Method For Treatment Of Children Research Articles

The ketogenic diet in refractory epilepsy: the experience of Children's Hospital of Pittsburgh.

The ketogenic diet appears to be effective in reducing seizure frequency in patients with epilepsy refractory to antiepileptic drug therapy. Reported seizure frequencies before and after the diet was initiated were obtained for 48 patients started on the ketogenic diet between December 1994 and January 1998 at Children's Hospital of Pittsburgh. The majority of patients (71%) were able to achieve > or = 50% reduction in seizure activity. Of these, more than half (53%) had > 90% reduction in seizures after 45 days of diet therapy. Complications included gastrointestinal complaints and infrequent lipid abnormalities. The ketogenic diet appears to be an effective method of treatment for children with epilepsy refractory to drug therapy.

Ablación con radiofrecuencia de la taquicardia ventricular izquierda idiopática en niños

Nowadays radiofrequency catheter ablation is an alternative to medical treatment in adult patients with idiopathic left ventricular tachycardia. To asses indications, results and long term follow-up of using this technique in children. : Radiofrequency catheter ablation was performed in five consecutive patients without structural heart disease, mean age 8.6+/-7.1 years (range, 1.3 to 17) and suffering from resistance to medical treatment left ventricular tachycardia (2.4+/-0.9 antiarrhythmic drugs per patient). Palpitations and syncope were the clinical manifestations in four patients while congestive heart failure in the other one. Six types of tachycardia were identified in the five-patient group. All of them responded to intravenous verapamil. There were 3 incessant tachycardias and the other three were paroxysmal ones. The ablation site was selected using activation mapping during tachycardia and pace-mapping. The Tachycardia cycle length was 275+/-123 ms and showed right bundle branch block with superior axis (left in 4 and right in 2 cases). The ablation target was located in the mid-septal region of the left ventricle in 3 cases, in the apical and inferior septal region in 2 other cases and in the anterior free wall in the other one. Local activation times preceded in 33+/-13 ms at QRS beginning and with a 12/12 agreement pattern in 5 cases and 9/12 in 1, in whom ablation was unsuccessful. At follow-up, the 4 patients with effective ablation have been tachycardia-free for 35.8+/-17 months. Radiofrequency catheter ablation is a useful method of treatment in children with idiopathic left ventricular tachycardia, including those under two years old.

"Detenzor" method in the complex treatment of children with functional disorders and diseases of the spine on an outpatient basis

Diseases of the spine (juvenile kyphosis, juvenile osteochondrosis, dysplastic scoliosis) and its functional disorders (non-fixed kyphosis, sluggish posture, flat back, postural disorder) occupy one of the first places in the structure of orthopedic pathology in childhood and adolescence [14]. Of 320 children examined by an orthopedist in a children's clinic for 6 months, 27 (8.4%) had dysplastic scoliosis, 48 (15%) had impaired posture, and 142 (44.4%) had flaccid posture. Out of 48 children with postural disorders, 4 had pathology of the hip joint, 3 had congenital muscular torticollis. One 9-year-old child with dysplastic scoliosis of the 1st degree suffered from congenital clubfoot.

Effect of cardiac or heart-lung transplantation on the quality of life of the paediatric patient.

Despite the increase in the use of heart and heart-lung transplantation as methods of treatment for children with end stage heart or lung disease, there is little documented research about the psychological implications of such procedures or about the effects of transplantation on quality of life. Twenty-eight children were studied before and 3 months after heart or heart-lung transplantation and compared with 28 normal children. Developmental and cognitive function were within the normal range, although performance was at a significantly lower level on a number of parameters compared with the normal group. There were no significant changes in any of the developmental or cognitive parameters after transplantation. Pre-operatively the prevalence of problem behaviour at home was significantly higher in the transplant group compared with the normal group, but there was a significant reduction in the prevalence of problem behaviour following transplantation. Early postoperative findings indicate an improvement in quality of life after heart or heart-lung transplantation but longer term follow-up is now necessary.

Cognitive and behavioural status of paediatric patients 1 year after cardiac or cardiopulmonary transplantation

Cardiac and cardiopulmonary transplantation are being increasingly used as methods of treatment for children with end-stage heart or lung disease, but little is documented about their psychological adjustment to such procedures. In all, 45 children who had undergone heart or heart-lung transplantation were studied 1 year after operation and compared with 39 children who had undergone bone marrow transplantation, 49 children who had undergone conventional cardiac surgery and 46 normal healthy children. None of the 3 treatment groups differed significantly with respect to developmental, cognitive or behavioural measures, but there were significant differences between the transplant and normal groups in the areas of developmental and cognitive functioning. The initial diagnosis of the transplant patients was found to be an important factor in the postoperative psychological functioning.

Conductive education at the Peto Institute, Budapest.

Conductive education, which was developed at the Petö Institute in Budapest, has been publicised incorrectly as a method of treatment for children with cerebral palsy. From the results of information given and our own observations during a week's visit to the institute we conclude that a minority of carefully selected children with cerebral palsy and spina bifida, who have a relatively good prognosis, are educated at the institute; the education is carried out with appropriate medical, surgical, and orthotic intervention; and the children probably function better as a result of the intensive programme than do similar children in Britain in areas where therapy is scarce. They seem to achieve, however, what we would expect similar children in Britain to do when facilities are adequate. Though our findings do not therefore justify using public funds to refer children to the institute, some (self selected) families benefit from a visit, particularly from the positive attitudes of the staff. The role of the conductor and the integration of programmes into a classroom setting have much to recommend them, and conductive education, if successfully transferred to Britain, might be beneficial to a wider range of children than in Hungary.

Bone Marrow Transplantation in the Treatment of Children with Cancer: Current Status

Bone marrow transplantation (BMT) is a promising method of treatment for children with resistant malignancies. The discrepancies in the results of BMT from institution to institution are based on patient selection, timing of transplantation, and preparatory regimens that differ from place to place. Studies that address specific questions are needed: questions like Under what conditions is BMT superior to conventional chemotherapy? Which preparatory regimen is superior? What are the results based on the status of the patients' malignancies and quality of life? Multi-institutional studies are needed to answer these questions.

Outcome of children with primary intramedullary spinal cord tumors.

The influence of clinical and treatment factors on the outcome of children with primary intramedullary spinal cord tumors (PST) was evaluated by reviewing the records of 26 children diagnosed during the 15-year period 1970-1984. Five-year survival was 39%, but 5-year event-free survival (EFS) was only 14%. Eighteen-month EFS was 53% (9/17) among children with low-grade astrocytoma. 100% (2/2) with ependymoma, and 0 of 7 with anaplastic astrocytoma or ganglioglioma. There was no significant difference in the 18-month EFS by location of tumor, duration of symptoms, or extent of surgical removal. Five of 9 children with locally recurrent PST had a second operation, and 4 were alive a median of 56 months later. PST disseminated to the leptomeninges or the III ventricle in 5 children: 2 at diagnosis, 2 as the first sign of disease relapse, and 1 after local recurrence. Given the poor outcome of our children, different methods of treatment for children with tumors in this location should be evaluated.

Continuous ambulatory and continuous cycling peritoneal dialysis in children. A report of the Southwest Pediatric Nephrology Study Group

Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) have become acceptable methods of treatment for children with endstage renal disease (ESRD). In this study we have compared the effectiveness of these two modalities of prolonged dwell peritoneal dialysis in 82 children treated at home with CAPD and/or CCPD for a mean of 10.2 months. Forty variables were evaluated during 92 patient periods (63 CAPD, 29 CCPD). There was no difference between the two groups with regard to sex, race, original disease, duration of dialysis, or volume of dialysis fluid. The only difference in biochemical profiles between the two groups was a higher serum creatinine in CCPD patients due in part to this group's greater age. The rate of peritonitis was not different (CAPD 1/4.6, CCPD 1/5.2 months), but the number of patient periods devoid of peritonitis was greater in the CCPD group (14/29 vs. 17/63, P = 0.04). Growth velocity index (GVI) and standard deviation scores (SD scores) were used to evaluate growth in the total group and subsets according to age. Overall GVI was 88% of expected and did not differ between PD groups (CAPD 88% vs. CCPD 89%). There were no significant changes in SD scores for growth during the course of prolonged dwell peritoneal dialysis indicating that the children did not experience further deterioration in growth. Children less than 4 years of age also did not have significant changes in SD scores. We conclude that CAPD and CCPD provide acceptable and comparable modes of dialytic therapy for children with ESRD.

Treatment of Congenital Hip Dislocation by Muscle Release, Skeletal Traction and Closed Reduction in Older Children

A method of treatment of congenital hip dislocation by preliminary multiple muscle releases around the hip, followed by skeletal traction, is employed for closed reduction and immobilization with long leg cast. In 29 hips treated during the period from 1961 to 1972, the results justify the method for treatment of children 3 to 11 years of age with neglected high posterior congenital hip dislocations. The main prerequisite for the procedure is a fairly well-developed acetabulum.

A PSYCHOANALYTIC VIEWPOINT OF BEHAVIOR MODIFICATION IN CLINICAL AND EDUCATIONAL SETTINGS

The Day Care Center of the University of Colorado Medical Center is a psychoeducational facility in the Department of 'Psychiatry which has been in operation since 1962. It serves a population of 16 to 18 elementary-school-age children whose social and academic problems are particularly manifest in the school setting. These children attend the Center from 9:00 A.M. to 3:00 P.M. daily for a period of 1 to 2 years with the goal of their returning to public school programs. The staff consists of teachers, psychologists, psychiatrists, social workers, pediatricians, and auxiliary personnel, and trainees in the indicated professional disciplines. A special education program is provided together with psychoanalytically oriented therapy for the children and their parents. In addition to this intramural activity, the Center conducts consultation and inservice training programs in a number of public elementary schools. The Center also functions as a research facility in special education and treatment methods for children and families. The Center, an environmental resource, has made it possible to program corrective and remedial efforts for troubled children. Such

The aetiology and treatment of children's phobias: a review.

Mention has been made of Mary Cover Jones's(20, 21) classic studies in which she describes her attempt to develop techniques for eliminating children's fears. The signfficance of this early work is only now becoming recognized. She gives an account of several methods of treatment. Four of these appear to be promising, practical and in accord with present-day learning theory. They are the methods of: 1. Direct conditioning. 2. Social imitation. 3. Systematic distraction and 4. Feeding responses. The fruitfulness of the behavior theory approach to phobias is well demonstrated if we add to Jones' list the additional new methods which have been, or could be used in overcoming children's phobias. 5. Systematic desensitization (Wolpe) 6. Assertive responses (Wolpe) 7. Relaxation responses (Wolpe) 8. "Pleasant" responses in the life situation–with drug enhancement (Wolpe) In a suggestive article by Jersild and Holmes(17) further possible methods for treatment of children's fears are discussed. From their survey of parent's experiences in dealing with children's fears, Jersild and Holmes suggest these techniques (among others) : Prompting the child to acquire skills which will enable him to cope with the feared situation; progressive contact with, and participation in, the feared situation; verbal explanation and reassurance; practical demonstration of fearlessness. Some of these techniques are already employed by prevailing therapies without receiving explicit acknowledgement. All these methods certainly provide therapists with a formidable armamentarium to begin with. What is now required is careful, thorough investigation of these methods and above all a major project to establish the degree and permanence of improvements which may be obtained by these techniques. In the meantime, active therapists may consider conducting their own investigations of these methods when faced with children suffering from phobic conditions. Obviously the choice of the method will depend to a considerable extent on the nature of the phobia. It is worth remembering also that these methods are not mutually exclusive and it is probable that in many cases a combination of these techniques may offer the most promising approach.