Late Adolescent Patients Research Articles

Orthodontic camouflage of a late adolescent patient with Class III malocclusion

This paper concerns orthodontic treatment of a 11-year-old female having an Angle Class III malocclusion with incisor edge-to-edge occlusion, a skeletal Class III jaw base relationship and a normal mandibular plane angle. When she was 13 years old, the mandibular third molars were extracted and the remaining mandibular molars were distalized. Good occlusion and facial esthetics were achieved. These results have been maintained for 4 years following completion of active treatment.

Skeletal, dental and soft-tissue changes induced by the Jasper Jumper appliance in late adolescence.

The purpose of this study was to evaluate the skeletal, dental, and soft-tissue changes in late-adolescent patients treated with Jasper Jumpers applied with sectional arches. The study sample consisted of 30 subjects (15 treated, 15 untreated) with skeletal and dental Class II malocclusion. Our study was carried out on 75 lateral cephalometric films. Among these radiograms, 15 were taken before the leveling stage in the treatment group. Half of the remaining 60 were taken before placement and after removal of the Jasper Jumper appliance in the treatment group and the other half at the beginning and six months after in the control group. The patient selection criteria were Class II malocclusion caused by retrognathic mandible, normal or low-angle growth pattern, and postpeak growth period. The statistical assessment of the data suggests that the sagittal growth potential of the maxilla was inhibited. There were no significant changes in the vertical skeletal parameters. The mandibular incisors were protruded and intruded, whereas the maxillary incisors were retruded and extruded. The upper molars tipped distally as the lower molars tipped mesially. Because of these changes, the occlusal plane rotated in the clockwise direction. Overbite and overjet were reduced, and the soft-tissue profile improved significantly. The results revealed that, in late-adolescent patients, the Jasper Jumper corrected Class II discrepancies mostly through dentoalveolar changes. It is suggested that this treatment method could be an alternative to orthognathic surgery in borderline Class II cases.

Beat‐to‐Beat Heart Rate Adaptation in Pediatric and Late Adolescent Patients with Closed Loop Rate‐Responsive Pacemakers

The aim of this study was to evaluate the efficacy of physiological rate-responsive pacemakers (Closed Loop Stimulation--CLS) to pace pediatric and late adolescent patients undergoing rest, mental, standing, and exercise testing. Dual-chamber pacemaker is increasingly indicated for young patients. A new physiological pacing mode based on the indirect measure of ventricular contractility (CLS), has shown interesting results in adults, while no data on pediatric patients are available. RR intervals and beat-to-beat systolic and diastolic pressures were monitored in 12 pediatric patients (6 males, mean age 17 years [12-22 years]) who had a transvenous implant of Inos2+-CLS dual-chamber pacemaker (Biotronik GmbH, Berlin, Germany) and endocardial leads. All the patients showed correct electrical parameters at the implant and during the follow-ups. Paced RR intervals decreased significantly (F = 7.28, P = 0.01) from 0.85 +/- 0.08 seconds (rest) to 0.73 +/- 0.10 seconds (mental) and to 0.75 +/- 0.010 seconds (standing); systolic/diastolic pressure was significantly higher (F = 12.2, P = 0.002/F = 13.6, P = 0.001) in mental (134.4 +/- 19.9/74.4 +/- 8.1 mmHg) with respect to rest (115.1 +/- 18.3/61.0 +/- 6.1 mmHg), and standing (118.7 +/- 23.9/67.3 +/- 0.1 mmHg). During exercise the paced RR interval showed significant decrease of about 35% from baseline to maximum load (F = 24.90, P = 0.001) and systolic pressure increased significantly (F = 4.91, P = 0.019) by about 34% from baseline to maximum load. The comparison between paced and spontaneous rates showed very similar values and trend. In addition, CLS mode does not seem to overrun the spontaneous heart activity, when present. This is a study to evaluate CLS pacing in pediatric and late adolescent patients. The study shows that CLS pacing responds to both physical and non-physical stressors, providing physiological pacing rates, as previously observed in adults.

A retrospective study of SSRI treatment in adolescent anorexia nervosa: insufficient evidence for efficacy

Although selective-serotonin-reuptake-inhibitors (SSRI) have been of limited efficacy in the treatment of eating disorder psychopathology and comorbid symptoms of malnourished patients with anorexia nervosa (AN), there is recent data suggesting that SSRI may play a role in preventing relapse among weight-restored patients. Though some previous studies included patients in late adolescence, the vast majority of investigated subjects have been adults. The aim of our retrospective study was to assess the effects of SSRI treatment in partially weight-restored children and adolescents with AN. Thirty two females with AN (mean 14.5 ± 1.4 years) were investigated three times during inpatient treatment and at 3- and 6-month follow-up for BMI, eating disorder psychopathology, depressive symptomology, and obsessive-compulsive symptomology. Medication history during inpatient and outpatient treatment was reconstructed at the 6-month follow-up. Nineteen patients received SSRI treatment, while 13 subjects were non-medicated. In comparison to the non-SSRI group, the SSRI group had similar BMI and obsessive-compulsive scores, but higher levels of core eating disorder psychopathology and depressive symptoms at the start of medication. Rates of re-admissions were similar in both groups (SSRI group: 36%, non-SSRI group: 31%, Φ: p = 0.72). Repeated measures ANOVA revealed no significant group with time interactions for BMI-SDS ( p = 0.84), core eating disorder symptoms (ANIS, p = 0.79), depression (DIKJ, p = 0.75), and obsessive-compulsive (CY-BOCS, p = 0.40) scores indicating minimal or no effects of SSRI medication on the course of these variables. In conclusion, our results challenge the efficacy of SSRI medication in the treatment of eating disorder psychopathology as well as depressive and obsessive-compulsive comorbidity in adolescent AN. Clinicians should be chary in prescribing SSRI in adolescent AN unless randomized controlled trials have proofed the benefit of these drugs.

Prognostic factors and survival in late adolescent and adult patients with small round cell tumors.

The primary objective of this study is to review the clinical characteristics of 25 patients in the adult and late adolescent age group, diagnosed and treated with small round cell tumors involving soft tissues (extraosseous Ewing sarcoma, rhabdo-myosarcoma, primitive neuroectodermal tumor, and undiffer-entiated small round cell tumors). Additionally, survival and prognostic factors influencing the outcome with multimodality treatment are evaluated. There were 19 males (76%) and 6 females (24%). The median age was 26 years (range: 15-56 years). In 9 patients (36%), the tumor was located at an extremity, whereas 16 patients (64%) had central localizations. Tumor size was larger than 10 cm in 7 patients (29.2%). Six patients (24%) had metastatic disease. Twelve patients (48%) received radiation and 16 patients (64%) underwent surgery. Among the resected tumors, 2 were resected with contaminated margins (12.5%), whereas 2 were radically resected and 12 (75%) were resected with wide margins. All patients were given a median of 4 cycles of multiagent chemotherapy (1-14 cycles). With preoperative chemotherapy, complete regression (CR) of the tumor was achieved in 6 patients (24%). In 4 patients (16%), a partial response was obtained. After the completion of multimodality treatment, 12 patients (48%) had a CR. Progression-free (PFS) and overall survival (OS) for the entire group was 25.0 +/- 10.8% at 1 year and 30.5 +/- 15.5% at 3 years, respectively. Nonmetastatic disease, wide and radical resection, and presence of CR to multimodality treatment were associated with a significantly longer PFS and OS by univariate analysis. By multivariate analysis, CR to multimodality treat-ment was the only independent predictive factor for a longer OS (p: 0.0036, relative risk [RR]: 23.6, 95% CI: 2.8; 198.7) and metastatic presentation was the only independent factor predic-tive for a shorter PFS (p: 0.017, RR. 15, 95% CI: 1.6; 141.2). Large-scale, multicenter studies are required for a better eval-uation of the nonpediatric age group with small round cell tumors.

Chronic pancreatitis in late childhood and adolescence.

Acute pancreatitis is unusual in pediatric patients, and chronic pancreatitis is even less common. Between 1983 and 1988, we diagnosed 24 patients in late childhood and adolescence with chronic pancreatitis. Our review revealed that chronic pancreatitis presents as recurrent abdominal pain in late childhood and adolescence. Individual laboratory and radiological investigations may be normal during acute exacerbations of pain, but the determination of serum amylase and lipase concentrations--combined with ultrasonography--will accurately identify most patients. We found that endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis of structural abnormalities. Surgical intervention may reduce symptoms in patients with structural abnormalities. There is a tendency toward decreased frequency and severity of pain as the patients increase in age.

Serum vitamin A and retinol-binding protein in patients with insulin-dependent diabetes mellitus

Serum concentrations of vitamins A and E and retinol-binding protein (RBP) were measured in 25 late adolescent and young adult patients with insulin-dependent diabetes mellitus. Their serum vitamin A levels were significantly lower than those of nondiabetic control subjects of comparable age. The serum concentrations of RBP were also significantly lower in the diabetic patients. The serum levels of vitamin A in the diabetic patients as well as in the control subjects showed a significant linear regression with serum concentrations of RBP. Unlike vitamin A, serum concentrations of vitamin E were not significantly different between the two groups of subjects. These findings suggest that the reduced serum vitamin A levels in the diabetic patients reflect reduced mobilization of vitamin A from the liver.

Divided loyalties in adolescent psychiatry: late adolescence.

The paper discusses problems that arise in psychotherapy with late adolescent patients when other individuals somehow become indirectly involved in ways that require or suggest some exchange of information. These individuals may be parents or administrative and teaching personnel within an institution. The differences between confidentiality, privileged communication, and privacy are discussed, and specific difficulties discussed in the therapy of late adolescents who are in the process of psychologically (as well as legally) attempting to achieve the independent status of a young adult.

Adolescents and Ritalin

To the Editor.— I continue to see patients in late adolescence with serious social and psychological problems that had been treated successfully with Ritalin. The medication was stopped at age 12 years because "the condition goes away at that age." Attention deficit disorder may indeed spontaneously remit at any age. Such remissions are unpredictable. Many patients continue with their problems long into adult life. If a child had problems related to attention deficit disorder of sufficient degree to warrant the use of medication, such medication should be continued as long as it exerts an obviously beneficial effect.

The self-image of adolescents with acute anorexia nervosa

The Offer Self-Image Questionnaire for Adolescents was administered to 30 female adolescents with a diagnosis of acute anorexia nervosa. Patients were divided ianto an early group (12 to 15 years; N = 15) and a late group (16 to 19 years; N = 15). The mean percent weight loss calculated as deviation from norm weight for age and height was 32%, and the mean duration of illness was 1.3 years, similar for both groups, whereas age of onset of anorexia was significantly (P less than 0.001) different. All patients differed significantly from normal adolescents by displaying disturbances in mood and self-esteem (P less than 0.05), in social relationships (P less than 0.05), and in attitude toward sex (P less than 0.05); late adolescent patients additionally showed maladjustment in impulse control (P less than 0.05), self-perception and body image (P less than 0.01), and in general psychopathology (P less than 0.05). Patients were found well adjusted with regard to moral values, family relationships, and educational goals. The lesser adjustment problems in the younger group agree well with reports finding a more favorable prognosis for patients with an early onset of anorexia nervosa.

Pectus carinatum: Results of surgical therapy

There are a variety of protrusion defects of the anterior chest which are collectively referred to as pectus carinatum. Over a 14-yr period, 13 patients have had surgical correction of pectus carinatum at The Johns Hopkins Hospital. Technique includes costal cartilage resection and a sternal osteotomy. There was no mortality, complications were few and results are good. Repair is recommended for patients in late adolescence due to the cosmetic nature of the procedure, the apparent lack of an associated postural deformity and the good results of operation in this age group.