An approach to chronic abdominal pain in adolescents.
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Biomedical subjects
Publications and source records attributed to R M Cavanaugh.
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Pityriasis rosea is a common disorder of unknown etiology that may simulate a number of other dermatologic entities. Secondary syphilis should always be ruled out, particularly in adolescents. Pruritus occurs more frequently than is generally appreciated. The herald patch may not always be present. Secondary lesions occasionally occur distal to the elbows and knees and on the face. Over the more proximal parts of the body the secondary lesions will characteristically align themselves with the long axis following the skin lines of cleavage. The natural course is that of spontaneous resolution within 6 to 8 weeks. Sequelae are rare and usually medically insignificant. Management with oral antipruritics and/or topical steroids may be necessary to relieve the itching.
Self-examination of the genital area is an important technique to teach adolescent males. It facilitates early detection of testicular cancer and permits prompt recognition of venereal lesions. The general physical examination enables the physician to assess the stage of sexual development, detect any genital abnormalities and instruct the adolescent in the self-examination technique.
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Although serious breast lesions are unusual in adolescence, girls should learn how to perform breast self-examination. This will enable them to detect abnormal growths or galactorrhea. It will also encourage them to establish an important lifelong practice while they are young. Respect for the patient's modesty during the course of the demonstration is essential.
Encopresis is usually secondary to constipation but is sometimes associated with a primary behavioral disorder or a functionally incompetent anal sphincter. Although rare, an underlying organic disorder must be excluded. Encopresis secondary to constipation is treated with mineral oil, with the dosage titrated to individual needs. Adjuncts to therapy include dietary manipulation and stool softeners.
The pneumatic otoscope is indispensable in evaluating pressure within the middle ear of infants and children by measuring the tympanic membrane mobility. If the eardrum moves normally in response to positive and negative pressure, then a significant ear effusion, suppurative or nonsuppurative, is highly unlikely. Tympanic membrane color, luster, translucence, and light reflex should therefore be correlated with mobility before any decisions regarding therapy are made. In addition, the pneumatic otoscope with a veterinary otic speculum appears to be a simple and safe way to evaluate the vagina and rectum of infants and young children.
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Supraglottitis is a life-threatening illness characterized by inflammation of the supraglottic structures including the epiglottis, arytenoids, aryepiglottic folds, and ventricular bands. This paper is a comprehensive review of the etiology, epidemiology, pathology, differential diagnosis, natural course, complications, and management of supraglottitis. A high index of suspicion is required to properly interpret the historical, physical, and radiologic findings. As soon as the diagnosis of supraglottitis is established, the airway sould be secured by either an endotracheal tube or tracheostomy followed by antibiotic and supportive therapy.