Adolescence Health Dictionary

Excessive growth (mainly in height) caused by overproduction, during childhood or adolescence, of GROWTH HORMONE by a tumour of the PITUITARY GLAND. Untreated, the affected individual may die in early adulthood. Sometimes the tumour appears after the individual has stopped growing and the result then is ACROMEGALY rather than gigantism.... gigantism

A disorder caused by insufficient or absent production of the hormone insulin by the pancreas, or because the tissues are resistant to the effects. Insulin is responsible for the absorption of glucose into cells. Lack of insulin causes high blood levels of glucose, resulting in the passage of large quantities of urine and excessive thirst. Other symptoms are weight loss, hunger, and fatigue. Urinary tract infections may also occur. Lipid (fat) metabolism is affected and small blood vessels degenerate. Undiagnosed diabetes can lead to blurred vision, boils, and tingling or numbness of the hands and feet.

There are 2 main types of diabetes mellitus, both of which tend to run in families. Type 1 (insulin-dependent) diabetes is the less common form of the disorder and usually develops in childhood or adolescence. In this type of diabetes, insulin-secreting cells in the pancreas are destroyed, and insulin production ceases. Type 2 (noninsulindependent) diabetes generally develops gradually, mainly in people over the age of 40. Although insulin is still produced, there is not enough for the body’s needs as the tissues become relatively resistant to its effects. Symptoms may be present in only a 3rd of people with this type of diabetes; it is often diagnosed only when complications occur.

Treatment aims to keep blood glucose as normal as possible. It involves achieving and maintaining a normal weight, regular physical activity, dietary management, and, if necessary, treatments with antidiabetic drugs.

People with type 1 diabetes require regular insulin injections. Carbohydrate intake is spread out over the day, intake of fats should be kept low, and selfmonitoring of blood glucose levels is important. If the glucose/insulin balance is not maintained, hyperglycaemia or hypoglycaemia may develop.

Treatment of type 2 diabetes usually consists of dietary measures, weight reduction, and antidiabetic drugs, often hypoglycaemic drugs such as sulphonylureas. Some people eventually need insulin injections.

Complications of diabetes mellitus include retinopathy, peripheral neuropathy, and nephropathy. Ulcers on the feet are another risk. People with diabetes mellitus also have a greater risk of atherosclerosis, hypertension, other cardiovascular disorders, and cataracts.

With modern treatment and sensible self-monitoring, nearly all diabetics can look forward to a normal lifespan.... diabetes mellitus

A tendency to have recurrent seizures. In many people with epilepsy, the cause is unclear, although a genetic factor may be involved. In other cases, seizures may be the result of brain damage from head injury, birth trauma, brain infection (such as meningitis or encephalitis), brain tumour, stroke, drug intoxication, or a metabolic disorder.

Many people with epilepsy do not have any symptoms between seizures. Some people experience an aura shortly before. In some cases, a stimulus such as a flashing light triggers a seizure. Epileptic seizures may occur more frequently in times of illness or stress.

Epileptic seizures can be classified into two groups: generalized and partial. Generalized seizures cause loss of consciousness and may affect all areas of the brain. There are two types: grand mal and absence (petit mal) seizures. During a grand mal seizure, there may be an aura initially, then the bodybecomes stiff and consciousness is lost; breathing may be irregular or may stop briefly, then the body jerks uncontrollably. The person may be disorientated for hours afterwards and have no memory of the event. Prolonged grand mal seizures are potentially life-threatening. Absence seizures occur mainly in children. Periods of altered consciousness last for only a few seconds and there are no abnormal movements of the body. This type of seizure may occur hundreds of times daily.

Partial seizures are caused by abnormal electrical activity in a more limited area of the brain. They may be simple or complex. In simple partial seizures, consciousness is not lost and an abnormal twitching movement, tingling sensation, or hallucination of smell, vision, or taste occurs, lasting several minutes. In complex partial seizures, also known as temporal lobe epilepsy, conscious contact with the surroundings is lost. The sufferer becomes dazed and may behave oddly. Typically, the person remembers little, if any, of the event.

Diagnosis is made from examination of the nervous system and an EEG.

CT scanning or MRI of the brain and blood tests may also be carried out.

Anticonvulsant drugs usually stop or reduce the frequency of seizures.

Surgery may be considered if a single area of brain damage is causing the seizures.

Epilepsy that develops during childhood may disappear following adolescence.... epilepsy

A disorder caused by the increased secretion of growth hormone by an ADENOMA of the anterior PITUITARY GLAND. It results in excessive growth of both the skeletal and the soft tissues. If it occurs in adolescence before the bony epiphyses have fused, the result is gigantism; if it occurs in adult life the skeletal overgrowth is con?ned to the hands, feet, cranial sinuses and jaw. Most of the features are due to overgrowth of the cartilage of the nose and ear and of the soft tissues which increase the thickness of the skin and lips. Viscera such as the thyroid and liver are also affected. The overgrowth of the soft tissues is gradual.

The local effects of the tumour commonly cause headache and, less frequently, impairment of vision, particularly of the temporal ?eld of vision, as a result of pressure on the nerves to the eye. The tumour may damage the other pituitary cells giving rise to gonadal, thyroid or adrenocortical insu?ciency. The disease often becomes obvious in persons over about 45 years of age; they may also complain of excessive sweating, joint pains and lethargy. The diagnosis is con?rmed by measuring the level of growth hormone in the serum and by an X-ray of the skull which usually shows enlargement of the pituitary fossa.

Treatment The most e?ective treatment is surgically to remove the pituitary adenoma. This can usually be done through the nose and the sphenoid sinus, but large adenomas may need a full CRANIOTOMY. Surgery cures about 80 per cent of patients with a microadenoma and 40 per cent of those with a large lesion; the rate of recurrence is 5–10 per cent. For recurrences, or for patients un?t for surgery or who refuse it, a combination of irradiation and drugs may be helpful. Deep X-ray therapy to the pituitary fossa is less e?ective than surgery but may also be helpful, and recently more sophisticated X-ray techniques, such as gamma knife irradiation, have shown promise. Drugs – such as BROMOCRIPTINE, capergoline and quiangoline, which are dopamine agonists – lower growth-hormone levels in acromegaly and are particularly useful as an adjunct to radiotherapy. Drugs which inhibit growth-hormone release by competing for its receptors, octeotride and lanreotride, also have a place in treatment.

See www.niddk.nih.gov/health/endo/pubs/ acro/acro.htm

www.umm.edu/endocrin/acromegaly.htm... acromegaly

A narrowing of the AORTA in the vicinity of the insertion of the ductus arteriosus. It is a congenital abnormality but may not be discovered until well into childhood or adolescence. The diagnosis is easily made by discovering a major di?erence between the blood pressure in the arms and that of the legs. If untreated it leads to hypertension and heart failure, but satisfactory results are now obtained from surgical treatment, preferably in infancy. Paediatricians screen for coarctation by feeling for femoral pulses, which are absent or weak in this condition.... coarctation of the aorta

This is the most common serious genetic disease in Caucasian children, with an incidence of about one per 2,500 births, and more than 6,000 patients in the UK (30,000 in the USA). It is an autosomal recessive disorder of the mucus-secreting glands of the lungs, the pancreas, the mouth, and the gastrointestinal tract, as well as the sweat glands of the skin. The defective gene is sited on chromosome 7 which encodes for a protein, cystic ?brosis transmembrane conductance regulator (CFTR). Individuals who inherit the gene only on one set of chromosomes can, however, carry the defect into successive generations. Where parents have a child with cystic ?brosis, they have a one-infour chance of subsequent children having the disease. They should seek GENETIC COUNSELLING.

The disorder is characterised by failure to gain weight in spite of a good appetite, by repeated attacks of bronchitis (with BRONCHIECTASIS developing at a young age), and by the passage of loose, foul-smelling and slimy stools (faeces). AMNIOCENTESIS, which yields amniotic ?uid along with cells shed from the fetus’s skin, can be used to diagnose cystic ?brosis prenatally. The levels of various enzymes can be measured in the ?uid and are abnormal when the fetus is affected by cystic ?brosis. Neonatal screening is possible using a test on blood spots – immunoreactive trypsin (IRT).

In children with symptoms or a positive family history, the disease can be tested for by measuring sweat chloride and sodium. This detects the abnormal amount of salt that is excreted via the sweat glands when cystic ?brosis is present. Con?rmation is by genetic testing.

Treatment This consists basically of regular physiotherapy and postural drainage, antibiotics and the taking of pancreatic enzyme tablets and vitamins. Some children need STEROID treatment and all require nutritional support. The earlier treatment is started, the better the results. Whereas two decades ago, only 12 per cent of affected children survived beyond adolescence, today 75 per cent survive into adult life, and an increasing number are surviving into their 40s. Patients with end-stage disease can be treated by heart-lung transplantation (with their own heart going to another recipient). Research is underway on the possible use of GENE THERAPY to control the disorder. Parents of children with cystic ?brosis, seeking help and advice, can obtain this from the Cystic Fibrosis Trust.... cystic fibrosis

The beginning of the reproductive phase of a woman’s life. It usually begins withy night sweats, continues a few months later with estrogen, followed by ovulation, then the full cycle and the growth of secondary sexual characteristics...in various order. Also called adolescence or puberty, it is mirrored in reverse at the end of the reproductive years as menopause.... menarche

A common practice in schoolchildren, most of whom gradually give it up as they approach adolescence. Too much signi?cance should therefore not be attached to it; in itself it does no harm, and punishment or restraining devices are not needed. It is a manifestation of tension or insecurity, the cause of which should be removed. In some people the habit is carried into adulthood.... nail-biting

This is an accessory sex gland in males which is wrapped round the URETHRA as this tube leaves the URINARY BLADDER. Opening into the urethra, the gland secretes an alkaline ?uid during ejaculation and is a constituent of SEMEN. The gland grows during adolescence and is sensitive to the concentrations of sex hormones.... prostate gland

The term ‘eating disorders’ covers OBESITY, feeding problems in childhood, anorexia nervosa, and bulimia nervosa. The latter two are described here.

Anorexia nervosa Often called the slimmer’s disease, this is a syndrome characterised by the loss of at least a quarter of a person’s normal body weight; by fear of normal weight; and, in women, by AMENORRHOEA. An individual’s body image may be distorted so that the sufferer cannot judge real weight and wants to diet even when already very thin.

Anorexia nervosa usually begins in adolescence, affecting about 1–2 per cent of teenagers and college students at any time. It is 20 times more common among women than men. Up to 10 per cent of sufferers’ sisters also have the syndrome. Anorexia may be linked with episodes of bulimia (see below).

The symptoms result from secretive self-starvation, usually with excessive exercise, self-induced vomiting, and misuse of laxatives. An anorexic (or anorectic) person may wear layers of baggy clothes to keep warm and to hide the ?gure. Starvation can cause serious problems such as ANAEMIA, low blood pressure, slow heart rate, swollen ankles, and osteoporosis. Sudden death from heart ARRHYTHMIA may occur, particularly if the sufferer misuses DIURETICS to lose weight and also depletes the body’s level of potassium.

There is probably no single cause of anorexia nervosa. Social pressure to be thin seems to be an important factor and has increased over the past 20–30 years, along with the incidence of the syndrome. Psychological theories include fear of adulthood and fear of losing parents’ attention.

Treatment should start with the general practitioner who should ?rst rule out other illnesses causing similar signs and symptoms. These include DEPRESSION and disorders of the bowel, PITUITARY GLAND, THYROID GLAND, and OVARIES.

If the diagnosis is clearly anorexia nervosa, the general practitioner may refer the sufferer to a psychiatrist or psychologist. Moderately ill sufferers can be treated by COGNITIVE BEHAVIOUR THERAPY. A simple form of this is to agree targets for daily calorie intake and for acceptable body weight. The sufferer and the therapist (the general practitioner or a member of the psychiatric team) then monitor progress towards both targets by keeping a diary of food intake and measuring weight regularly. Counselling or more intensely personal PSYCHOTHERAPY may help too. Severe life-threatening complications will need urgent medical treatment in hospital, including rehydration and feeding using a nasogastric tube or an intravenous drip.

About half of anorectic sufferers recover fully within four years, a quarter improve, and a quarter remain severely underweight with (in the case of women) menstrual abnormalities. Recovery after ten years is rare and about 3 per cent die within that period, half of them by suicide.

Bulimia nervosa is a syndrome characterised by binge eating, self-induced vomiting and laxative misuse, and fear of fatness. There is some overlap between anorexia nervosa and bulimia but, unlike the former, bulimia may start at any age from adolescence to 40 and is probably more directly linked with ordinary dieting. Bulimic sufferers say that, although they feel depressed and guilty after binges, the ‘buzz’ and relief after vomiting and purging are addictive. They often respond well to cognitive behaviour therapy.

Bulimia nervosa does not necessarily cause weight loss because the binges – for example of a loaf of bread, a packet of cereal, and several cans of cold baked beans at one sitting – are cancelled out by purging, by self-induced vomiting and by brief episodes of starvation. The full syndrome has been found in about 1 per cent of women but mild forms may be much more common. In one survey of female college students, 13 per cent admitted to having had bulimic symptoms.

Bulimia nervosa rarely leads to serious physical illness or death. However, repeated vomiting can cause oesophageal burns, salivary gland infections, small tears in the stomach, and occasionally dehydration and chemical imbalances in the blood. Inducing vomiting using ?ngers may produce two tell-tale signs – bite marks on the knuckles and rotten, pitted teeth.

Those suffering from this condition may obtain advice from the Eating Disorders Association.... eating disorders

An inherited disorder of blood COAGULATION which results in prolonged bleeding even after minor injury. There is a de?ciency of factor VIII, an essential clotting factor in the coagulation cascade – the complex series of biochemical events that leads from injury of the wall of a blood vessel to the formation of a blood clot that checks bleeding. Haemophilia is a sex-linked recessive disorder (though a small number of cases arise by spontaneous mutation), so that, if females carry the disease, one-half of their sons will be affected and one-half of their daughters will be carriers. The sons of haemophiliacs are unaffected but one-half of their daughters will be carriers.

Haemophilia affects approximately 1:4,000 of the UK population but only 1:20,000 is severely affected. Severity of the disease depends upon the percentage, compared with normal, of factor VIII activity present. Less than 1 per cent and there will be spontaneous bleeding into joints and muscles; 1–5 per cent and there will be occasional spontaneous bleeding and severe bleeding after minor injury; 5–25 per cent and there will only be severe bleeding after major injury. Before treatment was available, severe haemophiliacs suffered from acute pain and deformity from bleeds into joints and muscles. Bleeding also occurred into the gut, kidneys and brain, and few survived past adolescence.

Freeze-dried factor VIII may be kept in domestic refrigerators. Haemophiliacs can use it to abort minor bleeds by reconstituting it and injecting it intravenously. More major bleeding or preparation for surgery involves raising factor VIII levels to 30–100 per cent by giving cryoprecipitate.

With treatment, most haemophiliacs lead normal lives, although obviously dangerous or contact sports should be avoided. Before donors of blood were screened for HEPATITIS B and C or for HIV infection (see AIDS/HIV), some individuals with haemophilia receiving factor VIII were unwittingly infected with those diseases. Today’s screening procedures make such infections very unlikely.

There is a National Haemophilia Register and each registered sufferer carries a card with details about his or her condition. Information may also be obtained from NHS haemophilia centres and the Haemophilia Society.... haemophilia

A rare inherited condition in which the affected person suffers from premature ageing from adolescence onwards. His or her growth may be retarded, the skin become thin, and arterial disease, DIABETES MELLITUS and leg ulcers (see ULCER) develop. Treatment is symptomatic.... werner’s syndrome

There are times when the endocrine orchestra fails to strike its normal note; when energies of life flow slowly and body tone is low. Such is when stimulation of the thyroid, pancreas, and adrenals by natural precursors of their hormones is helpful. The following has a hormone- effect and proves useful for general weakness, change of life, persistent fatigue, sterility, puberty and adolescence, frigidity, metabolic disorders:

Formula. Ginseng 2; Liquorice 1; Sarsaparilla 1; Ginger half; Kelp half. Dose – powders: half a teaspoon; tinctures 1-3 teaspoons; liquid extracts: 1-2 teaspoons; in water or honey thrice daily. ... gland balancer

Learning disability, previously called mental handicap, is a problem of markedly low intellectual functioning. In general, people with learning disability want to be seen as themselves, to learn new skills, to choose where to live, to have good health care, to have girlfriends or boyfriends, to make decisions about their lives, and to have enough money to live on. They may live at home with their families, or in small residential units with access to work and leisure and to other people in ordinary communities. Some people with learning disabilities, however, also have a MENTAL ILLNESS. Most can be treated as outpatients, but a few need more intensive inpatient treatment, and a very small minority with disturbed behaviour need secure (i.e. locked) settings.

In the United Kingdom, the 1993 Education Act refers to ‘learning diffculties’: generalised (severe or moderate), or speci?c (e.g. DYSLEXIA, dyspraxia [or APRAXIA], language disorder). The 1991 Social Security (Disability Living Allowance) Regulations use the term ‘severely mentally impaired’ if a person suffers from a state of arrested development or incomplete physical development of the brain which results in severe impairment of intelligence and social functioning. This is distinct from the consequences of DEMENTIA. Though ‘mental handicap’ is widely used, ‘learning disability’ is preferred by the Department of Health.

There is a distinction between impairment (a biological de?cit), disability (the functional consequence) and handicap (the social consequence).

People with profound learning disability are usually unable to communicate adequately and may be seriously movement-impaired. They are totally dependent on others for care and mobility. Those with moderate disability may achieve basic functional literacy (recognition of name, common signs) and numeracy (some understanding of money) but most have a life-long dependency for aspects of self-care (some fastenings for clothes, preparation of meals, menstrual hygiene, shaving) and need supervision for outdoor mobility.

Children with moderate learning disability develop at between half and three-quarters of the normal rate, and reach the standard of an average child of 8–11 years. They become independent for self-care and public transport unless they have associated disabilities. Most are capable of supervised or sheltered employment. Living independently and raising a family may be possible.

Occurrence Profound learning disability affects about 1 in 1,000; severe learning disability 3 in 1,000; and moderate learning disability requiring special service, 1 per cent. With improved health care, survival of people with profound or severe learning disability is increasing.

Causation Many children with profound or severe learning disability have a diagnosable biological brain disorder. Forty per cent have a chromosome disorder – see CHROMOSOMES (three quarters of whom have DOWN’S (DOWN) SYNDROME); a further 15 per cent have other genetic causes, brain malformations or recognisable syndromes. About 10 per cent suffered brain damage during pregnancy (e.g. from CYTOMEGALOVIRUS (CMV) infection) or from lack of oxygen during labour or delivery. A similar proportion suffer postnatal brain damage from head injury – accidental or otherwise – near-miss cot death or drowning, cardiac arrest, brain infection (ENCEPHALITIS or MENINGITIS), or in association with severe seizure disorders.

Explanations for moderate learning disability include Fragile X or other chromosome abnormalities in a tenth, neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE), fetal alcohol syndrome and other causes of intra-uterine growth retardation. Genetic counselling should be considered for children with learning disability. Prenatal diagnosis is sometimes possible. In many children, especially those with mild or moderate disability, no known cause may be found.

Medical complications EPILEPSY affects 1 in 20 with moderate, 1 in 3 with severe and 2 in 3 with profound learning disability, although only 1 in 50 with Down’s syndrome is affected. One in 5 with severe or profound learning disability has CEREBRAL PALSY.

Psychological and psychiatric needs Over half of those with profound or severe – and many with moderate – learning disability show psychiatric or behavioural problems, especially in early years or adolescence. Symptoms may be atypical and hard to assess. Psychiatric disorders include autistic behaviour (see AUTISM) and SCHIZOPHRENIA. Emotional problems include anxiety, dependence and depression. Behavioural problems include tantrums, hyperactivity, self-injury, passivity, masturbation in public, and resistance to being shaved or helped with menstrual hygiene. There is greater vulnerability to abuse with its behavioural consequences.

Respite and care needs Respite care is arranged with link families for children or sta?ed family homes for adults where possible. Responsibility for care lies with social services departments which can advise also about bene?ts.

Education Special educational needs should be met in the least restrictive environment available to allow access to the national curriculum with appropriate modi?cation and support. For older children with learning disability, and for young children with severe or profound learning disability, this may be in a special day or boarding school. Other children can be provided for in mainstream schools with extra classroom support. The 1993 Education Act lays down stages of assessment and support up to a written statement of special educational needs with annual reviews.

Pupils with learning disability are entitled to remain at school until the age of 19, and most with severe or profound learning disability do so. Usually those with moderate learning disability move to further education after the age of 16.

Advice is available from the Mental Health Foundation, the British Institute of Learning Disabilities, MENCAP (Royal Society for Mentally Handicapped Children and Adults), and ENABLE (Scottish Society for the Mentally Handicapped).... learning disability

The most common form of eczema.

It usually begins in infancy but may flare up during adolescence and adulthood.

The cause is unknown, but people with atopy are more susceptible.... atopic eczema

Repetitive and persistent patterns of aggressive and/or antisocial behaviour, such as vandalism, substance abuse, and persistent lying, that occur in childhood or adolescence. (See also behavioural problems in children; adolescence.)

conductive deafness Deafness caused by faulty conduction of sound from the outer to the inner ear.... conduct disorders

A deformity of the hip in which the angle between the neck and head of the femur (thigh-bone) and the shaft of the femur is reduced, resulting in shortening of the leg, pain and stiffness in the hip, and a limp. The most common cause is a fracture to the neck of the femur or, during adolescence, injury to the developing part of the head of the bone. Coxa vara can also occur if the bone tissue in the neck of the femur is soft, a condition that may be congenital or the result of a bone disorder such as rickets or Paget’s disease. Treatment may include surgery (see osteotomy).... coxa vara

Diseases developing during a person’s lifetime may be the result of his or her lifestyle, environment, genetic factors and natural AGEING factors.

Lifestyle While this may change as people grow older – for instance, physical activity is commonly reduced – some lifestyle factors are unchanged: for example, cigarette smoking, commonly started in adolescence, may be continued as an adult, resulting in smoker’s cough and eventually chronic BRONCHITIS and EMPHYSEMA; widespread ATHEROSCLEROSIS causing heart attacks and STROKE; osteoporosis (see BONE, DISORDERS OF) producing bony fractures; and cancer affecting the lungs and bladder.

Genetic factors can cause sickle cell disease (see ANAEMIA), HUNTINGTON’S CHOREA and polycystic disease of the kidney.

Ageing process This is associated with the MENOPAUSE in women and, in both sexes, with a reduction in the body’s tissue elasticity and often a deterioration in mental and physical capabilities. When compared with illnesses described in much younger people, similar illnesses in old age present in an atypical manner

– for example, confusion and changed behaviour due to otherwise asymptomatic heart failure, causing a reduced supply of oxygen to the brain. Social adversity in old age may result from the combined effects of reduced body reserve, atypical presentation of illness, multiple disorders and POLYPHARMACY.

Age-related change in the presentation of illnesses This was ?rst recognised by the specialty of geriatric medicine (also called the medicine of ageing) which is concerned with the medical and social management of advanced age. The aim is to assess, treat and rehabilitate such patients. The number of institutional beds has been steadily cut, while availability of day-treatment centres and respite facilities has been boosted – although still inadequate to cope with the growing number of people over 65.

These developments, along with day social centres, provide relatives and carers with a break from the often demanding task of looking after the frail or ill elderly. As the proportion of elderly people in the population rises, along with the cost of hospital inpatient care, close cooperation between hospitals, COMMUNITY CARE services and primary care trusts (see under GENERAL PRACTITIONER (GP)) becomes increasingly important if senior citizens are not to suffer from the consequences of the tight operating budgets of the various medical and social agencies with responsibilities for the care of the elderly. Private or voluntary nursing and residential homes have expanded in the past 15 years and now care for many elderly people who previously would have been occupying NHS facilities. This trend has been accelerated by a tightening of the bene?t rules for funding such care. Local authorities are now responsible for assessing the needs of elderly people in the community and deciding whether they are eligible for ?nancial support (in full or in part) for nursing-home care.

With a substantial proportion of hospital inpatients in the United Kingdom being over 60, it is sometimes argued that all health professionals should be skilled in the care of the elderly; thus the need for doctors and nurses trained in the specialty of geriatrics is diminishing. Even so, as more people are reaching their 80s, there seems to be a reasonable case for training sta? in the type of care these individuals need and to facilitate research into illness at this stage of life.... medicine of ageing

(1) A term used to describe the common pigmented spots which occur on human SKIN. It arises from a collection of abnormal melanocytes (see MELANOCYTE) in the dermis adjacent to the epidermodermal junction. Moles are usually not present at birth, and appear in childhood or adolescence. Most moles are less than 5 mm in diameter and are macular at ?rst, becoming raised later. Rarely, moles are present at birth and may occasionally be massive. There is a substantial risk of future malignancy (see MALIGNANT) in massive congenital moles and prophylactic surgical removal is advised if feasible. All humans have moles, but their number varies from ten or fewer to 100 or more. The members of some families are genetically predisposed to large numbers of moles, some of which may be large and irregular in shape and colour. This ‘atypical mole syndrome’ is associated with an increased risk of future malignant MELANOMA.

(2) An internationally agreed unit (see SI UNITS) for measuring the quantity of a substance at molecular level.... mole

This is characterised by the presence of rapid eye movements and a reduction in muscle tone. Cerebral cortical activity is prominent and its blood ?ow increased. This activity is, however, di?erent from wakefulness and may cause irregular movements of the body as well as of the eyes. Most dreams occur in REM sleep: these may represent a process of reorganising mental associations after the period of wakefulness. The analysis of the content of dreams has been subject to a variety of interpretations, but no consensus view has evolved.

Physiological changes, such as a fall in temperature and blood pressure, take place just before sleep and continue during the early stages of NREM sleep. There is an intrinsic rhythm of sleep which in most subjects has a periodicity of around 25 hours. This can be modi?ed by external factors to bring it into line with the 24-hour day. Two peaks of a tendency to sleep have been identi?ed, and these usually occur between around 14.00–18.00 hours, and 02.00–06.00 hours. There are, however, di?erences according to age, in that, for instance, infants sleep for most of the 24 hours; during adolescence there is also an increase in the duration of sleep. Sleep requirements fall later in life, but there are wide genetic di?erences in the amount of sleep that people require and also the time at which they fall asleep most readily.

The internal clock can be disturbed by a variety of external factors which include irregular sleeping habits due, for instance, to shift work or jet lag. Sleep is also more likely to occur after physical exertion, reading and social activity. The duration and intensity of exposure to light can also modify sleep profoundly. Light promotes wakefulness and is the main factor that adjusts the 25-hour internal rhythm to the 24hour daily cycle. Neural connections from the retina of the EYE act on an area in the brain called the supra-chiasmatic nucleus which stimulates the pineal gland which produces MELATONIN. This is thought to trigger the range of neurological and metabolic processes that characterise sleep.... rapid-eye-movement (rem) sleep

The process of growth and change by which an individual matures physically, mentally, emotionally, and socially. Development takes place in major phases: during the first 2 months of pregnancy (see embryo); to a lesser extent, during the rest of pregnancy

(see fetus); during the first 5 years of life (see child development); and during puberty and adolescence.... development

A chronic in?ammation of the synovial lining (see SYNOVIAL MEMBRANE) of several joints, tendon sheaths or bursae which is not due to SEPSIS or a reaction to URIC ACID crystals. It is distinguished from other patterns of in?ammatory arthritis by the symmetrical involvement of a large number of peripheral joints; by the common blood-?nding of rheumatoid factor antibody; by the presence of bony erosions around joints; and, in a few, by the presence of subcutaneous nodules with necrobiotic (decaying) centres.

Causes There is a major immunogenetic predisposition to rheumatoid arthritis in people carrying the HLA-DR4 antigen (see HLA SYSTEM). Other minor immunogenetic factors have also been implicated. In addition, there is a degree of familial clustering which suggests other unidenti?ed genetic factors. Genetic factors cannot alone explain aetiology, and environmental and chance factors must be important, but these have yet to be identi?ed.

Epidemiology Rheumatoid arthritis more commonly occurs in women from the age of 30 onwards, the sex ratio being approximately 4:1. Typical rheumatoid arthritis may occur in adolescence, but in childhood chronic SYNOVITIS usually takes one of a number of di?erent patterns, classi?ed under juvenile chronic arthritis.

Pathology The primary lesion is an in?ammation of the synovial membrane of joints. The synovial ?uid becomes diluted with in?ammatory exudate: if this persists for months it leads to progressive destruction of articular CARTILAGE and BONE. Cartilage is replaced by in?ammatory tissue known as pannus; a similar tissue invades bone to form erosions. Synovitis also affects tendon sheaths, and may lead to adhesion ?brosis or attrition and rupture of tendons. Subcutaneous and other bursae may be involved. Necrobiotic nodules also occur at sites outside synovium, including the subcutaneous tissues, the lungs, the pericardium and the pleura.

Clinical features Rheumatoid arthritis varies from the very mild to the severely disabling. Many mild cases probably go undiagnosed. At least 50 per cent of patients continue to lead a reasonably normal life; around 25 per cent are signi?cantly disabled in terms of work and leisure activities; and a minority become markedly disabled and are limited in their independence. There is often an early acute phase, followed by substantial remission, but in other patients gradual step-wise deterioration may occur, with progressive involvement of an increasing number of joints.

The diagnosis of rheumatoid arthritis is largely based on clinical symptoms and signs. Approximately 70 per cent of patients have rheumatoid factor ANTIBODIES in the SERUM but, because of the large number of false positives and false negatives, this test has very little value in clinical practice. It may be a useful pointer to a worse prognosis in early cases if the level is high. X-RAYS may help in diagnosing early cases and are particularly helpful when considering surgery or possible complications such as pathological fracture. Patients commonly develop ANAEMIA, which may be partly due to gastrointestinal blood loss from antiin?ammatory drug treatment (see below).

Treatment involves physical, pharmacological, and surgical measures, together with psychological and social support tailored to the individual patient’s needs. Regular activity should be maintained. Resting of certain joints such as the wrist with splints may be helpful at night or to assist prolonged manual activities. Sound footwear is important. Early use of antirheumatic drugs reduces long-term disability. Drug treatment includes simple ANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and slow-acting drugs including GOLD SALTS (in the form of SODIUM AUROTHIOMALATE), PENICILLAMINE, SULFASALAZINE, METHOTREXATE and AZATHIOPRINE.

The non-steroidal agents are largely e?ective in reducing pain and early-morning sti?ness, and have no e?ect on the chronic in?ammatory process. It is important, especially in the elderly, to explain to patients the adverse effects of NSAIDs, the dosage of which can be cut by prescribing paracetamol at the same time. Combinations of anti-rheumatic drugs seem better than single agents. The slow-acting drugs take approximately three months to act but have a more global e?ect on chronic in?ammation, with a greater reduction in swelling and an associated fall in erythrocyte sedimentation rate (ESR) and rise in the level of HAEMOGLOBIN. Local CORTICOSTEROIDS are useful, given into individual joints. Systemic corticosteroids carry serious problems if continued long term, but may be useful under special circumstances. Much research is currently going on into the use of tumour necrosis factor antagonists such as INFLIXIMAB and etanercept, but their precise role remains uncertain.... rheumatoid arthritis

The end section of a long bone (such as the femur) separated from the diaphysis (shaft) by the epiphyseal plate.

During childhood and adolescence, the ephiphyseal plate is made of cartilage but is gradually replaced by bone.

epiphysis, slipped See femoral epiphysis, slipped.... epiphysis

An abnormal relationship between the upper and lower sets of teeth when they are closed, affecting the bite (see occlusion) or appearance.

Malocclusion usually develops during childhood. It is inherited, or is caused by thumb-sucking or a mismatch betweenthe teeth and jaws – for example, the combination of large teeth and a small mouth (see overcrowding, dental).

Orthodontic appliances (braces) may be used to move teeth into the proper position, and if there is dental overcrowding, some teeth may be extracted. Orthognathic surgery is used to treat severe recession or protrusion of the lower jaw. Treatment is best carried out in childhood or adolescence.... malocclusion

An unusual condition in which itchy, irregular, yellow or orangebrown swellings occur on the skin, most commonly on the trunk. Mastocytosis may also affect body organs, including the liver, spleen, and intestine, and it may cause symptoms such as diarrhoea, vomiting, and fainting. Very rarely, the condition leads to anaphylactic shock, which can be fatal. The condition usually begins in the 1st year of life and clears up by adolescence. Antihistamine drugs may be helpful in relieving symptoms of mastocytosis. ... mastocytosis

A type of behavioural disorder that usually appears in childhood or early adolescence.

Typically, a child shows hostile, argumentative behaviour that includes loss of temper, defiance of rules, and swearing.

To some extent such behaviour is common in adolescence, but when law-breaking or violence occur the condition is deemed to be pathological.... oppositional defiant disorder

Rare, but increasing in most countries. Three main types: teratomas, seminomas and lymphomas. The latter affect older men.

Symptoms. A hard usually painless mass in the scrotum can give rise to gynaecomastia – abnormal enlargement of the male breasts.

Of possible value. Alternatives: – Abundant herb teas – Cornsilk, Red Clover, Violet leaves.

Decoction. Echinacea 2; Kava Kava 1; Sarsaparilla 1. Mix. Half an ounce (15g) to 1 pint (500ml) water simmered gently 20 minutes. Cup thrice daily.

Formula. Sarsaparilla 2; Kava Kava l; Pulsatilla half; Thuja quarter. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily. Vinchristine.

Diet. See: DIET – CANCER. Researchers from Cambridge University found that an extra pint of milk a day during adolescence was associated with 2 and a half times increased risk of testicular cancer. (Journal of Epidemiology and Community Health, Oct. 1993)

Treatment by or in liaison with a general medical practitioner. ... cancer – testicles

Slow progressive muscle wasting and weakness in childhood, developing usually before the fifth year. Peroneal muscular atrophy. Few survive after adolescence. “Waddling” gait, frequent falls, deformity. Another type: facio-scapular-humeral develops in early adult life. No cure possible.

Associated with a deficiency of taurine, (an amino acid) and Vitamin E.

Treatment. No specific therapy. Surgery sometimes able to correct. Herbs to support the constitution. Herbs contain vital complexes of minerals which may arrest progress of the disease.

Teas: Plantain, Alfalfa, Fenugreek seeds.

Tablets/capsules. Alfalfa, Kelp, Irish Moss, Saw Palmetto, Damiana.

For pain. See: ANTISPASMODIC DROPS. Wild Lettuce.

Evening Primrose. 4 × 500mg capsules, daily.

Diet. Bananas for potassium. Oats: oatmeal porridge.

Vitamins. A. B6. B12. C. E. Pantothenic acid.

Minerals. Dolomite, Potassium. Zinc.

Aromatherapy. Massage spine. Three drops each – Rosemary and Lavender in 2 teaspoons Almond oil. Treatment by or in liaison with a general medical practitioner. ... muscular dystrophy

(ADHD) A behavioural disorder in which a child has a consistently high level of activity and/or difficulty in attending to tasks. Attention deficit hyperactivity, or hyperkinetic, disorder affects up to 1 in 20 children in the. The disorder, which is more common in boys, should not be confused with the normal boisterous conduct of a healthy child. Children with consistently show abnormal patterns of behaviour over a period of time. An affected child is likely to be restless, unable to sit still for more than a few moments, inattentive, and impulsive.

The causes of are not fully understood, but the disorder often runs in families, which suggests that genetic factors may be involved. is not, as popularly believed, a result of poor parenting or abuse.

Symptoms develop in early childhood, usually between the ages of 3 and 7, and may include inability to finish tasks; short attention span; inability to concentrate in class; difficulty in following instructions; a tendency to talk excessively, frequently interrupting other people; difficulty in waiting or taking turns; inability to play quietly alone; and physical impulsiveness. Children with may have difficulty in forming friendships. Self-esteem is often low because an affected child is frequently scolded and criticized.

Treatment includes behaviour modification techniques, both at home and at school. In some children, avoidance of certain foods or food additives seems to reduce symptoms. In severe cases, stimulant drugs, usually methylphenidate, may be prescribed. Paradoxically, the use of stimulants in reduces hyperactivity and improves concentration. In general, the condition improves by adolescence but may be followed by antisocial behaviour and drug abuse or substance abuse.... attention deficit hyperactivity disorder

Degeneration of a bone just under a joint surface, causing fragments of bone and cartilage to become separated, which may cause the joint to lock. The condition commonly affects the knee and usually starts in adolescence. Symptoms include aching discomfort and intermittent swelling of the affected joint.

If a fragment has not completely separated from the bone, the joint may be immobilized in a plaster cast to allow reattachment. Loose bone or cartilage fragments in the knee are removed during arthroscopy. Disruption to the smoothness of the joint surface increases the risk of osteoarthritis.... osteochondritis dissecans

 Sugar diabetes. Chronic disorder of fat, protein and carbohydrate metabolism. A decrease of insulin by the pancreas gives rise to high level blood sugar (glucose) which is eliminated in the urine by the kidneys. With low insulin production the body cannot convert food into energy. In Britain over 30,000 new cases are diagnosed each year. One in five people go blind because of diabetes. The genetic factor is important; it may run in families due to defect in the immune system. Women who have German measles during the first three months of pregnancy can have a child who develops diabetes during adolescence.

Etiology. The more severe form, in younger patients, needs insulin treatment, without which ketosis and diabetic coma are possible. The milder form in older patients can be managed with diet and hypoglycaemic agents. Now considered due to auto-immune attack on Islet of Langerhams cells in pancreas which secrete insulin. “The Pill” often raises blood sugar. Lack of trace minerals (chromium and zinc). Zinc is a component of insulin and Chromium produces enzymes to stimulate metabolism of sugars. Diabetes can cause heart attack, stroke, hardening of arteries, blindness. It is the leading cause of kidney failure and gangrene.

Symptoms. Great thirst. Urine of high specific gravity. Weakness, emaciation, skin ulcers, loss of tactile sensation in the fingertips (Vitamin B6). In men there may be inflammation of the glans penis and in women, itching of the vulvae. Boils are common. In spite of large appetite there may by severe weight loss. Magnesium deficiency.

Diabetics are subject to glaucoma and detachment of the retina. There is a high incidence of cataract of the eye. While surgery may be necessary, effective supportive herbal treatment can do much. Regular visits to the Hospital Specialist help detect in time future eye, kidney and circulation damage.

High fibre, low fat, high carbohydrate. To help control blood sugar a diabetic must avoid sweets.

Exercise lowers blood sugar.

Agents used with some success: Alfalfa, Damiana leaves, Fenugreek seeds, Aloe Vera juice, Dandelion, Fringe Tree, Guar gum, Garlic (anti-diabetic action shown by Dr Madaus, West Germany, 1967), Bilberry berries, Goat’s Rue (dried aerial parts reduce blood sugar BHP (1983), Olive leaves, onions, Nettles, Pipsissewa, White Horehound, Sweet Sumach, Jambul seeds rapidly reduce sugar in the urine. Karela. Gurmar, (Gymnema sylvestre) leaves are chewed in India to reduce sugar in the urine (mild cases). Balsam pear. Bitter melon (Momordica charastia).

Hypoglycaemic herbs can be effective where the pancreas still functions. Type 1 diabetes, suffered by children whose insulin-producing cells have been destroyed and who produce no insulin at all will always require administered insulin. Maturity-onset diabetes (Type 11) occurs in middle life, insulin- production being insufficient. This form is usually associated with obesity for which herbs are helpful.

Diabetics are specially prone to infections; a course of Echinacea at the onset of winter is beneficial. Coronary artery disease is common in diabetics (especially women) who may develop atherosclerosis at an early age. High blood pressure places undue strain upon kidneys which may excrete too much protein (Yarrow, Lime flowers, Hawthorn). Lack of sensation in the feet exposes the subject to unconscious bruising and injury from which septic ulceration may arise (Chamomile foot baths).

Alternatives. Liver herbs work positively on the pancreas. Diabetic cases should receive treatment for the liver also, Dandelion and Fringe Tree being a reliable combination. Dr John Fearn, California (Ellingwood) used Fringe Tree for all his cases of sugar in the urine: 10 drops, Liquid Extract, 4-5 times daily.

Tea. Equal parts: Peppermint leaves, Dandelion leaves, Goat’s Rue leaves. 1-2 teaspoons to each cup boiling water infuse 5-15 minutes. Cup 2-3 times daily.

Teas from any one of the following: Bilberry berries or leaves, Nettles, White Horehound, Alfalfa, Olive leaves.

Decoction. Fenugreek seeds. 2 teaspoons to each large cup water simmered gently 5 minutes. One cup daily, consuming the seeds.

Powders. Equal parts: Sweet Sumach, Jambul seeds, Dandelion. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Jambul, Fringe Tree, Goat’s Rue. Dose: 1 teaspoon thrice daily and at bedtime.

Tablets. Dr Alfred Vogel: tablet containing: Bilberry, Kidney Bean, Tormentil, English Walnut leaves, Alfalfa leaves, Cuckoo flowers.

Karela (Momordica Charantia) Hypoglycaemic action gave good results in clinical trials. Daily dose: 50/60ml fresh juice.

Evening Primrose. See entry.

Guar Gum. 5g unit dose sachets (Guarina) containing dispersible granules. This gum has shown beneficial effects for insulin-dependants.

Hypoglycaemics (second degree). Allspice, Bugleweed, Burdock, Ginseng, Lily of the Valley, Wormwood, Nettles.

Diabetic gangrene. Tinctures: equal parts, Echinacea, Thuja. Internally and externally. Internal dose: 30- 60 drops.

Diabetic neuralgia. Cayenne pepper (Capsicum). Frequently successful.

American traditional. It is claimed that 500mg Bayleaf, Cinnamon, Cloves and Turmeric halve the need for insulin in diabetics.

Diet. Dietary treatment has changed over the past few years. Patients are now advised by the British Diabetic Association to eat food rich in complex carbohydrates (starches) and high in fibre as in wholemeal bread, oats and wholegrain breakfast cereals, wholewheat pasta, brown rice, beans and lentils, vegetables and fruit. Fat intake should be carefully watched (lean meat); skimmed milk, polyunsaturated or low-fat cheeses and salad dressings. Certain foods are known to encourage the pancreas to produce more insulin: banana, barley, cabbage, lettuce, oats, olive, papaya, turnip, sweet potato.

Coffee intake should be limited to prevent hypoglycaemic symptoms.

Barley. A study has shown that the use of barley flour as a substitute for wheat in bread helps to control diabetes, in Iraq. (Naismith D, et al, ‘Therapeutic Value of Barley in Management of Diabetes’: Annals Nutr Metab, 35, 61-64 1991)

Supplementation. Vitamins A, B-complex, C, D, E, F. Vitamin B6. Brewer’s yeast. Minerals: Chromium 50mcg; Manganese 15mg; Magnesium 300mg; Zinc 25mg; to normalise glucose metabolism.

Note: Over 400 traditional plant medicines have been documented for diabetes, but few have been evaluated for efficacy. In the undeveloped countries they are chiefly used for non-insulin dependent diabetes. (Diabetes Care, 1989, Sept 12, p553)

Insulin dependents. Whether adults or children, insulin dependents should under no circumstances discontinue insulin injections.

Treatment by or in liaison with general medical practitioner.

Information. British Diabetic Association, 10 Queen Anne Street, London W1M 0BD, UK. Send SAE. ... diabetes, mellitus

A noncancerous bone tumour, which is formed from a stalk of bone capped with cartilage, and appears as a hard round swelling near a joint. An osteochondroma develops in late childhood and early adolescence, usually from the side of a long bone near the knee or shoulder. The tumour causes problems only if it interferes with movement of tendons or the surrounding joint, in which case it may be removed surgically. Large osteochondromas can interfere with skeletal growth, causing deformity.... osteochondroma

An acute viral infection characterized by a high temperature, sore throat, and swollen lymph nodes, particularly in the neck.

Commonly called glandular fever, it is caused by the Epstein–Barr virus and is most common during adolescence or early adulthood. One common mode of transmission is thought to be kissing.

In the body, the virus multiplies in the lymphocytes (also called mononuclear cells), which develop an atypical appearance. The first symptoms are a fever and headache, followed by swollen lymph nodes and a severe sore throat. Rarely, enlargement of the tonsils may obstruct breathing. Mild inflammation of the liver may occur, leading to jaundice.

Diagnosis is often made from the symptoms and a blood test.

Recovery usually takes 4–6 weeks, with rest the only treatment needed.

In rare cases, corticosteroid drugs are given to reduce severe inflammation, particularly if breathing is obstructed.

For 2–3 months after recovery, patients often feel depressed, lack energy, and have daytime sleepiness.... mononucleosis, infectious

A group of disorders in which there is degeneration of the nerves in the central nervous system that control muscular activity. This causes weakness and wasting of the muscles. The cause is unknown.

The most common type of motor neuron disease is amyotrophic lateral sclerosis ( or Lou Gehrig’s disease). It usually affects people over the age of 50 and is more common in men. Some cases run in families. Usually, symptoms start with weakness in the hands and arms or legs, and muscle wasting. There may be irregular muscle contractions, and muscle cramps or stiffness. All four extremities are soon affected.

Progressive muscular atrophy and progressive bulbar palsy both start with patterns of muscle weakness different from but usually develop into.There are 2 types of motor neuron disease that first appear in childhood or adolescence. In most cases, these conditions are inherited. Werdnig–Hoffman disease affects infants at birth or soon afterwards. In almost all cases, progressive muscle weakness leads to death within several years. Chronic spinal muscular atrophy begins in childhood or adolescence, causing progressive weakness but not always serious disability.

There are no specific tests for motor neuron disease. Diagnosis is based on careful clinical examination by a neurologist. Tests including EMG, muscle biopsy, blood tests, myelography, CT scanning, or MRI may be performed.

The disease typically goes on to affect the muscles involved in breathing and swallowing, leading to death within 2–4 years. However, about 10 per cent of sufferers survive for 10 years.

Nerve degeneration cannot be slowed down, but physiotherapy and the use of various aids may help to reduce disability. The drug riluzole is used to extend life (or the time until mechanical ventilation is required).... motor neuron disease

A rare, inherited disorder characterized by muscle wasting in the feet and calves and then in the hands and forearms.

The condition, also known as Charcot–Marie– Tooth disease, is caused by degeneration of some peripheral nerves.

It is more common in boys, and usually appears in late childhood or adolescence.

Muscle wasting stops halfway up the arms and legs, making them look like inverted bottles; sensation may be lost.

There is no treatment, but the sufferer rarely becomes totally incapacitated because the disease usually progresses very slowly.

Life expectancy is normal.... peroneal muscular atrophy

A common skin condition of childhood and adolescence.

Irregular, fine, scaly, pale patches appear on the face.

Caused by mild eczema, it usually clears up with emollients.... pityriasis alba

Premature aging. There are 2 forms of progeria, and both are very rare. In Hutchinson-Gilford syndrome, the premature aging starts at about 4 years old, and many features of old age, including grey hair, balding, sagging skin, and atherosclerosis, have developed by age 10–12. Death usually occurs at puberty. Werner’s syndrome (adult progeria) starts in adolescence or early adulthood and follows the same progression. The cause of progeria is unknown, although it is known that the cells in affected people reproduce far less frequently than those in healthy people.... progeria

A group of rare inherited metabolic disorders (see metabolism, inborn errors of) of which Hurler’s syndrome is the best known. All mucopolysaccharidoses are genetic disorders in which there is an abnormality of a specific enzyme. This leads to the accumulation within body cells of substances called mucopolysaccharides.

Features may include abnormalities of the skeleton and/or the central nervous system, with learning difficulties and, in some cases, a characteristic facial appearance. There may also be clouding of the cornea, liver enlargement, and joint stiffness. No specific treatment is available. However, a bone marrow transplant may successfully be used to treat Hurler’s syndrome.

Mild forms of mucopolysaccharidoses allow a child to have a relatively normal life.

More severe types usually cause death during childhood or adolescence.... mucopolysaccharidosis

A disorder, occurring mainly in children, that consists of abrupt arousals from sleep in a terrified state. Night terror (also called sleep terror) usually starts between the ages of 4 and 7, gradually disappearing in early adolescence.

Episodes occur during (nonrapid eye movement) sleep, usually half an hour to 3 and a half hours after falling asleep. Sufferers wake up screaming in a semiconscious state and remain frightened for some minutes. They do not recognize familiar faces or surroundings, and usually cannot be comforted. The sufferer gradually falls back to sleep and has no memory of the event the following day.

Night terror in children has no serious significance, but, in adults, is likely to be associated with an anxiety disorder.... night terror

A psychiatric condition in which a person is dogged by persistent ideas (obsessions) that lead to repetitive, ritualized acts (compulsions). Obsessions are commonly based on fears about security or becoming infected. In obsessional rumination, there is constant brooding over a word, phrase, or unanswerable problem. Compulsions may occur frequently enough to disrupt work and social life. The disorder is often accompanied by depression and anxiety. If severe, a person may become housebound.

The disorder usually starts in adolescence. Genetic factors, an obsessive personality, or a tendency to neurotic symptoms may contribute. Some types of brain damage, especially in encephalitis, can cause obsessional symptoms. Many sufferers respond well to behaviour therapy, which may be combined with antidepressant drugs, but symptoms may recur under stress.... obsessive–compulsive disorder

An abbreviation for oral rehydration therapy. (See also rehydration therapy.)

ortho- A prefix meaning normal, correct, or straight, as in orthopaedics, a branch of surgery concerned with correcting disorders of the bones and joints.

orthodontic appliances Fixed or removable devices, commonly known as braces, worn to correct malocclusion, or to reposition overcrowded or buck teeth. Usually fitted during childhood and adolescence, they move teeth using sustained gentle pressure. A fixed appliance has brackets attached to the teeth through which an arch wire is threaded and tightened to exert pressure. These are usually kept in place for about a year, after which time a retainer plate may be needed to hold the teeth in place until tooth and jaw growth has finished.

Removable appliances, consisting of a plastic plate with attachments that anchor over the back teeth, are used when only one or a few teeth need correcting. They apply force by means of springs, wire bows, screws, or rubber bands fitted to the plate.... ort

A congenital condition characterized by abnormally brittle bones that are unusually susceptible to fractures. The condition is caused by an inherited defect in the connective tissue that forms the basic material of bone. Severely affected infants are born with multiple fractures and a soft skull and do not usually survive. Others have many fractures during infancy and childhood, often as a result of normal handling and activities, and it may be difficult to distinguish the condition from child abuse. A common sign of the condition is that the whites of the eyes are abnormally thin, making them appear blue. Sufferers may also be deaf due to otosclerosis. Very mild cases may not be detected until adolescence or later.

There is no specific treatment. Fractures are immobilized and usually heal quickly, but they may cause shortening and deformity of the limbs, resulting in abnormal, stunted growth. Skull fractures may cause brain damage or death. Parents may have genetic counselling to estimate the risk in future children. Severe cases can be diagnosed prenatally by ultrasound scanning.... osteogenesis imperfecta

Underdevelopment of the lower jaw. The condition can be corrected by the use of orthodontic appliances used in the growth spurt at adolescence or by cosmetic surgery.... receding chin

An inherited condition in which there is degeneration of the rods and cones of the retina at the back of both eyes.

The 1st symptoms appear during or after adolescence and include night blindness.

Tests show a ring-shaped area of blindness which, over some years, extends to destroy an increasing area of the visual field, though central vision is retained, often for many years.

Opthalmoscopy reveals several masses of black pigment corresponding to the areas of visual loss.

Affected individuals and their parents should have genetic counselling.... retinitis pigmentosa

A deformity in which the spine is bent to one side. The thoracic or lumbar regions are most commonly affected.

Scoliosis usually starts in childhood or adolescence and becomes progressively more marked until growth stops. In many cases, another part of the spine curves to compensate, resulting in an S-shaped spine. The cause of juvenile scoliosis is unknown. Rarely, scoliosis is due to a congenital abnormality of the vertebrae.

In some cases, physiotherapy may be sufficient to control scoliosis.

Progressive or severe scoliosis may require immobilization of the spine in a brace, followed by surgery (spinal fusion) to straighten it.... scoliosis

A rare, inherited disorder in which copper accumulates in the liver, resulting in conditions such as hepatitis and cirrhosis. Copper is slowly released into other body parts, damaging the brain, causing mild intellectual impairment, and leading to debilitating rigidity, tremor, and dementia. Symptoms usually appear in adolescence but can occur much earlier or later. Lifelong treatment with penicillamine is needed and, if begun soon enough, can sometimes produce some improvement. If the disease is discovered before the onset of symptoms, the drug may prevent them from developing.... wilson’s disease

A group of conditions characterized by a failure to learn from experience or to adapt appropriately to changes, resulting in distress and impairment of social functioning. Personality disorders are ways of behaving that may become especially obvious during periods of stress. They are usually first recognizable in adolescence and continue throughout life, often leading to depression or anxiety.

Specific types of personality disorders are divided into 3 groups but there is often overlap. The 1st group is characterized by eccentric behaviour. Paranoid people show suspiciousness and mistrust of others, schizoid people are cold emotionally, and schizotypal personalities have behaviour oddities similar to those of schizophrenia, but less severe.In the 2nd group, behaviour tends to be dramatic. Histrionic people are excitable and constantly crave stimulation, narcissists have an exaggerated sense of their own importance (see narcissism), and people with antisocial personality disorder fail to conform to accepted social standards of behaviour.

People in the 3rd group show anxiety and fear. Dependent personalities lack the self-confidence to function independently (see dependence). Those with compulsive personalities are rigid in their habits (see obsessive–compulsive disorder), and passive-aggressive people resist demands from others.

Treatment is usually counselling, psychotherapy, and behaviour therapy.... personality disorders

A persistent, irrational fear of, and desire to avoid, a particular object or situation. Many people have minor phobias. A phobia is considered a psychiatric disorder when it interferes with normal social functioning. Simple phobias (specific phobias) are the most common. These may involve fear of particular animals or situations, such as enclosed spaces (claustrophobia). Animal phobias usually start in childhood, but others develop at any time. Treatment depends on the severity of the condition and the wishes of the individual.

Agoraphobia is a more serious phobia, often causing severe impairment. The disorder usually starts in the late teens or early 20s. Social phobia is fear of being exposed to scrutiny, such as a fear of eating or speaking in public. This disorder usually begins in late childhood or early adolescence.

Causes of phobias are unknown. Simple phobias are thought by some to be a form of conditioning. For example, a person with a fear of dogs may have been frightened by a dog in childhood.

Exposure to the feared object or situation causes intense anxiety and, in some cases, a panic attack. Phobias may be associated with depression or obsessive– compulsive behaviour. Treatment may be with behaviour therapy and sometimes antidepressant drugs.... phobia

A general term for a group of psychotic illnesses that are characterized by disturbances in thinking, emotional reaction, and behaviour.

Onset can be at any age but is most common in late adolescence and the early 20s, and may be triggered by stress. No causes have been identified, but many have been implicated. It is likely that inheritance plays a role. Disruption of the activity of some neurotransmitters in the brain is a possible mechanism. Brain imaging techniques have revealed abnormalities of structure and function in people with schizophrenia.

Schizophrenia may begin insidiously, with the individual becoming slowly more withdrawn and losing motivation. In other cases, the illness comes on more suddenly, often in response to external stress. The main symptoms are various forms of delusions such as those of persecution (which are typical of paranoid schizophrenia); hallucinations, which are usually auditory (hearing voices), but which may also be visual or tactile; and thought disorder, leading to impaired concentration and thought processes. Disordered thinking is often reflected in muddled and disjointed speech. Behaviour is eccentric, and selfneglect common. In a rare form of schizophrenia, catatonia may occur, in which rigid postures are adopted for prolonged periods, or there are outbursts of repeated movement.

Diagnosis of schizophrenia may take some time and, in some cases, it may be difficult to make a diagnosis at all.

Treatment is mainly with antipsychotic drugs, such as phenothiazine drugs, and new atypical antipsychotic drugs such as risperidone. In some cases, the drugs are given as monthly depot injections. Once the symptoms are controlled, community care, vocational opportunities, and family counselling can help to prevent a relapse.

Some people may make a complete recovery. However, the majority have relapses punctuated with partial or full recovery. A small proportion have a severe life-long disability.... schizophrenia

n. the wasting away of a normally developed organ or tissue due to degeneration of cells. This may be physiological or pathological. Physiological atrophy occurs during embryonic life and the neonatal period (web spaces, notochord, umbilical vessels), in adolescence (the thymus), in adult life (the *corpus luteum during the menstrual cycle), and in a variety of organs and tissues in old age. Pathological atrophy may occur through starvation, disuse, denervation, abnormal hormonal stimulation, lack of hormonal stimulation, or ischaemia. Muscular atrophy is associated with various diseases, such as poliomyelitis.... atrophy

a rare tumour of fetal remnants of the ovaries or testes. In women it is an aggressive malignant ovarian tumour that develops in adolescence and may secrete alpha-fetoprotein and human chorionic gonadotrophin, which can be used as *tumour markers. It is treated by oophorectomy with adjuvant chemotherapy.... endodermal sinus tumour

(disorganized schizophrenia) n. an often chronic form of *schizophrenia that typically starts in adolescence or young adulthood. The most prominent features are disordered thinking, inappropriate affect, flattening or shallowness of affect, naivety and vulnerability, thoughtless cheerfulness, apathy, and aimless or disjointed behaviour. Social and occupational rehabilitation are the most important therapies for most patients; *antipsychotic drugs are also efficacious. —hebephrenic adj.... hebephrenia

(Swyer-James syndrome) pulmonary *emphysema affecting only one lung and beginning in childhood or in adolescence; it occurs secondarily to necrotizing bronchitis, probably caused by a virus. [W. M. Macleod (1911–77), British physician]... macleod’s syndrome

An inherited blood disease in which the red blood cells contain haemoglobin S, an abnormal type of haemoglobin. This crystallizes in the capillaries, making red cells sickle-shaped and fragile, and leading to haemolytic anaemia. The abnormal cells are unable to pass easily through tiny blood vessels. The blood supply to organs is blocked intermittently, causing sickle cell crises. The disease affects mainly black people.Symptoms usually appear after age 6 months, often beginning with painful swelling of the hands and feet. Chronic haemolytic anaemia causes fatigue, headaches, shortness of breath on exertion, pallor, and jaundice. Sickle cell crises start suddenly; they are sometimes brought on by an infection, cold weather, or dehydration, but may also occur for no apparent reason. The sufferer may experience pains (especially in the bones), blood in the urine (from kidney damage) or damage to the lungs or intestines. If the brain is affected, seizures, a stroke, or unconsciousness may result.

In some affected children, the spleen enlarges and traps red cells at a particularly high rate, causing a life-threatening form of anaemia. After adolescence, the spleen usually stops functioning, increasing the risk of infection in those affected.

Diagnosis is made from examination of a blood smear and electrophoresis.

Supportive treatment may include folic acid supplements, and penicillin and immunization to protect against infection.

Life-threatening crises are treated with intravenous infusions of fluids, antibiotics, oxygen therapy, and analgesic drugs.

If the crisis still does not respond, an exchange blood transfusion may be performed.

This may be done regularly for people who suffer frequent severe crises.... sickle cell anaemia

n. the shaky movements and unsteady gait that result from the brain’s failure to regulate the body’s posture and the strength and direction of limb movements. In cerebellar ataxia, due to disease of the *cerebellum, there is clumsiness of willed movements. The patient staggers when walking; he or she cannot pronounce words properly and may have *nystagmus. The common causes are alcohol, drugs (e.g. phenytoin), multiple sclerosis, hereditary degenerative conditions, and *paraneoplastic syndromes. Friedreich’s ataxia is an inherited disorder appearing first in adolescence. It has the features of cerebellar ataxia, together with spasticity of the limbs. The unsteady movements of sensory ataxia, caused by disease of the sensory nerves, are exaggerated when the patient closes his eyes (see Romberg’s sign). See also ataxia telangiectasia; tabes dorsalis. —ataxic adj.... ataxia

a repetitive and persistent pattern of aggressive or otherwise antisocial behaviour. It is usually recognized in childhood or adolescence and may include such behaviours as unusually frequent and severe temper tantrums, arguing with adults, defying rules, being angry and resentful, cruelty to animals, lying or breaking promises, use of weapons, sexual aggression, destroying property, truancy, bullying, and general delinquency. It can lead to *antisocial personality disorder. Treatment is usually with *behaviour therapy or *family therapy, although there is some debate as to whether it should be seen as a social rather than a medical problem.... conduct disorder

n. outward curvature of the spine, which if excessive causes hunching of the back. A mobile kyphosis may be caused by bad posture or muscle weakness or may develop to compensate for another condition, such as hip deformity; it can be corrected by backward bending. A fixed kyphosis may be congenital; it may arise in adolescence (see Scheuermann’s disease); or it may result from collapse of the vertebrae, as in *osteoporosis, ankylosing *spondylitis, infections, or tumours. Treatment depends on the cause and may include physiotherapy, bracing, and surgery (spinal *osteotomy and fusion may be required in severe cases). See also kyphos; kyphoscoliosis.

l... kyphosis

a solution in which the number of grams of dissolved substance per litre equals its molecular weight, i.e. a solution of molarity 1 M.

mole1 n. the *SI unit of amount of substance, equal to the amount of substance that contains as many elementary units as there are atoms in 0.012 kilograms of carbon-12. The elementary units, which must be specified, may be atoms, molecules, ions, electrons, etc., or a specified group of such entities. One mole of a compound has a mass equal to its molecular weight expressed in grams. Symbol: mol.

mole2 n. a nonmalignant collection of pigmented cells in the skin. Moles are rare in infancy, increase in numbers during childhood and especially in adolescence, but decline in numbers in old age. They vary widely in appearance, being flat or raised, smooth or hairy. Changes in the shape, colour, etc., of moles in adult life should be investigated as this may be an early sign of malignant *melanoma. Medical name: pigmented naevus. See also atypical mole syndrome.... molar solution

inflammation and swelling at the site of insertion of the patellar tendon at the tibial tuberosity, just below the knee (see apophysitis), resulting in a prominent painful lump. It occurs in adolescence, as a result of excessive physical activity, and most cases resolve with time and rest. [R. B. Osgood (1873–1956), US orthopaedist; C. Schlatter (1864–1934), Swiss surgeon]... osgood–schlatter disease

(osteochondrosis) n. any one of a group of conditions affecting areas of growth at the *epiphyses and *apophyses of bones before skeletal maturity. Symptoms of localized pain and swelling are most common during periods of rapid growth in early adolescence. There are three types of osteochondritis: crushing (see Köhler’s disease; Kienböck’s disease; Legg-Calvé-Perthes disease; Scheuermann’s disease); splitting (see osteochondritis dissecans); and pulling (see Osgood-Schlatter disease; Sever’s disease).... osteochondritis

n. the general medicine of childhood. Handling the sick child requires a special approach at every age from birth (or preterm birth) to adolescence and also a proper understanding of parents. It also requires detailed knowledge of genetics, obstetrics, psychological development, management of disabilities at home and in school, and effects of social conditions on child health. The preventive measures associated with all these aspects of paediatrics are the concern of *public health consultants and *community paediatricians. See also child health clinic. —paediatrician n.... paediatrics

n. a small inflamed swelling on the skin that contains pus. It may be the result of bacterial infection of a skin pore that has become obstructed with fatty secretions from the sebaceous glands. Pimples occurring in large numbers on the chest, back, and face are usually described as *acne, a common condition of adolescence.... pimple

n. a chronic disease in which scaly pink patches form on the elbows, knees, scalp, and other parts of the body. Psoriasis is one of the commonest skin diseases in Britain, affecting about 2% of the population, although many mild cases are undiagnosed. The most common time of onset is in adolescence. It may occur in association with arthritis (see psoriatic arthritis), and severe psoriasis is associated with a higher risk of diabetes mellitus and cardiovascular disease. The disease may be very severe, affecting much of the skin and causing considerable disability and psychological stress. Psoriasis is partly of genetic origin with polygenic influences. Exacerbations of psoriasis may be associated with streptococcal infection and drugs such as lithium and beta blockers.

There is no cure, but first-line treatments include *coal tar, *dithranol, and topical corticosteroids and vitamin D analogues (e.g. *calcipotriol). Narrow-band UVB or *PUVA can also be effective as can systemic therapies, such as *methotrexate, *retinoids, and *ciclosporin. Biological treatments, such as *infliximab, *adalimumab, and *etanercept, are potent but expensive.... psoriasis

(adolescent kyphosis) a disorder of spinal growth in which a sequence of three or more vertebrae become slightly wedge-shaped. It arises in adolescence and usually occurs in the thoracic spine, causing poor posture, backache, fatigue, and exaggerated *kyphosis. X-ray findings include *Schmorl’s nodes. [H. W. Scheuermann (1877–1960), Danish surgeon]... scheuermann’s disease

(tocophobia) n. a profound fear of childbirth. There are two types: primary tokophobia, which develops in adolescence and causes many women to avoid childbirth altogether; and secondary tokophobia, which occurs after a traumatic delivery and can stop a woman having another child. Women are more at risk from tokophobia if they have had any of the following: a history of rape or sexual abuse; harrowing memories of educational videos during adolescence; a history of depression; or experience of panic attacks.... tokophobia

a rare genetic disorder resulting in premature ageing that starts at adolescence. Growth may be retarded and affected individuals may suffer from a thin skin, arterial disease, leg ulcers, and diabetes. Treatment is limited to the management of complications, such as diabetes. The gene responsible codes for an enzyme involved in the mechanisms of DNA replication and repair, which in affected individuals is defective. [C. W. O. Werner (1879–1936), German physician]... werner’s syndrome