Lung salvage and protection ventilatory techniques.

Physicians are in the beginning of an era in intensive care medicine in which they finally are starting to see improved outcomes in patients with AHRF. At the same time, intensivists are presented with a bewildering choice of ventilator options and adjunctive therapies. Trying to sort out which are "cosmetic," that is, improve the blood gases as opposed to influencing the outcome, remains a challenge and will be resolved only with additional RCTs. Principles of ventilator management that are driven by mimicking normal physiology are inappropriate and must be rethought.     

Radiological abnormalities of the skeleton in patients with sickle-cell anemia

The way in which bones are affected in cases of sickle-cell anemia is well known. Nevertheless, advances in treatment and in methods of transfusion mean that we are increasingly seeing cases of older patients with this disease. A retrospective analysis of 222 cases of sickle-cell anemia demonstrates the radiological appearance of the skeleton in the disease and reveals the various bone segments which are particularly vulnerable at certain periods of life. Correlation of X-rays permits the discovery of lesions which are not clinically apparent. The frequency and characteristics of epiphyseal osteonecrosis and osteitis are studied. Aggravation of the bone lesions when corticoids are administered poses the problem of differential diagnosis of the disease, especially in comparison with rheumatic fever.     

Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: somatization and other somatoform disorders

This article reviews current knowledge about somatoform disorders in children and adolescents. Somatoform disorders are likely to occur more frequently in children and adolescents who have been severely maltreated than in others. The symptoms of somatoform disorders are reviewed, strategies for distinguishing somatoform disorders from other disorders are examined, and treatment strategies are explored.     

Aggressiv-dissoziale Störungen

The article gives an overview on conduct disorders in childhood and adolescence. After a summary of empirical results concerning symptoms and prevalence as well as comorbid disorders concepts of releasing and maintaining factors are discussed. Assessment procedures are briefly reviewed and an overview on therapeutic interventions, their indication and efficacy is given. Conduct disorders are frequent. In childhood less severe forms (oppositional defiant disorders) are most prevalent and during adolescence more severe manifestations with antisocial behaviour are seen. Besides biologically co-determined disturbances of impulse control (inhibition) psychosocial factors, especially family interactions, are important in the development of the disorder. In less severe cases counselling and training of parents in educational management practices are helpful. In more severe cases comprehensive multimodal interventions are indicated. Often these interventions have to be accompanied by social services. The effects of behavioural interventions especially of parent trainings and interventions in the family are well established.     

Petrous apex lesions in the pediatric population

A variety of abnormal imaging findings of the petrous apex are encountered in children. Many petrous apex lesions are identified incidentally while images of the brain or head and neck are being obtained for indications unrelated to the temporal bone. Differential considerations of petrous apex lesions in children include “leave me alone” lesions, infectious or inflammatory lesions, fibro-osseous lesions, neoplasms and neoplasm-like lesions, as well as a few rare miscellaneous conditions. Some lesions are similar to those encountered in adults, and some are unique to children. Langerhans cell histiocytosis (LCH) and primary and metastatic pediatric malignancies such as neuroblastoma, rhabomyosarcoma and Ewing sarcoma are more likely to be encountered in children. Lesions such as petrous apex cholesterol granuloma, cholesteatoma and chondrosarcoma are more common in adults and are rarely a diagnostic consideration in children. We present a comprehensive pictorial review of CT and MRI appearances of pediatric petrous apex lesions.     

Neonatal Neuropathology

In this review of neonatal neuropathology the causes, various areas of the neuroaxis which are vulnerable to insult at different gestational ages, and the major reasons why some areas are more susceptible to insult than are others are discussed. Functional deficits resulting from the more common types of central nervous system lesions are covered and the reasons why some deficits may, or may not, be overtly expressed in the developing infant or later in life are described.     

Zur Häufigkeit und ätiologie der Omphalozelen

Omphaloceles are congenital malformations with herniation of the abdominal viscera into the umbilical cord. The incidence in newborns is 1:4300, the sex ratio 1.24:1 in favour to boys. Children with this malformation are neither more frequent at the beginning nor at the end of the sibship; the average maternal age is not increased. In about 50% other different malformations are found. All those omphaloceles, which are found as an obligatory symptom in the EMG syndrome (Wiedemann-Beckwith syndrome) to be probably in most cases autosomal recessively inherited or which are seen within a chromosomal malformation syndrome are of etiologically known origin. Omphaloceles without other malformations are mainly sporadic, less frequent in sibs, possibly due to a polygenic or multifactorial mode of inheritance. Findings in population genetics and animal experiments suggest that exogenous factors, too, can be the cause of malformation syndromes with omphaloceles.     

Old and new antithrombotic drugs in neonates and infants

Thromboembolic complications are becoming more frequent in children and the use of anticoagulation has increased considerably. The most widely used agents in children, heparin, low molecular weight heparin, and warfarin all have limitations which are exaggerated in children. This has led to the study of newer agents with improved pharmacologic properties such as bivalirudin, argatroban, and fondaparinux. Clinical trials are under way to assess several new oral anticoagulants that are in late phase studies or already licensed in adults. Based on the completed studies in children, several recommendations for the use of currently available agents (bivalirudin, argatroban, and fondaparinux) are suggested for clinical use today. Additional studies need to be conducted for the these agents, so that their use may be expanded in selected indications. New regulatory requirements are leading to a number of studies in the newer anticoagulants that are yet to be licensed in adults for treatment of venous thromboembolism. Pediatric thrombosis is entering a fruitful era of research in anticoagulation management, which is sure to lead to significant changes in how children are treated in the next 10 years.     

Radiological features in paediatric primary gastric MALT lymphoma and association with Helicobacter pylori

Primary malignant tumours of the stomach are very rare in children, most being lymphomas and sarcomas. The majority of primary gastric lymphomas are high-grade non-Hodgkin's lymphomas and are of B-cell origin. However, a significant number are low-grade B-cell lymphomas that are derived from mucosa-associated lymphoid tissue (MALT) that is not found in the normal stomach. Helicobacter pylori infection predisposes to the development of MALT in the stomach and provides the pathogenic background for MALT-type lymphomagenesis. To our knowledge, only eight paediatric cases of primary gastric lymphoma have been described. The diagnosis and follow-up of gastric lymphoma are mainly made by endoscopy. Nevertheless, radiologists must be aware of this disease because it may be observed on radiological examinations that are performed for non-specific upper digestive symptoms in children.     

Pseudoseizures

Pseudoseizures are paroxysmal alterations in behavior that resemble seizures but are without any organic cause. They are recognized by various terms. Pseudoseizures are found in about one fourth of all patients seen with hysteria and 20% of those referred to epilepsy clinic. Pseudoseizures are often difficult to differentiate because there are client based or clinician based factors leading to misdiagnosis. Detailed history, observation, psychological testing and laboratory investigations are used for correct diagnosis. Pseudoseizures are not only to be differentiated from various forms of epilepsy but also from disorders like malingering, somatization disorder, hyperventilation, migraine, syncope etc. Management consists of making the patient and relatives aware about the causation and diagnosis. Psychotherapy (supportive and psycho-dynamic), behavior therapy (biofeedback, relaxation), drugs (anxiolytic and anti-depressants), hypnosis and placebo are used for treatment. The correct recognition is helpful in avoiding physical tests and the unnecessary use of antiepileptic drugs.     

Nichtorganische Schlafstörungen im Kindesalter

Sleep disorders are common in childhood. The results of the Cologne Children’s Sleep Study indicate that insomnia and parasomnia are frequent in children, occurring in approximately 15% and 14%, respectively. Children with sleep disorders seldom show daytime sleepiness but often exhibit hyperactive behaviour. In addition to the classification and diagnostic procedures for nonorganic sleep disorders in childhood, four therapy-related topics are described in the present article. First, sleep education and the significance of sleep hygiene are discussed. Strategies are presented on how to treat conflicts regarding the sleep situation and how to treat anxiety in the sleep situation. Finally, specific measures are given for dealing with difficulties in initiating and maintaining sleep, as well as ways to deal with nightmares, sleepwalking, and night terrors.     

Cot death update 2007

Sudden unexpected death remains the commonest way for post-neonatal infants to die despite a reduction in unexplained deaths of 75% over 20 years. Deaths were frequent in all sections of society but are now concentrated in the more deprived groups where mortality from infection, accident and congenital abnormality has always been greater. The hazards of some forms of infant care are clearer, and clues to the underlying mechanisms are emerging, Although paediatricians are less experienced in sudden deaths, modes of investigation and support are improving.     

Clinico-pathology of salivary gland tumors of the head in children and adolescents

Tumours of salivary glands are rare in childhood and adolescence. Our material consists of 10 observations. The principles of classification of these tumours and the differences to the adults are reviewed. Nonepithelial tumours are diagnosed in a higher percentage in the first two decades of life. Epithelial neoplasms are often connected with doubtful or malignant behaviour.     

Childhood bereavement following parental death

Psychological outcomes in children who have experienced the death of a parent are heterogeneous. One child in five is likely to develop psychiatric disorder. In the year following bereavement, children commonly display grief, distress, and dysphoria. Nonspecific emotional and behavioural difficulties among children are often reported by surviving parents and the bereaved children themselves. The highest rates of reported difficulties are found in boys. This review identifies the moderating and mediating variables that lead to some children being more vulnerable to disturbance than others following parental death. Limitations and gaps in the recent bereavement literature are identified. Theoretical and methodological advances that are necessary for a coherent account of childhood bereavement are outlined.     

Recommendations in neonatal resuscitation

The recommendations for neonatal resuscitation are not always based on sufficient scientific evidence and thus expert consensus based on current research, knowledge, and experience are useful for formulating practical protocols that are easy to follow. The latest recommendations, in 2000, modified previously published recommendations and are included in the present text.     

Thalassämien

Thalassemias belong to a group of disorders that are, in most cases, inherited in an autosomal recessive fashion. Mutations of the globin genes or of their regulatory DNA sequences, resulting in the defective synthesis of one or more hemoglobin chains, are responsible for these disorders. The thalassemias (from the Greek word “thalassa” = sea) are widespread throughout the Mediterranean region, Asia and Africa. Due to immigration from these regions, thalassemias are no longer rare in Germany. Currently, approximately 400–500 patients with β-thalassemia major are being treated in German children’s hospitals. α-Thalassemias and other forms of thalassemia are less common in Germany. Here, we summarize the basic principles and therapeutic guidelines for α-and β-thalassemia.     

Adolescent pregnancy

Teen birth rates have decreased steadily over the past decade, but the United States still has the highest birth rates among all developed countries. Young women who give birth as adolescents are likely to have poor school performance, and come from families with low socioeconomic status, a history of teen pregnancies, and low maternal education. The fathers of babies who are born to teen mothers are likely to be unsuccessful in school, have limited earnings, have high rates of substance use, and have trouble with the law. Infants who are born to teen mothers are at risk for low birth weight and physical neglect and abuse; at school age, these children are more likely than children born to adult women to have trouble with school achievement, and they are at risk for becoming teen mothers or fathers themselves. Programs that are successful in reducing teen birthrates are usually multifactorial and combine comprehensive sexuality education with youth development activities; reduction in repeat pregnancies is associated with home visits by nurses combined with long-acting contraceptive use.     

Benign vulvovaginal tumefactions in children. General review illustrated by a series of 57 personal cases

There are numerous etiologies of benign vulvo-vaginal tumefactions in children. However, the etiological diagnosis can usually be based on clinical data after careful examination. Para-urethral cysts are the main cause of labial and vestibular tumefactions; they are generally cured by simple puncture. Solid vaginal tumors are uncommon, but they always require surgical resection in order to exclude the exceptional and severe malignant tumours. Neonatal hydrocolpos is frequent in our experience and must always be treated surgically; associated malformations are frequent and must be systematically searched for. Ectopic prolapsed ureterocele and circular prolapse of the urethral mucosa are easily recognizable and need surgical treatment.