Depression in the adolescent patient

Depression in adolescence is a major public health problem that is associated with significant morbidity and mortality. A large number of clinically depressed adolescents still are unrecognized and untreated. This chapter provides pediatricians with useful guidelines for recognizing and managing adolescent depression in a primary care setting.     

Prenatal diagnosis in the adolescent patient

Despite a 21% reduction in the birth rate for adolescents aged 15-19 years between 1991 and 2000, there are still over 470,000 births to adolescents nationwide. The primary purpose of prenatal screening is to determine the risk of a disease or condition affecting either the patient or her fetus. A determination of risk is possible only after an accurate assessment of all information unique to each pregnancy. This assessment includes a medical, obstetrical, social, and family history. Ethnicity-based screening tests should be offered to patients at risk for specific disorders unique to their ancestry, whereas population-based screening tests, such as maternal serum screening and ultrasound screening, should be offered to all pregnant women. Invasive diagnostic testing should be reserved for patients whose pregnancy has been determined to be at risk for a particular disease or condition.     

Breast disorders in the adolescent patient

Although breast cancer is rare in childhood and adolescence, breast concerns among patients in this age group are common. Benign proliferative changes and benign masses such as fibroadenomas are the most common entities encountered in the adolescent patient. Evaluation of breast complaints includes a careful history and physical examination. Ultrasonography is the best adjunctive radiologic modality to assess the adolescent breast. Surgical intervention usually is contraindicated in prepubertal patients. In the postpubertal patient, discrete breast masses, which are not suspicious on clinical examination, may be observed. Additionally, FNA and surgical removal are also safe diagnostic and therapeutic alternatives in this patient population.     

Spontaneous pneumomediastinum in an adolescent patient

Chest pain is a frequent complaint requiring evaluation. The differential diagnosis is extensive and includes diseases of the respiratory, cardiac, gastrointestinal, neurologic, or musculoskeletal systems. This report describes an adolescent patient with chest pain secondary to spontaneous pneumomediastinum. The work-up and etiology is discussed.     

Massive pulmonary embolism in wife-caregiver of terminally ill patient with sarcoma

We report a case of massive pulmonary embolism in a 63-year-old female caregiver of her terminally ill husband. Venous thromboembolism in family caregivers is a rare but a serious problem. Increased awareness and implementation of policies and guidelines to decrease potentially preventable venous thromboembolism are vital to help prevent unnecessary death, to increase patient safety, and to contain rising costs in health care.     

Emergency medical services and the adolescent patient

A study of 10,493 prehospital care report forms from 11 counties in California demonstrated that the adolescent age group (ages 12 to 18 years) accessed prehospital care through the emergency medical service (EMS) system more frequently than other pediatric patients (5978 reports). They did so most commonly for trauma (87.6%), but also for behavioral emergencies such as suicide and psychiatric problems. The most common cause of injury was automobiles, and care rendered was most commonly wound care and splinting. The most common substances given to adolescents in the prehospital setting were naloxone and 50% dextrose. EMS systems need to address the need for triage and care of adolescent patients.     

Autoimmune hemolytic and thrombocytopenic disease in the adolescent patient

Adolescent patients with immune-mediated hematologic disorders present a challenging clinical picture. The combination of a careful history, physical examination, and appropriate laboratory tests will help establish the correct diagnosis. Thoughtful consideration of therapeutic options will result in the best treatment outcomes.     

The alcohol patient and surgery.

Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance. The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity.