Characteristics of high-risk adolescent outpatients with treponemal antibody.

This study analyzes variables associated with syphilis infection among adolescents attending a public medical clinic in the District of Columbia. All adolescent clinic patients found to have Treponema pallidum antibody from June 1, 1989 through June 1, 1990 were included in the study. Medical records were reviewed for the following data: age, sex, presence or absence of court jurisdiction over the patient, chief complaint, concurrent infections, and the clinical stage of syphilis. The study population included 52 patients. The results revealed that male patients carry a higher risk of remaining undetected because only one third acknowledged any complaints prior to examination. This cohort study illustrates the predilection of syphilis for the indigent and underserved. Moreover, it highlights that insidious disease in adolescents is often unsuspected and undetected until routine screening tests are performed.

Condom misuse among adolescents.

PIP: In the adolescent clinic of the Children's Center at the District of Columbia General Hospital, the proficiency of high-risk adolescents in condom usage was investigated. The majority of patients are served for sexually transmitted diseases (STDs), contraception, and the diagnosis of pregnancy. In December 1990 and March 1991, each teenager who visited the clinic was given a latex reservoir-tipped condom and the plastic cover of a 60 mL syringe and was instructed to place the condom on the plastic cover. Then each was asked if it is better to remove the condom while the penis is still hard (erect) or when it is soft (flaccid). A performance score was assigned to each subject based on the following variables: 1) pinch the reservoir tip, 2) orient the condom correctly (not inside out), 3) roll the condom down the shaft, and 4) know that condoms should be removed while the penis is still erect. The maximum performance score was 4 with 1 point awarded for each successfully completed component. 38 females and 19 males with an age range from 13 to 19 years were included in the study group. 3 males (15.8%) and 22 females (57.8%) were either treated or were receiving follow-up for an STD, for an overall STD rate of 43.9%. The mean performance score for the study population was 2.3. Females averaged a performance score of 2.34, versus 2.31 for males. Females with STDs averaged higher scores than females who were infection-free (2.4 versus 2.1). Conversely, males with STDs averaged lower scores than those without STDs (2.0 versus 2.4). The most common deficiency was the failure to pinch the reservoir tip (67%) followed by failure to remove the condom while the penis is erect (61%), incorrect (inside out) orientation (25%), and failure to roll the condom completely down the shaft (9%). Among adolescents, health-compromising sexual behavior continues. Health-care workers should provide information on sexuality issues such as genital tract infections and contraception.^ieng

Diabetes in infancy: diagnosis and current management.

This article reviews diagnosis and management of infants with diabetes. These infants present with signs and symptoms confused with other more common illnesses in this age group. A physician examining an ill-appearing dehydrated infant, without any obvious cause for the dehydration, should quickly screen the urine for glucose and ketones. Diagnosis of diabetes is a problem when an infant has only hyperglycemia or ketonuria. Febrile illnesses, convulsions, and dehydration can cause these laboratory abnormalities. Once the diagnosis of diabetes is made in the infant, management is complicated by the difficulty in administering small doses of insulin, monitoring blood glucose, complementing insulin administration with feedings, and hypoglycemia. The potential for brain damage with unrecognized episodes of hypoglycemia is always a concern in infants. This article offers suggestions for treating hypoglycemia as well as guidelines for making insulin adjustments when the infant is ill. The physician should be aware of the psychosocial issues involving the family of an infant with diabetes. Optimism and ongoing support should be provided to the family, so that the infant can grow up healthy and possibly benefit from research on the cure of diabetes.

Sexually transmitted disease among adolescents in the juvenile justice system of the District of Columbia.

Disenfranchised youth are known to be at high risk for sexually transmitted infections. A study was conducted to validate the screening for sexually transmitted disease (STD) among adolescents under court jurisdiction, to characterize variables associated with STD among this group, and to contrast and compare the characteristics of STD among incarcerated youth as opposed to those in alternative court-sponsored facilities. Sixty teenagers referred to an outpatient adolescent clinic for court-ordered physical examination were tested for infection with syphilis. Fifty-four were tested for gonorrhea and chlamydia. The overall rates for gonorrhea and chlamydia among the group were an identical 9.2%. Six percent of the study population were diagnosed with syphilis infection. While only 17% of the youths were female, they accounted for over half of all infections with gonorrhea and chlamydia. All cases of sexually transmitted bacterial infections were found in youth residing in alternative court-sponsored facilities.

Congenital syphilis presenting as desquamative dermatitis.

During the last 5 years the incidence of congenital syphilis has increased several-fold and reached epidemic proportions. This increase is directly related to a similar increase in cases of primary and secondary syphilis in women and has been linked to the use of "crack" cocaine. Factors responsible for the increase in reported cases of congenital syphilis include poor prenatal care, implementation of new surveillance case definition, failure to perform serological tests, treatment failures with benzathine penicillin, and maternal reinfection. Clinical manifestation of congenital syphilis are multisystemic but are often absent at birth. We report a case of congenital syphilis missed at birth and later characterized by prominent desquamative dermatitis affecting most of the skin surface.

Submucous cleft palate: a 10-year series.

Twenty-nine consecutive patients with submucous cleft palate were treated at the University of Florida during the 10-year period from 1986 to 1996. Twenty-seven patients were available for speech follow-up. The evaluation of these patients and rationale for treatment are discussed. The largest subgroup of patients were treated with the Furlow Z-plasty palatoplasty, which yielded a successful outcome in 15 of 18 patients, or 83%. The overall success rate was 96%. The Furlow Z-plasty palatoplasty was noted to have a very high rate of success for patients with velopharyngeal gaps of 8 mm or less, and less likelihood of success when the velopharyngeal gap exceeded 8 mm.