Paediatrician最新文献

Hypertension is a common disease which may often be modified, sometimes cured and, perhaps in some cases, prevented. This communication emphasizes the importance of obtaining blood pressure measurements in children no later than at the age of 3 years and sequentially thereafter, and stresses the importance of using techniques for measuring blood pressure which assure accuracy. Levels of blood pressure readings diagnostic of hypertension are suggested. The evaluation of hypertensive children is outlined. The classification and differential diagnosis of hypertension is reviewed. Current concepts in nonpharmacologic and pharmacologic therapy for hypertension in children and youths are presented. Therapy for acute hypertensive crisis is described.

This paper reviews the four types of systemic lupus erythematosus (SLE) glomerulonephritis in children and presents the clinical and renal histologic findings. A therapeutic program based upon the hypothesis that the nephritis of SLE is the result of the glomerular deposition of pathogenic dsDNA-anti-ds/DNA immune complexes is outlined. The effectiveness of therapy in suppressing disease activity is best estimated by serial determinations of serum complement components, particularly C3, and secondarily by monitoring serum levels of antibody to native DNA.

Most of the paediatric patients presenting with nephrotic syndrome (NS) have a nephrosis (minimal glomerular changes with or without focal lesion NS) and most of them are characterized by a clear-cut steroid response: a complete remission is rapidly obtained with high dose of glucocorticoids. Many of them, however, relapse during or after the treatment's withdrawal. Most often, these patients can be managed for several years with long-term alternate-day steroid therapy. Alkylating agents must be used exclusively when the doses of steroids required result in severe toxicity. In other types of NS (steroid resistant nephrosis, membranous and membranoproliferative glomerulonephritides) the efficiency of drugs is not established. Whatever the cause for the NS, adequate supportive therapy is necessary. The constant aim is to allow the patient a normal physical, school and social activity.

Acute poisoning in the teenager is rarely accidental. Frequently, it is intentional. The pharmacological spectrum includes drugs, chemicals, plants and pollutants, and constantly changes in accordance with the prevailing popularity among the youth, the availability and the financial capability of the young adolescent to purchase the offender. This article discusses the pharmacological properties of drugs and chemicals frequently involved in the acute teenager intoxication, the clinical diagnoses, and outlines the principles of therapeutic management.

Despite the decline of birth rate and the advancement attained toward prevention and early diagnosis and therapy, congenital heart disease remains a problem of major importance, particularly for the practitioner who is the first in the line of medical professionals to diagnose, treat, and counsel patients and family. In this article the diagnosis and management of congenital cardiac defects are discussed with clarity and appropriate detail that is necessary for proper and meaningful understanding and handling of these entities. The text is supplemented with a wide number of properly executed illustrations and tables that summarize the most important pertinent findings.

Several immunologic tests hve been developed to predict allograft rejection prior to functional renal impairment. Unfortunately, no test has as yet proven unequivocally to be of clinical value. Serial serum creatinine determinations and 131I hippuran scintiphotography have proven to be the most useful tests in detecting rejection episodes. Treatment of an acute rejection episode is often successful, but chronic rejection causes a slowly progressive deterioration of allograft function and is unresponsive to treatment.

Antigen-antibody complexes and antibasement antibodies are involved in the pathogenesis of most immune-mediated renal diseases. The major feature of these two kidney tissue-damaging mechanisms, and their interrelations with amplification systems (complement, coagulation, and kinin) are outlined. A brief discussion of current immunologic concepts applicable to representative experimental models and pediatric nephropathies, and of their immunohistopathologic and ultrastructural expressions is presented.

The many challenging, painful and complex problems of chronic illness are intensified during the adolescent years due to a myriad of rapid growth and development changes which must occur in order to achieve complete maturity. The more traditional approaches to chronic illness predicated on the categorial disease or an organ system model have not been helpful in dealing with adolescents. Thus, a development approach is offered as a more appropriate methodology for addressing this complex problem. With increasing awareness of this development perspective and maximal use of medical, psychological and social technology and resources, chronically ill adolescents can in most instances be helped to lead satisfying and useful lives.

The epidemiologic patterns of venereal diseases (VD) in Greece were studied using data from the National Statistical Service, the University Hospital for VD and the special clinic for VD of the Ministry of Health, where prostitutes and homosexuals are examined. The main findings are as follows. Between 1962 and 1976 the frequency of both syphilis and gonorrhea declined among men as well as among women but the decline was more evident among women and among the older age groups (20+). Among men, the highest incidence is the age group 20-29 years, whereas among women the peak incidence is a little earlier. The rates for both syphilis and gonorrhea are higher in men than in women, higher in the greater Athens area than in the rest of Greece, and higher in single persons than in married one. There was a marked seasonal variation of VD with peak incidence at late summer. The decline of VD was also evident among prostitutes and male homosexuals with the exception of syphilis among uncontrolled prostitutes (increase) and male homosexuals (slight decrease).