Treatment Of Disease In Children Research Articles

Conservative surgical treatment of pulmonary hydatid disease in children: an analysis of 35 cases.

Hydatid cyst disease is a major health problem for people who live in endemic countries such as Turkey. The definitive cure for pulmonary hydatidosis is still surgical. This study evaluates our experience of treating pulmonary hydatidosis, focusing on the conservative surgical management of children with this disease. We retrospectively analyzed 35 children ranging in age from 3 to 13 years old, treated for pulmonary hydatidosis during a recent 4-year period. The 35 patients had a collective total of 48 cysts. Twenty-seven patients had a single cyst, 7 had unilateral multiple cysts, and 1 had bilateral multiple cysts. Six patients had multiple coexisting liver cysts. The 33 pulmonary cysts were intact and uncomplicated. Of the total 48 cysts, 34 were larger than 5 cm in diameter. Fever, cough, and dyspnea were the most common symptoms and chest radiography gave a correct diagnosis in 96.4% of the patients. Conservative surgical treatment was carried out in 33 of the 35 children (94%). There were few postoperative complications, and no mortality or recurrence in this series. Parenchyma-saving surgical procedures such as cystotomy and capitonnage are the preferred methods of treatment for pulmonary hydatid disease in childhood. These simple procedures are safe, reliable, and successful. Combined medical treatment can be given but not as an alternative to surgery. Simultaneous surgical procedures for coexisting liver cysts may be preferred because of the lower morbidity rates and hospitalization. Ultrasound or computed tomography scanning should be done to detect coexisting liver cysts in every patient with pulmonary hydatid disease.

Treatment of Childhood Disease and Prevention of Childhood and Adult Disease.

There are many examples of safe and efficacious supplement use in pediatric care, mostly the use of vitamins, minerals, protein, carbohydrate, and fat in specific clinical and diagnostic settings. The available scientific literature does not support the use of herbal and botanical compounds for common acute or chronic pediatric conditions. In health promotion and disease prevention, with few exceptions, there are no data to evaluate the safety and efficacy of supplements in preventing childhood disease. There is no literature to support supplement use in childhood to prevent adult disease, and this would require very long observation periods to establish efficacy.

Treating meningococcal infections in children.

Aggressive early treatment of meningococcal disease in children can reduce mortality. This relies on prompt recognition of septicaemia and meningitis, and treatment of the complications of shock and raised intracranial pressure.

Treatment of inflammatory periodontal diseases in children infected with Helicobacter pylori

Microorganisms, including Helicobacter pylori, play an important role in the etiology of inflammatory periodontal diseases. The aim of our study was to study the effectiveness of topical use of metronidazole on the mucous membranes of the oral cavity in combination with antihelicobacter therapy for Helicobacter pylori infection in childhood.

Treatment of Inflammatory Bowel Disease in Childhood

Of all patients with Crohn disease and ulcerative colitis, the first presentation of inflammatory bowel disease (IBD) is at a paediatric or adolescent age in 20% to 30%, most children being prepubertal at diagnosis. It is essential to provide an accurate diagnosis in children suspected of IBD, as the initial treatment of Crohn disease and ulcerative colitis in children is not the same as it is in adults. While the role of enteral feeding in the treatment of Crohn disease in adults continues to be controversial, there is firm evidence to support the use of enteral feeding as primary therapy for Crohn disease in children. Nutrition is improved by enteral feeding, and growth and pubertal development are promoted, while the systemic toxicity of corticosteroid therapy is avoided. Supplementary nocturnal enteral nutrition (with daytime intake of normal diet) after primary therapy and remission induction may be associated with the prolongation of remission. Drug treatment in children with IBD is characterized by a lack of evidence from controlled trials.

Open questions in the case management of sick children

Despite much progress in the specific treatment of diseases in children, some basic management questions remain controversial. Examples for this are fluid management of children with infectious diseases and the control of fever in children. Fluid restriction in children with meningitis has been recommended by several authorities in the field; the basis for these recommendations is reviewed, and reasons are outlined why these recommendations may not be appropriate. Similarly, there are few data on which to base recommendations for fluid management in severe pneumonia and cerebral malaria. Some activities supported by WHO are presented. In the management of fever, opinions vary whether fever is a useful protective factor in combating infections, or whether fever might be harmful and should be lowered. Results of a recent survey of experts on this topic are presented, and the research agenda in the field of supportive management of childhood infections is outlined.

Prospects for in utero human gene therapy.

Gene therapy for the treatment of disease in children and adults is being actively pursued at many medical centers. However, a number of genetic disorders result in irreversible damage to the fetus before birth. In these cases, as well as for those with genetic diseases who may benefit from therapy before symptoms are manifested, in utero gene therapy (IUGT) could be beneficial. Although some successes with in utero gene transfer have been reported in animals, significant questions remain to be answered before IUGT clinical trials would be acceptable. This review analyzes the state of the art and delineates the studies that still need to be performed before it would be appropriate to consider human IUGT.

Percutaneous renal revascularization in children and adolescents with renovascular hypertension

The diagnosis and treatment of renovascular disease in children poses unique challenges. Renal vein renin assessment is sometimes necessary to complement thorough digital subtraction angiography to determine the presence and/or hemodynamic significance of a renal artery lesion. Once a lesion is identified, most cases can be successfully managed with percutaneous techniques.

On the importance of psychological factors in allergic diseases in children

Allergic diseases account for 20-25% in the overall structure of all morbidity in Russia [5]. The problem of prevention and treatment of allergic diseases in children is especially urgent, because allergic diseases occupy a leading place in the structure of childhood diseases. According to A.M. Potemkina, treatment and prevention of allergic diseases in children are most effective in the first three years of life. In children of the first year of life, monoallergy prevails, that is, one allergic disease (85%).

Hepatitis C virus infection and chronic liver diseases after treatment of malignant disease in children: A multicenter study from the Children's Cancer and Leukemia Study Group of Japan

Background We studied the prevalence of chronic liver diseases, including hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, as late effects of therapeutic regimens against childhood malignancies in Japan.

Antiviral chemotherapy.

Over the last few years, several new antiviral agents have been added to the chemotherapeutic armamentarium. This review discusses advances in the treatment of HIV disease in children and adults. More pronounced antiviral effects have been achieved through the study of new agents such as the protease inhibitors as well as through a better understanding of previously approved drugs, such as reverse transcriptase inhibitors.

The Prevention and Treatment of Thromboembolic Disease in Children

The Prevention and Treatment of Thromboembolic Disease in Children

Cost Analysis of Laparoscopic and Open Fundoplication in Children

ABSTRACT Laparoscopy has been successfully applied to the treatment of gastroesophageal reflux disease in children. Initial series demonstrate equivalent early outcomes for laparoscopic and open techniques of fundoplication. Increased operative times, expensive equipment, and non-contemporary comparison samples have made financial benefits for the laparoscopic techniques difficult to realize. This study compares the cost and early outcome for 59 consecutive primary fundoplications (25 laparoscopic, 34 open) performed at the same children's hospital between January 1,1995 and September 30,1995. Prospective database entries, hospital medical records, and telephone interviews were used to assess demographics, operating room time, associated procedures, time until full feeding and discharge, complications, financial data, and degree of clinical success for each case. The two groups were similar demographically and had equivalent early outcomes. One laparoscopic case was converted to the open technique. Operat...

Methotrexate plasma pharmacokinetics: importance of assay method.

Intravenous methotrexate (MTX) therapy is widely used for treatment of various neoplastic diseases in children. The optimization of the MTX dose and/or the subsequent leucovorin rescue is based on pharmacokinetic data calculated from plasma concentrations collected after cessation of the MTX administration. The influence of the MTX assay method on the subsequent pharmacokinetic evaluation was studied in 13 children with acute lymphoblastic leukemia. Plasma samples were collected after administration of MTX (5-8 g/m2) as 24 h infusions. All samples were analyzed by five different analytical procedures, viz. liquid chromatography (LC), enzyme inhibition assay (EIA), two fluorescence polarization immunoassays (FPIA1 and FPIA2) and enzyme multiplied immunoassay (EMIT). Using measurements from the four non-chromatographic procedures, only about 50% of determined pharmacokinetic parameters (area under the plasma concentration time curve, calculated by the trapezoidal rule and from pharmacokinetic modelling, and the terminal half life time) were within the range 75-125% of the values obtained from LC data. We conclude that the clinical outcome of MTX therapy using estimated MTX pharmacokinetics as guidelines for proper dosing of MTX and/or leucovorin rescue might be affected by the lack of accuracy of non-chromatographic procedures for MTX analysis. There is still a need for improving the accuracy of the procedures aimed at therapeutic drug monitoring of MTX.

The Triggers of Heightened Parental Uncertainty in Chronic, Life-Threatening Childhood Illness

Advances in the treatment of childhood diseases have created a population of technology-dependent and medically fragile children whose life expectancy is unknown and whose future quality of life is unpredictable. Seven commonly occurring events were found to precipitate increased parental anxiety by triggering a heightened awareness of the uncertainty concerning the child's survival. These triggers are presented, with supporting data from parental interviews and published autobiographical accounts, as a set of causes, contexts, conditions, and interactions that account for predictable variation in the intensity of parental awareness of uncertainty. The findings reported here constitute one aspect of the grounded theory of living under conditions of sustained uncertainty for families who have a child with a chronic, life-threatening illness. That theory, it is proposed, is related to the larger chronic illness trajectory framework of Strauss and associates. Implications for practice are suggested.

Peptic Disease in Childhood in Asir Province

The records of 15 patients (10 females and five males) with peptic disease, i.e., peptic ulcer and/or chronic gastroduodenis who were endoscoped at Asir Central Hospital between 1989G and 1991G were reviewed. The patients' ages ranged between two and 12 years. All the patients were studied radiologically by barium meal (except for two), followed by endoscopy. Histopathology and culture for Helicobacter pylori were done in six patients. Thirty-three percent (five patients) and positive family history of peptic ulcer. Radiological examination was abnormal in only 38% of the patients (five out of 13). Four out of six patients (67%) were positive for H. pylori. Patients confirmed to have peptic disease were treated using H2 blockers (ranitidine) and antacid and one was referred for surgery. The response to treatment was quite favorable in 87%. Endoscopy was uneventful in all the patients. It is concluded that peptic disease in childhood in Saudi Arabia is not uncommon and should be kept in mind. A significant number of the patients have a family history of peptic disease in the first degree relatives. Upper gastrointestinal endoscopy in the pediatric age group in expert hands is a safe procedure with minimal complications. H2 blockers and antacids are effective in the treatment of peptic disease in childhood.

Childhood tuberculosis in Leeds, 1982-90: social and ethnic factors and the role of the contact clinic in diagnosis.

A retrospective analysis of childhood tuberculosis in Leeds over a nine year period (1982-90) was performed which showed that the contact clinic is important for the early detection and treatment of disease in children. Two thirds of the cases of tuberculosis in children under 15 years were diagnosed and treated at the clinic. The incidence of tuberculosis was greater in Asian than in white children and, independent of race, was greater in the most deprived area of the city.

Analysis of the variations of the fixation of proximal part of the femur in the treatment of hip joint diseases in children using the apparatus

On the basis of a numerical experiment using the mathematical apparatus of finite element method on the computer IBM PC by means of program package Microcomputeraided design of structures modified for design of structures, applied in traumatology and orthopedics, a new method of the apparatus fixation if proximal part of the femur is developed. The arranging of Elizarovs apparatus suggested provides the needle rod fixation of the femur. The method is used in the treatment of 84 patients with hip joint diseases, positive results are obtained in 96,4% of the cases. The efficacy of the method allows recommending it for the treatment of patients with congenital dislocations of the femur, aseptic necrosis of the head of the femur and coxa-vara in specialized hospitals.

Collaborative Research in Pediatric Practice

Research in practice has a long and distinguished history. Pickles,1 a general practitioner in Yorkshire, deduced the difference between infectious and serum hepatitis through careful clinical observation of hundreds of patients in his own practice. In recent years, pediatricians such as Breese2,3 and his colleagues in Rochester, New York, outlined effective methods for the diagnosis and treatment of streptococcal disease in children as a result of studies in their practice, and Carey4 in his suburban Philadelphia practice developed a widely used scale for assessing temperament in children. In the 1970s, Charney and his colleagues in Rochester, New York, developed a more systematic approach to collaborative research in practice, enlisting a large number of the practicing pediatricians who kept registries of their patients with data on visits, laboratory studies, and diagnoses in easily retrievable form.

Guidelines for treatment of skin diseases in children with HIV infection

Bacterial infection. Bacterial skin infections, including impetigo, ecthyma, and cellulitis, may occur in the child with HIV infection. Most skin lesions are caused by infection with staphylococci or streptococci; if there is doubt as to the cause of the skin infection, a skin biopsy specimen should be taken for both culture and histologic examination. Obvious impetigo may be treated with appropriate oral antibiotics effective against both staphylococci and streptococci; most HIV-infected children will require hospitalization and intravenous antibiotic therapy effective against staphylococci and streptococci for therapy of more involved skin infections. Candidiasis. Oral thrush and recalcitrant monilial diaper dermatitis are the most common mucocutaneous manifestations of HIV infection in children. Monilial infection also may involve intertriginal areas (axilla, neck folds) and the proximal nail folds (paronychia). In addition to topical therapy, a therapeutic regimen for these infections may include oral therapy to eradicate a gastrointestinal source of the fungus. The first line of therapy for oral thrush during infancy consists of nystatin solution (100,000 U/ml) in a dose of 1 to 2 ml four times per day. In older children clotrimazole troches may be more effective. For infants who do not respond to nystatin, these troches also may be inserted into a plastic nipple and used four times a day as a pacifier. Ketoconazole at 5 to 10 mg/kg /day or fluconazole (not licensed for use in children) at 3 to 6 mg/kg /day may be required for the treatment of oral thrush that does not respond to these measures. The development of feeding difficulty or dysphagia in the child with oral thrush may signal the presence of candidal esophagitis. Topical nystatin or an imidazole cream are effective in treating candidal infection of the skin. Dermatophyte infection. Children with HIV infection may develop severe or widespread tinea corporis or tinea capitis. The presence of fungal infection should be verified by either a potassium hydroxide preparation or a fungal culture. Tinea corporis may be treated with twice daily application of an imidazole cream. Tinea capitis will not respond to topical antifungals and requires a 4to 6-week course of oral griseofulvin 10 to 20 mg/kg/day. Viral infection Herpes simplex. Severe, chronic, or recurrent infection with herpes simplex virus is a complication of HIV infection in children. The most common presentation is the development of severe and persistent erosions of the lips and tongue. However, vesicular and ulcerative lesions of the fingers and other cutaneous surfaces sometimes are seen. Any chronic ulcer of the mouth or skin should be cultured for herpes simplex.