Pediatrician最新文献

Congenital vascular birthmarks, classified as either hemangioma or vascular malformations (portwine stains), can now be cleared successfully using certain lasers. Since their introduction into medicine in the mid-1960s, several types of lasers including the argon, carbon dioxide, neodymium yttrium aluminum garnet (Nd:YAG) and pulsed tunable dye lasers have been used to treat benign cutaneous vascular lesions such as portwine stains. After extensive research examining the effects of specific laser parameters on tissue, a set of parameters was identified which together selectively destroyed blood vessels in the skin. Application of this laser technique for the treatment of benign cutaneous vascular lesions, such as portwine stains, meant that it was possible to destroy only the abnormally ectatic vessels which are inherent in these birthmarks. Because of the specificity of the laser injury, only the abnormal blood vessels are destroyed and healthy adjacent structures such as epidermal pigment and dermal collagen are left intact. Thus, unwanted adverse effects such as scar formation and pigmentary abnormalities at the laser-exposed site have been minimized. Skin treated using this combination of laser parameters normalizes in color, texture and its markings, and adnexae are maintained at the treated site. Not only has this new laser treatment provided a way of removing these disfiguring birthmarks with the return of normal-appearing skin at the treated site, but the lack of adverse effects following this treatment has meant that not only adults but children of all ages can now be treated using this technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Some long-term survivors of childhood cancer experience changes in cognitive functioning and have learning difficulties in school. Psychological and educational studies of children who received cranial irradiation in treatment for acute lymphocytic leukemia or brain tumor have identified specific disabilities. A coordinated educational intervention approach is needed, using special education services available through local school districts.

Chronic sinusitis has been suggested to play a causal role in creating recalcitrant asthma. However, this hypothesis has never been confirmed in a blind placebo-controlled study. Several studies have documented an association between abnormal sinus X-rays and asthma in 30-70% of patients, depending on criteria chosen for evaluation of the radiologic changes. Asthma is associated with inflammation in the lower airways, and the same inflammation might involve the sinuses in a parallel fashion. It is now felt that early therapy of this inflammation can modify the course of asthma resulting in its amelioration. Conversely, delay in institution of this therapy might result in the inflammation entrenching airway reactivity. It must be clearly proven in a controlled fashion that antibiotic or other therapy of sinusitis will improve the course of asthma since such therapy could delay the aggressive management of inflammation.

Advances in the long-term survival and possible cure of the child with cancer have challenged pediatric professionals to no longer view this child as terminally ill, but rather as a developing person with a future. The time of initial diagnosis presents the family with coping tasks which, once mastered, lay the ground work for future adjustment and, hopefully, the child's eventual return to good health. A multidimensional psychosocial assessment can be used to identify strengths and difficulties. A range of psychosocial interventions helps children and families with the coping tasks of this difficult but challenging experience.

Survivors of childhood cancer who received anthracycline treatment have a high incidence of abnormal cardiac function. Cardiac decompensation and death can appear many years after completion of chemotherapy. These survivors require periodic evaluation of cardiac function and rhythm.

The concept of the truly cured child, denoting a child on par with his or her peers in development, maturation, achievement, and aspirations, was introduced in 1977. 'Cure' is the norm in pediatric oncology. However, the cure of a disease and the consequences of that disease are complex concepts. Cure has at least three components: a biological cure, a psychological cure, and a social cure. Biological and psychological cures have been realized, but the social cure is yet to be achieved. The concept of the truly cured child is widely accepted. School reintegration is the primary method by which psychosocial cure is approached. The characteristics of psychosocial cure and the obstacles that hinder uniformly achieving the goal should be recognized so that the truly cured child can be a realistic goal in pediatric oncology.

With improved medical treatment for childhood cancer, many patients are enjoying long disease-free remission or cure. It is important to address the psychosocial adjustment of the survivor's life. There are two approaches to the study of psychosocial adjustment: study of psychiatric disturbances and assessment of quality of life. Incidences of psychiatric disturbances were reviewed with the most commonly reported difficulties being depression, anxiety and chemical dependency for older survivors and school attendance problems and learning difficulties for school age survivors. The assessment of quality of life focused on school performance, social adjustment, employment status, independent living and marital status. In addition, family coping has received increasing emphasis with regard to the effects on marital relationship and financial difficulties, although there is no consistent evidence to suggest an increased divorce rate in these families. Healthy siblings of cancer survivors are also subject to vulnerability. However, there is evidence to suggest most siblings will resolve their feelings of jealousy, fear of abandonment and establish a normal sibling relationship with the survivor.

The epidemiology of asthma in childhood is undergoing changes in many parts of the world. Prevalence, rates of hospitalization and mortality are all on the rise. In the United States, urban dwellers and minorities have experienced the greatest acceleration in rates. Elsewhere, some countries have experienced large increases in asthma morbidity and mortality, while others have not. Inconsistency in defining asthma and variations in methodology complicate epidemiologic investigation, but recent studies confirm the disturbing trend toward increased morbidity and mortality from childhood asthma and offer some insights into possible contributing factors.