The child with an acute limp

The limping child is a common presentation to the emergency department. When confronted with a crying child who cannot walk or explain why, a structured approach based on an appreciation of the underlying physiology can help identify those children with (sometimes subtle) red flags, avoid unnecessary interventions and hospital stays. Here we discuss the differential diagnosis of an acute atraumatic limp, and suggest an approach to examination and investigation, including some key pitfalls and signs to look out for.     

The child with recurrent respiratory infections: normal or not?

Respiratory infections (RI) are one of the major complaints in children and adolescents, and represent a demanding challenge for the pediatrician. It has been estimated that at least 6% of Italian children younger than 6 yr of age present recurrent respiratory infections (RRI). Children with RRI are not affected by severe alterations of the immune system. RRI represent essentially the consequence of an increased exposure to infectious agents during the first years of life, when immune functions are still largely immature. Several social and environmental factors, such as day-care attendance, family size, air pollution, parental smoking, and home dampness, represent important risk factors for airway diseases and may contribute in various degrees to determine the incidence of RRI. The main problem for the pediatrician is to discriminate normal children with high RI frequency related to an augmented exposure to environmental risk factors from children affected by other underlying pathological conditions (immunological or not), predisposing to infectious diseases. When RRI diagnosis has been formulated, removal of environmental risk factors (i.e. precocious day-care attendance, smoking in the household) must first be suggested.     

Evidence for symptom management in the child with cancer

The use of complementary/alternative medicine (CAM) has been well documented among children with cancer. This report summarizes the research evidence on the role of CAM therapies for prevention and treatment of the most commonly reported cancer-related symptoms and late effects among children with cancer. Small clinical trials document evidence of effectiveness for select therapies, such as acupuncture or ginger for nausea and vomiting, TRAUMEEL S for mucositis, and hypnosis and imagery for pain and anxiety. Several relatively small clinical trials of varying quality have been conducted on these CAM therapies in children with cancer. Some herbs have demonstrated efficacy in adults, but few studies of herbs have been conducted in children. Larger randomized clinical trials are warranted for each of these promising therapies. Until the evidence is more conclusive, the providers' role is to assess and document the child's use of CAM, critically evaluate the evidence or lack of evidence, balance the potential risks with possible benefits, and assist the family in their choices and decisions regarding use of CAM for their child with cancer.     

1例儿童先天性粒细胞减少症的基因诊断

目的应用基因诊断方法进一步提高对儿童先天性粒细胞减少症(CN)的认识和诊断水平。方法以1例儿童CN患者为研究对象,收集其临床资料、实验室检查结果,按序检测ELA2、GFI1、HAX1及WASp致病基因突变情况。依上述步骤对患儿分别进行疾病的临床及基因诊断并随访。结果参照诊断标准该患儿诊断为无遗传背景的散发性非综合征性CN;基因检测显示其携带已经报道的ELA2基因突变:c.164G>A;此外患儿中性粒细胞表面G-CSFR表达正常,G-CSFR胞内段未发现获得性截短性突变。结论基因突变检测证实1例儿童CN为ELA2基因突变所致,为该患儿未来的分组临床研究及基因治疗提供依据。     

An unusual germ causing a limp: Eikenella corrodens

A case of retroperitoneal appendicular abscess due to Eikenella corrodens is reported. This facultative anaerobe is normally found on the respiratory and intestinal mucosa and may be responsible for opportunistic infections. Culture is difficult and growth is slow. There have been few previous reports of the localization reported herein. A limp was the first manifestation of the infection. The differential diagnosis and pathophysiology of this symptom are discussed.     

1例黑热病患儿的循证诊断和治疗

目的借助循证医学方法明确诊断疑似黑热病患儿并拟定治疗方案。方法针对1例患儿临床问题,遵循循证临床实践的PICO原则(患者或问题、干预措施、对照干预措施及结局指标),检索中华人民共和国卫生部和中国疾病控制中心官网,Cochrane Library,PubMed,Embase和CBM,收集和评价文献以取得当前最佳证据,并结合临床经验及患儿家属的意愿,拟定诊断及治疗方案。结果经循证分析,rK39免疫层析(rK39 ICT)诊断黑热病的检验效能高,快速、简单;葡萄糖酸锑钠仍可作为黑热病患者治疗的一线药物。在获得家属知情同意后,采用rK39 ICT和骨髓细胞学检查,快速明确诊断后给予葡萄糖酸锑钠治疗,患儿症状明显好转,未出现锑剂的不良反应,骨髓细胞学复查未见杜氏利什曼原虫无鞭毛体。结论循证临床实践可以快速而准确地解决临床问题。     

The child who will not sleep

Sleep problems affect up to 40% of children in the first eight years of life. Most problems are behavioural in origin (eg refusing to go to sleep or waking frequently during the night) and as such are often amenable to behavioural interventions. Behavioural interventions such as graduated extinction (controlled crying) and adult fading (camping out) have been shown to be effective and acceptable to parents. Interventions should be tailored to individual families and address family’s goals. Most families will benefit from a discussion about good ‘sleep hygiene’ that is setting and maintaining a constant bedtime, ensuring bedrooms are a media free zone, and avoiding caffeinated drinks and foods after 3pm. Sleep diaries are a useful adjunct to clarify sleep problems and response to management. Medication has a limited role in management of sleep problems as effects are usually short-term and side effects can occur. Currently, there is no evidence that behavioural sleep interventions cause any long-term harm to children.     

以双肾肿大为首发症状的急性淋巴细胞白血病一例

患儿男 ,5岁。因反复发热 4 0余天 ,进行性全身浮肿、腹胀伴面色苍白 2周入院。患儿开始无明显诱因出现发热 ,体温最高达 38 5℃ ,热型不规则 ,无寒战 ,伴轻微咳嗽 ,在当地医院以“上呼吸道感染”给予抗感染治疗 (具体不详 ) ,效果不佳 ,仍反复发热。 2周前自双睑开始逐渐出现全身水肿、腹胀、面色苍白 ,伴有气促等表现。查血常规示 :白细胞18 8× 10 9/L ,中性粒细胞 0 5 4 ,血红蛋白 86g/L ;血沉 5 0mm/ 1h ;补体C3 、C4正常 ;尿常规示 :蛋白 ( ) ,红细胞 ( ) ;胸部X线摄片正常 ;腹部B超示 :双肾增大、肿胀 ,肝、胆、脾、胰、膀胱未见…