Management of Hematometra and Hematocolpos in Obstructive Mullerian Anomalies by Image-Guided Drainage with Interventional Radiology: A Multi-Institutional Case Series

STUDY OBJECTIVE

To describe cases of image-guided drainage of symptomatic hematometrocolpos from obstructive Mullerian anomalies as a temporizing measure to manage acute pain symptoms and delay definitive management of the obstructive Mullerian anomalies which require complex reconstruction.

METHODS

IRB exemption from all included institutions was obtained. A retrospective case series of eight females from three academic children's hospitals under the age of 21 with symptomatic hematometrocolpos due to obstructive Mullerian anomalies drained by image-guided percutaneous transabdominal vaginal or uterine drainage with interventional radiology were reviewed and described.

RESULTS

Eight pubertal patients with obstructive Müllerian anomalies (six patients with distal vaginal agenesis, one patient with an obstructed uterine horn, one patient with a high obstructed hemi-vagina) and symptomatic hematometrocolpos are reported. All patients with distal vaginal agenesis had greater than 3 cm lower vaginal agenesis, which would usually require complex vaginoplasty and use of post-operative stents. Given immaturity and inability to use stents or dilators post-operatively or medical complexity, they subsequently underwent ultrasound-guided drainage of hematometrocolpos with interventional radiology (IR) to relieve pain symptoms, followed by menstrual suppression. The patients with obstructed uterine horns had complex medical and surgical histories requiring perioperative planning, also had ultrasound-guided drainage of hematometra as a temporizing measure to manage acute symptoms.

CONCLUSION

Patients presenting with symptomatic hematometrocolpos due to obstructive Müllerian anomalies may not be psychologically mature enough to undergo definitive complex reconstruction which requires vaginal stent or dilator use post-operatively to prevent stenosis and other complications. Image-guided percutaneous drainage of symptomatic hematometrocolpos serves as a temporizing measure by offering pain relief until patients are ready to undergo surgical management and/or allow time for complex surgical planning.

Fourteen years old as the best age cutoff to differentiate prepubertal from pubertal papillary thyroid carcinoma

BACKGROUND

It is unclear whether differences in clinical presentation and/or prognosis exist between prepubertal papillary thyroid cancer (PTC) and pubertal PTC. At present, there is a lack of definition for the appropriate cutoff age to define prepubertal PTC.

METHODS

This study retrospectively reviewed 227 pediatric PTC patients (aged ≤18 years) who underwent initial surgery from March 2000 to December 2018. The median duration of follow-up was 85 months (range, 8-258).

RESULTS

The age range was basically linearly related to multiple risk factors, such as T3-T4 disease, distant metastasis. Age (p = 0.032) was an independent risk factor for recurrence and persistent disease. Patients aged <14 years had obviously higher rates of extensive disease. The 10-year disease-free survival (DFS) rate of patients aged <14 years was 59.5% and that of patients aged ≥14 years was 82.6% (p = 0.004).

CONCLUSIONS

Fourteen years of age may be an appropriate cutoff to differentiate prepubertal PTC from pubertal PTC.

Testicular Volume in Children with Sickle Cell Anaemia in Uyo, a South-South Nigerian City

INTRODUCTION

Sickle cell anaemia (SCA) often presents in early childhood with repeated vaso-occlusive crisis that leads to ischaemia, infarction and fibrosis which may result in a reduction in expected testicular volume (TV) at puberty.

METHOD

This was a cross-sectional study of 95 children with SCA aged 1-18 years compared with 95 age-matched controls. Participants responded to an interviewer-administered questionnaire, with their anthropometric measurements taken, pubertal maturity assessed by Tanner staging and testicular ultrasonography done. Changes in TV across the ages were compared graphically and regression analyses were used to determine the factors independently associated with TV. A p-value of <0.05 was considered statistically significant.

RESULTS

In the prepubertal period, the haemoglobin SS (HbSS) participants had larger median ultrasound TV (MUSTV) compared to the haemoglobin AA (HbAA) controls (p = 0.001). This trend reversed in the pubertal period. On regression analysis, the frequency of testicular pain (p = 0.04), weight (p = 0.02) and pubic hair rating (p = 0.03) of the HbSS participants were significant predictors of increased TVs in the HbSS participants, irrespective of pubertal status.

CONCLUSION

The prepubertal MUSTV of the HbSS participants were higher than those of the HbAA controls, while the HbAA controls had higher MUSTV at puberty and beyond. The frequency of testicular pain episodes, pubic hair rating and weight were independent predictors of TV changes in the HbSS participants. Prevention of repeated vaso-occlusive crisis in the prepubertal period may help prevent the reduction in TV and possible hypogonadism. Lay summarySickle cell anaemia (SCA) causes repeated episodes of painful crisis and in boys, these may affect the way their testes grow. The study set out to document testicular sizes on a one-time basis in boys aged 1-18 years with SCA compared with controls of similar ages. The participants responded to structured questions assisted by the researchers and their body measurements were appropriately taken. Their level of sexual maturation was assessed according to the method by Tanner and the sizes of their testes were measured using an ultrasound machine. The research information was analysed and a statistical value less than 0.05 was taken to mean that there was a difference between the measured variables. The mid-testicular sizes of the SCA participants were noted to be higher than that of their controls during the prepubertal period while the non-SCA boys had higher sizes from puberty onwards. The frequency of testicular pain, weight and pubic hair stage of the SCA boys were important contributors to their increased testes sizes, irrespective of pubertal status. Efforts aimed at preventing painful crisis should start during early childhood to forestall future sexual challenges in adulthood.

Effects of Plyometric, Strength and Change of Direction Training on High-School Basketball Player's Physical Fitness

The study aim was to compare the effects of a 7-week plyometric, strength and change of direction (COD) training program on basketball-specific performance measures in high-school players. Forty male players were randomly assigned to one of the four groups: plyometric (PG, n = 10), strength (SG, n = 10), COD (CODG, n = 10), and control group training (CG, n = 10). Two training sessions were performed at weekly intervals before basketball training. Performance of the counter movement jump (CMJ), Abalakov jump (ABKJ), 10 m zig-zag sprint, 20 m in line sprint (measurements at 10 and 20 m), and sit and reach flexibility test (SRFT) was assessed before and after the intervention. A 4 (group) × 2 (time) repeated measures analysis of variances (ANOVA) was conducted for each variable. Bonferroni post-hoc tests were used when the interaction was significant. Significant (all p < 0.05) time x group interaction was noted for SRFT, CMJ, ABK, sprint, and zig-zag 10 m, in favor of the experimental groups compared to the control group. However, improvements in physical fitness were similar between the three experimental groups. In conclusion, 7 weeks of specific plyometric, strength and COD training produced similar medium to large improvements in physical fitness of high-school basketball players.

The effect of constant-intensity endurance training and high-intensity interval training on aerobic and anaerobic parameters in youth

INTRODUCTION

High-Intensity Interval Training (HIIT) and Constant-Intensity Endurance Training (CIET) improves peak oxygen uptake (V̇O₂) similarly in adults; but in children this remains unclear, as does the influence of maturity.

METHODS

Thirty-seven boys formed three groups: HIIT (football; n = 14; 14.3 ± 3.1 years), CIET (distance runners; n = 12; 13.1 ± 2.5 years) and a control (CON) group (n = 11; 13.7 ± 3.2 years). Peak V̇O₂ and gas exchange threshold (GET) were determined from a ramp test and anaerobic performance using a 30 m sprint pre-and-post a three-month training cycle.

RESULTS

The HIIT groups peak V̇O₂ was significantly higher than the CON group pre (peak V̇O₂: 2.54 ± 0.63 l·min^-1 vs 2.03 ± 0.53 l·min^-1, d = 0.88; GET: 1.41 ± 0.26 l·min^-1 vs 1.13 ± 0.29 l·min^-1, d = 1.02) and post-training (peak V̇O₂: 2.63 ± 0.73 l·min^-1 vs 2.08 ± 0.64 l·min^-1, d = 0.80; GET: 1.32 ± 0.33 l·min^-1 vs 1.15 ± 0.38 l·min^-1, d = 0.48). All groups showed a similar magnitude of change during the training (p > 0.05).

CONCLUSION

HIIT was not superior to CIET for improving aerobic or anaerobic parameters in adolescents. Secondly, pre- and post-pubertal participants demonstrated similar trainability.

Disseminated Tuberculosis in a Healthy Adolescent Female

Disseminated tuberculosis (TB) is an uncommon sequela of Mycobacterium TB infection in which bacteria disseminate and form colonies outside of the lungs. Most reports of disseminated TB are found in immunocompromised patients, particularly in patients with human immunodeficiency virus (HIV) infection, malnutrition, genetic susceptibility, diabetes mellitus, smoking, and alcohol abuse. Few case reports describe the finding of disseminated TB in immunocompetent patients, especially in healthy adolescents. The purpose of this report is to present a case in which disseminated TB was found in an otherwise healthy adolescent, female patient, and to explore the effects of pubertal hormonal changes on the immune system. Several studies in the pediatric population have suggested that hormonal changes of estrogen and testosterone associated with puberty may influence the pathogenesis of active TB. While the exact pathogenesis of disseminated TB remains unknown, this case highlights the need for heightened awareness of TB among otherwise healthy adolescents, and specifically, the effect puberty has on disease progression.

Puberty in the Last 25 Years: A Retrospective Bibliometric Analysis

Puberty research has been highly productive in the past few decades and is gaining momentum. We conducted an analysis of bibliographic data, including titles, abstracts, keywords, indexing terms, and citation data to assess the sheer numbers, audience and reach, publication types, and impact of puberty-related publications. Findings suggest that puberty-related publications are increasing in sheer numbers, and have reach in many fields as befits an interdisciplinary science. Puberty-related publications typically have higher impact in terms of citations than the journal averages, among the journals that published the most studies on puberty. Limitations of the field and recommendations for researchers to improve the impact and reach of puberty-related publications (e.g., clear conclusions in abstracts, highlighting the importance of puberty) are discussed.

Effects of Di-(2-ethylhexyl) Phthalate on the Hypothalamus-Uterus in Pubertal Female Rats

The pollution of endocrine disruptors and its impact on human reproductive system have attracted much attention. Di-(2-ethylhexyl) phthalate (DEHP), an environmental endocrine disruptor, is widely used in food packages, containers, medical supplies and children's toys. It can cause diseases such as infertility, sexual precocity and uterine bleeding and thus arouse concerns from the society and scholars. The effect of DEHP on pubertal female reproductive system is still not well-studied. This study was to investigate the effects of DEHP on the hypothalamus-uterus in pubertal female rats, reveal the reproductive toxicity of DEHP on pubertal female rats and its mechanism, and provide scientific evidence for the evaluation of toxicity and toxic mechanism of DEHP on reproductive system. Forty-eight pubertal female rats were randomly divided into four groups and respectively administered via oral gavage 0, 250, 500, or 1000 mg/kg/d DEHP in 0.1 mL corn oil/20 g body weight for up to four weeks. Compared with control rats, the DEHP-treated rats showed: (1) higher gonadotropin-releasing hormone (GnRH) level in the hypothalamus; (2) higher protein levels of GnRH in the hypothalamus; and (3) higher mRNA and protein levels of GnRH receptor (GnRHR) in the uterus. Our data reveal that DEHP exposure may lead to a disruption in pubertal female rats and an imbalance of hypothalamus-uterus. Meanwhile, DEHP may, through the GnRH in the hypothalamus and its receptor on the uterus, lead to diseases of the uterus. DEHP may impose a negative influence on the development and functioning of the reproductive system in pubertal female rats.

Seven and up: individual differences in male voice fundamental frequency emerge before puberty and remain stable throughout adulthood

Voice pitch (the perceptual correlate of fundamental frequency, F0) varies considerably even among individuals of the same sex and age, communicating a host of socially and evolutionarily relevant information. However, due to the almost exclusive utilization of cross-sectional designs in previous studies, it remains unknown whether these individual differences in voice pitch emerge before, during or after sexual maturation, and whether voice pitch remains stable into adulthood. Here, we measured the F0 parameters of men who were recorded once every 7 years from age 7 to 56 as they participated in the British television documentary Up Series. Linear mixed models revealed significant effects of age on all F0 parameters, wherein F0 mean, minimum, maximum and the standard deviation of F0 showed sharp pubertal decreases between age 7 and 21, yet remained remarkably stable after age 28. Critically, men's pre-pubertal F0 at age 7 strongly predicted their F0 at every subsequent adult age, explaining up to 64% of the variance in post-pubertal F0. This finding suggests that between-individual differences in voice pitch that are known to play an important role in men's reproductive success are in fact largely determined by age 7, and may therefore be linked to prenatal and/or pre-pubertal androgen exposure.

Early risk factors for pubertal asthma

BACKGROUND

Early life risk factors are previously described for childhood asthma, but less is known related to asthma in adolescence. We aimed to investigate early risk factors (before 2 years) for pubertal asthma and secondarily for pubertal asthma phenotypes based upon allergic comorbidities.

METHODS

Based on data from 550 adolescents in the prospective birth cohort 'Environment and Childhood Asthma' study, subjects were categorized by recurrent bronchial obstruction (rBO) 0-2 years, asthma 2-10 years, and pubertal asthma from 10 to 16 years including incident asthma in puberty and asthma in remission from 10 to 16 years or as never rBO/asthma 0-16 years. Asthma in puberty was further classified based on the comorbidities atopic dermatitis and allergic rhinitis (AR) from 10 to 16 years. Twenty-three common asthma risk factors identified by 2 years of age, including frequency and persistence of bronchial obstruction (severity score), were analysed by weighted logistic regression for each phenotype.

RESULTS

In adjusted models, the risk of pubertal asthma increased significantly with higher severity score, parental rhinitis, being the firstborn child, and familial stress around birth. Pubertal asthma in remission was significantly associated with severity score and number of lower respiratory tract infections and inversely associated with breastfeeding beyond 4 months. Pubertal incident asthma was more common among firstborn children. All asthma phenotypes with allergic diseases were significantly associated with severity score, whereas familial perinatal stress increased the risk of asthma only. Asthma combined with AR was associated with parental asthma and being firstborn, whereas the risk of asthma with both atopic dermatitis and AR increased with higher paternal education, atopic dermatitis, being firstborn, and familial perinatal stress.

CONCLUSION AND CLINICAL RELEVANCE

Important early risk factors for pubertal asthma were early airways obstruction, parental rhinitis, being the firstborn child, and perinatal familial stress.

Gene expression during testis development in Duroc boars

Androstenone is a steroid pheromone occurring in the pubertal Leydig cells. Breeding against androstenone can decrease pheromone odour in swine meat but appears to cause unwanted side effects such as delayed onset of puberty. To study causality, global gene expression in developing boar testes at 12, 16, 20 and 27 weeks was investigated using a porcine cDNA microarray. The morphological status and androgenic levels of the same individuals have been described in a previous publication. In the present paper, expression of genes and pathways has been analysed with reference to these findings. Nine clusters of genes with significant differential expression over time and 49 functional charts were found in the analysed testis samples. Prominent pathways in the prepubertal testis were associated with tissue renewal, cell respiration and increased endocytocis. E-cadherines may be associated with the onset of pubertal development. With elevated steroidogenesis (weeks 16 to 27), there was an increase in the expression of genes in the MAPK pathway, STAR and its analogue STARD6. A pubertal shift in genes coding for cellular cholesterol transport was observed. Increased expression of meiotic pathways coincided with the morphological onset of puberty. Puberty-related change in Ca(2+) pathway transcripts, neurosteroids, neuronal changes and signalling in redox pathways suggested a developmental-specific period of neuromorphogenesis. Several growth factors were found to increase differentially over time as the testis matured. There may be interactions between MAPK, STAR and growth factors during specific periods. In conclusion, pathways for neurogenesis, morphological pathways and several transcripts for growth factors, which have known modulating effects on steroidogenesis and gonadotropins in humans and rodents, act at specific ages and developmental stages in the boar testis. The age dependency and complexity shown for development-specific testis transcripts must be considered when selecting phenotypic parameters for genetic selection for low androstenone. The results of selection based on measurement of phenotypic maturation and androstenone (or other steroid) levels at one specific age may differ depending on the age used. More research is necessary to find the optimal phenotype to use in order to reduce the unwanted side effects.

Prepubertal unilateral gynecomastia: report of 2 cases

Prepubertal unilateral gynecomastia is an extremely rare condition. At present, its etiology and management strategy are not well known. Two unrelated prepubertal boys of ages 8 and 9 who presented with complaints of unilateral enlargement of breast tissue are reported. Physical examination, biochemical, hormonal and oncologic work-up findings were normal. Both patients were treated with peripheral liposuction successfully. Histopathological and immunohistochemical examinations showed benign fibroglandular gynecomastia and intensive (3+) estrogen receptor expression in 100% of periductal epithelial cells. Although an extremely rare and generally benign condition, patients with prepubertal unilateral gynecomastia should have a full endocrine and oncologic work-up.

Hypothalamic distribution of somatostatin mRNA expressing neurones relative to pubertal and adult changes in pulsatile growth hormone secretion in mice

The age-associated decline in growth hormone (GH) secretion may be a consequence of the reduction in the number of GH-releasing hormone (GHRH) positive neurones. However, it remains unclear whether an alteration in the number or distribution of somatostatin (SST) neurones contributes to this change. In the present study, we characterised the role of SST in modulating the change in pulsatile GH secretion in male C57Bl/6J mice throughout puberty and into early adulthood. We assessed pulsatile GH secretion in mice at 4, 8 and 16 weeks of age. These ages correspond to early pubertal, early adulthood and adulthood, respectively. We show an elevation in peak, total and pulsatile GH secretion coinciding with periods of rapid linear growth. Using in situ hybridisation and morphometric methods, we mapped the distribution of Sst mRNA expression within the mouse brain relative to this change in pulsatile GH secretion. The results obtained show that altered pulsatile GH secretion in male mice from 4-16 weeks of age does not coincide with a significant change in the number of Sst mRNA expressing neurones or an abundance of Sst mRNA expression throughout the arcuate nucleus (ARC) and periventricular nucleus (PeV). Rather, we observed a progressive decline in Sst mRNA expressing neurones within subnuclei of the paraventricular nucleus at this time. We conclude that structural changes in Sst expression within the PeV and ARC may not reflect the observed decline in pulsatile GH secretion in mice from puberty into early adulthood.