Clinical Points

CHAPTER 5

Cysts: Non-neoplastic ovarian cysts are the most common cause of ovarian enlargement, though luteal cysts are the most common cause of ovarian enlargement during pregnancy. Follicular cysts are unruptured follicles that may cause abdominal pan when ruptured.

Polycystic ovarian syndrome (Stein-Leventhal syndrome): The most common female endocrine disorder, affecting approximately 5%-10% of all females. It is a hormonal disorder (increased LH and androgens and decreased FSH) that may involve multiple tissues and organ systems within the body, and can be caused by insensitivity to the hormone insulin (PCOSupport). Signs and symptoms include multiple follicular cysts of the ovaries associated with obesity, amenorrhea (oligomenorrhea), hirsutism, and infertility due to lack of ovulation.

Ovarian tumors are very common, and there are various types: Teratomas are germ cell tumors of the ovary; cystic teratomas or dermoid cysts of the ovary contain various tissues, including bone, teeth, skin, cartilage, muscle, and even thyroid tissue (struma ovarii).

Cervical Incompetence: In some females, the internal os is incompetent and leads to repeated abortions (two or more painless abortions between 16 and 28 weeks), usually in the second trimester. There may be many causes, including infections, hypertension, diabetes, and others. However, if the cervix is incompetent, surgical treatment (Shirodkar/McDonald) to tie the cervix may be necessary between 12-28 weeks, with removal of the sutures at 36 weeks.

McDonald’s is a variation on the original Shirodkar suture, wherein the patient may have a scarred patulous cervix. One should exclude abnormalities such as uterine septa (for which the patient needs a hysterosalpingogram) and fibroids in between pregnancies, which can also cause second-trimester abortions. In McDonald’s surgery, the suture is inserted superiorly in the outer surface of the cervix, near the level of the internal os at regular intervals, in order to encircle the cervix and tighten the suture around it and reduce its diameter to a few mm. The canal must be just patent as the suture is tied.

Leiomyomas (fibroids) are smooth muscle tumors of the uterus, and are the most common overall tumors (benign) in women. They are symptomatic in approximately 25% of reproductive age females. Careful pathologic examination of the uterus shows over 75% of reproductive age females have leiomyomas with the average affected uterus containing six to seven fibroids. Uterine leiomyomas are frequent in women older than 30 years of age, very rare in women below the age of 18, and tend to regress after menopause.

CHAPTER 9

Congenital Malformation of the Palate: A cleft palate occurs when the lateral palatine processes, the nasal septum, and/or the median palatine process fail to fuse, and there are a number of possible causes. A posterior cleft palate is more common than an anterior cleft palate. Increased steroid use during fetal development increases the chance of cleft lip/palate.

Salivary gland stones (sialolithiasis) are one of the most common diseases of the salivary gland. The submandibular gland and its duct appear to be the sites most susceptible to this disease. Sioloadenectomt (removal of the gland) may be necessary when the disease becomes chronic (chronic sialoadenitis); however, there are a few reports that the removal of large submandibular gland calculi by gland-preserving procedures makes it possible to retain an asymptomatic salivary gland.

Mumps: Inflammation of the parotid gland caused by the mumps virus (myxovirus).

Macroglossia: Enlargement of the tongue, often seen in hypothyroidism, amyloidosis, and cretinism (congenital hypothyroidism).

Tetracycline: is an antibiotic that, when given to a child may lead to yellow discoloration of the teeth, enamel hypoplasia, and reduced growth of the long bone

Congenital syphilis (Treponema pallidum) results in deformed teeth (Hutchinson’s