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Purpose: Despite the increasing number of childhood cancer survivors, significant advances in ovarian tissue cryopreservation (OTC) technique and medical societies' recommendations, fertility preservation (FP) and FP discussions are not always offered as a standard of care in the pediatric context. The aim of this literature review is to understand what ethical, legal, social, and policy issues may influence the provision of FP by OTC in prepubertal girls with cancer. Methods: A critical interpretive review of peer-reviewed papers published between 2000 and January 2023 was conducted, guided by the McDougall's version of the critical interpretive synthesis (Dixon-Woods), to capture recurring concepts, principles, and arguments regarding FP by OTC for prepubertal girls. Results: Of 931 potentially relevant papers, 162 were included in our analysis. Data were grouped into seven thematic categories: (1) risks of the procedure, (2) unique decision-making issues in pediatric oncofertility, (3) counseling, (4) cultural and cost issues, and (5) disposition of cryopreserved reproductive tissue. Conclusion: This first literature review focusing on ethical, legal, social, and policy issues surrounding OTC in prepubertal girls highlights concerns in the oncofertility debate. Although OTC is no longer experimental as of December 2019, these issues could limit its availability and the child's future reproductive autonomy. This review concludes that specific actions must be provided to enable the offer of FP, such as supporting families' decision-making in this unique and complex context, and providing pediatric patients universal and full access to free or highly subsidized OTC. [ABSTRACT FROM AUTHOR]

Background: In Scandinavian countries, programs for fertility preservation (FP) are offered free of charge at tertiary-care university hospitals to all patients facing infertility risks due to malignant diagnoses or benign conditions. In this prospective study we aimed to investigate trends and outcomes of FP indicated by a diagnosis of Turner syndrome. Methods: Prospective cohort study of patients with Turner karyotype receiving fertility preservation counselling at the Karolinska University Hospital between 1 January 1999 and 31 December 2021. Results: The cohort included 100 women and girls that received counselling, whereof 27% were prepubertal girls, 59% were adolescents and 14% of adult age. Before 2006 all patients were referred for fertility counselling at the time of Turner diagnosis. Based on updated guidelines, mainly patients who showed signs of puberty were referred after 2006. As a result, spontaneous menarche was more common in the later period. In total, 39% of the cohort had monosomal karyotype (45X), 20% had 45X/46XX or 45X/47XXX mosaicisms and 36% had an X-chromosomal structural anomaly. Ovarian tissue cryopreservation was planned for 73% of all patients, and oocyte cryopreservation following gonadotropin stimulation was planned for 10% of the patients. Follicles were present in 25% of all biopsies analyzed. Adolescents were more likely to have follicles present (30%) than prepubertal girls (16%) or adult women (17%). The ten patients that underwent gonadotropin stimulation for oocyte cryopreservation underwent a total of 15 cycles and eight patients successfully preserved oocytes. In total, 26% of the cohort has undergone fertility treatment or expressed further interest in fertility preservation. Six women have given birth using donated oocytes and three following spontaneous conception. Two women have undergone re-transplantation of cryopreserved ovarian tissue, without regaining ovarian function, and none of the women that have cryopreserved oocytes has returned to use them. Conclusion: Fertility counselling for girls with Turner syndrome should ideally be offered at onset of spontaneous puberty to improve the chances of fertility preservation. Since the girls and women in this cohort are still young, the return rate and utilization of the preserved tissue and oocytes is expected to increase with time. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Enlargement and cystic changes in ovaries of patients with long-standing overt hypothyroidism have been described in numerous case reports. However, there are limited data about the effect of subclinical hypothyroidism (SH) on ovarian volume. The aim of the study is to evaluate the relationship between serum thyroid stimulating hormone (TSH) level and ovarian volume in prepubertal girls with SH. METHODS: Patients who were aged between 6 and 10 years and diagnosed with SH and age-matched healthy euthyroid controls were enrolled in the study. All subjects were prepubertal. RESULTS: Thirty-five children with SH (mean age; 7.6±1.0 years) and 50 euthyroid healthy girls (mean age; 7.7±1.2 years) were enrolled in the study. TSH and LH levels and both ovarian volumes were significantly higher in SH group than controls (p<0.05). In addition, TSH was positively correlated with ovarian volumes and LH in patients with SH (p<0.05). CONCLUSION: The results of this study showed that ovarian volumes of prepubertal girls with SH were significantly greater than those with normal thyroid function. Although ovarian enlargement and cyst formation is well recognized in long-standing overt hypothyroidism, it has been shown for the 1st time in patients with SH. [ABSTRACT FROM AUTHOR]

This is the first case describing vaginal papillomatosis with a fibroepithelial polyp of the vulva in a prepubertal girl and vaginal papillomatosis in her twin sister. Parents contacted pediatric urologist regarding their eight-year-old daughter (twin A), who had a growth next to the external urethral meatus. The girl was referred to a pediatric surgeon. The exophytic 3 cm long structure with necrosis on top was found. After obtaining informed consent from girl parents, pediatric surgeon removed the exophytic structure and perform cystoscopy and vaginoscopy for possible changes in the bladder and vagina. Cystoscopy findings were normal. On vaginoscopy, numerous macroscopic papillomatous structures were identified on the cervix and vaginal walls. Vaginal biopsies were performed on the areas affected by papillomatosis. Histopathologic examination showed a fibroepithelial polyp with a central fibrovascular core covered by squamous epithelium and vaginal squamous papillomatosis. The decision was made to perform vaginoscopy on her twin sister (twin B), too. On vaginoscopy, solitary small vaginal papillomas were also found. In this case manifestation of vaginal papillomatosis in twins might have been influenced by inheritance and the same bacterial and viral environment.

Purpose: This study evaluated the concentrations of hormones resulting from the transplantation of ovarian tissue (OTT) in relation to whether the tissue was frozen at a time close to puberty or above the age of 19 years. Methods: Six girls and adolescents (aged 9–14 years) who underwent ovarian tissue cryopreservation (OTC) were followed after transplantation in adulthood. After OTT, the women were followed via regular blood samples to evaluate the concentrations of FSH, LH, oestradiol and AMH. Twenty-three women undergoing OTT (aged 19–36 years at the time of OTC) were included as a reference group. All of the women had postmenopausal levels of gonadotropins at the time of transplantation. Results: The return of FSH and LH to normal premenopausal concentrations in adult women transplanted with ovarian tissue that was frozen at a time close to puberty was similar to the profiles in women from the reference group. Serum AMH levels were below the detection limit (via the Roche Elecsys assay) in many samples, but four out of six young girls showed measurable concentrations. Oestradiol similarly increased in the first 12 weeks following transplantation, after which it tended to be higher in women having frozen tissue in adulthood. Conclusions: Ovarian tissue that was excised from girls at a time close to puberty, after which it was frozen and transplanted in adulthood, interacts with pituitary tissue in a similar manner to ovarian tissue that is frozen from adult women. Follicles located in the ovarian tissue from young girls are equally sensitive to gonadotropin stimulation as follicles from adult women when exposed to postmenopausal levels of gonadotropins. This result indicates that it is not the ovaries that require maturation to sustain full reproductive potential but rather proper FSH and LH stimulation. Moreover, these results support the continued use of OTC in young women. [ABSTRACT FROM AUTHOR]

As a cause of vulvovaginitis in prepubertal girls, Streptococcus pyogenes (S. pyogenes) is commonly isolated from vaginal introitus swabs. Studies have identified several risk factors, but have not focused on the correlation between ambient air pollutants and S. pyogenes-induced vulvovaginitis in prepubertal girls. This study was conducted to determine whether ambient air pollutants were associated with S. pyogenes-induced vulvovaginitis in prepubertal girls. Daily data about S. pyogenes-induced vulvovaginitis in prepubertal girls from the outpatient department of Children's Hospital at the Zhejiang University School of Medicine in Hangzhou City between January 1, 2015, and December 31, 2018, were retrospectively reviewed. Ambient air pollutants in Hangzhou were measured daily. A generalized additive model (GAM) was utilized to assess the associations between daily air pollutants and S. pyogenes isolates obtained from vaginal introitus swabs of prepubertal girls. The mean daily concentration of nitrogen dioxide (NO2) in Hangzhou City during the study period was 44.6 μg/m3 (25th–75th percentiles, 32.0–56.0 μg/m3). The GAM showed that the largest estimate effects in S. pyogenes-induced vulvovaginitis in prepubertal girls were found in NO2 with a moving (accumulative) average on day 3. The excess risk of NO2 in terms of the daily number of S. pyogenes isolates obtained from the vaginal introitus swabs was 14.91% (95% confidence interval [CI]: 4.85–25.94%) in the single-pollutant model. The multipollutant model revealed that an increase of 10 μg/m3 in NO2 exposure was associated with an 18.33% increased risk for acquiring S. pyogenes-induced vulvovaginitis in prepubertal girls (95% CI: 1.21–38.35%; P < 0.05). In conclusion, short-term NO2 exposure was strongly associated with the spread of S. pyogenes-induced vulvovaginitis in prepubertal girls. [ABSTRACT FROM AUTHOR]

The present study focused on the characteristics of the vaginal microbiomes in prepubertal girls with and without vulvovaginitis. We collected 24 vaginal samples and 16 fecal samples from 10 girls aged 3–9 years with vulvovaginitis and 16 healthy girls of the same age. The samples were divided into three groups: fecal swabs from healthy controls (HF), vaginal swabs from healthy controls (HVS), and vaginal swabs from girls with vulvovaginitis (VVS). Sequencing of the V3–V4 region of the 16S rDNA gene was performed with the NovaSeq PE250 platform to reveal the vaginal microbial community structure in healthy prepubertal girls and vulvovaginitis-associated microbiota. The intestinal microbiomes of healthy children were also analyzed for comparison. This study revealed that the healthy vaginal tract in prepubertal girls was dominated by Prevotella, Porphyromonas, Ezakiella, and Peptoniphilus species, with a high diversity of microbiota. The vulvovaginitis-associated microbiota were dominated by Streptococcus, Prevotella, Haemophilus, and Granulicatella, with lower diversity than that in healthy girls. Furthermore, the compositions of the vaginal and intestinal microbiomes were completely different. ANOSIM, MRPP, Adonis, and AMOVA were used to analyze the beta diversity, and the results showed that there were significant differences in the microbial communities among the three groups. Lactobacillus deficiency and high bacterial diversity were characteristics of the vaginal microbiome in healthy prepubertal girls; this is inconsistent with that in reproductive-age women. The vulvovaginitis-associated vaginal microbiota differed dramatically from normal microbiota, and the main causative agents were not fecal in origin. [ABSTRACT FROM AUTHOR]

To evaluate genital microbiological findings in prepubertal girls with vulvovaginitis and in healthy controls. Prospective case-control study. Pediatric Outpatient unit of the Department of Pediatrics of the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos from November 2014 to May 2017. Fifty-two prepubertal girls aged 1-9 years diagnosed with vulvovaginitis, and 42 age-matched healthy controls. Samples for microbiological culture were collected using sterile cotton swabs from the introitus and the lower third of the vagina from all study participants. Microbiological findings were analyzed according to bacteria type and intensity of growth. Most of the vaginal microbiological swab results were positive for bacterial growth: 47 (90.4%) and 34 (80.9%) were similar in the study and control groups, respectively (P =.24). Sixteen (30.8%) and 9 (21.4%) of the microbiological traits results in the case and control groups, respectively, were regarded as potential causative agents (P =.27). Streptococcus pyogenes was the most frequent pathogen in the study group (P =.03); all other microorganisms detected as either a pure or dominant growth in the control group, were considered opportunistic. Vaginal bacterial culture results were positive in prepubertal girls with vulvovaginitis and in healthy controls. Nonspecific vulvovaginitis without a dominant/isolated pathogen was seen to be more common than vulvovaginitis with a potential causative agent. Clinical symptoms were more frequent among girls when the potential infectious agent was identified. [ABSTRACT FROM AUTHOR]

Vulvar lichen sclerosus (VLS) is a chronic skin disease that affects the skin of the vulva with itching, irritation, and pain. It may present in a prepubertal or adolescent patient. The etiology of VLS remains unclear. Autoimmune, genetic, hormonal, or infectious conditions may be involved in the pathogenesis of VLS [1]. Recent studies suggested unbalanced skin microbiota in the region of VLS [2-4]. We thus hypothesized that alterations of skin microbiotas may contribute to the development of VLS. To evaluate the compositional characteristics and the differences in the vulvar skin microbiota, we performed a pilot case-control study by comparing the prepubertal girls with VLS to girls with Labial adhesions and healthy controls. We recruited a total of 45 patients in the outpatient Pediatric and Adolescent Gynecology clinic of the Children's Hospital Zhejiang University from October 2021 to June 2022. Vulvar dermal swab samples from prepubertal girls with VLS (n=19), girls with Nevus of vulva and without specific vulvovaginitis (n=11), and girls with Labial adhesions (n=15) were obtained. DNA was extracted from all the vulvar skin swab samples. The V4 fragments of 16S rRNA were amplified for high-throughput sequencing and analyzed by QIIME2 [5]. The composition differences of the vulvar skin microbiota between the VLS and the other two groups were analyzed by α diversity, β diversity, and LEfSe analysis (http://huttenhower.sph.harvard.edu/galaxy/). Our results showed that the average age of onset of VLS is 6.52 (Table 1). There were no differences in the α diversity (Kruskal-Wallis test; P=0.06 for Faith_pd diversity index, Figure 1a; P=0.58 for Pielou diversity index, Figure 1b) among three groups. In terms of β diversity, principal coordinate analysis (PCoA) showed the statistical differences of composition of taxa among these three groups (PERMANOVA test; Jaccard, p=0.001, Figure 1c; unweighted UniFrac, p=0.001, Figure 1d). Our results revealed girls with VLS had a statistically higher relative abundance of Parvimonas spp., Helcococcus spp., and Peptococcus spp. compared to the controls, and a higher relative abundance of Parvimonas spp., Methylobacterium spp., Helcococcus spp., Peptococcus spp., Moryella spp., Lactobacillus spp. compared to girls with Labial adhesions. Parvimonas spp., Helcococcus spp., and Peptococcus spp. are specifically higher in girls with VLS. Cutaneous dysbiosis in patients with VLS may provide a chance to explain the pathogenesis of VLS and new concepts for its treatment. ▪ ▪ ▪ [ABSTRACT FROM AUTHOR]

Topical estrogen treatment has been considered the first-line treatment of labial adhesions in prepubertal girls. However, the effect of topical estrogen cream is different according to studies, and no study compared estrogen cream to observation. This study aims to investigate the efficacy of topical estrogen cream treatment compared with observation in prepubertal girls with labial adhesions. The medical records of prepubertal girls diagnosed with labial adhesions from April 2005 to June 2019 were retrospectively analyzed. Baseline characteristics such as age at diagnosis and initial symptoms were collected. The primary outcome was the resolution of labial adhesion. Secondary outcomes were recurrence and side effects. A total of 114 patients were enrolled and divided into two groups, topical estrogen cream (n = 94), and observation (n = 20). Girls who were treated with estrogen cream had older age (24.6 ± 19.0 vs. 16.7 ± 15.3 months, p = 0.037) and higher resolution rate than the observation group (100.0% vs. 85.0%, respectively, p = 0.005). Girls younger than 23.3 months showed a significantly higher resolution rate to topical estrogen treatment (100% vs. 86.7%, p = 0.043). Side effects and recurrences occurred exclusively in children treated with topical estrogen therapy without significant differences compared to the observation group. Topical estrogen therapy showed a higher resolution rate than observation for the treatment of prepubertal girls with labial adhesions, especially in younger girls. [Display omitted] [ABSTRACT FROM AUTHOR]

In the present clinical study, the effect of oligofructose-enriched inulin was studied on bone metabolism in girls from 9 to 12 years old, with low habitual calcium intakes, who attended public schools. Two calcium-enriched formulations, supplemented with oligofructose-enriched inulin (test drink) or without (standard drink) were made. Sixty pre-pubertal girls were randomized into a double-blind and crossover design, divided into three groups and received one daily portion of either the standard drink (group 1) or test drink (group 2) during 11 weeks, followed by a three-week washout period. Group control did not receive any supplementation. Biochemical evaluations of serum calcium, intact parathyroid hormone - iPTH - and bone alkaline phosphatase - BAP - were performed at baseline and after 4, 8 and 11 weeks of each intervention period. In group 1, a significant increase in serum calcium and BAP and a reduction of iPTH were observed after consumption of the test drink.No presente ensaio clínico, o efeito de oligofrutose enriquecida com inulina foi estudado no metabolismo ósseo de meninas de 9 a 12 anos com baixa ingestão habitual de cálcio, matriculadas em escolas públicas. Duas formulações foram suplementadas ou não (bebida padrão) com oligofrutose enriquecida com inulina (bebida teste). Sessenta meninas pré-púberes foram aleatorizadas em estudo duplo cego crossover e divididas em três grupos e receberam uma porção diária da bebida padrão (grupo 1) ou teste (grupo 2) durante 11 semanas, seguidos por um período de intervalo de três semanas. O grupo controle não recebeu nenhuma suplementação. As avaliações bioquímicas de cálcio sérico, paratormônio intacto - PTHi e fosfatase alcalina fração óssea - FAO foram executadas ao início e após 4, 8 e 11 semanas de cada período de intervenção. No grupo 1, um aumento significante no cálcio sérico e FAO e uma redução no PTHi foram observadas após o consumo da bebida teste.

Introduction With increasing numbers of adult female survivors of childhood cancers due to advances in early diagnosis and treatment, the issue of preserving the reproductive potential of prepubertal girls undergoing gonadotoxic treatments has gained greater attention. Methods According to PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English throughout the past 15 years to explore the significant updates in preserving the reproductive potential of prepubertal girls with cancer. Results The two established fertility preservation options, embryo freezing and egg freezing, cannot be offered routinely to prepubertal girls as these options necessitate prior ovarian stimulation and subsequent mature oocytes retrieval that are contraindicated or infeasible before puberty. Therefore, the most suitable fertility preservation options to prepubertal girls are (1) ovarian tissue freezing and autotransplantation, (2) in vitro maturation, and (3) ovarian protection techniques. In this review, we discuss in detail those options as well as their success rates, advantages, disadvantages and future directions. We also suggest a new integrated strategy to preserve the reproductive potential of prepubertal girls with cancer. Conclusion Although experimental, ovarian tissue slow freezing and orthotopic autotransplantation may be the most feasible option to preserve the reproductive potential of prepubertal girls with cancer. However, this technique has two major and serious disadvantages: (1) the risk of reintroducing malignant cells, and (2) the relatively short lifespan of ovarian tissue transplants. Several medical and ethical considerations should be taken into account before applying this technique to prepubertal girls with cancer. [ABSTRACT FROM AUTHOR]

Study Objective To compare the prevalence of human papillomavirus (HPV) genital infection among prepubertal children, sexually active and not sexually active adolescents, and assess potential risk factors for transmission. Design Prospective study. Setting Outpatient adolescent health clinic. Participants Ninety-five girls aged 2-21 years; 38 sexually active adolescents (group A), 28 not sexually active adolescents (group B), and 29 prepubertal children (group C). Interventions Participants' vaginal or cervical specimens were tested for HPV with the CLART HPV 2 assay (Clinical Array Technology, Genomica, Madrid, Spain) and for cytological abnormalities with liquid-based cytology. Main Outcome Measures Differences in prevalence of low- and high-risk HPV infections among the 3 groups. Results Genital HPV was detected in 37.9% (36/95) of all participants; 47.4% (18/38) of group A, 28.6% (8/28) of group B, and 34.5% (10/29)of group C ( P = .27). Multiple HPV infection was detected in 26.3% (10/38), 10.7% (3/28), and 13.8% (4/29) of groups A, B, and C, respectively ( P = .21). High-risk genotypes were detected in 47.4% (18/38), 28.6% (8/28), and 24.1% (7/29) of groups A, B, and C, respectively ( P = .10). Main high-risk genotypes were HPV 16 (27%, 10/37), HPV 31 (21.6%, 8/37 ), HPV 35 (13.5%, 5/37), HPV 53 (13.5%, 5/37), and low-risk HPV 6 (18.9%, 7/37). Sexual activity was associated with increased risk for genital high-risk HPV infection (odds ratio = 3.41; 95% confidence interval, 1.19-9.78); specifically with HPV 33 and HPV 51. Forty percent of sexually active adolescents with normal cervical cytology were infected with high-risk HPV types. Family history of skin HPV was positively associated with genital HPV in the sexually active group (odds ratio = 2.01; 95% confidence interval, 1.17-3.46). Conclusion Timeline and target population for HPV vaccination might need to be reappraised, in view of significant nonsexual transmission of genital HPV so early in childhood. [ABSTRACT FROM AUTHOR]

Study Objective To determine and compare clinical and microbiological features of vulvovaginitis in prepubertal girls. Vulvovaginitis is the most common gynecological problem of childhood. Design, Setting, Participants, Interventions, and Main Outcome Measures This study involved 45 girls from 2-12 (5.38 ± 2.9) years old; and 26 girls from 3-12 (5.72 ± 3.1) years old as a control group. Anamnesis and physical examination were followed by vaginal smear, urine culture, and stool analyses from both groups, and the personal hygiene status and education level of the mother were determined. Results The most common symptoms among the patients were vaginal discharge (44.4%, vulvar erythema (37.8%), and vaginal itch (24.4%). Microorganisms, isolated from vaginal smears, were detected in 48.9% of the patients. Escherichia coli was shown in the urine culture of 3 patients with vulvovaginitis (6.70%). In microscopic stool analysis parasites were detected (45.9%). We found some relevant personal hygiene factors, such as wiping back to front (42.9%), cleaning by herself after defecation (89.3%), using toilet paper (60.7%) and wet wipes (21.4%), and bathing standing (14.3%) and sitting (46.4%) among patients. The questionnaire also showed that the children wore tight clothing (35.7%). Conclusion Our findings suggest that vulvovaginitis in prepubertal girls is related not only to microorganisms but also poor personal hygiene, the educational status of mothers, and specific irritants. [ABSTRACT FROM AUTHOR]

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Vulvovaginitis caused by Shigella species (Shigella spp.) has rarely been reported. This paper describes two cases of prepubertal vulvovaginitis, presenting with a bloody and purulent vaginal discharge, separately caused by ampicillin-resistant Shigella flexneri and trimethoprim-sulfomethoxazole-resistant Shigella sonnei. Our conclusions are that Shigella spp. is the potential cause of vulvovaginitis in prepubertal girls in developing countries where these pathogens are endemic, and identification of the bacteria and making antibiotic susceptibility testing in these cases should not be overlooked.

Abstract: Purpose: We developed a new technique of temporary ovarian transposition (OT) for prepubertal girls undergoing brachytherapy. The aim of this study was to describe it, assess its feasibility and safety and calculate the dose delivered to the ovary in order to prove its efficacy. Methods: Sixteen prepubertal patients underwent temporary OT for brachytherapy at our center from March 2001 to December 2012. OT was done either by laparotomy or by laparoscopy. In all patients, the ovaries were grasped with an atraumatic forceps and mobilized above the iliac crest level as high as possible without any dissection or division of the ovarian ligaments or of the fallopian tube. They were sutured to the anterior abdominal wall by a transfixing stitch of non-dissolvable suture knotted on the outside of the patient on a pledget. Results: Median age at surgery was 3years (range: 2–9years). The integrity of the fallopian tube was respected and not a single ligament was dissected or divided. None of the patients had intraoperative or postoperative complications. The stitches were retrieved after completion of irradiation and the ovaries in all the patients fell back into the pelvis. The calculated median radiation dose to the ovary was 1.4Gy (range: 0.4–2.4Gy). Conclusions: This surgical technique is simple and safe, either by laparotomy or by laparoscopy. It meets the radiation and physical constraints in prepubertal girls with vaginal or bladder RMS. However, longer follow-up is required to assess the ovarian function. [Copyright &y& Elsevier]

Background Prepubertal hypertrichosis is a reportedly benign condition characterized by an excessive growth of vellous hair in non-androgen dependent areas of the body compared to the amount usually present in normal subjects of the same age, race and sex. Although this condition is usually considered idiopathic and regarded as benign, it may be very disturbing cosmetically, causing significant patient and parental anxiety. Method: We performed a hormonal and androgen receptor study in 42 prepubertal girls with hypertrichosis and 29 control girls from 2 to 8 years of age. Both groups underwent a determination of basal LH, FSH, 17OHprogesterone, androstenedione, testosterone, estradiol and SHBG, abdominal ultrasound to assess ovarian morphology, and the number of androgen receptor CAG/GGC repeats in DNA obtained from peripheral leukocytes. Results The hypertrichosis score was higher in the cases compared to controls. Serum gonadotropins and sex steroids were similar in both groups, but SHBG was significantly lower in the girls with hypertrichosis (71.1 ± 2.9vs81.9 ± 3.0 nmol/L,p < 0.02). The distribution of shorter, larger and total alleles was not statistically different between cases and controls. The combined analysis of CAG/GGC, however, showed a significantly higher prevalence of the most androgen-sensitive haplotypes(1-2:<22CAG + 17/17GGC- < 14CAG + 17/18GGC) in girls with hypertrichosis compared to controls. Conclusions We conclude that girls with hypertrychosis exhibit AR(s) with enhanced sensitivity, which may facilitate the growth of their body hair. [ABSTRACT FROM AUTHOR]

Abstract: Significant improvement in the survival rates of children with pediatric cancers has been achieved over the last 25 years, so the number of long-term survivors is increasing and their subsequent quality of life is of increasing importance. One of the most serious side effects of chemotherapy or radiotherapy is damage to the ovarian function, which can lead to loss of fertility. The degree of this damage depends on the substances used, the dose of radiotherapy reaching the ovaries, and the age of the girl at the time of treatment. Up to now, the only established method of fertility preservation has been cryoconservation of fertilized egg cells or embryos, but this is not possible in prepubertal girls because of their sexual immaturity. Removal of ovarian tissue and subsequent cryoconservation with the option of later orthotopic retransplantation is therefore an option to these girls. This method can lead to pregnancy and birth in adult women. Up to now there are no studies about the retransplantation of ovarian tissue which was removed before puberty. Displacement of the ovaries away from the radiation field before radiation to the pelvic area can be considered; however, the data is controversial. One problem in the use of fertility preservation methods in these very young patients is that they undergo procedures which, because of their age, they mostly do not understand and the parents must make a decision based on the assumed later wishes of their daughter. [Copyright &y& Elsevier]

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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the relationships between specific anthropometric (9 skinfolds, 13 girths, 8 lengths and 8 breadths), body composition (body fat %, fat free mass [FFM], fatmass [FM]) parameters and bone mineral parameters (bone mineral density [BMD], bone mineral content [BMC]) in young rhythmic gymnasts and same age controls. Eighty nine 7-8-year-old girls participated in this study and were divided to the rhythmic gymnast's (n=46) and control (n=43) groups. Body composition was determined by dual energy X-ray absorptiometry (FFM, FM, body fat %, BMD and BMC). Body fat % and FM were lower and BMD and BMC values at lumbar spine (L2-L4) and femoral neck were higher in rhythmic gymnasts compared with controls. All measured skinfold thicknesses were thicker in controls. In girths, lengths and widths there were only few significant differences between the groups. Stepwise multiple regression analysis indicated that skinfold thicknesses (supraspinale and medial calf) influenced L2-L4 BMD only in controls 38.2% (R2x100). Supraspinale and iliac crest skinfold thicknesses characterised L2-L4 BMC 43.9% (R2x100). Calf girths influenced BMD in L2-L4 52.3% (R(sup)²(/sup)x100) in controls. BMC in L2-L4 was dependent only on mid-thigh girths 35.9% (R2x100). BMD in L2-L4 was dependent on tibiale-laterale height 30.0% (R2x100). Biiliocristal breadths together with sitting height characterised BMC in L2-L4 BMD 62.3% (R2x100). In conclusion, we found that the relationships between anthropometry, body composition and bone parameters in young rhythmic gymnasts are weak. In control group first of all lower body anthropometric parameters significantly correlated with BMD and BMC in spine. [ABSTRACT FROM AUTHOR]

Background: A connection between premature adrenarche (PA) and polycystic ovary syndrome (PCOS) has been proposed. We investigated whether anti-müllerian hormone (AMH) production is increased in prepubertal girls with PA, as it is in women with PCOS and in their prepubertal daughters. Methods: Fifty-two prepubertal girls with PA and 48 prepubertal age-matched controls were studied. Serum AMH concentrations were determined by a specific ELISA assay and correlated with baseline steroid hormone, GnRH-stimulated LH and FSH, and glucose and insulin concentrations during an oral glucose tolerance test (OGTT). Results: Girls with PA had lower serum AMH concentrations than their controls (2.65 vs. 3.43 ng/ml, p = 0.035). This difference between the study groups vanished when adjusted for BMI SDS score (SDS) or body fat percentage. In the entire cohort, serum AMH concentration was negatively correlated with BMI SDS (r = –0.23, p = 0.019) and androstenedione (r = –0.22, p = 0.03), but not with age, GnRH-stimulated LH or FSH, baseline or OGTT insulin concentrations. Within the control group only, there was an inverse relationship of serum AMH with DHEAS (r = –0.32, p = 0.028) concentrations. Conclusions: Unlike prepubertal daughters of PCOS women, PA girls do not have abnormalities in serum AMH concentrations at prepubertal age. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We examined longitudinally the association between calcium intake and total body bone mineral content (TBBMC) in 151 non-Hispanic white girls. Intakes of dairy, energy, and calcium were assessed using three 24-h dietary recalls in girls at ages 5, 7, 9, and 11 y. We assessed their total-body bone mineral content with dual-energy X-ray absorptiometry at ages 9 and 11 y. Dairy foods comprised the major contributor (70%) to calcium intake over the 6-y period; 28% of calcium came from other foods, and 2% from supplements. By age 9 and 11 y, the majority of girls did not meet calcium recommendations. Higher calcium intake at ages 7 and 9 y was associated with higher TBBMC at age 11 y. Calcium intake at age 9 y was also positively associated with TBBMC gained from age 9 to 11 y. Calcium intake at age 11 y was not correlated with TBBMC at the same age. Relations between calcium intake and TBBMC did not differ for total calcium and for calcium from dairy sources, likely reflecting the fact that dairy products were the major source of calcium in this sample. Results from the present study provide new longitudinal evidence that calcium intake, especially calcium from dairy foods, can have a favorable effect on girls' TBBMC during middle childhood. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that adults and adolescents throughout the United States are at risk of poor vitamin D status. However, vitamin D concentrations in young American children have not been assessed. Objective: The relations between serum 25-hydroxyvitamin D [25(OH)D] and bone were examined in prepubertal girls. Design: In the present cross-sectional study, serum 25(OH)D concentration was assessed in 168 prepubertal girls aged 4 - 8 y living in the southeastern United States with the use of radioimmunoassay. Bone area, bone mineral content, and areal bone mineral density were measured from total body, lumbar spine, proximal femur, and forearm with dual-energy X-ray absorptiometry. Data were analyzed with analysis of variance, analysis of covariance, stepwise multiple regression, and partial correlations. Results: The mean (±SD) serum 25(OH)D was 93.8 ±28.1 nmol/L (range: 31.1-181.4 nmol/L). In a multiple regression analysis, race and season were the strongest predictors of vitamin D status. The black girls had lower mean 25(OH)D values than did the white girls (P < 0.01), and 25(OH)D values were significantly different in the total sample between the seasons (P < 0.001), ranging from 74.4 nmol/L during the winter months to 107 nmol/L during the summer. After adjustment for season, age, race, and body mass index, 25(OH)D values were negatively correlated with forearm bone mineral content (r = - 0.18; P = 0.02). Conclusions: Unlike prior reports of adults and adolescents living in the southeastern United States, vitamin D status was adequate in the children of the present study. 25(OH)D concentrations were not positively associated with higher bone mineral. [ABSTRACT FROM AUTHOR]

Paediatric vulvovaginitis, with or without vaginal discharge is a very distressing condition and at times very difficult to treat. The current article reviews the aetiopathology and the systematic approach towards the management of the condition. [Copyright &y& Elsevier]

Background: Very few studies have evaluated both parathyroid hormone (PTH) and 25-hydroxyvitamin D [25(OH)D] and their effects on bone mass in children. Objective: We studied the associations of serum 25(OH)D and intact PTH (iPTH) with bone mineral content (BMC) and bone mineral density (BMD) at different bone sites and the relation between serum 25(OH)D and iPTH in early pubertal and prepu-bertal Finnish girls. Design: The subjects were 10-12-y-old girls (n = 193) at Tanner stage 1 or 2, who reported a mean (± SD) dietary calcium intake of 733 ± 288 mg/d. 25(OH)D, iPTH, tartrate-resistant acid phosphatase 5b (TRAP 5b), urinary calcium excretion, BMC, areal BMD, and volumetric BMD were assessed by using different methods. Results: Thirty-two percent of the girls were vitamin D deficient [serum 25(OH)D ⩽25 nmol/L], and 46% of the girls had an insufficient concentration (26-40 nmol/L). iPTH and TRAP 5b concentrations were significantly higher in the deficient group than in the insufficient and sufficient groups [iPTH: 43.9 ± 15.7 compared with 38.6 ± 11.2 pg/L (P = 0.049) and 32.7 ± 12.1 pg/L (P < 0.001), respectively; TRAP 5b: 12.2 ± 2.9 compared with 11.0 ± 2.8 U/L (P = 0.009) and 10.9 ± 1.9 U/L (P = 0.006), respectively]. The girls in the deficient group also had significantly lower cortical volumetric BMD of the distal radius (P < 0.001) and tibia shaft (P = 0.002). High iPTH concentrations were also associated with low total-body apparent mineral density and urinary calcium excretion (P < 0.007). Conclusions: Vitamin D-deficient girls have low cortical BMD and high iPTH concentrations, which are consistent with secondary hyperparathyroidism. A low vitamin D concentration accompanied by high bone resorption (TRAP 5b) may limit the accretion of bone mass in young girls. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether high-impact exercises have an osteogenic effect in 21 prepubertal female monozygotic twins aged 8.7 (SD 0.7) years. Bone mineral density (aBMD), bone mineral content (BMC), bone area, and body composition were derived from DXA. Skeletal maturity was assessed by the Tanner-Whitehouse technique. Anthropometric dimensions (28 dimensions) were measured and also used to derive adiposity and muscularity indices, and information about physical activity was obtained by questionnaire. These measurements were taken before and after the exercise period. The exercise program consisted of high-impact exercises. During 9 months, one girl of each twin pair performed the exercises 3 times a week under supervision of a teacher while their sisters served as control group. At baseline there were no differences between the groups. After 9 months, exercisers (Ex) and controls (Con) had similar increases in height and weight. Significant lower adiposity was observed in the exercise group vs the control group. None of the bone indices differed significantly between the two groups. When the analyses were done for a subgroup of twin pairs (n=12) who did not participate in high-impact sports during their leisure time, significant differences were obtained for aBMD and BMC of the proximal femur in favor of the exercise group. These results indicate that for prepubertal girls who are not involved in sport activities or who are only involved in low-impact sport activities this exercise program has an osteogenic effect on the proximal femur, but for girls who are already involved in high-impact sports this protocol does not have any additional effect on the bone status. [ABSTRACT FROM AUTHOR]

Background: The prevalence of childhood obesity is increasing and the causes of this are unknown. Objective: The objective of this study was to determine whether energy expenditure (EE), measured by 24-h calorimetry and doubly labeled water, differed in normal-weight-for-height, multiethnic prepubertal girls with or without a familial predisposition to obesity. Design: Normal-weight, prepubertal white (n = 52), African American (n = 30), and Hispanic (n = 19) girls with a mean (±SD) age of 8.5 ± 0.4 y were studied according to parental leanness and overweight or obesity. The girls were grouped according to whether they had 2 lean parents (n = 30), 2 obese parents (n = 27), or 1 lean and 1 obese parent (n = 44). Basal metabolic rate (BMR), sleeping metabolic rate (SMR), 24-h EE, respiratory quotient, heart rate, and activity were measured by 24-h room calorimetry; free-living total EE (TEE), activity-related EE (AEE), and physical activity level were measured by doubly labeled water. EE was standardized by fat-free mass (FFM). Results: There were no significant differences among familial groups in weight, height, fat mass, FFM, or percentage body fat. African American girls had a higher FFM than did white or Hispanic girls (P < 0.05). BMR, SMR, 24-h EE, respiratory quotient, heart rate, and activity levels were not significantly different among familial groups. Additionally, there were no significant familial group differences in TEE, AEE, or physical activity level. However, BMR, SMR, and TEE were lower in African American girls than in white girls (P < 0.05). Conclusion: There was no significant difference in EE between normal-weight, multiethnic prepubertal girls predisposed to obesity and those not predisposed to obesity. [ABSTRACT FROM AUTHOR]

After the introduction of the colposcope for the examination of children suspected of being sexually abused in Leeds, a study was undertaken to describe the findings in detail. A total of 109 consecutive prepubertal girls, mean age 70.4 months were assessed including colposcopic genital and anal examination, and peer group review of reports and photographs. Fifty nine children had signs consistent with blunt force penetrating trauma (hymenal transection/major notch, scar, or hymenal attenuation). Transections were encountered most commonly at 6 o'clock (directly posterior). In 46 the hymenal orifice was gaping with thigh abduction only and in 47 the hymenal orifice transverse diameter was greater than 4 mm on labial separation. Overall, physical findings were commonly present and in only two cases were no signs recorded. Non-specific and frequent findings included patterns of labial and introital reddening. Supportive hymenal signs including swelling, rounding of edge, thickening, distortion, and loss of symmetry were common. Labial fusion was present in 20. Urethral dilatation with labial separation was noted in 14. Physical findings including normality are consistent with abuse and even minor anogenital signs as well as negative findings should be documented. Colposcopy and photography are valuable tools in peer review, teaching, and case management. [ABSTRACT FROM AUTHOR]

In a prospective clinical and microbiological study covering 67 prepubertal children the vaginal flora of 31 asymptomatic children was compared to 36 children suffering from abnormal vaginal discharge and/or vulvovaginitis. Vaginoscopy was employed to obtain bacteriological specimens without contamination. Swabs were inoculated into prereduced transportmedia (PORT A CUL, BBL) and cultured aerobically and anaerobically. The most prevalent aerobic organisms were Staphylococcus epidermidis, Enterococci and Escherichia coli; the predominant anaerobic bacteria were Peptococcus and Peptostreptococcus, Veillonella parvula, Eubacteria, Propionibacterium and Bacteroides species. A similar microbiological pattern was found in both groups, although anaerobes, like Peptococci and Peptostreptococci and Bacteroides species, as well as yeasts, like Candida albicans were significantly more frequent in the group with signs and symptoms. Lactobacilli were less common in this group. [ABSTRACT FROM AUTHOR]

Vulvovaginitis caused by Shigella species (Shigella spp.) has rarely been reported. This paper describes two cases of prepubertal vulvovaginitis, presenting with a bloody and purulent vaginal discharge, separately caused by ampicillin-resistant Shigella flexneri and trimethoprim-sulfomethoxazoleresistant Shigella sonnei. Our conclusions are that Shigella spp. is the potential cause of vulvovaginitis in prepubertal girls in developing countries where these pathogens are endemic, and identification of the bacteria and making antibiotic susceptibility testing in these cases should not be overlooked. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]