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Dysfunctional uterine bleeding (DUB) is a gynecologic problem that occurs often during adolescence and is the most frequent cause of urgent admission to the hospital. DUB occurs in the adolescent usually because of anovulation, a result of developmental immaturity of the hypothalamic-pituitary-ovarian (HPO) axis. Diagnosis can only be confirmed when there is no other pathology present, so it is important to exclude all the other possibilities. The aim of this study was to evaluate the frequency of coagulation disorders and other underlying situations as a cause of menorrhagia in adolescents with DUB and to assess the response to the treatment(s) given.

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UNLABELLED: The aim of this study was to compare the proprioceptive accuracy in the dominant and nondominant lower extremities between early and late stages of adolescence in boys. Participants displaying sexual development consistent with Tanner stages I or II were included in the early adolescent group, and those displaying development consistent with Tanner Stages IV or V were included in the late adolescent group. Proprioception was evaluated using the following 4 tests: one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test. There were statistically significant differences between the early and late stages of adolescence in nondominant ankles with regard to this single-limb-standing test. There were no statistically significant differences between the early and late adolescent stages, and between dominant and nondominant extremities with regard to the single-limb-hopping test. There were no statistically significant differences between early and late adolescent stages with regard to passive and active ankle plantar- and dorsiflexion position reproduction. Based on these findings, we concluded that sexual maturation categorized by Tanner stage does not affect proprioceptive ability in adolescent individuals. CLINICAL RELEVANCE: This method, as a clinical assessment of detecting deficits in neuromuscular control examined by foot and ankle surgeons and a rehabilitation technique to treat functional instability of the ankle used by physical therapists, might be applied to adolescents. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in adolescents.

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OBJECTIVE: To investigate the effects of socioeconomic factors and oral health behaviors on adolescents in Turkey. METHOD AND MATERIALS: Data were collected through a self-administered questionnaire. The sample consisted of 582 randomly selected adolescents, 309 boys and 273 girls, who presented over a 3-month period with various complaints to the Hacettepe University Medical Faculty Adolescent Clinic. RESULTS: Halitosis complaints were higher in the 11-, 12-, and 13-year-old groups than in other age groups (P < .05). When the sex factor was examined, prevalence of dental fear was found to be higher among girls, while irregular toothbrushing was seen more among boys. In parallel to the increase in the education levels of the parents, an increase was seen in the regular dental visits by the adolescents (P < .05). As the socioeconomic status of the family increased, frequency of dental visits, rate of dental floss usage, and number of teeth with restorations increased. In parallel with the dental visit increase, the rate of restored teeth increased. Of those who did not have regular dental visits because of financial difficulties, however, the rate of teeth with restorations was low. CONCLUSION: A strong correlation exists between the oral health behaviors, socioeconomic and sociodemographic factors, and the oral health status of Turkish adolescents.

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The aim of this study was to investigate the relationships between dental age and bone age in Turkish adolescents with constitutional delay of growth and compare them with a group of normal, healthy adolescents. Left hand and wrist radiographs and dental panaromic radiographs of 33 adolescents (25 boys and 8 girls) aged between 10 and 16 years with constitutionally delayed growth were assessed. The control group comprised 41 healthy adolescents (24 boys, 17 girls) aged between 10 and 16 years. Bone age was determined according to Greulich and Pyle; dental age was assessed using the Demirjian method. In the control group, no statistical difference was found between chronological, bone and dental ages. In the group of adolescents with constitutional growth delay, there was no significant difference between chronological age and dental age, but the differences between dental age and bone age and between chronological age and bone age were found to be statistically significant. It was found that Demirjian's dental age assessment is a valid method for scoring dental age in Turkish adolescents. Adolescents with constitutional delay of growth had dental maturation appropriate for chronological age, but not for bone age.

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The authors describe a case of accidental ethylene glycol poisoning in an 18-month-old boy who developed hemophagocytic syndrome (HPS). Ethylene glycol is a common substance in various antifreeze preparations. Acute ethylene glycol intoxication is a medical emergency that, if not diagnosed correctly and treated aggressively, will lead to serious neurological, cardiopulmonary, and renal dysfunction, and may result in death. The taking of a detailed history, physical examination, and laboratory testing are essential for diagnosis. To the best of the authors' knowledge this is the first case in the literature of a subject who developed HPS after ethylene glycol intoxication.

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SUMMARY: The aim of this study was to evaluate the psychiatric symptoms among adolescents who were seen in the outpatient clinic for their physical complaints. Two hundred and ninety adolescent outpatients (154 males and 136 females) between 13 and 17 years of age (mean 14.3+/-1.2) are included in this study. Patients with known psychiatric disorders, mental retardation, organic brain diseases, or chronic organic problems were excluded. The Brief Symptom Inventory, which measures the psychiatric symptoms under the categories of anxiety, depression, negative self, somatization, and hostility, was given to all subjects. Symptoms of urinary and cardiovascular systems were related to hostility. Patients with obesity, hirsutism, problems of external genitalia, enuresis nocturna, abdominal pain, chest pain, and lack of weight gain showed psychiatric symptoms at pathological levels. Hostility symptom was found to be high in all groups.

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As IGF-1 is the major factor that affects bone growth, and both osteocalcin and bone-specific alkaline phosphatase are important markers of bone formation during puberty, there must be a relationship between these markers that does not change according to sex. The aim of this study was to investigate the relationships between pubertal development, the IGF-1 axis, and bone formation in healthy adolescents. Two hundred and five healthy children and adolescents were included in this cross-sectional study. Tanner's classification was used to determine the pubertal developmental stage. Serum IGF-1 levels and IGF-1/IGFBP-3 ratios increased with advancing pubertal stages, and maximum mean values were found at stages III-IV in girls and at stage IV in boys. Serum IGF-1 and IGFBP-3 levels were significantly correlated with osteocalcin and bone-specific alkaline phosphatase levels in boys, but not in girls. This difference between the sexes, and the relation of the IGF-1 axis to increased bone formation during puberty in both sexes, can be explained by the rate of increase of the IGF-1/IGFBP-3 ratio. We conclude that the timing of the increased bone formation rate during puberty; that is, the timing of the pubertal growth spurt, is determined by the maximum increase rate of the IGF-1/IGFBP-3 ratio. But this new hypothesis needs to be supported by longitudinal studies.

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This study determined the age-specific measles seroprevalence of an adolescent population in Ankara vaccinated with a single dose of measles vaccine before their first birthday. The study sample included 440 adolescents (227 female, 213 male) aged 9-16 years admitted to the Adolescent Outpatient Clinic of Hacettepe University Faculty of Medicine. For each participant, a questionnaire was completed and measles specific IgG antibodies screened quantitatively by the enzyme linked immunosorbent assay. Of the 440 subjects screened for measles antibodies, 114 (25.9 %) were seronegative. Measles seronegativity according to sex and age groups were, 32.6, 24.7, 13.3% in females and 29.5, 30.1, 6.3% in males in the age groups of 9-11, 12-14, 15-16 years, respectively. In countries where the two dose vaccination schedule against measles has not been incorporated to the national immunization program, the adolescent health maintenance visit at age 11-12 years should serve as an opportunity to evaluate vaccination status and administer MMR vaccine to all adolescents who have not received two doses at the recommended ages.

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OBJECTIVE: To investigate the frequency of premenstrual syndrome (PMS) associated symptoms and effects of nutrition on PMS in adolescent girls. PATIENTS AND METHODS: One hundred and seventy-one adolescent girls who had menstrual cycles were included in this study. They were given a questionnaire on criteria for PMS, dysmenorrhea and regularity of menstrual cycle. Modified Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria were used for the diagnosis of PMS. We also investigated which nutritional supplements affect the PMS-associated symptoms and signs. RESULTS: One hundred and five adolescent girls out of 171 (61.4%) met DSM-IV criteria for PMS. There was an association between dysmenorrhea and PMS in 60 (57.1%). Half of the girls, i.e. 52 (49.5%) had mild, 39 (37.1%) had moderate and 14 (13.4%) had severe PMS. The most common symptom of PMS was negative affect particularly in the form of stress (87.6%) and nervousness (87.6%). There was a statistically significant negative relationship between milk consumption and the following: abdominal bloating, cramps, craving for some foods and increased appetite. CONCLUSION: PMS and dysmenorrhea are frequently overlapping. We also found that PMS is associated with dietary habits.

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Intrauterine neural tube defects, meningomyelocele, and diastematomyelia are developmental errors at different stages of the closure of the neural tube. The familial aggregation of these neural tube defects is not previously reported in the literature and should make one think about a common embryogenesis and a possible common mechanism of etiopathogenesis leading to anomalies at different stages of this embryogenesis. This paper presents a 12-year-old Turkish boy with diastematomyelia who was suspected with a demonstrative dermatologic finding without any neurologic sign and diagnosed with magnetic resonance imaging (MRI). He has a positive family history of a stillbirth with neural tube defect, an exitus with meningomyelocele, and an epileptic child in his female siblings.

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This study was undertaken to assess the frequency of coagulation disorders as a cause of menorrhagia in adolescents. A retrospective chart review was conducted of all adolescents with menorrhagia admitted to the Adolescent Unit of Ihsan Dogramaci Childrens Hospital of Hacettepe University Faculty of Medicine in Ankara, Turkey from May 1999 to April 2002. 47 admissions for menorrhagia were identified, 44 were dysfunctional uterine bleeding due to anovulation, while a primary coagulation disorder was found in three patients. Two had Von Willebrand disease and one factor 11 deficiency. We suggest that pediatricians, gynecologists and other adolescent health care providers should be aware of the primary coagulopathy as a cause of menorrhagia in adolescence.

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This study was designed to determine the effectiveness of desmopressin in the treatment of adolescent nocturnal enuresis and factors that may predict responsiveness. Eighteen adolescents (14 boys, 4 girls) with monosymptomatic nocturnal enuresis were treated with oral desmopressin for three months, starting with 0.2 mg at night and controlling the symptoms every two weeks. After this period, desmopressin was used every other day and the dose was reduced gradually. The treatment was completed at the end of six months. As factors that may predict response before treatment, a range of variables (family history of enuresis, educational levels of parents, number of children, first child in family, birth weight) and urine osmolality was evaluated. Disappearance of bedwetting by using desmopressin has been observed in adolescents who have a high urine osmolality. We did not observe any relapse during reducing desmopressin dose gradually, but on complete cessation of the treatment, relapses were seen. Six months after the end of the therapy, we could not find any patient who recovered completely. Desmopressin seems to be effective in the treatment of primary nocturnal enuresis while on therapy but during the long-term follow-up, all cases relapsed.

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This study aimed to detect the age-specific mumps seroprevalence of an unvaccinated population of adolescents in Ankara, Turkey and to compare the prevaccination epidemiology of mumps with those of some other countries. Four hundred and forty adolescents (227 females, 213 males) aged 9 - 16 years who were admitted to the Adolescent Unit were included in this study. For each participant, a questionnaire was completed and mumps-specific IgG antibodies were screened quantitatively by enzyme-linked fluorescent assay. Of the 440 patients screened for mumps antibodies, 48 (10.9%) were seronegative. Mumps seronegativity according to sex and age groups were 13.6, 9.9, and 10.4% in females and 18, 10.2, and 6.2% in males in the age groups of 9 - 10, 11 - 13, and 14 - 16, respectively. Mumps immunization models similar to those of European countries might be acceptable for Turkey, but since a low vaccination coverage may shift mumps infection to older ages, mumps immunization of adolescents is important until a national mumps vaccination program with a high coverage could be sustained. The routine health supervision visit at ages 11 to 12 years is an ideal time to immunize unvaccinated adolescents.

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This study was designed to detect the age-specific rubella seroprevalence of an unvaccinated population of adolescents in Ankara, Turkey. Four hundred and forty adolescents (227 females, 213 males), aged 9-16 years, who were admitted to the Adolescent Unit from July to August 2000 were included in this study. For each participant, a questionnaire was completed and rubella-specific IgG antibodies were screened quantitatively by enzyme-linked fluorescent assay. Of the 440 patients screened for rubella antibodies, 32 (7.3%) were seronegative. Rubella seronegativity values according to sex and age groups were as follows: 15.3, 6.6, and 1.3% in females, and 12.0, 6.1, and 6.2% in males, in the age groups of 9-10, 11-13, and 14-16 years, respectively. The routine health supervision visit recommended between the age of 11 and 12 is an ideal time to immunize unvaccinated adolescents.

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