Problemy medycyny wieku rozwojowego最新文献

The aim of the work was an analysis of the causes of difficulties in the rehabilitation of children with profound hearing loss. A theoretical basis of this analysis is the assumption that rehabilitation effects are determined by factors related to the system of care of the deaf child, diagnostic possibilities, and psychophysical properties of the child. The reported analysis was carried out in a material of 232 children aged up to 3 years, treated at the Audiology Outpatient Clinic of the Institute. The following factors were found of great importance in the analysis of difficulties in rehabilitation: care-system applied to the child with a profound hearing loss, diagnosis of the hearing impairment, type of a central nervous system disfunctions .

The anatomy and pathophysiology of epispadic urethra and bladder is presented. The operative procedures used for correction of the genital deformity and coexisting incontinence are described. The controversial points concerning the staging of procedures, the choice of optimal time and technic is discussed, with the results reported in recent series. In the Surgical Clinic of the Institute of Mother and Child 15 children with epispadias were treated during 1969-1979. There were 12 males and 3 females. 13 children had complete peno -pubic epispadias, with prolapse of bladder mucosa in two of them. Thery were totally incontinent. Amongst two boys with partial penile deformity 1 had bladder control. IVP showed no abnormalities, excluding solitary kidney in one boy. Cystography revealed wide bladder neck and short urethra with dilation of its posterior part; transient vesico-ureteral reflux was observed in 2 patients. Two children with prolapsing bladder mucosa were operated on when 6 and 14 months old. The age of remaining 13 children at the time of surgery was: between 3,5 and 6 years in 7, 6-9 years in four, the oldest two were 10 and 12. The Cantwell -Young reconstruction of the urethera was usually performed, with mobilizing of corpora cavernosa. In 5 children it was combined with wedge resection of anterior bladder neck and in 4 with infra-pubic wedge excision of dilated anterior urethera and Mayo plasty of external sphincter. The Young- Dees operation was performed twice, as a secondary procedure for treatment of total incontinence. During follow up the gradual improvement of bladder control was observed. Continence was achieved in 5, including 2 children after Young- Dees plasty. 3 children have stress incontinence, another 3 are dry at night and at rest, but wet during normal activities, 1 is totally incontinent.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of a study was to evaluate health, psychological and social problems related to rehabilitation of cerebral palsy children (c.p. children). The study was based on 30 children c.p. who after diagnosis underwent systematic complex rehabilitation. Half of the children was under observation in outpatient clinics and their parents played the role of physiotherapeutists another half of the children apart from ambulatory kind of rehabilitation was hospitalized periodically in rehabilitation centres. Each half year all the children underwent control examinations of physical and motor development (including evaluation of postural and righting reflexes) as well as of psycho-motor development. Environmental conditions, parental attitudes towards examined children taking into consideration their evolution were also evaluated. The therapeutic team consisting of a paediatrician, neurologist, psychologist, physiotheraupeutist and psychiatrist took advantage of these examinations in psychotherapy of parents. Observation period of children was from 1:6 to 3 years. Age when rehabilitation was initiated was below 20 months of life. It was observed that result are influenced mainly by the degree of neurological disorders not by the conditions of rehabilitation. There are differences with regard to motor efficiency between rehabilitation at home and in rehabilitation center. Treatment at home has a better effect upon psychomotor development of children with more serious developmental disorders. Infections of upper respiratory tract are more rare in this group of children. There are two reasons why children in preschool age should be recommended for sanatorium treatment: medical indication e.g. operation and social indications.

An analysis of 141 families with children with neural-tube defects was performed. The families were consulted in the Department of Genetics, the Institute of Mother and in Child the period between 17.01.1978 and 29.02.1980. The family histories were obtained from the parents. The diagnosis was established on the basis of autopsy data and/or medical records. In cases of multiple congenital malformations coexisting with a neural-tube defect the precise diagnosis of the syndrome was established after a thorough search of the medical literature. Analysis of the material, showed that in 10 families (6,5%) neural-tube defect was associated with other malformations. There were 5 cases of sporadic syndromes (cloacal extrophy-2, aberrant tissue bands-2, sacrococageal teratoma-1), 3 families with Meckel's syndrome and 2 cases in which the nature of the syndrome was not determined. In 131 families the neural-tube defect was isolated and multifactorial inheritance was assumed (table VII). 113 families were given information about the cause of malformation, risk of recurrence, possibility of prenatal diagnosis and indications for amniocentesis (estimation of alpha-foetoprotein in amniotic fluid). After receiving genetic counseling and being fully informed about prenatal diagnosis the parents were asked about their procreative plans and their attitude to amniocentesis. Out of these families 74,3% planned next pregnancy (table IX), 57,6% wanted to have prenatal diagnosis (table VI). 131 family histories (probands with isolated neural-tube defect) were reviewed to determine recurrence risk for relatives. The recurrence risk for sibs was found to be: 4,9% (table III) and was higher than the expected risk (3,4%) from the population incidence of neural-tube defects in Poland (1, 15/1000 births including stillbirths). The recurrence risk for second and third degree relatives was found to be 0,1% (table IV) and 0,3% (table V) respectively.

In the years 1962-1976, 168 children with nephroblastoma (Wilms Tumour) were treated in the Clinical Department of Child Oncology of the Institute of Mother and Child in Warsaw. In 150 cases, independently from surgery and radiotherapy, chemotherapy was performed. Our material was divided into 5 groups: a) without chemotherapy, b) chemotherapy with different drugs, c) chemotherapy with 1 course of Actinomycine D, d) chemotherapy with several courses of Actinomycine D, e) chemotherapy according to SIOP Trial. The results with reccurency free survival are as follows: a) 22,2%, b) 24,1%, c) 28,1%, d) 46,6%, e) 56,6%. In our material the best results were received with SIOP Trial chemotherapy.

The percentage of pupils in school feeding in the German Democratic Republic increased in the years from 1965 to 1980 from 26 to about 80. There are given organizational principles, as well as nutritional and financial principles in the school feeding programme in the GDR. On account of own observations there is described the state of school feeding in Leipzig. In this town with about 500000 inhabitants the number of daily produced school lunches is ca 64000 portions. The biggest part of it, ca 47000 portions, is prepared in 7 central kitchens; the rest--ca 17000 portions--is prepared at 40 different kitchens (restaurants, institutional, hotels). There is described the whole organizational--technological system from central potato peeling plants to the school canteens. Three bigger schools (1-12 forms) in Leipzig were visited where the percentage of pupils in milk drinking were: 46,7, 50 and 68,2 and in lunch consumption: 66,3, 84,0 and 85,3.

It is known that two biogenic amines:serotonin and histamine, as well as the enzymes connected with their metabolism (mono- and diamine oxidase), play very important role in human and animal fetal development. We have investigated the effect of Biseptol and sodium salicylate administered to pregnant rats on the concentrations of serotonin and histamine and activities of the above mentioned enzymes in placenta. The obtained results showed that the administration of Biseptol has no influence on the serotonin concentration, whereas the administration of sodium salicylate caused slight increase of serotonin concentration in rat placenta. The activity of monoamine oxidase was elevated after administration of both drugs (Tabl. I, Fig. 1). The administration of Biseptol decreased the histamine concentration and caused the marked increase of DAO activity. The sodium salicylate administration to the pregnant rats didn't influence on the histamine concentration, whereas it caused parallel twofold increase of DAO activity (Tabl. II, Fig. 2).

IgD level examination was performed in 139 healthy children in various age groups (from birth till 14 years). There was no IgD in umbilical cord blood neither in infant serum. In children over 1 year of age, average IgD level was 35 IU/m1 and no significant differences were found in higher age groups. Nevertheless the percentage of detectability was growing with age of children.

The state of health and of general development of two and four-year-old children are presented on the bases of balance medical examinations performed in 3 centres (Integrated Health Care Centres). The methods and goals of those medical examinations are exposed. The examined population consisted of 1379 two- year-old and 1200-four-year-old children. About 26% of examined two-year-old urban children and 16% of rural ones have been qualified to active care groups. In the examined population of four-year-old children the respective values were 28% and 17%. Among 2-year-old children qualified for specialist's care, 85% have not been under such care before the balance-medical examination. In the 4-year-old group this situation was found in 70% of children. The most frequently observed deviations form the normal concerned: body build and posture, visual disorders, faulty mastication, insufficient body weight and/or height, dental caries and behaviour problems. Some differences in the health status were also found between the 3 centres. Environmental conditions such as sanitary facilities of the dwellings, overcrowding, utilities and home equipment were also analysed, and marked differences were observed between urban and rural areas. Further studies will be conducted in five more centres.

In advanced stages of neuroblastoma, surgical management is limitedly indicated. In majority of cases (25/26 in own material) surgical procedures were performed for the sake of receiving samples for pathological examination. Surgical treatment was very rarely indicated. The only one case of neuroblastoma in stage IV that was indicated to surgical treatment after complete remission of metastases, the child died in spite of radical excision of the primary tumour. The reason of that was new metastases in distant lymphonodes which appeared when complex therapy was finished. A little larger indications for surgery exist in stage IV-S of neuroblastoma, which gives better prognosis than stage IV. Anyhow indications for surgery in stages IV and IV-S have to be given very cautiously. Histopathological evaluation can be done on the basis of fine needle biopsy, that is much safer for the children.