Contraception for adolescents with lupus

Sexually active adolescents, including young women with lupus, are at high risk for unplanned pregnancy. Unplanned pregnancy among teens with lupus is associated with an elevated risk of poor maternal and fetal outcomes. The provision of effective contraception is a crucial element of care for a sexually-active young woman with lupus. Unfortunately, providers may be hesitant to prescribe contraception to this group due to concerns about increasing the risk of lupus complications. This article reviews the risks and benefits of currently-available contraceptives for young women with lupus. Providers are encouraged to consider long-term, highly-effective contraception, such as implantables and intrauterine devices, for appropriately selected adolescents with lupus.     

Amifostine for children with medulloblastoma treated with cisplatin-based chemotherapy

In adult patients, amifostine appears to ameliorate cisplatin-related nephrotoxicity and ototoxicity. We assessed the safety and efficacy of amifostine in 11 children with newly diagnosed medulloblastoma/primitive neuroectodermal tumor treated with radiotherapy and vincristine, lomustine, and cisplatin. Amifostine was administered immediately prior to and 4 hr into the cisplatin infusion. Amifostine caused assymptomatic hypotension and hypocalcemia in 18 and 82% of patients, respectively. Despite amifostine use, 78% of patients developed significant ototoxicity. Although relatively well tolerated, amifostine does not appear to have a major impact on ameliorating the risk of developing significant nephro- and ototoxicity in children with medulloblastoma. Larger studies will help clarify these findings.     

小儿胰岛细胞增生症的外科治疗

目的：总结上儿少见的胰岛细胞增生症的诊断和外科治疗要点。方法：收集本院10年内收治的4例患儿资料，从症状、血糖、胰岛素及其比值、手术方法、术后监测等方面进行分析。结果：1例首次手术切除胰腺量不够，术后复发，3年后再次手术治愈，但遗留脑损害；1例术后败血症死亡；2例切除胰腺95％以上，术后血糖胰岛素恢复正常。结论：①新生儿及婴幼儿期反复出现抽搐、低血糖症状要考虑由于胰岛细胞增生所致的高胰岛素血症，需作血糖胰岛素比值测定及B超、CT检查排除胰腺占位性病变；②一旦诊断明确尽早手术，减轻脑损害。尤其是新生儿期发病者，应在诊断明确后尽早手术，术后症状复发者亦应果断再次手术；③正确进行胰腺大部分切除术，切除胰腺组织不能少于95％。     

小儿漏斗胸纠治不同术式的特点

目的　探讨小儿漏斗胸纠治不同术式优缺点。方法　小儿漏斗胸畸形 2 3例中 ,应用胸骨抬高法 2例 ,用胸骨翻转法 4例 ,采用胸肋骨截骨内固定术矫治漏斗胸 17例。结果　胸骨抬高法 2例外观不满意 ;胸骨翻转法外观不满意 3例 ,满意 1例 ;胸、肋骨截骨加克氏针内固定法无 1例出现并发症 ,矫形效果优良。结论　胸肋骨截骨加克氏针内固定术操作简单 ,矫形效果好     

Nutritional support for children with cancer

Children with cancer are at risk of suffering from under nutrition, which can affect tolerance of therapy and may influence their overall survival. The goals of nutritional support in the cancer patient are to achieve and maintain desirable weight and to prevent or correct nutritional deficiencies. So early identification of patients at high risk for malnutrition is essential. There are different options for nutritional support. Oral feeding, when possible, is the first line. Enterai nutrition should be considered for those patients who cannot consume adequate macronutrients by mouth. Options are nasogastric tube or gastrostomy tube feeding. The advantages of enterai nutrition, when compared with parenteral nutrition, include better maintenance of the structural and functional integrity of the gastrointestinal tract, a decreased risk of bacterial translocation, greater ease and safety of administration, more physiologic and efficient use of nutrient substrates, decreased hepato-biliary complications, improved outcome and cost-effectiveness. Thus, parenteral nutrition should be considered if the gut is not functioning adequately to allow the normal absorption and digestion of nutrients or if enterai nutritional support is not sufficient to meet nutritional needs. Nutritional assessment and support should be integrated into treatment protocols for all children with neoplastic diseases.     

Adult outcome for children with autism

BACKGROUND: Information on long-term prognosis in autism is limited. Outcome is known to be poor for those with an IQ below 50, but there have been few systematic studies of individuals with an IQ above this. METHOD: Sixty-eight individuals meeting criteria for autism and with a performance IQ of 50 or above in childhood were followed up as adults. Their mean age when first seen was 7 years (range 3-15 years); at follow-up the average age was 29 years (range 21-48 years). Outcome measures included standardised cognitive, language and attainment tests. Information on social, communication and behavioural problems was obtained from the Autism Diagnostic Interview (ADI). RESULTS: Although a minority of adults had achieved relatively high levels of independence, most remained very dependent on their families or other support services. Few lived alone, had close friends, or permanent employment. Communication generally was impaired, and reading and spelling abilities were poor. Stereotyped behaviours or interests frequently persisted into adulthood. Ten individuals had developed epilepsy. Overall, only 12% were rated as having a 'Very Good' outcome; 10% were rated as 'Good' and 19% as 'Fair'. The majority was rated as having a 'Poor' (46%) or 'Very Poor' (12%) outcome. Individuals with a childhood performance IQ of at least 70 had a significantly better outcome than those with an IQ below this. However, within the normal IQ range outcome was very variable and, on an individual level, neither verbal nor performance IQ proved to be consistent prognostic indicators. CONCLUSIONS: Although outcome for adults with autism has improved over recent years, many remain highly dependent on others for support. This study provides some information on prognostic indicators, but more fine-grained research is needed into the childhood variables that are associated with good or poor outcome.     

胸腔镜下胸交感神经干切断术治疗小儿手掌、腋窝和足底多汗症

目的评估胸腔镜下胸交感神经干切断术治疗手掌、腋窝和足底多汗症的有效性和安全性。方法自2003年1月至2005年12月，60例多汗症小儿患者经电视胸腔镜行双侧胸交感神经干切断术。男31例，女29例，平均年龄14．8岁（10-15岁）。术中均用电凝钩烧灼切断胸2或3交感神经干。结果全组60例术后手掌和腋窝多汗症状全部消失，其中45例伴随的足底多汗症状也同时消失，另15例减少，有4例出现转移代偿性多汗。全组无手术死亡和严重并发症。结论胸腔镜下交感神经干切断术是治疗小儿手掌、腋窝和足底多汗症最有效的微创治疗手段。     

Keyboarding for Students with Handwriting Problems

A literature review is presented regarding keyboarding for school students experiencing handwriting difficulties. Despite the overall dearth of research, some general conclusions appear warranted. Students need to be able to keyboard at least as fast as they can handwrite and should learn the touch-keyboarding method if possible. Appropriate instruction appears critical for the development of keyboarding competency. The upper elementary age is an appropriate time to start teaching keyboarding, with students possibly requiring 25-30 total hours of instruction. Students experiencing handwriting difficulties might need customized goals and strategies. Although the existing literature regarding the role of performance components in keyboarding provides some direction to clinicians, further investigation is required.     

Children's strategies for coping with pain

Children's typical modes of responding to stress influence their ability to manage painful events. Coping skills mediate a child's response to pain that is associated with illness, injuries, and medical procedures. A number of factors can influence children's use of coping skills and their adaptation responding to pain, including cognitive-developmental level, previous experiences with painful events and children's belief in their ability to tolerate pain, parental support, and the extent to which the pain is acute or chronic and perceived as controllable by the child. There has been recent progress in the assessment of children's coping with distressing and/or painful experiences. Research in this area is providing a foundation upon which interventions can be tailored to a particular child's specific needs to assist him or her in the management of pain.     

Immunizations for patients with metabolic disorders

Individuals with underlying metabolic disorders are a potential high-risk group for vaccine-preventable diseases. Newborn metabolic screening has provided a means of early identification and treatment for many of these disorders, whereas childhood immunization is one of the most effective means of decreasing the morbidity and mortality resulting from communicable diseases worldwide. There are very few contraindications to the routine administration of vaccines to the healthy, immunocompetent individual. In certain high-risk groups, such as immunocompromised patients, gravid females, and those with a history of previous anaphylactic reaction to a vaccine or its components, selective withholding of immunizations must be considered to decrease potential adverse events. A detailed analysis of the medical literature revealed few specific recommendations regarding appropriate immunization techniques for patients with metabolic disorders. In this review we detail the major metabolic disorder subtypes, elaborate on the available literature on immunizations for patients with these disorders, and provide suggested vaccine recommendations.     

Health supervision for children with neurofibromatosis

Neurofibromatosis 1 is a multisystem disorder that primarily involves the skin and nervous system. Its population prevalence is 1 in 3500. The condition usually is recognized in early childhood, when cutaneous manifestations are apparent. Although neurofibromatosis 1 is associated with marked clinical variability, most affected children do well from the standpoint of their growth and development. Some features of neurofibromatosis 1 are present at birth, and others are age-related abnormalities of tissue proliferation, which necessitate periodic monitoring to address ongoing health and developmental needs and to minimize the risk of serious medical complications. This clinical report provides a review of the clinical criteria needed to establish a diagnosis, the inheritance pattern of neurofibromatosis 1, its major clinical and developmental manifestations, and guidelines for monitoring and providing intervention to maximize the growth, development, and health of an affected child.