pediatric patients with
bloody vaginal discharge.
9 years old girl with real
puberty precox
She was using GnRH analogue
and aromatase inhibitor.
She have a unstoppable vaginal
bleeding! With vaginal heavy
discharge
Primary Clear Cell Vaginal Ca
51. Hysteroscopy in Adolescent Patients
Main indication for hyteroscopic surgery in adolescent patient is
dysfunctional uterine bleeding (DUB)
15 years old girl, with vaginal heavy
bleeding and anemia.
She used different medication
including GnRH analogues
BMI= 46.2 !!
52. Common Problems in Pediatric
Gynecology
Vulvovaginitis
Vaginal bleeding
Genital trauma
Labial fusion
Early puberty - cliteromegaly
53. Common Problems in Adolescent
Gynecology
Gynecologic Endocrinology
Dysfunctional uterine
bleeding
Vaginal discharge
Dysmenorrhea
PCOS
Primary amenorrhea
Premature ovarian failure
Gynecologic Surgery
Intersex disorders and
surgİcal treatment
Clitoral surgery
Gonadectomy
Mullarian system
abnormalities
Management of adnexal
mass