Chronische Kopf-, Bauch- oder Gelenkschmerzen

Headache

In chronic headaches, targeted drug therapy of migraine attacks and the multimodal treatment of tension headaches are important.

Abdominal pain

Functional gastrointestinal disorders are the predominant cause of chronic abdominal pain and a multimodal treatment approach should be performed early.

Musculoskeletal pain

In addition to primary chronic musculoskeletal pain also secondary pain disorders can be observed in a large number of congenital and acquired diseases. Even in these cases, multimodal pain treatment has proven to be the method of choice.

Multimodal pain treatment

The principles and treatment modules of this approach are presented systematically. Treatment has the following objectives: increase in exercise capacity, reduction of pain perception, improving control and empowerment experiences, reestablishing normal structures in daily life and social contacts.     

Sprachentwicklungsdiagnostik bei Mehrsprachigkeit

Background

In Germany the linguistic abilities and skills of children are assessed on a regular basis in pediatric examinations. Because of time limitations this examination is highly selective and does not always reflect the current state of language acquisition research.

Additional problem in multilingualism

In the case of bilingual children to date almost no instruments are available which are capable of reliably differentiating typically developing second language learners of German from language impaired children.

Diagnostic options in multilingualism

In this article the central problems in the assessment of young bilingual children are summarized and the test LiSe-DaZ® (linguistic assessment of language development for German as a second language) is introduced which measures children’s development in core grammatical areas and which takes into account the age of first exposure and the duration of exposure to the target language. In addition, results are reported from a study examining how pediatricians deal with diagnostic challenges. It is argued that the diagnosis of language impairment in bilingual children requires a standardized assessment of central grammatical properties and that this can in principle be accomplished without testing the first language.     

Meningitis bei Diphtherie

Ohne Zusammenfassung     

Indicanurie bei Neugeborenen

Ohne Zusammenfassung     

Antiepileptika bei Kindern

More than 20 approved substances are currently available for the treatment of epilepsy, doubling the number of antiepileptics (AE) available 20?years ago. However, not all AE have been tested and approved for use in children. These drugs are not infrequently used in the context of individual treatment approaches as a back-up in particularly challenging cases. Of the new AE approved for use in children, four substances have become established: (sustained release) oxcarbazepine, lamotrigine, levetiracetam and topiramate. Two drugs with special??orphan drug?? status are additionally available. Although used less frequently other drugs, their use in patients with Lennox-Gastaut or Dravet syndrome is interesting and significantly more effective. A prerequisite of the successful use of both old and new AE is a thorough knowledge of the spectrum of their effectiveness and side effects, including their interaction potential. The present article discusses the particular features of the six AE mentioned here.     

Epilepsie bei Kindern

Ohne ZusammenfassungMit 6 Textabbildungen.Nach einem Vortrag, gehalten auf dem II. Internationalen Pädiaterkongreß. Stockholm 1930.     

Mongolismus bei Zwillingskindern

Ohne ZusammenfassungMit 2 Textabbildungen.     

Spontanpneumothorax bei Neugeborenen

Ohne Zusammenfassung     

Kopfschmerzbehandlung bei Kindern

Die Diagnostik kindlicher Kopfschmerzen stellt in der kinder?rztlichen Praxis kein besonderes Problem dar. Dies gilt v. a. für den Ausschluss organischer Ursachen und die Behandlung symptomatischer Kopfschmerzen. Dagegen bereitet die Kopfschmerztherapie weiterhin Schwierigkeiten. Der Zuwachs an Erkenntnissen in den letzten Jahren [2, 22] erlaubt inzwischen jedoch auch diesbezüglich bei Kindern Perspektiven für eine pragmatische Behandlung. Dieser Beitrag wurde erstmals in leicht abweichender Form publiziert in “Der Schmerz”,Ausgabe 04/2001 Dr.R.Pothmann Neurop?diatrisches Zentrum und Schmerzambulanz,Virchowstr. 20, 46047 Oberhausen     

Nierenbeteiligung bei Systemerkrankungen

The most important systemic disorders involving the kidney are systemic lupus erythematosus (SLE) and systemic vasculitis. The kidney is a critical organ for the outcome of the diseases. Early diagnosis and adequate therapy may reverse or even heal glomerulonephritis and kidney vasculitis. This contribution is restricted to SLE, the ANCA-associated forms of vasculitis, and the classic Periarteriitis nodosa. Depending on the size of involved vessels, different forms of glomerulonephritis (small vessel disease) or necroses (medium-sized vessel disease) are noted. All diseases mentioned need aggressive immune suppressive therapy (induction with glucocorticoid steroids and cyclophosphamide). In SLE, this is indicated mainly for diffuse proliferative glomerulonephritis (type IV), very severe forms of focal-proliferative glomerulonephritis (type III), and membranous glomerulonephritis (type V). To avoid toxicity, cyclophosphamide should be substituted by azathioprine or mycophenolate mofetil as early as possible. This can be performed for ANCA-associated forms of vasculitis 3–6 months after the start of therapy as was shown in randomized studies, whereas such studies are missing for SLE.     

Hautblutungen bei Kindern

Bruises in children are commonly seen and mainly caused by minor injury. However, they might be the first sign of a coagulopathy. Therefore, it is necessary to distinguish between normal bruises and relevant bleeding symptoms. Apart from the clinical examination, a detailed, standardized history of both the child and its family is mandatory. If a bleeding disorder is suspected, extended coagulation tests are necessary, because conventional screening tests (activated partial thromboplastin time (aPTT) and Quick) cannot exclude common disorders like von Willebrand disease. In the following contribution, the necessary diagnostic procedures with an emphasis on relatively common disorders are described.     

Skelettbefall bei Langerhanszellhistiozytose

Langerhans cell histiocytosis is a reactive disorder of the dendritic cell system and is characterized by proliferation of cells bearing the phenotype of the normal Langerhans cells. Bone lesions are the most common manifestation of LCH and account for about 1% of all childhood bone tumors. They occur in about 80% of paediatric cases of LCH, either in the form of isolated bony disease (single system LCH) or within the context of a multisystem disease (multisystem LCH). Images of LCH bone lesions are not pathognomonic, and histopathological confirmation of the diagnosis is therefore mandatory. LCH confined to the skeleton has an excellent prognosis, and only local treatment (curettage, intralesional steroids) is given in most cases. In cases of extended lesions in weight-bearing bones or of multiple bone lesions systemic therapy may be indicated.     

Kontrazeption bei Jugendlichen

Counseling adolescents on contraception is fundamentally different from counseling adults. On the one hand teenagers are uncertain or even ignorant about their first sexual experiences and on the other hand they find it hard to discuss the problem with doctors and to seek their advice. When counseling adolescents doctors should aim at informing them thoroughly about contraception and explaining all the methods of contraception in order to avoid unwanted teenage pregnancies or induced abortions, which could have far-reaching implications for their further life. To avoid teenage pregnancy a combination of hormonal contraception and condoms is the best method at hand. It allows a high level of safety as well as protection from sexually transmitted diseases which occur frequently in this age group. First of all, a precise patient report as to contraindications and interactions must be carried out including information on side-effects and risks, in particular the risk of thromboembolism.     

Beobachtungen bei Cystinspeicherkrankheit

Schlußfolgerungen und Zusammenfassung Es wird von einem 11 Monate alten Kind berichtet, bei welchem eine Erkrankung der Harnwege mit Zwergwuchs, Rachitis, Aminoacidurie und Kristallablagerungen in Knochenmark und Conjunctiva nachgewiesen wurde. Erblichkeit, Blutsverwandtschaft der Eltern zeigen die Wirkung des Cystin-Gen in der Familie des Kindes, in welcher eine Cystin-Diathese bereits zu unerkannten Störungen führte, bevor sich bei der Patientin nach dem Auftreten einer entzündlichen Erkrankung der Harnwege in früher Kindheit die voll ausgebildete Cystinkrankheit manifistierte. Im Urin wurden Aminosäuren vermehrt ausgeschieden, ferner gebundenes Cystin, freies Cystin jedoch nicht. Im Blut hingegen war gebundenes Cystin zweifelsfrei auf das Doppelte vermehrt, während eine Vermehrung von freiem Cystin nicht nachweisbar war. Von den freien Aminosäuren wurden diejenigen im Serum vermehrt angetrffen, die auch im Urin vermehrt ausgeschieden wurden. Mithin würde unser Fall nach Fanconis hypothetischer Einteilung die metabolische Form der Aminoacidurie repräsentieren. Darüber hinaus fordert er zu der Deutung auf, daß überhaupt die metabolische Komponente bei der Entstehung der Krankheit vor der renalen rangiert, womit wir den Anschauungen von Bickel, Freudenberg, Linneweh und Ullrich beipflichten. Die abnorme Anhäufung von Cystin in den Geweben und im Blut steht im Vordergrund. In den Geweben wurde außer Cystin noch ein anderer, kristallographisch unterscheidbarer Stoff nachgewiesen.     

Bronchoskopie bei Kindern

Pediatric bronchoscopy is a valuable diagnostic and therapeutic tool in the hands of experienced physicians, in particular pediatric pulmonologist and in anesthesia and pediatric intensive care. A large body of publications exists with regard to the indications, results, safety, side effects and sedation or anesthesia for this procedure; however, as for many other long-established diagnostic and therapeutic techniques, no prospective controlled studies in the sense of evidence-based medicine are available for many practical aspects of the technical details of this procedure. This is unlikely to change in the future as such studies for well-established techniques are difficult to envision for many reasons (e.g. ethical, parental acceptance and financing). It is therefore the aim of this paper to summarize the current knowledge and report a consensus by experts in the field regarding rational indications and safe technical performance of pediatric bronchoscopy.     

Schmerzreduktion bei Impfungen

Monatsschrift Kinderheilkunde - Impfungen sind in jedem Lebensalter mit Schmerzen und Stress verbunden. Die Umstände beim Impfen und die Erinnerungen daran können die Einstellungen...