The publication data currently available has been vetted by Vanderbilt faculty, staff, administrators and trainees. The data itself is retrieved directly from NCBI's PubMed and is automatically updated on a weekly basis to ensure accuracy and completeness.
If you have any questions or comments, please contact us.
Sickle cell anemia is one of the most common genetic blood disorders worldwide. Individuals with sickle cell disease (SCD) experience clinical manifestations such as chronic anemia, developmental delay, vaso-occlusive pain, acute chest syndrome, and neurological complications. Adolescent girls with SCD face unique gynecological challenges including delayed puberty marked by a later onset in menarche, vaso-occlusive pain associated with their menstrual cycle, and underdiagnosed abnormal uterine bleeding. This review focuses on these challenges with particular emphasis on delayed menarche and vaso-occlusive pain episodes associated with menstruation, in addition to the evaluation and initial management of heavy menstrual bleeding for adolescents with SCD. We highlight research opportunities in this neglected area to help enhance the comprehensive care model for this population.
Progesterone action normally mediates the balance between anti-inflammatory and proinflammatory processes throughout the female reproductive tract. However, in women with endometriosis, endometrial progesterone resistance, characterized by alterations in progesterone responsive gene and protein expression, is now considered a central element in disease pathophysiology. Recent studies additionally suggest that the peritoneal microenvironment of endometriosis patients exhibits altered physiological characteristics that may further promote inflammation-driven disease development and progression. Within this review, we summarize our current understanding of the pathogenesis of endometriosis with an emphasis on the role that inflammation plays in generating not only the progesterone-resistant eutopic endometrium but also a peritoneal microenvironment that may contribute significantly to disease establishment. Viewing endometriosis from the emerging perspective that a progesterone resistant endometrium and an immunologically compromised peritoneal microenvironment are biologically linked risk factors for disease development provides a novel mechanistic framework to identify new therapeutic targets for appropriate medical management.
Genitourinary complaints are common in children, and the busy primary care provider must determine initial treatment and assess need for specialty referral. Many complaints are self-limited, but some represent disorders that can threaten organ function. In this article, an initial approach in the primary care office and a guide to specialty referral for pediatric urologic conditions of the urinary tract, male genitalia, and female genitalia are suggested.
Copyright © 2011 Elsevier Inc. All rights reserved.
The guinea pig exhibits cyclic and luteal similarities to the human, a feature not present in other small experimental animals such as rats, mice, or rabbits. Studies were undertaken to investigate the in vivo effects of three persistent environmental xenobiotics (nonylphenol, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene [p,p'-DDE], and pentachlorophenol) on the microanatomy of the adult female guinea pig reproductive system. The effects brought about by these compounds (40 mg/kg/day) were compared to those caused by the synthetic estrogen diethylstilbestrol (DES; 50 microg/kg/day). Adult female guinea pigs, intact and castrated, were treated with 14 daily subcutaneous (s.c.) doses of one of these agents. The 50% decline in the weight of the tract that occurred following castration, was prevented by administration of nonylphenol, p,p'-DDE, and DES, but not of pentachlorophenol. Nonylphenol produced weak estrogenic stimulation of the tract of intact animals and maintained a relatively normal histologic appearance in castrated animals. Focal mucinous metaplasia of the endometrium, however, was observed in both groups. Treatment of intact and castrated animals with p,p'-DDE resulted in cystic hyperplasia and mucinous metaplasia of the endometrium, hyperplasia of the cervical epithelium, estrogenic stimulation of the vagina, and dilation of the rete ovarii. Treatment of intact or castrated animals with DES resulted in effects that were qualitatively similar to those caused by p,p'-DDE. The appearance of the vaginal epithelium, however, was abnormal and the rete ovarii were less dilated. Pentachlorophenol had minimal effect on the histology of the tract of castrated or intact animals. These data support our hypothesis that some environmental toxicants can substitute for estradiol in regulating the microanatomy of the female reproductive tract. They indicate the potential of these compounds to act as endocrine disrupting agents.
Quantitative enzyme-linked immunosorbent assays were used to measure interleukin (IL)-2, IL-10, and IL-12 in cervical secretions from female adolescents with and without sexually transmitted infections. Compared with human immunodeficiency virus [HIV]-negative patients, HIV-positive patients had higher concentrations of IL-10 (118.2 pg/mL vs. 34.5 pg/mL; P=.002) and IL-12 (175.5 pg/mL vs. 85.1; P=.03). IL-2 concentrations were not statistically different. Furthermore, genital tract infections were predictors of IL-10 and IL-12 concentrations. Coinfection with HIV and human papillomavirus predicted the highest IL-10 concentrations; coinfection with HIV, human papillomavirus, and other sexually transmitted pathogens predicted the highest IL-12 concentrations. The data indicate that concomitant infection of the genital tract with HIV and other viral, bacterial, or protozoan pathogens influences the local concentrations of some immunoregulatory cytokines.
Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1% (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7%) heterosexual men, 3 of 5 (60%) homosexual/bisexual men, and 9 of 484 (1.9%) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaint of genital ulcer [odds ratio (OR) 7.3; 95% confidence interval (CI) 1.4-72], past history of genital ulcer (OR, 4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR, 3.2; CI, 1.1-9.5), and history of genital ulcer (OR, 2.9; CI, 1.0-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)
Recent trends in reported primary genital syphilis and genital ulcer disease (GUD) were assessed in Burkina Faso using incidence data reported to the Ministry of Health. From 1978 to 1983 the yearly reports of genital syphilis and GUD rose by 42%. A single period moving average was calculated for each consecutive 13-week period from 1978 to 1983, documenting an average 7% rise per year. Severe limitations in the Ministry of Health of personnel and other resources for surveillance were noted and no improvements in surveillance methods were evident during this study. The rising trend suggests a growing problem of ulcerative sexually transmitted diseases, which may, in turn, facilitate infection with sexually acquired human immunodeficiency virus, coincident with the expansion of this epidemic in Africa. Syphilis complications are also almost certain to include adverse pregnancy outcome due to maternal syphilis. The rising trend in genital syphilis and GUD, and the probable increase in associated adverse sequellae, require that prevention and control of sexually transmitted diseases should be made a high priority.
OBJECTIVE - To enhance nurse clinicians' knowledge of genital human papillomavirus infection in women.
DATA SOURCES - Several literature searches using the following terms, dating back to 1986: human papillomavirus (HPV), females, human, cervical neoplasia, risk factors, condylomata acuminata, detection, epidemiology, pathology, psychology, Papanicolaou test, immunosuppression, HIV infection, and AIDS.
STUDY SELECTIONS - Forty-three formal research studies regarding the association of various types of HPV infection with cervical intraepithelial lesions, the putative precursor lesions for cervical neoplasia; the outcomes of diagnostic techniques for HPV types; the outcomes of diagnostic/screening techniques for abnormal cervical cells; the association of risk factors for acquiring HPV infection; or the outcomes of therapy. Some additional references were chosen for their presentation of epidemiologic or surveillance data, others for their scientific discussions on related topics.
DATA EXTRACTION - Data were abstracted according to summary measures of the parameter of interest in the sample studied. In most instances, it was the prevalence of HPV, cervical neoplasia, or frequency of use of screening tests.
DATA SYNTHESIS - Immunosuppressed clients are at particular risk for HPV-mediated cervical neoplasia.
CONCLUSION - Because Papanicolaou tests are an effective screening tool, cervical cancer is easily detectable. The nurse may facilitate treatment. This is an especially important issue for young women, among whom sexual activity is growing--with attendant increases of HPV and HIV infection.