Abnormal control of ventilation in adolescents with myelodysplasia

Infants with myelomeningocele have abnormalities in ventilatory control. To determine whether these persist into later life, we studied 14 patients with myelomeningocele and Arnold-Chiari malformation (age 18.0 +/- 0.8 (SE) years), and compared them with 14 control subjects (age 24.0 +/- 0.9 years). Pulmonary function and ventilatory muscle strength did not differ between patients with myelomeningocele and control subjects. Hypercapnic ventilatory responses were significantly lower in the group with myelomeningocele (1.98 L/min/mm Hg) compared with control values (3.33 L/min/mm Hg; p less than 0.01). Hypoxic ventilatory responses (-1.4 L/min/%oxygen saturation of hemoglobin in arterial blood) were not significantly different from control values (-2.14 L/min/%oxygen saturation). In control subjects the hypercapnic and hypoxic ventilatory responses were highly correlated with each other within subjects (r = 0.84; p less than 0.002) but not in those with myelomeningocele (r = 0.34; not significant). We concluded that adolescents and young adults with myelomeningocele have abnormalities in control of ventilation during sleep and wakefulness. We speculate that the Arnold-Chiari malformation interferes with central chemosensitivity (hypercapnic ventilatory response) and central integration of chemoreceptor output.     

Upper gastrointestinal bleeding in children and adolescents.

This is a retrospective study of upper gastrointestinal hemorrhage in 68 children and adolescents who were less than 19 years old. In descending order of frequency, the five most common causes were duodenal ulcers, gastric ulcers, esophagitis, gastritis, and esophageal varices. There was male predominance in all diagnoses except gastric ulcers and gastritis. Signs and symptoms correlated poorly with the source of bleeding. Endoscopy was the most reliable method of identifying the bleeding site. Mortality correlated with the following: (1) initial hematocrit or hemoglobin level of less than 20% or less than 7 gm/100 ml, respectively, (2) transfusion requirements of greater than 85 ml/kg of blood without surgical intervention, (3) failure to identify the source of bleeding, (4) presence of a coagulation disorder, and (5) coexistence of another life-threatening disease.     

Urethral prolapse misdiagnosed as vaginal bleeding in a premenarchal girl

We report on a 10-year-old girl who was presented to the Emergency Department with a 3-day history of "vaginal bleeding", the cause of which was determined to be urethral prolapse. Urethral prolapse occurs when the urethra mucosa evaginates beyond the urethral meatus. This uncommon condition in prepubescent girls should not be confused with other causes of peri-vaginal bleeding, the most importantly being sexual abuse.     

Treatment of vaginal bleeding from a pelvic vascular malformation with desmopressin

We report the case of a 2-year-old female child with a pelvic vascular malformation complicated by chronic low-grade bleeding. Treatment with intranasal desmopressin significantly reduced vaginal bleeding. Therefore, we suggest that intermittent use of intranasal desmopressin may be useful in the treatment of chronically bleeding low-flow vascular malformations.     

Early vaginal bleeding, late prenatal care, and misdating in adolescent pregnancies

Vaginal bleeding early in pregnancy may be mistaken for menstrual bleeding and delay entry into prenatal care by delaying the diagnosis of pregnancy. This study tests the hypotheses that (1) more adolescents report early first-trimester vaginal bleeding than do adults and (2) a history of vaginal bleeding is associated with later entry into prenatal care, particularly among adolescents. Reports of early vaginal bleeding were prospectively obtained from black, predominantly primiparous, unmarried poor women (136 adolescents and 53 adults). As hypothesized, more adolescents reported early first-trimester vaginal bleeding than did adults (16.9% vs 5.7%; P less than .01). Adolescents who reported early vaginal bleeding also entered prenatal care later (16.2 weeks) than did adolescents who reported no bleeding (12.7 weeks) (P less than .03); this was not true for adults. If dating of the gestation is based solely on last menstrual period history, inflation of the incidence of preterm births to adolescents and the mean birth weights of those preterm neonates may occur. The findings suggest that new strategies focusing on the recognition of menstrual irregularities as a symptom of pregnancy may be needed to promote early prenatal care among adolescents. Additionally, adolescent pregnancies should be dated by both ultrasound and Dubowitz examinations.     

Abnormal gastroduodenal motility in children and adolescents with recurrent functional abdominal pain

To determine whether motor activity of the stomach and proximal small intestine is a factor in recurrent abdominal pain in adolescents, we prospectively investigated eight patients with recurrent abdominal pain and compared them with seven normal adolescents. All patients underwent a detailed examination to exclude other known organic causes of the pain. The gastroduodenal motor activity during fasting was studied with a semiconductor recording probe. The recordings were analyzed for periodicity, duration, and propagation velocity of the activity front of the migrating motor complex. The amplitude of the antral and duodenal contractions was also determined. The patients with recurrent abdominal pain had more frequent migrating motor complexes, but these were shorter in duration and moved more slowly down the intestine (slower propagation velocities). The patients also had high-pressure duodenal contractions that were associated with abdominal pain during the study period. These studies suggest that altered intestinal motility may be the underlying mechanism of recurrent abdominal pain in some children.     

Characterizing adolescents with heavy menstrual bleeding and generalized joint hypermobility

Patients with generalized joint hypermobility (JHM) may experience excessive bruising/bleeding, with heavy menstrual bleeding (HMB) commonly reported. We performed a retrospective review of 30 adolescents seen in a Young Women's Hematology Clinic with both HMB and JHM. We found that (1) a significant delay (mean 36 months, range 5–72) occurred between menarche and referral to specialty care, (2) HMB had moderate to severe impact on school and physical activities in 60% of patients, and (3) most patients (68%) required escalation of their initial therapy. We suggest providers consider JHM as a risk factor for a more complex clinical course.