Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice

Polycystic ovary syndrome represents 80% of anovulatory infertility cases. Treatment initially includes preconception guidelines, such as lifestyle changes (weight loss), folic acid therapy to prevent the risk of fetal neural tube defects and halting the consumption of tobacco and alcohol. The first-line pharmacological treatment for inducing ovulation consists of a clomiphene citrate treatment for timed intercourse. The second-line pharmacological treatment includes the administration of exogenous gonadotropins or laparoscopic ovarian surgery (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective with cumulative live birth rates of approximately 70%. Ovarian drilling should be performed when laparoscopy is indicated; this procedure is typically effective in approximately 50% of cases. Finally, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is the third-line treatment and is recommended when the previous interventions fail. This option is also the first choice in cases of bilateral tubal occlusion or semen alterations that impair the occurrence of natural pregnancy. Evidence for the routine use of metformin in infertility treatment of anovulatory women with polycystic ovary syndrome is not available. Aromatase inhibitors are promising and longer term studies are necessary to prove their safety.     

Psychopathological features during childhood and adolescence among adult bipolar patients: A retrospective study

Objective

There are still several concerns regarding the inconsistency in the diagnosis of Bipolar Disorder (BD) in children and adolescents. This study reviews the symptoms of youth admitted to The University of Texas Harris County Psychiatric Center (UT-HCPC) prior to a confirmed diagnosis of BD to elucidate patterns and target symptoms which may facilitate early recognition of BD.

Methods

This is a retrospective review of charts of adult patients with a discharge diagnosis of BD for three consecutive admissions who were also admitted to UT-HCPC as children or adolescents (N = 26). The Kiddie SADS was completed based on each patient’s first admission as a child and last admission as an adult.

Results

Most of the symptoms found in adult BD were present in the child/adolescent subjects at equivalent rates, except for mood elevation, which was less common during childhood and adolescence. In spite of the psychopathological similarity, only 6 (23%) of the subjects were diagnosed with BD as youth.

Conclusion

BD is poorly diagnosed among children and adolescents. Difficulties in the assessment of the youth, as well as particularities in the psychopathology of mood among children and adolescents may account for the low diagnostic rate.     

Psammomatoid juvenile ossifying fibroma: an analysis of 2 cases affecting the mandible with review of the literature

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous neoplasm, defined as a variant of the ossifying fibroma that arises within the craniofacial bones. Two subgroups, juvenile psammomatoid ossifying fibroma (PsJOF) and juvenile trabecular ossifying fibroma, have been delineated by their histology. PsJOF occurs predominantly in the sinonasal and orbital bones. This work reports on 2 cases of extensive PsJOF in the body of the right mandible as well as reviews the literature regarding the radiographic and histologic features, treatment, and prognosis of PsJOF of the jaws.