Klinische Padiatrie最新文献

Background: Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome with numerous etiologies, mostly characterized by magnetic resonance imaging (MRI) abnormalities in the posterior cerebral white and gray matter and acute neurological symptoms.

Aim: To examine the predisposing factors, clinical results, and radiological features of PRES in children diagnosed with malignancy.

Materials and methods: The study included 20 patients (7 F/13 M) aged 4-16 years at the time of diagnosis who were diagnosed with malignancy and developed PRES during chemotherapy.

Results: All the patients were diagnosed as having PRES both clinically and radiographically during chemotherapy. The time from the initiation of the chemotherapy to the onset of PRES ranged from 7-675 days. Hypertension was detected in nine patients, seizure was the most common presenting symptom - had involvement in the occipital and parietal lobes on MRI (n=14)/followed by headache (n=8)/altered consciousness (n=5)/visual impairment (n=4). Hydrocephalus and tentorial herniation were observed in one patient. Most of the lesions on MRI resolved within 10-33 days and the EEG findings within 9 months. Clinical symptoms of PRES also disappeared completely the 5-year Press frequency was found to be 2.48%.

Conclusion: PRES may complicate the oncological treatment in children. Hypertension is a leading risk factor for PRES, while it should be kept in mind that the blood pressure may be normal in chemotherapy-induced PRES cases. PRES should be included in the differential diagnosis of all patients receiving chemotherapy and presenting with acute neurological symptoms.

The clinical course of neuroblastoma is more heterogeneous than any other malignant disease. Many low-risk patients experience regression after limited or even no chemotherapy. However, more than half of high-risk patients die from disease despite intensive multimodal treatment. Precise disease characterization for each patient at diagnosis is key for risk-adapted treatment. The guidelines presented here incorporate results from national and international clinical trials to produce recommendations for diagnosing and treating neuroblastoma patients in German hospitals outside of clinical trials.

Background: In the period from 2019 to 2022, pediatric hemato-oncological patients were cared for in a pilot project in North Rhine-Westphalia (NRW). The project delivered care at the homes of the patients as opposed to care at the clinics and included both general nursing as well as specific treatments that were delegated from physicians. Patients were admitted to this form of care upon referral by a physician.

Objectives: The project objective was to test the feasibility of such a method of care in the context of pediatric hemato-oncologic disease.

Method: For the evaluation, a documentation system was designed and applied, which made it possible to evaluate relevant health care data. The evaluation was carried out by means of descriptive statistics and content-analytical categorization.

Results: From 11/2019 to 12/2022, a total of N=475 hemato-oncological patients were enrolled in the care project and n=4005 home visits were performed in 242 different zip code areas in NRW. The majority of activities that could be delegated to physicians consisted of blood sampling (79.2%). Assessment of general condition (96.5%) represented the largest proportion of care services. Complications related to the method of care did not occur.

Conclusion: The nurse-led outpatient care of pediatric, hemato-oncological patients was shown to be a patient- and team-oriented form of care and seems to be an alternative to purely clinic based care. Presumably, transfer to other pediatric specialties is possible. In the next step, a prospective multicenter randomized study is needed to draw relevant conclusions about the actual possibilities and limitations.

Duchenne muscular dystrophy is the most common inherited neuromuscular disease in children. In addition to the progressive loss of motor skills and cardiac involvement, respiratory muscle weakness leads to a restrictive lung disease and cough insufficiency. Specific respiratory interventions have significantly improved survival and quality of life of the affected boys. The pediatric pulmonologist's tasks include monitoring of the lung function, polysomnography, starting and adjusting of non-invasive or invasive nocturnal ventilation and optimizing of secretion management. Providing of vaccinations, enhancing of nutrition, treatment of intercurrent infections, and provision of advice and training are important tasks for the pediatric pulmonologist. This article emphasizes on the tasks for the pediatric pulmonologist in the treatment of children with neuromuscular diseases i. e. Duchenne muscular dystrophy in interaction with the other specialist disciplines.