Paediatrician最新文献

This study presents observations about certain preliminary conditions necessary for the practicing physician's teaching ambulatory pediatrics. The author's practical experience is cited in the transcription of a lesson about 'negativism in the toddler', and a sensorimotor psychodynamic concept is proposed to explain the child's oppositional behavior: the unusual energy potential at this age, the immediacy of an act, an object concept different from that of the adult. The pediatrician's role as 'health counselor' is evoked in the therapeutic considerations.

18 central nervous system bleeding episodes in 8 patients with hemophilia A, B, or von Willebrand's disease are reviewed. Survival was seen in 17 of the 18 episodes. There was no mortality from uncontrolled bleeding and permanent neurological sequelae were seen in 8 instances. Management consisted of the use of neurological procedures to define the site of bleeding, therapeutic neurological or neurosurgical treatment where indicated, and vigorous factor replacement under laboratory control. The optimal duration of replacement therapy appears to be 14 days. Trauma as a precipitant was found in only 40% of the episodes with no other common etiologic factor.

The child life therapist utilizes play techniques with hospitalized children for preparation and integration before and after medical procedures and surgery. Unstructured and structured play sessions enable children to anticipate threatening events and mobilize their coping behaviors. Through manipulating appropriate play materials including miniature-size medical equipment, children communicate if facts of preparation have been understood, misinterpreted or denied. Concrete play experiences (e.g., doctor puppet play), enable children to understand hospital routines and sequences of events. Sensory experiences (e.g., needle play), help them dramatize situations and to adopt changes of role from passive to active ones. Opportunities for play after procedures (particularly intrusive ones) and surgery must be made available to clarify any misconceptions and to emphasize the nurturing and healing aspects of treatment. Psychological preparation for necessary procedures and surgery through play results in children enduring and cooperating more readily and have more trust in all medical personnel.

The following article presents an overall picture of child health care delivery in Finland. The history and priorities of the Finnish Child Care Services are discussed with statistical data regarding birth rate, mortality and immunization.

The enhancement of pulmonary maturation with the resultant ability to prevent hyaline membrane disease has given rise to the use of a number of drugs experimentally including corticosteroids, thyroxine, aminophylline, heroin, and several suggested others for this purpose. In clinical use to date only the corticosteroids have been widely utilized in man but it is clear that these agents are capable of effecting an advancement in the maturation of the surfactant system of the lung and a subsequent reduction in the incidence of severity of hyaline membrane disease. However, all agents which act by the enhancement of maturation also carry with them a resultant arrest to replication of tissues and there have been demonstrable effects on both the lung and possibly the brain of the organisms to whom these agents have been administreted. In this connection it is, therefore, important to realize that the advantages gained from these agents may be counterbalanced by disadvantages from their usage and that a reasoned and careful approach in each individual case is mandatory when use of such agents is considered. Experimental and clinical studies suggest the possibility that Vitamin E acting as a free radical scavenger may be important in the prevention of oxygen toxicity both to the eye (retrolental fibroplasia) as well as ameliorating the oxygen component of the destructive effects of respirator lung disease (bronchopulmonary dysplasia). The action of Vitamin E under these circumstances is not dependent upon its actual quantitative level in the plasma of premature infants but in utilization to its excess. Although phototherapy has been universally and widely used since 1958, precise studies of its mechanism of action have not been revealing. Recent work has suggested that following exposure to photoirradiation, bilirubin in its unconjugated form can be seen to appear in the excretory bile ducts suggesting the transport of unconjugated bilirubin through the liver. More recent evidence has also suggested that this occurrence is the result of internal rotation following light exposure of one of the double bonded rings which effectively converts the molecule from a lipid soluble to a water soluble and thereby excretable form. These studies would not only account for an appropriate explanation of the quantitative reduction in bilirubin observed but carry with them the other important consideration that the amount of light exposure necessary to accomplish this is strikingly less than the previously considered photooxidation reaction. The clinical implications of these findings may suggest a reevaluation of the quanta of light which has been used for purposes of phototherapy to date.

Necrotizing enterocolitis poses a serious threat to the increasing number of "at risk" neonates. Its clinical picture is characterized by abdominal distension, gastric retention, bile vomitus, and bloody stools. Abdominal roentgenograms demonstrate loops of intestine with intramural gas. Many of the neonates with necrotizing enterocolitis have been successfully managed by aggressive medical treatment. A review of the clinical course of 64 neonates with necrotizing enterocolitis in the acute phase suggests that either persistence of abdominal distention, development of edema and erythema of the abdominal wall, or pneumoperitoneum are indications for surgical intervention. Seven neonates presented with colonic stenosis several months after the management of the acute phase of necrotizing entercolitis.

This article outlines some of the most common problems that a physician treating the female adolescent will encounter in his practice. It is important for the primary care pediatrician to initiate the gynecological examination in the adolescent. Few special instruments are required, no new techniques need be mastered, and if the pediatrician is patient and shows his concern, he will rapidly develop competence and find that this examination is as important as the evaluation of any other organ system in the care of the adolescent female.

A review of neonatal sepsis, based on 30 recent cases is presented. After analyzing their personal experiences, the authors review the etiopathogeny (higher incidence in small-for-date, preterm, postterm and in some macrosomic newborns; predominance of gram-negative germs), the importance of early diagnosis, and correct treatment, adapting the antibiotherapy to the bacteriological flora of the location at the time of treatment.

A review of the diagnostic methods of pertussis (clinical, radiological, laboratoryy: 42 case reports in a period of 2 1/2 years, being all hospitalized children with pertussis, aged from 23 days to 7 years. A review of the treatment with hyperimmune globulin, antibiotics, symptomatic treatment, and the results obtained, is presented.