The histology and management of ovarian cysts found in children and adolescents presenting to a children's hospital from 1991 to 2007: a call for more paediatric gynaecologists.

OBJECTIVE: To determine the nature and surgical management of ovarian cysts. DESIGN: Retrospective case-note study. SETTING: Large Childrens' Hospital: Alder Hey NHS Foundation Trust. SAMPLE: Children undergoing surgery for ovarian cysts between 1991 and 2007. METHODS: Cases identified using coding and the pathology database, and analysed using snap 9. MAIN OUTCOME MEASURES: Extent of surgery performed. Size and histological features of cysts removed. RESULTS: A total of 155 cases were identified. There were 62 ovarian cysts in children under nine who were prepubertal. There were 58 neoplastic cysts in total. Most were benign teratomas (36). Ten cysts were malignant, including five granulosa cell tumours, one yolk sac tumour, one endodermal sinus tumour and one dysgerminoma. Tumour markers were performed in only 16 cases (10%). Sixty-one (39%) had an ultrasound scan and 16 (10%) had a computed tomography (CT) or magnetic resonance imaging (MRI) scan. Ninety girls (58%) had an oophorectomy and 40 (25%) had an ovarian cystectomy. Oophorectomies were performed for all cases of malignancy, but 75 were also performed for benign or normal pathology. Only 16% of cases were referred to the paediatric gynaecologist and all were for post-operative management. CONCLUSIONS: We recommend the greater use of imaging of the pelvis and tumour markers preoperatively. There should be greater use of conservative expectant management or ovarian-sparing surgery in view of the low risk of malignancy in this age group. The practice of removing ovaries for benign cysts may be overcome by appointing more gynaecologists with advanced training skills training in paediatric and adolescent gynaecology.

Congenital malignant melanoma.

This is the first case of congenital metastatic malignant melanoma to be reported in a premature infant whose mother did not have the disease. The possible relation of host immunity and multicentric origin to this rare occurrence is discussed. Exchange transfusion, using maternal blood, may improve survival in such cases.

Intraoperative placement of a self-retaining Foley catheter for continuous drainage of malignant ascites.

Malignant ascites in advanced cancer is usually treated by repeated paracentesis, causing both discomfort and inconvenience to patients in the terminal stages of disease. We present a case of advanced ovarian carcinoma in which intraoperative placement of a Foley's self-retaining catheter into the peritoneal cavity was used to facilitate long-term continuous drainage of malignant ascites. This is a simple, convenient and cost-effective method which decreases the need for repeated hospital admissions. The aim complication might be peritonitis, but with proper care of the device and the use of antibiotics, this was not seen in our patient.

Use of continuous fluid drainage for severe polyhydramnios due to twin to twin transfusion syndrome.

Acute polyhydramnios due to twin to twin transfusion is a rare complication of twin pregnancies which, despite treatment, has a high perinatal mortality. Repeated decompression amniocentesis has been used but is associated with certain risks. We report the use of continuous, gradual fluid drainage as an alternative method of uterine decompression.

Value of routine long bone radiographs in management of babies with a positive VDRL at the Mount Hope Women's Hospital.

This retrospective study examined the records of 44 mothers and 44 babies with a positive blood VDRL test and/or who showed symptoms of congenital syphilis at the Mount Hope Women's Hospital (MHWH), Trinidad, between June 1, 1996 and September 30, 1998. Long bone radiographs of 40/44 (91%) babies were assessed independently by two radiologists for signs of congenital syphilis and the data were analysed using frequency tables. Of the 44 mothers in the study, 34 (77%) were VDRL positive and the rest were either negative or unknown. Maternal age ranged from 14 to 39 years and most (92%) had antenatal care. Fourteen of the 34 (41%) VDRL positive mothers received treatment antenatally. All mothers were asymptomatic and none had any clinical features of syphilis. In 35/44 babies, the VDRL test was positive and in nine, the test was either negative or unknown. Twenty-six of the babies had signs suggestive of congenital syphilis and in 12, (46%) long bone radiographs revealed changes compatible with the diagnosis of congenital syphilis. Radiographic abnormalities were present only in infants with VDRL titres > 1:8.

Caroli's disease associated with a gastric diverticulum.

Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient.

Mesenteric venous thrombosis and oral contraceptive use.

A case of mesenteric venous thrombosis in a young woman receiving oral contraceptives is reported. This is the first case encountered in the Caribbean region.

Actinomycosis of the liver.

We present our first case of actinomycosis in Trinidad and we believe this is also the first reported case of hepatic actinomycosis in the West Indies.

Unsuspected infective cholestatic jaundice after bilateral tubal ligation

Severe bacterial infection from a primary septic focus remote from the liver is accepted to be a cause of hepatic dysfunction. This may range from minor biochemical abnormality of standard liver function tests to fulminant hepatic failure. This report highlights a presentation with deep obstructive-type jaundice associated with profound bio-chemical changes suggestive of cholestatic hepatitis. There was no clinical indication of infection during the first 4 weeks and at admission. As a result, the absence of fever and leucocytosis was misleading. Halothane hepatitis was the working diagnosis until the sixth week when pelvic sepsis emerged as the possible cause. However, drainage of the abscess led to prompt clinical and biochemical resolution of jaundice so that it is unlikely that halothane exposure was a primary contributing cause. In addition, other common causes of jaundice were excluded by serological and sonographic screening. This case was an unusual case in which the cause of cholestatic jaundice occurred after a minor gynaecological operation commonly performed in developing countries (AU)

Value of routine long bone radiographs in management of babies with a positive VDRL at the Mount Hope Women's Hospital

This retrospective study examined the records of 44 mothers and 44 babies with a positive blood VDRL test and/or who showed symptoms of congenital syphilis at the Mount Hope Women's Hospital (MHWH), Trinidad, between June 1, 1996 and September 30, 1998. Long bone radiographs of 40/44 (91) babies were assessed independently by two radiologists for signs of congenital syphilis and the data were analysed using frequency tables. Of the 44 mothers in the study, 34 (77) were VDRL positive and the rest were either negative or unknown. Maternal age ranged from 14 to 39 years and most (92) had antenatal care. Fourteen of the 34 (41) VDRL positive mothers received treatment antenatally. All mothers were asymptomatic and none had any clinical features of syphilis. In 35/44 babies, the VDRL test was positive and in nine, the test was either negative or unknown. Twenty-six of the babies had signs suggestive of congenital syphilis and in 12, (46) long bone radiographs revealed changes compatible with the diagnosis of congenital syphilis. Radiographic abnormalities were present only in infants with VDRL titres > 1:8