[Diagnostic workup and therapy of acute venous diseases]. / Diagnostik und Therapie akuter venöser Erkrankungen.

Acute venous diseases, especially deep leg and pelvic vein thrombosis, present an angiological emergency and can lead to acute life-threatening events such as pulmonary embolism. Long-term consequences may be postthrombotic syndromes. In addition to stroke and myocardial infarction, deep leg and pelvic vein thrombosis are one of the most common cardiovascular diseases. Early diagnosis and rapid initiation of therapy are important.

Anorexia nervosa in children and adolescents: diagnosis, treatment and the role of the pediatrician.

The diagnosis and treatment of anorexia nervosa (AN) in children and adolescents has some commonality but also differs from that of this condition in adults. A new understanding of AN is emerging: research data from the fields of epidemiology, genetics, and brain biology, suggest that there may be an underlying brain diathesis predisposing towards AN. It is now proposed that that what starts as a harmless diet, once it turns into a more prolonged food restriction may trigger an eating disorder in a genetically neurobiologically predisposed population. The condition may be then perpetuated by the biochemical changes induced by weight loss, ketosis, and the impact of the ensuing malnutrition on the brain (starvation illness). This change of paradigm from a psychological understanding to a neurobiological conceptualization calls for an early intervention to assure nutritional rehabilitation as soon as an eating disorder is suspected in children, without needing to wait for all the classical features of the diagnosis as seen in adults. This new model is agnostic about the origins of the disease and questions the classic assumption of "an underlying family pathology". It gives strong support to treatments such as Family Based Treatment, also referred to as the "Maudsley method". Essentially this consists of empowering parents to monitor and supervise the nutritional rehabilitation of their children. Hence pediatricians no longer need to be bystanders when treating these children and adolescents. They now have a clearly defined role: early diagnosticians, clinical monitors (of potential medical complications), nutrition advisors, and as members of a multidisciplinary team, patient and family advocates and educators.

Assessing African American adolescents' risk for suicide attempts: attachment theory.

The threat of separation from a parent theoretically increases the risk of adolescent suicide attempts. The present study evaluated this and other hypothesized risk factors in a sample of adolescent suicide attempters and nonsuicidal controls, using the Psychiatric Consultation Checklist (Lyon, 1987). Stepwise logistic regression was used to predict group membership. It was found that threat of separation from a parental figure, insomnia, neglect, substance abuse, suicidal ideation, and failing grades were the strongest predictors of suicide attempt. Ten predictor variables correctly identified 97% of suicide attempters and 86% of nonattempters. Unexpected findings included high levels of truancy, threatening others, and separation from a parent before the age of 12 among nonattempters.

Eating disorders in adolescents and young women with spina bifida.

This is the first report of the association of spina bifida and eating disorders. Five patients were diagnosed rather late in the course of their illness. They all had been overweight premorbidly and had been urged to lose weight for years in order to improve their mobility. As they dieted, they experienced their weight loss as a source of power that could somehow compensate for their losses and neurologic limitations. They responded to a multidisciplinary intervention. Clinicians taking care of patients with spina bifida need to be cognizant that they may be at risk of developing an eating disorder. Such awareness should influence the quality of nutritional counseling (prevention aspect) and the clinical assessment of sudden weight loss (early intervention).

Psychosocial aspects of chronic illness in adolescence.

Success in the survival of children with significant medical conditions has resulted in a dramatic increase in the prevalence of adolescents with chronic illness. Unfortunately, the traditional biomedical approach does not prepare practitioners for the complexities of managing chronic illness, because numerous psychosocial factors are involved. This article will address the need for integrating psychosocial issues into the assessment and treatment of the chronically ill adolescent. Assessment of the teen should incorporate an understanding of the developmental stages of adolescence, a review of how these developmental tasks are being accomplished, a discernment of individual characteristics, and knowledge of the family and community to which they belong. Management should take into account the phases of illness (acute, chronic or terminal) and encourage empowerment of the adolescent and family in decision making. A team approach that is community-based, comprehensive, and culturally appropriate is ideal.

Testing the hypothesis of the multidimensional model of anorexia nervosa in adolescents.

This study statistically tested six hypothesized risk factors of the model for anorexia nervosa. Forty-three adolescents with anorexia nervosa and 85 controls were administered the EAT, EDI, and FES. In addition, 43 parents of anorexics and 85 parents of controls completed the Family History Data Sheet, the FES, and the Perfect Child Questionnaire. Three of six hypothesized risk factors were confirmed: family history of depression, feelings of ineffectiveness, and poor interceptive awareness. Log-linear analysis indicated that the hierarchical model that best fit the data had significant two-way interactions with anorexia nervosa, G2 (11, N = 128) = 65.87, p < .001. In addition, alcohol and drug abuse or dependence figured prominently in the family history of patients with anorexia nervosa. The multidimensional model for anorexia nervosa holds up as an exploratory model of this condition in the adolescent age group.

Eating disorders and reflex sympathetic dystrophy syndrome: is there a common pathway?

The comorbidity of eating disorders and reflex sympathetic dystrophy syndrome in the same patients raises the possibility of a common pathway for both conditions. Reflex sympathetic dystrophy syndrome may be manifesting itself in those individuals who have sympathetic overdrive. Microtrauma, often induced by compulsive exercise, and depression may be contributory factors. It is recommended that: patients with eating disorders who develop pain in an extremity should be investigated for possible reflex sympathetic dystrophy syndrome; patients with reflex sympathetic dystrophy syndrome should be discouraged from dieting, and eating disorders should be suspected if they begin to lose weight or are already malnourished.

Immunologic cytofluorometric studies in adolescents with anorexia nervosa.

OBJECTIVE: To assess lymphocyte stimulation and lymphocyte phenotype evaluation in adolescent patients with anorexia nervosa (AN). METHOD: In vitro lymphocyte stimulation and flow cytometric phenotype studies were done on 26 hospitalized patients with AN receiving nutritional rehabilitation. The laboratory assessment consisted of lymphocyte subset analysis and in vitro lymphoproliferative responses to mitogens and antigens. RESULTS: Flow cytometric phenotype analysis showed that only a minority of the patients had abnormal phenotype and immune responses, moreover their immune systems were not significantly impaired. DISCUSSION: The cytofluorometric study of immune function does not show significant alterations in adolescents hospitalized for anorexia nervosa.

Eating disorders and health insurance.

Eating disorders are being diagnosed and managed by an increasing number of pediatricians and practitioners of adolescent medicine. These physicians are increasingly discovering the power and importance of their patients' health insurance status in the management of these conditions because the lack of appropriate insurance may often pose obstacles and barriers to care. This article provides an analysis of this situation through brief case presentations followed by a discussion and recommendations.

An epidemiological view of adolescent health in Latin America.

PIP: Only recently has attention been given to the condition and needs of adolescents in Latin America. Many assume that the low mortality rate among adolescents is an indication of their more than adequate health status. In reality, however, data on the health status of Latin American teens in lacking and those data which are available have been poorly synthesized and employed. In an effort to redress this oversight, the authors review and synthesize existing data on the subject from UNESCO, the World Bank, PAHO, the ILO, and other international organizations. From sections on the demography of adolescents, education, employment, economic and social conditions, mortality, morbidity, risk behaviors, and reproductive health, the authors find that adolescents in Latin America suffer traditional infectious illnesses and nutritional deficiencies; are increasingly exposed to alcohol, tobacco and drugs; and are experiencing new morbidities from violence, self-destructive behaviors, injuries, and addictions. While the level of educational attainment had increased for these youths and illiteracy has decreased across the board, poverty pervades much of the region and constrains the ability of adolescents to secure and maintain a decent quality of life. Health professionals and the general public need to dismiss the myth that adolescents in Latin America are overwhelmingly healthy and move proactively to provide them with the attention and services they so desperately need.^ieng

Clinical spectrum of anorexia nervosa in children.

A retrospective review of 21 patients ages 12 years and younger (age of onset range 7 to 12 years) with anorexia nervosa showed diagnostic delay in the youngest ones, high incidence of family psychiatric history, a remarkable severity of illness, and positive response to intensive treatment. Additional findings included significant comorbidity, a distinct subgroup with personality disorder and another with features of the "vulnerable child syndrome." This broad clinical spectrum of anorexia nervosa in children may explain the great variability in outcome. The development of anorexia nervosa in children relates to a complex combination of etiological and trigger factors. Precipitants identified in this study were physical maturation, entry into junior high, loss, or some combination thereof.