Adolescent medicine (Philadelphia, Pa.)
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Syncope is the sudden loss of consciousness and postural tone resulting from an abrupt, transient cerebral malfunction, followed by spontaneous recovery. It is common among adolescents and is usually due to a benign neurocardiogenic (vasovagal) etiology. Rarely, syncope is premonitory of sudden death. ⋯ Evaluation of syncope should be based on a complete personal and family history, a thorough physical examination, and an electrocardiogram. Risk factors include syncope that is recurrent, exercise-induced, or not neurocardiogenic in nature; accompanying anginal chest pain, palpitations, and/or dyspnea; cardiac disease; seizure activity; athletic competition; and positive family history for conditions associated with sudden death (e.g., hypertrophic cardiomyopathy, long QT syndrome). Adolescents with these risk factors should be referred to a pediatric cardiologist for specialized testing and management.
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Review
Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess.
Central nervous system infections in adolescents range from the diffuse cerebritis of encephalitis to the regional inflammation of meningitis, and very focal disease of brain abscess. Clinical presentations reflect this wide spectrum, with encephalitis primarily characterized by altered mental status, meningitis by fever, headache, and neck stiffness, and brain abscess manifesting localizing findings. Encephalitis and viral meningitis are frequently caused by the seasonal enteroviruses and arboviruses, while most adolescent bacterial meningitis is due to Neisseria meningitidis and Streptococcus pneumoniae. ⋯ New diagnostic tests include the use of PCR. A variety of safe and effective treatment regimens exists for most bacterial infections as well as for some herpesvirus infections. New vaccines are under study to further control bacterial meningitis.
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Viral hepatitis is the most common cause of acute and chronic hepatitis. The term viral hepatitis generally refers to infections resulting from one of the hepatotrophic viruses: hepatitis A, B, C, D, and E. The last 10 years have brought many important advances in understanding the epidemiology, pathogenesis, molecular biology, and immunoprophylaxis of infections caused by hepatotrophic viruses. ⋯ Additionally, serologic markers have allowed for isolation of contaminated blood products and a reduction in the spread of disease. The remaining challenge is the application of this knowledge to the treatment and prevention of viral hepatitis. This article explores the risk factors, epidemiology, microbiology, clinical and laboratory diagnosis, treatment, and prevention of the hepatotrophic viral infections.
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Review
Romance with the automobile in the 20th century: implications for adolescents in a new millennium.
Nearly three-fourths of deaths among American adolescents and young adults result from only four causes: motor vehicle accidents, other unintentional injuries, homicide, and suicide. Thirty percent of those deaths result from motor vehicle accidents, the number one cause of death among adolescents. A number of factors that influence the morbidity and mortality are associated with driving. ⋯ For the young driver, adolescent development and increased risk taking, inexperience, dangerous driving behavior, and alcohol-related factors are of special significance. In this article, we review recent crash statistics as well as effectiveness of various preventive measures, including driver education, graduated licensing, alcohol-related measures, and vehicle-related factors. Graduated licensing and alcohol-related measures have been the most effective measures so far.