Management of chronic medical conditions in children and adolescents.

The care of children and adolescents with chronic medical conditions is an area of great interest for primary care physicians. With longer lives and more "mainstreaming" of care, the primary care physician often finds an increased role in the management of children and adolescents with chronic conditions such as mental retardation, Down syndrome, and diabetes mellitus. This article discusses familiarity with the most common chronic conditions and common pitfalls of management.

Reexamination of the paradigm of HIV risk reduction in adolescents.

Infection with the human immunodeficiency virus (HIV) in the adolescent/young adult population of the United States is a serious, growing problem. The current HIV risk-reduction strategies for adolescents have been less than effective in stemming the tide of infection. This ineffectiveness can be linked to failure of making developmentally appropriate risk-reduction informational material and reliance on condom-based interventions, which have an unacceptably high failure rate. A critical analysis of current models of HIV-risk reduction should be undertaken to create more developmentally appropriate and effective methods.

Depo-Provera: an injectable contraceptive.

Medroxyprogesterone acetate (Depo-Provera) is now approved for use as an injectable contraceptive. It is highly effective and has the advantage of only needing to be administered once every 12 weeks. The most common side effects are menstrual irregularities, amenorrhea in particular. Several illustrative cases are presented that demonstrate appropriate patient selection for this agent.

How to recognize adolescents at risk for HIV infection.

HIV infection is a growing problem for primary care physicians in that the coming of adolescents to clinics for primary care may not clearly demark members of a high-risk group. Therefore, clinicians need to be familiar with the risk categories and question the patients as to high-risk activities in order to determine their risk for HIV infection. Adolescents may be at a higher risk for HIV, but may not bear manifestations of infection with HIV infection until later. Therefore, it would behoove clinicians to establish the serologic status of adolescents at risk in a timely fashion in order to offer counseling and manage the protean manifestations of HIV-related disease that may occur. Counseling must also emphasize the importance of curtailing the high-risk activity so as to curb the spread of the infection.

Results of inpatient and outpatient cataract surgery. A historical cohort comparison.

PURPOSE: The transition from inpatient to outpatient cataract surgery during the last decade was not accompanied by prospective investigation of its effect on visual outcomes or surgical complications. The authors performed this study to assess the impact of this transition on surgical results. METHODS: The authors reviewed 600 extracapsular cataract extractions performed by 4 experienced ophthalmic surgeons during a 36-month period; in 300 cases, patients were hospitalized after surgery (inpatient group), and, in 300 cases, patients were never hospitalized (outpatient group). The same surgical techniques were used in all cases. Visual outcome and rates for operative and postoperative complications were compared. RESULTS: There were no statistically significant differences between the inpatient and outpatient groups for visual acuity. Excluding patients with pre-existing nonlenticular ocular disease, a best-corrected visual acuity of 20/40 or better was achieved in 93.1% of inpatient cases and in 97.2% of outpatient cases 6 months after surgery. Postoperative, clinically apparent cystoid macular edema was more common in the inpatient group (P = 0.03); however, after exclusion of patients with diabetes, hypertension, age younger than 65 years, and eyes with pre-existing nonlenticular disease, there was no statistically significant difference between groups. No significant differences in rates for other operative and postoperative complications were identified, including wound dehiscence, unplanned postoperative filtering blebs, infectious endophthalmitis, retinal detachment, persistent iridocyclitis, glaucoma, and corneal edema. CONCLUSION: This study does not demonstrate that the transition to outpatient cataract extractions has had an adverse effect on surgical outcomes.

Calcium channel blockers and dysmenorrhea.

Dysmenorrhea is a significant problem in adolescents. Routine medical management has included analgesics and prostaglandin inhibitors. We describe the use of a calcium channel blocker, nicardipine, in the management of an adolescent who was refractory in routine treatment for severe dysmenorrhea. The patient had excellent resolution of menstrual cramping without serious side effects. The role of calcium channel blockers in the management of refractory dysmenorrhea should be further studied to examine a future role.

Adolescent involvement in Kansas City gangs.

The authors present information to enlighten physicians on the subject of adolescent gang involvement. Discussion includes explanations of who gets involved in these gangs, why they get involved and why it is important to identify youths who may be involved with gangs.