Faculty Bibliography

PURPOSE: To determine: 1) the proportion of Neisseria gonorrhoeae caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) in our inner-city population; 2) any difference in the isolation rates of PPNG between adolescents and adults; 3) co-infection rates with Chlamydia trachomatis in this adolescent population; and 4) the appropriateness of current CDC recommendations for initial treatment of patients with suspected gonococcal infection. METHODS: Genital cultures for GC were obtained from 1990 patients seen in the emergency room or primary care clinics. Of these, 285 were adolescents between 12 and 19 years of age. All adolescent patients were tested for chlamydial infection. Comparisons of gonococcal infection rates were made between adults and adolescents and between males and females. The rates of symptomatic versus asymptomatic adolescents were compared. RESULTS: Genital cultures were positive for GC in 13% of the patients tested. Of these, 51% were identified as being caused by PPNG. Among the adolescents, cultures were positive in 25%, and 63% of these were identified as PPNG. The rate of PPNG was significantly higher in adolescents than in adults. The rate of PPNG was highest in adolescent females and lowest in adult males. There was no difference in the rate of PPNG between adolescents and adult males. Of the 71 adolescents with GC, 58% were coinfected with C. trachomatis. Adolescents with PPNG had a higher rate of concomitant infection with C. trachomatis than those with a penicillin-sensitive strain. Adolescents with N. gonorrhoeae were more likely to be infected with PPNG if they had GU symptoms. CONCLUSIONS: Our data supports the most recent CDC recommendations that the initial treatment for suspected N. gonorrhoeae be effective against PPNG. Furthermore, chlamydia screening and treatment is warranted in patients suspected of having an STD

To evaluate the possible role of central dopaminergic suppression of gonadotropin secretion in the genesis of amenorrhea associated with anorexia nervosa (A.N.), a central D-2 dopamine receptor blocker was administered to 10 women with A.N. and 10 regularly menstruating age-matched controls. Serum prolactin and luteinizing hormone (LH) levels were measured at -15, 0, 30, 60, 120, and 180 min after administration of metoclopramide (10 mg orally). Mean basal prolactin (p less than 0.001) and estradiol levels (p less than 0.02) were significantly lower in women with A.N. The prolactin response to metoclopramide was significantly impaired in women with anorexia nervosa. No correlation was found between the prolactin response and percentage ideal body weight. Basal and post-stimulation prolactin levels were correlated with estradiol levels. After adjusting for the effects of estradiol, significant differences between patients with A.N. and controls remained in prolactin levels at baseline (p less than 0.01), 120 min (p less than 0.02) and 180 min (p less than 0.05). Metoclopramide did not induce a significant rise in LH levels in either the A.N. or control groups. These data are consistent with central dopaminergic inhibition of prolactin secretion in anorexia nervosa but do not support the hypothesis that central dopaminergic inhibition is related to diminished LH release in this state

This study assesses whether nonhospitalized adolescents with chronic diseases differ from their healthy peers on standardized measurements of depression, self-esteem, and life events. The study group consisted of 80 patients (20 with sickle cell disease, 40 with asthma, and 20 with diabetes). All patients had been admitted at least twice in the preceding year, had their disease for at least 2 years, and were between the ages of 12 and 18. The control group consisted of 100 adolescents, matched for age and socioeconomic status, from local schools. All subjects completed a questionnaire compiled from the Beck Depression Inventory (BDI), the Rosenberg Scale of Self-Esteem, and the McCutcheon Life Events Checklist. Adolescents with chronic disease had higher depression scores (p less than 0.001) and lower self-esteem (p less than 0.001) than their healthy age-matched controls. There was no statistically significant difference in life events between the chronic disease and control groups. Depression, self-esteem, and life events did not differ significantly among the three disease groups. These findings suggest a need for intervention strategies to address depression and low self-esteem in adolescents with chronic disease

The incidence of anorexia nervosa is increasing in adolescents. The pediatrician caring for teenagers is often the first professional confronted with the early signs and symptoms of this disorder. Clinical features and available literature on the psychological, nutritional, and family disorganization found in patients with anorexia nervosa are reviewed. Different therapeutic approaches are discussed, and current data on outcome are presented.