The Journal of the Singapore Paediatric Society最新文献

Transcatheter closure of Patent Ductus Arteriosus (PDA) was done in 18 children using the USCI Rashkind PDA occluder system. Patient age ranged from 1.2 to 14 years and their weights ranged from 8 to 36 kg. Isolated restrictive PDA was present in 15 patients; 3 had additional cardiac defects. The diameter of the PDA ranged from 2 to 6 mm as determined by lateral aortogram. PDA occlusion was successfully done in all 18 children. Ten 12 mm and eight 17 mm occluders were implanted with no complications. Post-implant aortogram showed complete ductal closure in 6 and trivial or small residual ductal flow in 12 cases. Doppler color flow mapping done within 3 days of the procedure showed complete ductal closure in 9, 8 had trivial ductal flow and 1 had small ductal flow. Transcatheter technique using a Rashkind PDA occluder system is a safe and effective method of non-surgical PDA occlusion.

To evaluate the effect of leukaemia and its treatment on growth and puberty, we studied retrospectively the serial heights and pubertal development of 37 children with acute leukaemia. The age of diagnosis ranged from 10 months to 13 years, with a duration of follow-up varying from 2 years to 14 years. The SDS (Z score) which reflects the deviation of height measurements from the population mean was used to assess height change at yearly intervals. Pubertal assessment was also made using the Tanner standards. 25 (69%) children showed a falling trend in mean Z scores over a 5 year follow-up period. The difference between the mean Z scores at 0 and 5 years was statistically significant (p < 0.035). However, there was no significant correlation between age of onset of disease and duration of survival with the deviation in the Z score. 11 children did not demonstrate a fall in the Z scores. There were, however, no defined factors such as age of onset, duration of follow-up, and sex distribution which could predict growth failure. Pubertal assessment showed normal development in all children with the pubertal age group (n = 11), except for 3 boys, two of whom had received testicular irradiation.

Natural varicella in healthy children is normally not a severe illness. Nevertheless, the need to be away from school such as during an important examination, or from work, may be inopportune. It is therefore attractive to be able to prevent chickenpox. Such a proposition became a reality in 1974 with the development of a live attenuated varicella vaccine (the Oka strain). This has since been used in leukaemic children and children with other malignancies, and found to be safe and effective. Some of these children were immunised without complete suspension of anticancer therapy. The vaccine has also been used on healthy children and adults, mainly in Japan and North America. The results too indicated the vaccine to be safe and immunogenic, with minimal side effects. It has been shown to confer protection even if given within 3 days of exposure. The occurrence of zoster appears to be no higher than in natural infection. The vaccine has so far been shown to be protective up to 10 years post-immunisation. It appears safe enough to offer the vaccine routinely to those who are at risk of infection. One dose of vaccine given subcutaneously is usually sufficient for healthy children, but two doses are needed for immunocompromised children and adults.

A retrospective study on discharges of children from hospital against medical advice or at own risk (AOR) discharges was conducted at our department from March 1981 to February 1990. There were altogether 890 patients giving an average incidence of 2%/year. The racial composition comprised 62.5% Chinese, 28.5% Malay, 7.3% Indian and 1.7% others. The common reasons for AOR discharge includes: (a) Inconvenience of having the child hospitalised (18.4%). (b) Preference of being treated by the general practitioner (15%). (c) Parents think child is well (14%). (d) Preference of being treated by private specialist or other hospital (11.9%) etc. Neonate comprised 16.9%, infants (except neonates) 44%, children > 1-5 yrs 28.6%, > 5-10 yrs 7.7% and > 10 yr 1.9%. The common diagnoses of these children include gastroenteritis (13.9%), febrile fit (13%), upper respiratory tract infection (11.7%), neonatal jaundice (5.7%). In conclusion AOR discharges of children from hospital is not uncommon and more could be done to reduce the incidence.

The genetic basis of human cancer is well established, although much work remains to be done to unravel the mechanisms of carcinogenesis. Multiple genetic alterations appear to the hallmark in the adult cancers. Molecular cloning and characterization of the amplified proto-oncogenes and mutated recessive oncogenes would shed light on the mechanisms involved in the initiation and progression of human cancer. New tests are likely to be available in the near future (for specific oncogenes) for the diagnosis and management of various forms of human cancer.

Post-streptococcal glomerulonephritis (PSGN) classically presents with hypertension, edema, macroscopic hematuria, acute renal failure, proteinuria, and an active urine sediment with red blood cells and red blood cell casts. A patient who developed PSGN but who had only minimal and transient abnormalities in the urinalysis is reported. Physicians should be aware that a normal urinalysis does not rule out the diagnosis of PSGN.

Bacterial meningitis remains one of the most common life threatening infections of childhood. There exists a conventional therapy for this disease. However, with the increasing incidence of Haemophilus strains resistant to ampicillin and chloramphenicol and Streptococcus pneumonia strains relatively resistant to penicillin, alteration of current therapeutic regimens for meningitis may become necessary. Cephalosporins were considered as alternatives to the conventional therapy for the treatment of bacterial meningitis during the past decade. However, there are still some discrepancies on the use of these against some organisms despite the advent of the cephalosporins. Thus, a review article analyzing quite a number of reliable clinical trials related to cephalosporins for the treatment of bacterial meningitis during the past decade to date is introduced.