Ovulation induction in young girls with menometrorragia: a safe and effective treatment

The prevalence of menometrorrhagia in fertile women is 11.4–13.2% and increases with aging. The presence of metrorrhagia is a relatively common cause of concern among adolescents and their parents, as well as a frequent cause of visits to emergency departments, gynaecologists, and pediatricians. Clomiphene is a selective estrogen receptor modulator (SERM) that increases the production of gonadotropins by inhibiting negative feedback on the hypothalamus.

Clomiphene is primarily used in the treatment of female infertility for ovulation induction to reverse oligoovulation or anovulation, as occurs in polycystic ovary syndrome.

Objective: The aim of our study was to evaluate the use of clomiphene citrate in ovulation induction, and therefore, in the cessation of bleeding in adolescents with menometrorrhagia in the absence of uterine, ovarian, or systemic pathologies.

Design: Cohort study.

Materials and methods: The study group was comprised of 50 subjects (age range, 13–16 years) with menometrorrhagia (bleeding >7 days in length with an average blood loss >80?ml). The treatment with clomiphene citrate at a dose of 50?mg/day for 5 days during the attack cycle, and from days 3 to 7 of three subsequent cycles, was offered to the patients.

Results: After three cycles of therapy, all patients had resolution of the menometrorrhagia and resumption of ovulatory cycles. No patient reported unwanted side effects.

Conclusion: We propose that low-dose clomiphene should be the first step in the treatment of adolescent dysfunctional bleeding (DUB).     

Review of Risk Assessment of Major Anatomical Variations in Clinical Dentistry

Most of the studies of the mandible's anatomical variations have presented the authors' speculations, and only a limited number has provided evidence that demonstrated the actual complications injury to the variant structures caused. To our knowledge, no study has evaluated the risks associated with these variant anatomical structures' injury. We reviewed articles that described clinical cases of the injury to, and anatomical studies of, three anatomical variants of the mandible—the accessory mental, lingual, and retromolar foramina—with which dentists are relatively familiar and that are mentioned often in the context of implant and third molar surgeries, to describe risk assessment methods with which to evaluate potential complications preoperatively. Only a limited number of the clinical reports of injury to the mandible's accessory foramina were available. The potential severe complication of injury of the accessory mental foramen (AMF) is sensory disturbance of the lower lip. Risk of neurosensory disturbance of lower lip can be assessed by AMF/MF ratio and positional relations to the MF. Potential severe complication of injury of the lingual foramen is bleeding and hemorrhage in the oral cavity's floor. Risk of bleeding can be assessed by diameter and positional relation between the mental spine/mylohyoid line. A risk assessment of the retromolar foramen could not be made because of inadequate data. We hope the risk assessments suggested will encourage dentists to predict intraoperative/postoperative complications caused by damaging the mandible's accessory foramina. Clin. Anat. 32:672–677, 2019. © 2019 Wiley Periodicals, Inc.     

Profilaxis para sangrado por ulceras de estrés en la unidad de cuidados intensivos

BackgroundThe critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal.AimsThe purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit.MethodsWe identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases “stress ulcer”, “stress ulcer bleeding prophylaxis”, and “stress-related mucosal bleeding” in combination with “intensive care unit”.ResultsThe incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies.ConclusionsAdmittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis.