Teenage Patient Research Articles

The UK gender identity clinic for young people

The Gender Identity Development Service (GIDS) in London—the only one of its kind in the UK—started out from small beginnings at St George's Hospital nearly 30 years ago. Its founder, the child and adolescent psychiatrist Domenico di Ceglie, was inspired to start the service after seeing a teenage patient who claimed she was a boy in a female body. “She wondered why [her parents] had not sought help for her when she was a child”, di Ceglie subsequently wrote. “Her thoughts made me wonder why there was no service for children with these rare and unusual experiences. This planted in me the seed for the creation of such a service.”

Acute Inpatient Rehabilitation Management Following Lightning Strike: Pediatric Acquired Brain Injury Case Study

To describe a case of lightening strike in a teenage patient, his rehabilitation course, and measures of functional recovery.

Unusual traumatic uterine injury

Cervical agenesis is one of the Mullerian developmental anomalies that can occur and is usually associated with vaginal atresia rarely isolated. Here we are reporting a case that has been referred as cervical agenesis and found to be a cervicouterine transection, so far not reported in literature. We report a case of traumatic cervicouterine transection in teenager patient who presented with amenorrhea and hematometra. She was primarily investigated and found to have intact full length cervical canal, normal uterus, and urinary system. Operative management confirmed our diagnosis of transection rather than agenesis with her history of trauma at the age of 3 years. We report our case with medical diagnostic approach and management. Keywords: cervical agenesis, cervicouterine transection, hematometra, primary amenorrhea, uterine injury

Lost in the Present

Lost in the Present

Management of a Complex Lower Limb Open Fracture in a Teenage Patient: A Case Report

The challenges of managing Gustilo IIIB tibial fractures (ie, high energy trauma with a contaminated wound >10 cm in length, severe comminution ["crumbling"] or segmental fractures, and periosteal stripping) in children are unique in part because no clear guidelines exist and the injuries may cause short-term and long-term complications. Repeated wound debridement and secondary reconstruction are required in approximately 20% of these cases in both adults and children. A 13-year-old girl presented with severe polytrauma including an open Gustilo type IIIB fracture of the left lower leg. The patient declined limb amputation; a multidisciplinary team (plastic, pediatric, orthopedic-trauma surgeons, pediatrician, psychiatrist, clinical pharmacologist, anesthesiologist, physiotherapist, nurses) was assembled in order to give the patient the best chance of a successful outcome. Multiple limb salvage and reconstructive procedures including wound debridements, necrectomies, long-term negative pressure wound therapy, soft tissue reconstructions, external bone fixation, bone osteosynthesis, multiple skin grafts, and free-flap reconstruction were provided over a period of 6 months with great success. The patient is doing well 3 years after initial injury and is walking without complications. A multidisciplinary approach and structured treatment plan are important to minimize complications, avoid unnecessary delays in treatment, decrease morbidity, and provide the patient with the best result possible. Studies examining optimal treatment strategies for children and adolescents with these complicated fractures are needed.

Catheter‐based edge‐to‐edge mitral valve repair for pulmonary pressure reduction and to postpone heart transplantation in a teenaged patient

We report a case of catheter‐based edge‐to‐edge mitral valve repair in a teenage male patient with non‐ischaemic cardiomyopathy to improve pulmonary hypertension secondary to severe functional mitral regurgitation (FMR) to defer anticipated heart transplantation. A 19‐year‐old patient with previous history of fulminant myocarditis followed by markedly left ventricular dysfunction presented with severe mitral regurgitation 3 years after initial recovery. Slightly over time, deterioration of FMR was associated with gradual increase in pulmonary artery pressures despite optimal medical therapy. MitraClip implantation in this young patient was successfully performed with sustainable improvement of pulmonary hypertension.

A Review of the Incidence, Manifestation, Predisposing Factors, and Management of Recurrent Pediatric Inguinal Hernia.

AbstractRecurrent pediatric inguinal hernia is relatively rare. In a large series, the recurrence rates vary from 0.3 to 1.2%. In a university hospital with surgical service for a wide spectrum of sick pediatric patients, the real recurrence rate may be 3 to 6%. Recurrence manifests typically 6 months after first repair. Current evidence indicates that recurrence rates in open and laparoscopic repair are similar. Laparoscopic repairs are, however, still performed by a minority of skilled pediatric surgeons, whereas the majority of pediatric surgeons rely on open repair not least because of the assumed lower risk of recurrence. After repair of an indirect hernia, the majority of recurrences (97%) are indirect, whereas in rare cases the recurrence turns out to be a formerly undiagnosed direct or femoral hernia. In Children's Hospital of Helsinki, Finland, recurrence rate from 2012 to 2016 was 2.8% and operations for recurrent hernias comprised 3.3% of the total. From 1991 to 2017, a total of 130 operations for recurrent hernias were performed with open inguinal approach (n = 75, 58%), laparoscopy (n = 49, 38%), and laparotomy (n = 4, 4%). One teenage patient underwent a Lichtenstein Prolene net repair. A recurrent inguinal hernia can be repaired either with an open or laparoscopic approach. In laparoscopy, the nature of the recurrent hernia can be clarified and an immediate repair performed either by laparoscopic or open technique. In expert hands new laparoscopic techniques using muscular arch, lateral umbilical ligament, iliopubic tract, and division of the sac may be an alternative to a simple purse-string closure.

Extubation Failure in an Adolescent Patient after General Anesthesia for Gastrostomy Tube Placement

Myasthenia gravis (MG) is an autoimmune disease resulting in destruction of the post-synaptic nicotinic receptors at the neuromuscular junction. Classically, the earliest symptoms of MG are ocular, including ptosis and diplopia. Other less common early symptoms include dysphagia and fatigable chewing. Our case report describes the unusual presentation of MG in a teenager patient and presented for an elective percutaneous endoscopic gastrostomy (PEG), tube placement due to persistent weight loss. The patient underwent the procedure without any complications. At the time of tracheal extubation, she could not maintain spontaneous ventilation, so requiring mechanical ventilation. The patient was transferred from the recovery room to the pediatric intensive care unit (PICU). Subsequent investigations including a bedside electromyography (EMG), led to the diagnosis of MG. The patient was successfully extubated after treatment with intravenous immunoglobulin, oral prednisone 40 mg per day and pyridostigmine 60 mg every 8 hours.

A Self-Injurious Behavior Causing Unusual Bilateral Gingival Recessions and Affecting the Periodontal Treatment: A Case Report

Gingival recessions (GRs) can be multifactorial in its etiology. They occur either due to a mechanical influence or an inflammatory reaction in the gingival tissues. The cause should be diagnosed before taking any step in the treatment. The purpose of this case report was to highlight any adverse effect of the destructive ability of the psychological self-injurious behavior (SIB) to the gingiva and illustrate how such habits may affect the treatment success. In the reported case, a teenage patient had a constant habit of fingernails scratching that caused bilateral GRs in both mandibular canines. She admitted that this SIB was because of family problems. Usually, such persistent habit complicates the treatment; therefore, we planned for her psychological treatment first and then the periodontal surgical intervention using Alloderm ® for root coverage. After 7 days of good healing and predictable results, the patient’s careless behavior decreased the chances of the successful treatment. J Med Cases. 2017;8(2):42-47 doi: https://doi.org/10.14740/jmc2719w

Treatment of a Class II Division 2 Malocclusion in a Teenage Patient: Clinical Case Report

This article describes the orthodontic treatment of an adolescent patient presenting a class II skeletal, convex profile, mesofacial biotype, upper dental midline deviated 1 mm to the left, Class I bilateral molar, canine distoclusion of ½ right unit and left canine relationship non-determinable because piece 23 is in ectopic position, proinclination and inferior protrusion. The treatment plan was to distalize the maxillary molars and create enough space to incorporate pieces 13, 23 in the dental arch, a pendulum appliance supported with two orthodontic mini implants were used. The active treatment lasted 18 months and at the end of it, all the objectives were fulfilled, resulting in facial balance. The pendulum appliance is a good alternative for a Class II dental correction, it produces distalization of the maxillary molars in an optimal treatment time.

Venous malformations management by Er,Cr:YSGG laser: An Alternative approach.

Venous malformations (VMs) are slow-flow vascular anomalies composed of ectatic venous channels. Its management with Er,Cr:YSGG laser has been proven effective. In the present case a teenage patient reported with a bluish lesion, soft inconsistency on the dorsal aspect of tongue. The lesion was removed with Er, Cr: YSGG laser (2780 nm) with minimal anaesthetic infiltration. Patient reported no postoperative pain. Clinical follow up after three months showed excellent results and uneventful healing. Er,Cr:YSGG laser showed high clinical safety. Its advantages resulted in excellent healing of lesion and better acceptance by patient.

Solitary rectal ulcer in a teenage patient

Solitary rectal ulcer in a teenage patient

Thoracic wall metastases from nasopharyngeal carcinoma in a teenage boy: A case report

We report an extremely rare case of nasopharyngeal carcinoma in a 14-year old boy presenting with neck and chest wall metastasis. Radiological and histological examinations established the diagnosis of nasopharyngeal carcinoma with non-keratinizing undifferentiated, WHO Type III form. He received 3 courses of chemotherapy followed by 35 cycles of radiotherapy. The primary site and the neck and chest wall metastases responded well with treatment. At 3years follow up, the patient is still in a symptom-free and relapse-free state. Despite presenting late, juvenile onset WHO type 3 NPC showed a good response to chemoradiotherapy in our teenage patient.

A case of constitutional trisomy 3 mosaicism in a teenage patient with mild phenotype

Constitutional mosaicism for trisomy 3 is extremely rare, with only a few postnatally diagnosed cases reported in the literature. We report a case of constitutional trisomy 3 mosaicism in a 16-year-old female, who presented with chronic joint pain, easy bruising, joint hypermobility and dysmorphic features, including long, thin facies, over-folded dysplastic ears, and Pierre-Robin sequence (PRS) with cleft palate. The patient was small at birth, had cleft palate repair, developed chronic joint pain at age 12, and has a history of mild leukopenia and mild thrombocytopenia. Microarray analysis was consistent with a mosaic gain of an entire chromosome 3. FISH analysis of peripheral blood and buccal cells showed the presence of the supernumerary chromosome 3 in a low percentage of cells in both tissues, suggesting that the nondisjunction event occurred prior to the germ cell layer differentiation. Since trisomy 3 has been observed somatically in lymphoma, a Hematology/Oncology consultation was provided for the patient. The oncologist's evaluation for malignancy was unremarkable. A review of findings from other trisomy 3 patients reported in the literature reveals a diverse phenotypic spectrum and does not show a correlation between the proportion of abnormal cells observed in peripheral blood and the patients' clinical features or severity. This case demonstrates that the clinical presentation of an individual with trisomy 3 is highly individualized and the clinical course is difficult to predict.

A Family's Perspective on Family-Centered Rounds: Progress and Frustrations.

As a mom and a teenage patient with a rare autoimmune disease that requires monthly hospitalizations, we are big believers in making communication in the hospital more cohesive and inclusive. Family-centered rounds make a lot of sense from a patient and family point of view. When we first heard that our hospital was an advocate of rounds including the family, we were interested and happy that we would be included. It seems that so much of health care happens without the patient being in the center and with different people talking to the patient about the same thing at different times throughout the day. This study on family-centered rounds is interesting because the perception and definitions seem to vary greatly depending on whom you ask. The study in this issue by Pickel et al highlighted both things that we appreciate and things that frustrate us. For example, the study highlighted that the attending physicians talk outside the room as much as or more than they do inside the room. It is frustrating to hear the team speaking about you in the hallway before they come in and wondering what they are saying. Then, after they leave the room, they continue to have discussions in the …

Salmonella Typhi-Induced Septic Shock and Acute Respiratory Distress Syndrome in a Previously Healthy Teenage Patient Treated With High-Dose Dexamethasone.

Typhoid fever is commonly characterized by fever and abdominal pain. Rare complications include intestinal hemorrhage, bowel perforation, delirium, obtundation, and septic shock. Herein we describe the case of a previously healthy 16-year-old male without history of travel, diagnosed with typhoid fever complicated by septic shock and acute respiratory distress syndrome treated with high-dose dexamethasone. This case details severe complications of typhoid fever that are uncommonly seen in developed countries, and the successful response to high-dose dexamethasone as adjunct therapy. High-dose dexamethasone treatment has reportedly decreased Salmonella Typhi mortality, but controlled studies specifically performed in children are lacking, and most reports of its use are over 30 years old and all have originated in developing countries. Providers should include Salmonella Typhi in the differential diagnosis of the pediatric patient with fever, severe abdominal pain, and enteritis, and be aware of its potentially severe complications and the limited data on safety and efficacy of adjunctive therapies that can be considered in addition to antibiotics.

Aphasic Dystextia as Presenting Feature of Ischemic Stroke in a Pediatric Patient

Aphasia is an important presenting symptom of acute stroke. With increasing reliance on electronic communication, incoherent texting or “dystextia,” which is a subset of aphasia that is reflected in text messages, can be a useful tool for symptom recognition and analysis. It can be a red flag for the family and therefore can help in early identification of an acute neurological deficit. It is also useful for providers to reliably analyze the deficit as well as establish a timeline of evolution of symptoms. There have been case reports where dystextia has been the presenting feature of stroke or complicated migraine and in one case of meningioma. We present the case of a teenage patient that in our knowledge is the youngest reported case of dystextia, whose aphasia recorded in a text message assisted with stroke localization. This also adds to the literature of dystextia which so far has only seven other cases reported.

Collecting duct carcinoma of kidney in a teenage boy

Carcinoma of the collecting ducts of Bellini are rare aggressive neoplasms of distal nephron origin; it accounts for 2% of all renal cell carcinomas. Clinically, collecting duct carcinoma (CDC) is characterized by an extremely aggressive phenotype, accompanying metastatic diseases at presentation in most reported cases. Most cases of CDC have been reported with median age above 50 years. To our knowledge, this is the only second case report of CDC in a young teenager patient below 19 years with metastasis to lungs and bones at presentation.

Fibrocartilaginous Embolism of The Spinal Cord - A Case Report

Fibrocartilaginous embolism of the spinal cord is considered a rare ischemic vascular syndrome [1-4], though some authors believe it to be underdiagnosed. It results in abrupt onset and rapidly progressive sensory, motor and autonomic neurologic deficits. This paper reports a case of a teenage patient presenting with sudden onset rapidly progressive back pain associated with paraparesthesia, paraparesis and urinary retention after physical exertion. A magnetic resonance imaging (MRI) test led to a presumptive diagnosis of spinal cord fibrocartilaginous embolism.

Radiotherapy is Important for Local Control at Primary and Metastatic Sites in Pediatric Rhabdomyosarcoma.

Purpose: The current recommended practice for pediatric patients with metastatic rhabdomyosarcoma includes full-dose radiotherapy to each metastatic site. We wished to question this practice, which can cause side-effects and is often logistically challenging, by studying the pattern of failure in our pediatric and teenage patient population.Methods and Materials: Our institution’s cancer registry was queried for patients diagnosed with rhabdomyosarcoma aged 18 or less from January 1990 until January 2014. Twenty-nine patients were found and, of these, six had metastatic disease. Five of the six were treated with standard chemotherapy together with radiotherapy to the primary and metastatic sites with doses and fractionation according to the site. Progression-free survival was calculated from the end of radiotherapy until radiological or pathological evidence of disease progression or death.Results: Median age was 13 years (range: 12-18). Three were girls. All had alveolar histology and unfavorable primary sites. Twelve metastatic sites were treated with radiotherapy. Doses used were 41.4 - 50.4 Gy in 1.8 Gy fractions for most sites, and 15 Gy in 1.5 Gy fractions for whole lung radiotherapy. The median number of sites treated per patient was two (range: 1 - 6). Median time to progression was 10.1 months (range: 1.9 - 15.7). Local control was 100% for all metastatic sites. Median overall survival (OS) was 31.8 months (range: 20.4 – 95.4 months). Three patients developed progressive disease outside the treated field. One patient died from a secondary hematological malignancy without evidence of disease progression. One patient remains progression-free at 88.6 months post-radiotherapy.Conclusions: Radiotherapy to metastatic disease sites prevented in-field progression in all five patients with metastatic alveolar rhabdomyosarcoma. However, failure at sites outside of the radiotherapy volume occurred in three of five of patients and overall survival was very poor despite aggressive treatment to all sites of disease. Radiotherapy has a role in metastatic disease, although future studies evaluating dose and fractionation are needed.