Pathological Evaluation of Renal Tumors in Children: International Society of Pediatric Oncology Approach

In the majority of European countries, children with renal tumors now enter the SIOP-93-01 Trial and Study. The objective of this Study is to refine methods of treatment especialy in stage I patients. The role of institutional pathologists is important in this trial. There are new criteria for stages I and II, a new SIOP Working Classification of Renal Tumors of Childhood, and morphologic and prognostic similarities of pretreated and non-pretreated anaplastic cases. Specific problems encountered in assessing tumors treated with preoperative chemotherapy, administered to the majority of children over 6 months of age entering the SIOP Study, are discussed. The identification of a new low-risk group, the completely necrotic Wilms tumor, is outlined. Received October 10, 1997; accepted October 27, 1997.     

炎症性肠病24例

目的 总结儿童炎症性肠病(IBD)的临床特点和诊疗经验,提高儿童IBD的诊疗水平.方法 参照2001年中华医学会消化病学会制定的标准,2000年12月-2010年12月重庆医科大学附属儿童医院共确诊IBD患儿24例,通过调阅病例、随访获取资料,并对24例IBD患儿的临床、实验室检查、影像学、内窥镜、组织病理学检查,按照Sutherland指数和Harvey和Bradshow标准疾病活动性评分结果进行回顾性分析.结果 IBD 24例中溃疡性结肠炎(UC)组16例,克罗恩病(CD)组8例;男童略多于女童;IBD主要肠道表现有腹痛、腹泻、便血,主要肠外表现有发热、贫血、关节痛／炎、消瘦、生长发育迟缓;UC组与CD组临床表现差异无统计学意义,仅便血症状UC组占优势.病变侵犯部位:UC病变主要侵犯左半结肠(P =0.027);CD病变可侵犯全消化道任何部位,以回盲部及其周围肠管(P =0.002)和上消化道(P =0.028)受累最为多见.经过积极治疗IBD患儿疾病活动度显著下降,其中英夫利昔单抗对常规治疗无效的UC患儿可迅速控制临床症状.结论 儿童IBD的诊断需要对临床、实验室检查、影像学、内窥镜检查及组织病理学检查综合分析,尤其结肠镜和组织病理学检查.儿童IBD积极治疗仍可获得显著疗效.     

The Evaluation of Suspected Pediatric Sexual Abuse

Children with suspected sexual abuse often present to the ED, not infrequently like those in the 2 cases described. Most children who are sexually abused have normal genital examinations, which should be explained in discussions with caretakers and investigators. Interviewing of the child should be avoided by the physician, except to establish current symptoms that may impact examination or testing. Exams should not be forced on children. The hymen is extremely sensitive in the unestrogenized female and should not be touched. Speculum examination is never performed in the prepubertal child, except under anesthesia by a practitioner experienced in child sexual abuse evaluation or gynecology. Examination under anesthesia by a physician experienced in surgical repair is indicated with active vaginal or rectal bleeding. In cases in which the examination is abnormal or inadequate, the subspecialist should be consulted. Patients with contact less than 72 hours before presentation may need forensic evidence collection, which should be coordinated with the subspecialist. Prepubertal females with vaginal discharge seen on examination should have testing sent not only for STDs, but also for non-STD etiologies including group A streptococcus and enterics. Postexposure prophylaxis (pregnancy, STD, HIV) should be considered when appropriate. There are many conditions that may be mistaken for sexual abuse. Detailed documentation of the history and the physical examination (written, drawings, and ideally photographs) is essential.     

恶性实体瘤110例

目的探讨小儿恶性实体瘤的临床特点、治疗措施和预后。方法收集本院住院治疗的小儿恶性实体瘤110例。病例均经病理证实。男64例,女46例。患儿常规进行B超检查、病理检查、增强CT扫描、螺旋CT、MRI,根据情况进行免疫组织化学检查及全身骨扫描等检查,以指导治疗及预后。结果 110例中肾母细胞瘤26例,恶性淋巴瘤26例(非霍奇金淋巴瘤20例,霍奇金淋巴瘤6例),肝母细胞瘤17例,生殖细胞瘤、横纹肌肉瘤各10例,神经母细胞瘤8例,视网膜母细胞瘤6例,畸胎瘤3例,髓母细胞瘤、骨肉瘤各2例,本组总体治愈率为58.18%。结论采取手术、化疗、放疗等综合治疗小儿恶性实体瘤的生存率有很大提高,但由于小儿恶性肿瘤发病比较隐匿,确诊一般都到晚期,小儿实体肿瘤仍是儿童死亡的主要原因之一。     

小儿血尿的评价

血尿是小儿时期最常见的泌尿症状之一,包括肉眼和镜下血尿。小儿血尿的病因复杂,主要分为肾小球性和非肾小球性血尿两大类,其检查方法多样。本文就小儿血尿的评价方法及小儿血尿的诊断流程进行综述,尽可能做到明确病因、合理治疗、避免不必要且昂贵、有创的检查,避免乱用药物。     

Content and Construct Validity of a Spanish Translation of the Pediatric Evaluation of Disability Inventory for Children Living in Puerto Rico

Although Puerto Rican children with disabilities are at high risk for poor developmental outcomes, no standardized measures are validated for use with these children. In this study, we evaluated the content and construct validity of a Spanish translation of the Pediatric Evaluation of Disability Inventory (PEDI) for use with children livingin Puerto Rico. Methods included expert content review, surveys of parents, and the evaluation of 44 children with and without disabilities, who were matched for socio-economic status, age, and gender. The results demonstrated that the translated version of the PEDIis valid; yet additional research is warranted to identify socio-cultural influences on the performance and capability of typically developing Puerto Rican children.     

小儿心跳呼吸骤停特点与儿科高级生命支持

从1956年首次除颤器的应用,到1960年Kouwenhoveu等公布胸外按压是恢复心跳骤停患者的有效方法,现代心肺复苏(CPR)技术开始形成,1966年全美复苏会议对CPR技术标准化,1974年制定CPR指南,多次修订再版,最新CPR指南于2005年公布,是一个全球性的国际CPR指南。一、小儿心跳呼吸骤停的     

儿童心肺复苏术的研究状况和对比

心肺复苏指南自1974年制定以来,多次修订改进。2005年心肺复苏和心血管病急诊科学治疗建议国际会议的召开,对心肺复苏指南再次进行了修订,并利用循证程序就心肺复苏的治疗推荐方案达成了一致性意见。本文主要对心肺复苏的程序进行简略介绍,并对历年的心肺复苏指南作以简单比较。     

小儿实体肿瘤233例

目的探讨小儿实体肿瘤治疗措施及预后。方法收集小儿实体肿瘤233例。男117例,女116例。良性肿瘤142例,恶性肿瘤91例。患儿术前常规进行B超检查,根据情况行增强CT扫描、螺旋CT的三维立体成像技术,以指导治疗及预后。结果良性肿瘤142例均采取Ⅰ期手术切除。恶性肿瘤91例中,76例手术完整切除,处理黏连、包埋于肿瘤内的腔静脉、腹主动脉,作血管吻合2例;13例无法Ⅰ期切除的患儿,则行术前化疗后再手术切除。2例腹部霍奇金病因广泛浸润小肠及结肠,无法手术切除,仅作肿瘤活检术。结论早期诊断、综合治疗是儿童肿瘤诊治的基本原则。手术是否扩大根治范围及化疗剂量的选择均应根据儿童对治疗的耐受程度而定。     

Acute Poisoning in Children; Data of a Pediatric Emergency Unit

Objective

Acute Poisoning in children is still an important public health problem and represents a frequent cause of admission in emergency units. The epidemiological surveillance specific for each country is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken.

Methods

The present retrospective study describes the epidemiology of accidental and suicidal poisonings in a pediatric population admitted to the Pediatric Emergency Department of Eskisehir Osmangazi University Hospital during the year 2009.

Findings

Two hundred eighteen children were reffered to the emergency department due to acute poisoning. 48.4% of patients were boys and 51.6% were girls. The majority of cases were due to accidental poisoning (73.3% of all patients). Drugs were the most common agent causing the poisoning (48.3%), followed by ingestion of corrosive substance (23.1%) and carbon monoxide (CO) intoxication (12.5%). Tricyclic antidepressant was the most common drug (11.7%). Methylphenidate poisoning, the second common drug. 262 patients were discharged from hospital within 48 hours.

Conclusion

Preventable accidental poisonings are still a significant cause of morbidity among children in developing countries. Drugs and corrosive agents are the most frequent agents causing poisoning.     

Pulmonary Evaluation in Pediatric Liver Transplant Candidates

Objective  

Liver transplantation (LT) maybe complicated by pulmonary problems. This study aimed to evaluate pulmonary function and gas exchange abnormalities in pediatric patients listing for LT.     

Concurrent Validity of the School Outcomes Measure (SOM) and Pediatric Evaluation of Disability Inventory (PEDI) in Preschool-Age Children

ABSTRACT

Aims: The purpose of this study was to examine the concurrent validity of the School Outcomes Measure (SOM) compared with the Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children. This study also examined the consistency of children's motor performance across the home and school settings. Methods: Five school-based physical therapists collected data on 44 preschool-age children with physical or combined physical and cognitive disability. Correlation coefficients analyzed the strength of association between SOM and PEDI subscale scores, while participant group mean scores analyzed agreement between measures regarding level of motor performance. Results: Correlations between homologous PEDI and SOM subscale scores varied from r_s = .53 to r_s = .92 supporting concurrent validity. With some exceptions, group mean SOM scores showed agreement with group mean PEDI scores when children were categorized by age, gross motor function level, or PEDI cutoff score (1 or 2 SD below the mean). Conclusions: The results partially support concurrent validity between the SOM and PEDI, and suggest that the children's motor performance was similar across home and school settings. The findings also suggest that as a minimal database the SOM can reliably assess motor performance in the school setting; the disadvantage is difficulty interpreting SOM scores.