Iris F. Litt

The drug-using adolescent as a pediatric patient

The adolescent who uses drugs for pleasure or social reasons differs from the adult in the type of drug used, in the route of administration, and in the resulting medical complications. A group of 1,429 ambulatory and hospitalized adolescent patients, selected in part because of suspected delinquency, used heroin more often than other drugs. Hepatitis was the most frequent complication. Other complications of drug use included secondary amenorrhea, renal failure, eosinophilia, glycosuria, elevated serum alkaline phosphatase levels, and false positive serologic tests.

Liver disease in the drug-using adolescent

Evaluation of 7,272 presumably well adolescent users of heroin, sedatives and airplane glue revealed abnormalities in liver function in 37 per cent. Elevation of the concentration of serum glutamic pyruvic transaminase was the most common abnormality, while elevation of serum bilirubin levels was recorded in less than 10 per cent. These abnormalities were prevalent in the patients who used heroin and sedatives. Inhalation of airplane glue was not associated with abnormalities in liver function tests. The substances commontly abused by our patients did not appear toxic when tested in an in vitro system designed to evaluate acute hepatotoxicity. The long-term prognosis of chronic persistent hepatitis in teen-agers who abuse drugs is still unknown.

Isoniazid hepatitis in adolescents.

Prophylactic isoniazid therapy is currently recommended for adolescents with positive tuberculin reactions because of the risk of activation of tuberculosis in this age group. Since this drug has been associated with hepatic dysfunction in adults, the present study was undertaken to evaluate its effect on liver function in teen-agers. Accordingly, liver function tests were performed on 178 adolescents prior to and following administration of INH. Abnormalities in SGPT values were encountered in 10% of these patients and occurred in the main within the first 10 weeks of testing, suggesting INH maybe hepatotoxic. However, jaundice was notably absent in the patients with enzyme elevations and prompted a further investigation into the possible effect of INH on bilirubin metabolism. Thus, Sprague-Dawley rats were given four daily injections of INH. These animals manifested increased hepatic bilirubin glucuronyl transferase activity when compared with control rats, supporting the hypothesis that enzymatic induction may be responsible for the absence of jaundice in our adolescent subjects.

The effect of maternal heroin addiction on neonatal jaundice

The lack of significant jaundice among infants of heroin-addicted mothers suggested a possible mitigating effect of heroin on bilirubin accumulation in the newborn infant. This possibility was substantiated by the finding of increased bilirubin glucuronyl transferase activity in morphine-addicted mice and the morphologic demonstration of an increase in the smooth endoplasmic reticulum of their liver cells as seen by electron microscopy. The significance of enhanced glucuronyl transferase activity may extend beyond the metabolism of bilirubin.

The Role and Effect of Parenteral Nutrition on the Liver and Its Use in Chronic Inflammatory Bowel Disease in Childhood

At the present time, specific and clear-cut clinical indications for the use of intravenous nutrition in the infant, child or adolescent with hepatobiliary disease do not exist. The indications for the implementation of such a life-support system on a temporary basis in children undergoing extensive operative procedures on the liver or biliary tract is similar to that found in any child undergoing radical surgery. The use of intravenous nutrition in such situations is, however, primarily if not solely, related to the need to nutritionally sustain such children during prolonged periods when they cannot tolerate oral feedings. There does not appear to be any specific advantage to this group of postoperative pediatric surgical patients as opposed to any other group of poorly nourished children following extensive surgery of the cardiovascular, neuromuscular or genito-urinary systems.

Diazepam in the management of heroin withdrawal in adolescents: Preliminary report

In a group of mice experimentally addicted to morphine, diazepam eliminated the major manifestation of withdrawal. Diazepam was similarly effective in reducing the duration and severity of withdrawal symptoms in a large group of adolescent heroin addicts. The ideal agent for opiate detoxification is one which is nontoxic, nonaddictive, inexpensive, easily administered, and above all, effective in eliminating the potentially life-threatening consequences of withdrawal. On the basis of the animal experiment and clinical trial in adolescent heroin addicts reported herein, diazepam appears to fulfill these criteria.

Age of menarche: a changing pattern and its relationship to ethnic origin and delinquency

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1. PERSPECTIVES ON ADOLESCENT MEDICINE: CONCEPTS AND PROGRAM DESIGN

ABSTRACT

Laparoscopy for presumed nonacute salpingitis: A new look at an old problem

The increased prevalence of venereal disease among adolescents has resulted in a rise in nonacute salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of presumed nonacute salpingitis in 29 adolescents. The patients had a mean duration of symptoms of 5.5 months, 50% had a recent history of discharge and/or bilateral pelvic pain, and on examination 50% had pain on motion of the cervix, 75% had adnexal tenderness, and 50% had a palpable adnexal fullness or mass. Anatomic findings at laparoscopy included normal pelvic structures in 8, active salpingitis in 13 and nonacute disease in 8. The anaerobic, aerobic, and viral peritoneal cultures obtained at laparascopy from 22 patients resulted in no growth in 18. The four with positive cultures had one organism identified in three cases and two organisms in one case. Anatomic findings were more helpful in diagnosis than the bacteriologic analysis, and our results suggest that laparoscopy increases diagnostic accuracy in the management of presumed nonacute salpingitis.