Paediatrician最新文献

New developments in the symptomatic treatment of beta-thalassaemia major are expected to improve the quality of life and survival of the patients. However, there are still many problems related to the clinical management of the patients due to the severity of the disease per se and the complications of blood transfusion and iron overload. Some of the problems related to the treatment of hypersplenism, post-transfusion complications, bone manifestations, hormonal deficiencies and haemosiderosis are reviewed in the light of recent investigations.

Infant screening should cover the need for general information regarding the child's development of attention functions important for communication with surroundings, as well as for the acquistion of language and speech. BOEL is a screening method applied by child health centers in Sweden, Finland, The Netherlands, Denmark and Italy. With the help of two visual stimuli, the "gripper" and the "spinner", and four sound sources, ranging in frequency between 4,000 and 12,500 Hz, the child's capacity to give adequate response to signals is checked, preferably within the frame of routine health check-ups, by one tester.

Arterial lesions appear in the human vascular system early in life. In some predisposed arterial segments calcifications of the internal elastic sheets have regularly been demonstrated macroscopically in infancy and early childhood. Atherosclerotic lesions also begin in childhood, and the seeds of their later clinical manifestations are probably sown in infancy. Hyperlipemia, hypertension, and cigarette smoking represent the major risk factors of atherosclerosis and its premature development. Accordingly, the main task of pediatricians is early identification of the risk groups and their appropriate treatment, particularly of children with hyperlipoproteinemia type II and those with family history indicating a premature atherosclerotic event, hypertension, and diabetes mellitus. In most populations, however, elevated serum cholesterol levels are probably not caused by genetically determined metabolic disorders but mainly promoted by environmental factors, such as nutrition. Therefore, establishment of beneficial nutritional habits early in life may prevent the development or at least limit the extent of fatty streaks and their further transformation into fibrous plaques or more advanced atherosclerotic lesions. The education of the community, especially of parents, to the hazards of the cardiovascular risk factors must become an essential part of preventive programs directed to sound cardiovascular health. The wide individual variation of the extent of early lesions, e.g., of fatty streaking in childhood even in most homogeneous population subgroups, points to the existence of still undiscovered risk factors. Cooperative efforts between pediatric pathologists and pediatricians appear, therefore, a necessity for further progress in the evaluation of these factors and for establishing successful preventive programs.

Child health begins long before the birth of the baby. At they very least, child health care begins with prenatal care, but preferably begins with the mother's prior health as a child and adolescent herself. The longitudinal intergenerational viewpoint is necessary in order to improve the health status of infants and children. Many societal and demographic factors influence child health and child health care. The education, socioeconomic, and employment status of the parents are important, as well as their age, marital status, and family health history. Their geographic residence (urban, rural), health knowledge, and the degree of development of medical and health care resources play an important role in the availability and utilization of health care, both for themselves and their children.

Substance abuse is a major public health problem affecting increasing numbers of children and adolescents. It is important to consider the various etiologic factors and the detrimental effects on individuals and social welfare. Intervention refers to early diagnosis, treatment, rehabilitation, and resocialization, as well as prevention, education, and alternatives. Its effectiveness depends on: the recognition of the problem as biopsychosocial; a humanistic/holistic approach; and collaboration of family, school, work, etc., with the physician and the patient. Training in substance abuse will prepare the pediatrician to meets his responsibilities as clinician, school consultant, family counselor, public health worker, and community educator.

In this review a critical appraisal of the criteria proposed for the diagnosis of iron deficiency and iron deficiency anemia is presented, together with an analytical report on the prevalence of both deficiencies among 3,586 infants, children and adolescents from various areas of Greece. Recent advances in prevention are also discussed, especially for infants and children at puberty, in which the prevalence of iron deficiency anemia was found to be very high.

All forms of glomerulonephritis (GN) in man seem to be immunologically mediated and the complement system appears as one of the most important mediators of renal injury. The study of complement activation is therefore of great help in the identification of the immunopathogenic process involved in the various types of glomerular diseases. After a review of the molecular events of complement activation and the methods used to study the complement system in man, we will attempt to summarize current knowledge concerning complement in nonsystemic glomerular diseases frequently encountered in children. The terms used are those descriptive of glomerular morphology as defined either by light microscopy and electron microscopy (endocapillary-proliferative GN with humps, extramembranous GN, membranoproliferative GN) or by immunofluorescent microscopy (mesangial IgA GN).

Two methods are described for enlarging the aortic and mitral valvular annuli. The first method is aortoventriculoplasty, the results of which are reported here in 7 patients with small aortic annulus and in 4 cases with stenotic aortic valvular prosthesis inserted previously. The second method is developed for enlargement of the mitral ring to insert larger mitral valvular prosthesis. In this method the aortic and mitral annuli are split through a conventional incision and patched after mitral and aortic valve replacement with larger prostheses are done. This method is used in an 8-year-old boy with success. Both methods have proved to be useful especially in children and the results are very encouraging so that they could be accepted in the repertoire of the cardiac surgeon.