Teenage Patients Research Articles

Profile of Steroid Toxicity During Maintenance Treatment in Teenage and Young Adult (TYA) Patients with Acute Lymphoblastic Leukaemia (ALL)

AbstractAbstract 4305There has been recent interest in exploring the use of paediatric ALL protocols in treating older patients. TYA patients (16–25 years) were therefore included in the UKALL 2003 trial (Eudract No: 2007–004013-34) as the age range of the trial was raised in 2006 to 18 years and again in 2007 to include patients up to their 25th birthday. The tolerability of this approach is unknown and we therefore investigated the steroid toxicity during maintenance in a sub-set of the TYA cohort in this study.Data was collected through SAE reports, case report forms and additional questionnaires sent to participating centres. We report on 91 evaluable patients (40% of 229 recruited to the trial) who had commenced or completed maintenance. Given the nature of the survey, this cohort was enriched for the toxicities described and therefore the incidences reported are not representative of that observed in the full trial cohort. The median age of these 91 patients was 17 yrs (16–23) and there were 64 male (median18; range 16–23) and 27 female (median 17; range 16–22). Most patients had completed maintenance (median follow up 39.5 months; range 4–96 months) post start of induction.76 patients were on the intermediate risk Regimen B and 15 on the high risk Regimen C due poor cytogenetics at diagnosis or a poor marrow response at day 29.Of the 91 patients 66% (n=60) had grade 2 – 4 possible or probable steroid toxicity. This was grade 2–3 in the majority and only four patients experienced grade 4 toxicity (3 avascular necrosis – AVN, 1 infection). In 91 patients there were 68 grade 2–4 toxicities; AVN 41% (n=28/68), infection 27% (n=18/68), psychological disturbances 16% (n=11/68), joint pain/fracture 7% (n=5/68), GI bleed 3% (n=2/68), other 6% (n=4/68). The causes of infections are likely to have been multifactorial. 24/91 patients (26%) stopped steroids early during maintenance due to the toxicity. 13/91 (14%) patients required modification of steroids (pause, tapered or change to prednisolone) during maintenance. Treatment for AVN and joint pain or fracture ranged from bed rest, hydrotherapy and analgesia (grade 2–3 toxicity) to joint replacement in patients with grade 4 AVN. Toxicities were otherwise managed with appropriate medication. The use of bisphophonates was inconsistent and only used in a minority of patients (11% n=10). There was a significantly higher chance that patients did not receive steroids as per protocol if they had joint pains, fracture or AVN.There is increasing use of paediatric protocols in TYA patients. Steroid intensity might be difficult to deliver in this age group due to associated morbidity. Bony complications are a significant cause of steroid morbidity in this age group with uncertainty about their optimal management and impact on long term joint health. Disclosures:No relevant conflicts of interest to declare.

Ending the epidemic of adolescent obesity

Ending the epidemic of adolescent obesity

Total Hip Arthroplasty in Teenagers: An Alternative to Hip Arthrodesis

Debilitating arthritis in teenage patients is a complex problem with limited surgical options. Hip arthrodesis is unpopular amongst patients, and contemporary total hip arthroplasty (THA) may be a promising alternative. We report on the outcomes of THA in patients less than 20 years of age. All consecutive teenage patients undergoing THA at a tertiary referral centre were reviewed. Mean follow-up was 3.4 years (range 0.6-6.8) and 9 patients had at least 5 years follow-up. There were 51 THAs in 43 patients with a mean age of 17 years (range 12-19). The commonest indication was osteonecrosis (35 cases), mostly secondary to slipped upper femoral epiphysis (15 cases). Forty-six were uncemented and 5 were reverse hybrid THAs of which 7 were computer assisted design/manufacture (CADCAM) components. The commonest bearing surface used was ceramic on ceramic (40 cases). The survival rate was 96% and there were 2 complications. At latest follow-up, the mean Harris hip score was 90 (range 68-99) and UCLA activity score was 6 (range 4-9). Radiological analysis showed 2 patients with lucent lines around the acetabular component, but no signs of osteolysis or wear. We report good short to intermediate term survivorship and outcomes, and feel THA represents a valid alternative option to hip arthrodesis.

The impact of a cancer diagnosis on the education engagement of teenagers – Patient and staff perspective

PurposeEngagement with education during treatment is an important and complex issue for practitioners and an important psychosocial need of teenagers with cancer. There is limited research currently available specifically concerning the education of teenagers with cancer. This paper reports the outcomes from a patient and a practitioner questionnaire study which explore prominent issues and experiences in educational engagement for this population. MethodEighty-eight teenage cancer patients completed a questionnaire about their education experiences since diagnosis. Forty oncology practitioners completed an online questionnaire on experiences of education engagement of teenage patients. Questionnaires were developed from a systematic research review conducted by the authors and included; peer relationships, school attendance, reintegration and long term effects of cancer on attainment. ResultsAmong teenagers there was a significant relationship between successful maintenance of peer groups, successful reintegration into school and positive ratings of the education support. Teenagers who reported school as their primary source of support had significantly more successfully maintained peer groups. Practitioners rated peer support as the most important factor in education satisfaction for patients and stressed the need for collaborative planning between hospital, school and home. ConclusionsCollaborative education planning should be initiated on diagnosis and aim to include non-academic variables, such as peer groups, which can influence successful maintenance of education. Further research is needed to understand the relationship between education engagement and teenagers' cancer experiences as a whole, as well as gaining a more in depth understanding of how teenagers experience their education after a diagnosis of cancer.

Fixed-dose combination gel clindamycin 1.2%/tretinoin 0.025% for the treatment of acne vulgaris: a review

Topical fixed-dose combinations are recommended as a first-line treatment for mild-to-moderate inflammatory (papulopustular) acne, as they target multiple acne pathogenetic factors, are associated with a favorable efficacy and tolerability profile, are easy to apply and may increase patient compliance, especially in teenage acne patients. The combination of a topical antibiotic with a retinoid combines the antibiotic-associated effects of improving inflammatory and noninflammatory acne lesions, with the retinoid-associated effects of normalizing desquamation and reducing comedogenesis, while aiming at reducing the risk of bacterial resistance. In this article, data regarding the efficacy, safety and tolerability of topical clindamycin 1.2%/tretinoin 0.025% gel for acne treatment will be presented. The effects of topical clindamycin 1.2%/tretinoin 0.025% gel therapy in children and young teenagers, as well as different skin types, will be addressed.

159. Multimodality management and surgical outcomes following post neo-adjuvant chemotherapy radical chest wall resection & reconstruction for PNET chest wall

Background: Primitive neuroectodermal tumor (PNET) is a rare undifferentiated and highly aggressive tumor, most commonly arising in chest wall in teen age patients. Treatment of these patients is challenging and multimodality treatment had a major impact on their outcome. We present our experience of post neo-adjuvant chemotherapy radical chest wall resection and reconstruction and surgical outcomes.

Poster 93: Successful Reconstruction of Non-Growing Hemifacial Microsomia Patients With Unilateral TMJ Concepts Total Joint Prosthesis and Orthognathic Surgery

Hemifacial microsomia (HFM) is a specific condition of hypoplasia or absence of the mandibular condyle, ramus, and body as well as hypoplasia of the maxilla and zygomatico-orbital complex and associated soft tissues. Traditionally, autogenous tissues have been used to reconstruct the TMJ and ramus of the mandible in complex cases. This paper will address teenage and adult HFM patients with significant hypoplasia or aplasia of the condyle and ramus reconstructed by ipsilateral TMJ and advancement of the mandible with a patient-fitted (TMJ Concepts system) total joint prosthesis. A mandibular ramus sagittal split osteotomy was performed on the contra-lateral side and the indicated maxillary osteotomies were completed as well as any other adjunctive procedures, all performed at one operation.

“Not all my friends need to know”: a qualitative study of teenage patients, privacy, and social media

BackgroundThe literature describes teenagers as active users of social media, who seem to care about privacy, but who also reveal a considerable amount of personal information. There have been no studies of how they manage personal health information on social media.ObjectiveTo understand how chronically ill teenage patients manage their privacy on social media sites.DesignA qualitative study based on a content analysis of semistructured interviews with 20 hospital patients (12–18 years).ResultsMost teenage patients do not disclose their personal health information on social media, even though the study found a pervasive use of Facebook. Facebook is a place to be a “regular”, rather than a sick teenager. It is a place where teenage patients stay up-to-date about their social life—it is not seen as a place to discuss their diagnosis and treatment. The majority of teenage patients don't use social media to come into contact with others with similar conditions and they don't use the internet to find health information about their diagnosis.ConclusionsSocial media play an important role in the social life of teenage patients. They enable young patients to be “regular” teenagers. Teenage patients' online privacy behavior is an expression of their need for self-definition and self-protection.

Sharing evidence-based knowledge by Internet with children and teenage patients

Sharing evidence-based knowledge by Internet with children and teenage patients

Hydrocephalic fits: forgotten but not gone

Hydrocephalic fit is a fatal complication of posterior fossa tumors that is uncommon in modern neurosurgical practices. As such, most primary physicians and neurosurgeons lack experience with hydrocephalic fits, which makes some patients vulnerable to this fatal condition. We analyzed the patterns of hydrocephalic fits that we have observed directly in our hospital or indirectly after referral to our institution. Eight patients who had a brain tumor and hydrocephalic fit before surgery were managed in our institution between 2001 and 2012. The clinical records and radiological data were reviewed and analyzed. The patients were divided into two groups: One group included six classical patients who were under age 4, had a posterior fossa tumor, and succumbed rapidly after a hydrocephalic fit. The other group consisted of two teenage patients who had germ cell tumors in the third ventricle and had more favorable outcomes after extraventricular drainage (EVD). Missed brain tumor diagnosis, sedation for imaging studies, poor management of elevated intracranial pressure, referral delay, and neglect during referral and transportation contributed hydrocephalic fit development. Only one patient, a 16-year-old girl with a suprasellar germinoma, survived the hydrocephalic fit. Prompt institution of EVD may have helped her recover from the fit. Early diagnosis and active preoperative intracranial pressure control are critical in preventing hydrocephalic fits. It is important that primary physicians, pediatricians, and neurosurgeons have a thorough knowledge of brain tumor symptomatology and hydrocephalic fit risks.

L’adhésion thérapeutique chez l’adolescent atteint de maladie chronique : état de la question

The continual progress in medicine has increased patient life expectation. However, treatments for chronic diseases are often consequential. This leads to problems of patient compliance, most particularly in teenage patients. Depression is frequently observed in persons affected by a chronic illness. These diseases can cause despair, which contributes to the risk of suicide. This article investigates the various notional and explanatory approaches to compliance. The literature review was based on the CAIRN, Medline, and EBSCOhost databases. The period investigated extended from 1999 to 2009. The keywords used were "adhésion thérapeutique", "observance", "compliance", "adolescence", "chronic illness", and "depression". Three axes stand out from this review: (1) the theoretical definition of compliance, (2) the frequency of depressive disorders among adolescents affected by a chronic illness, (3) the different ways to interpret compliance. We introduce and discuss the contents of each of these axes and discuss how they could orient research on the compliance of adolescents with a chronic illness.

ISP4-04 Late recurrence of stage la ovarian mucinous cystadenocarcinoma in teenage patients : Case report and review of the literature

ISP4-04 Late recurrence of stage la ovarian mucinous cystadenocarcinoma in teenage patients : Case report and review of the literature

Contact lenses and teenagers

Teenagers' contact lens requirements differ from those of adults. The reasons for wanting lenses are similar, but the emphasis varies. Extra caution is needed when fitting adolescents due to the difference in their attitude to lenses and lens care and also to hormonal effects. The practitioner must explain to both the patient and their parent about the choice of lenses and the importance of lens hygiene. Information must be given in a format that will be of interest to a teenager if it is to have the desired effect. On the whole teenagers do well with contact lenses, which not only provide a visual aid, but also improve self perceptions and boost self confidence as they mature. This article discusses the aspects that must be considered for teenage patients and ways of overcoming problems that can occur.

An Exploratory Study of HIV+ Adolescents’ Spirituality: Will You Pray with Me?

The aims of the study were (1) to determine whether adolescents find it acceptable to have physicians explore their spiritual beliefs as part of their medical care, (2) to characterize the role of spirituality and religious beliefs in adolescents with and without HIV, and (3) to examine associations between spirituality/religion and quality of life. Adolescents receiving their medical care at an urban Adolescent Health Clinic completed a study-specific questionnaire about spiritual inquiry by their physician, the Brief Multidimensional Measurement of Religiousness/Spirituality, and the Pediatric Quality of Life Inventory 4.0. Chi-squared analysis, Fischer's exact test, and t tests were used to assess associations. A total of 45 participants enrolled: 19 HIV+ (53% vertical transmission) and 26 HIV-; mean age 17.2years; 80% African American. Four out of 45 (9%) had ever been asked by their doctor about their spiritual/religious beliefs, and only 8 (18%) had ever shared these beliefs with their healthcare provider. Most teens wanted their provider to ask them about their spiritual beliefs during some visits, especially when dealing with death/dying or chronic illness (67%). Those with HIV were more likely to endorse wanting their doctors to pray with them (42% vs. 15%), feeling "God's presence" (Mean=3.95 vs. 2.83), being "part of a larger force" (Mean=2.58 vs. 1.69), and feeling "God had abandoned them" (Mean=1.63 vs. 1.15). There are certain circumstances in which healthcare providers should include a spiritual history with teenage patients. Few differences emerged in the teens studied with and without HIV.

Evaluation of Occlusal Status of Teenage Patients visiting a Dental School in Andhra Pradesh: An Epidemiological Study

Objectives: The objective of the study was to evaluate the occlusal status of teenage patients and to determine the possible association of gender with the type of malocclusion. Materials and methods: The study sample consisted of 410 patients. Patients who did not fulfil the inclusion criteria for the study were excluded, thus the final sample accounted for 318. The selected subjects were interviewed by trained examiners and underwent thorough clinical evaluation pertaining to orthodontic diagnosis. Statistical analysis: The Pearson’s Chi-square test was done to assess the statistical significance between males and females while taking p-values of less than 0.001 as statistically significant. Results: Among the 318 samples, 166 (52.2%) of them were females and 152 (47.8%) were males. Angle’s class I molar relation was common (69.2%) followed by normal molar relation (10.1%), class III and its subdivision and class II and its subdivision were found common among males and females respectively. In regard to canine relationship, majority of them were class I followed by class II and III. Normal overjet and overbite was observed in 53.5% of the cases and there was higher incidence of increased overjet and overbite in females and reverse overjet in males. Conclusion: The prevalence of malocclusion noted in the present study was 89.9% and it was more common in females. Class I canine relationship 96.9% was the most common one followed by class I molar relation (69.2%). Angle class II division 2; canine class III relationship and scissors bite were the least common (0.6%) occlusal alterations.

Prevalence and aetiology of neuropathic pain in cancer patients: A systematic review

Pain in cancer patients remains common and is often associated with insufficient prescribing of targeted analgesia. An explanation for undertreatment could be the failure to identify neuropathic pain mechanisms, which require additional prescribing strategies. We wanted to identify the prevalence of neuropathic mechanisms in patients with cancer pain to highlight the need for detailed assessment and to support the development of an international classification system for cancer pain. We searched for studies that included adult and teenage patients (age above 12 years), with active cancer and who reported pain, and in which a clinical assessment of their pain had been made. We found 22 eligible studies that reported on 13,683 patients. Clinical assessment methods varied, and only 14 studies reported confirmatory testing for either sensory abnormality or diagnostic lesion to corroborate a diagnosis of neuropathic pain. We calculated that the prevalence of patients with neuropathic pain (95% confidence interval) varied from a conservative estimate of 19% (9.4% to 28.4%) to a liberal estimate of 39.1% (28.9% to 49.5%) when patients with mixed pain were included. The prevalence of pain with a neuropathic mechanism (95% confidence interval) ranged from a conservative estimate of 18.7% (15.3% to 22.1%) to a liberal estimate of 21.4% (15.2% to 27.6%) of all recorded cancer pains. The proportion of pain caused by cancer treatment was higher in neuropathic pain compared with all types of cancer pain. A standardised approach or taxonomy used for assessing neuropathic pain in patients with cancer is needed to improve treatment outcomes.

Anatomical glenoid reconstruction via a J-bone graft for recurrent posttraumatic anterior shoulder dislocation

To reconstruct the anatomical glenoid shape in cases of osseous glenoid rim defects after recurrent posttraumatic anterior shoulder dislocation to restore stability without severely compromising the range of motion. Osseous glenoid defects after recurrent posttraumatic anterior shoulder dislocation. Suitable for primary stabilization as well as for revision surgery in cases previously operated on. Recurrent anterior shoulder dislocations without glenoid rim defects. Hyperlax shoulders with multidirectional instability. Patients over 60years of age due to compromised bone quality. Teenage patients due to incomplete apophyseal fusion at the iliac crest. The subscapularis tendon and capsule are split. The humeral head is retracted laterally, and the glenoid defect is prepared and abraded with a rasp. A bicortical iliac crest bone block including crest and outer cortex is harvested and molded in a J-shaped manner. To incorporate the graft, a crevice on the glenoid rim is produced using a chisel. The keel is fitted into the preformed crevice with a spiked impactor. The graft's surface is contoured using a high-speed burr. A total of 47shoulders were followed-up after an average of 90months (range 25-152months). The mean Rowe scores were 94.3 for the affected shoulder and 96.8 for the uninjured shoulder. The Constant scores reached 93.5 and 95points, respectively. Loss of external rotation was 4.4°. In addition, 24shoulders were followed-up by computed tomography (CT). There were no recurrences, with the exception of one traumatic graft fracture. Of 19patients with arthropathy at follow-up, 11already had arthropathy prior to the procedure.

Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients

Free vascularised fibular grafting has been reported to be successful for adult patients with osteonecrosis of the femoral head (ONFH). However, its benefit in teenage patients with post-traumatic ONFH has not been determined. We evaluated the effectiveness of free vascularised fibular grafting in the treatment of this condition in children and adolescents. We retrospectively analysed 28 hips in 28 patients in whom an osteonecrotic femoral head had been treated with free vascularised fibular grafting between 2002 and 2008. Their mean age was 16.3 years (13 to 19). The stage of the disease at time of surgery, and results of treatment including pre- and post-operative Harris hip scores, were studied. We defined clinical failure as conversion to total hip replacement. All patients were followed up for a mean of four years (2 to 7). The mean Harris hip score improved from 60.4 (37 to 84) pre-operatively to 94.2 (87 to 100) at final follow-up. At the latest follow-up we found improved or unchanged radiographs in all four initially stage II hips and in 23 of 24 stage III or IV hips. Only one hip (stage V) deteriorated. No patient underwent total hip replacement. Free vascularised fibular grafting is indicated for the treatment of post-traumatic ONFH in teenage patients.

Informing choice or teaching submission to medical authority: a case study of adolescent transitioning for sickle cell patients

Objectives. To understand how some of the top pediatric sickle cell centers are transitioning their adolescent patients from pediatric care given the diminished availability and quality of services in adult care. Design. The ethnographic research for this project was carried out over more than seven years. Patients, medical professionals, and disease advocates were interviewed and observed in clinics, homes, offices, at national meetings, and at sickle cell-related events. This paper focuses narrowly on adolescent transitioning programs that are designed to educate teenage patients about sickle cell disease (SCD) and treatments; how to communicate with medical professionals; and when it is appropriate to use healthcare services. This paper uses the experiences of a social worker in a pediatric hospital clinic as a lens for understanding the role patient education can play in improved outcomes. Results.Adolescent sickle cell patients are already skeptical about medical care. In transitioning meetings, legitimating that skepticism worked better than simply teaching them to submit to medical authority. One important strategy was to teach patients about what medical anthropologists and sociologists call the culture of medicine. By learning about how healthcare institutions operate, the social worker felt that they were better able to ask relevant questions, understand the limits of both the treatments and care, and to resist institutional demands without alienating themselves from the staff. Conclusion. For the past 15 years, cultural competency training has been considered one of the best approaches for improving patient care. The rationale for cultural competency is that if a physician understands a patient’s ‘culture’ he or she can better communicate with, and therefore treat, a patient. This research demonstrates that perhaps a better approach is for patients to be taught how medical professionals think and how healthcare institutions rationalize treatment options. In adult care, patient services are nominal and medical professionals have less time to develop relationships with patients. Given these constraints, enhancing self-advocacy through knowledge about the culture of medicine should be the focus.

Anti-Signal Recognition Particle Myopathy in the First Decade of Life

Autoantibodies to signal recognition particle have been associated with juvenile and adult-onset necrotizing myopathy. However, only a few teenage patients with anti-signal recognition particle myopathy have been reported, and to date, to our knowledge, no patient younger than 10 years has been documented. We describe 2 Japanese girls with anti-signal recognition particle myopathy who developed symptoms from the ages of 5 and 9 years, respectively. Both patients had progressive muscle weakness and atrophy without myalgia. Facioscapulohumeral muscular dystrophy was initially suspected because of asymmetric shoulder girdle muscle involvement in one patient, and limb girdle muscular dystrophy due to proximal limb muscle weakness in the other. There were no extramuscular manifestations, including fever or arthritis. Serum creatine kinase levels were elevated to 2,467-4,629 IU/L. Results of muscle biopsy revealed necrotizing myopathy with minimal to mild endomysial fibrosis but without inflammatory infiltrates. Immunosuppressive agents were not effective for muscle weakness, resulting in marked disability. Anti-signal recognition particle myopathy can occur in the first decade of life and should be included in the differential diagnosis for children with progressive limb girdle muscle weakness and high creatine kinase levels.