Clinical aspects and treatment of pain in children and adolescents with cancer

BACKGROUND: The aim of this study was to characterize the clinical aspects and the treatment of mild to severe pain in Brazilian children and adolescents with cancer. We evaluated the importance of classifying patients according to the phase of cancer treatment (diagnosis, treatment, recurrence, and end-of-life palliative care) and the opioid-related side effects. METHODS: An institutional prospective study of 184 episodes of pain in children and adolescents with cancer was conducted. Pain was classified according to its cause, physiopathology and intensity. Treatment was based on the WHO guidelines for cancer pain relief. RESULTS: Pain scales were completed by 77% of the patients. Numerical scales were used by 49% of them. Morphine was given in 111 episodes for 2,758 patient days. Morphine doses had to be escalated when it was given to patients during end-of-life palliative care. Opioids were well tolerated with no severe side effects. Psychological dependence on morphine was found in 2% (2/111) of the cases. Pain control was satisfactory in 97% of the episodes. CONCLUSIONS: The WHO guidelines for cancer pain relief were effective in controlling pain in children and adolescents with cancer. Despite their low socioeconomic level, patients were able to quantify their pain using rating scales.     

Psychological aspects in children and adolescents with hypopituitarism

Psychological studies in children with stunted growth have partly shown inconsistent results due to heterogeneity of samples and the use of non-standardized test procedures. We have examined patients with proven hypopituitarism using a selection of standardized and age-related psychological tests. Forty-eight patients, 32 male, 16 female, age 6 to 26 years with isolated growth hormone deficiency (n = 22) and multiple pituitary deficiencies (n = 26) were investigated. The patients had had hormonal substitution therapy for 0.1-16.8 years. Test procedures included evaluation of intelligence and various personality parameters. Full score IQ was in the average range. Despite these findings a high percentage of patients had delayed schooling or had to repeat a class. They were normal regarding emotional balance and frustration tolerance and did not show any tendency towards depression or psychosomatic disorders. Social behavior was characterized by an infantile attitude toward their personal environment. The patients showed a tendency to avoid aggressiveness in frustrating situations. In contrast to the results of these tests, a non-standarized interview demonstrated that the majority of patients had serious problems because of their short stature, including difficulties in finding social contacts. Continuous medical and psychological guidance is therefore recommended.     

Anorexia nervosa in adolescents. Clinical aspects of the diagnosis and a follow-up

In a brief review of the literature, the diagnostic, prognostic and therapeutic criteria of anorexia nervosa in adolescence are considered. An interdisciplinary approach (child neuropsychiatrists, clinical psychologists, auxological pediatricians) was adopted in 52 cases with a diagnosis of anorexia nervosa (46 females, 6 males; mean age 14). The results of the analysis of somatic disturbances (weight loss, anomalous sexual maturation), psychological aspects (cognitive level, organization of the personality), environmental implications (familial, social and school adjustment; mother-child relationship; pedagogic modalities; social and economic factors) are reported. The data from a follow-up of 29 patients (26 females, 3 males; mean age 19) are reported, and the degree of recovery assessed as follows: 1) clinical recovery at somatic-adjustment level (79% complete, 17% with atypical characteristics); 2) achievement of a harmonic organization of the personality (48%). The paper concludes with some remarks on the treatment, prognosis and prospects for prevention of the condition.     

Clinical symptoms in 35 children and adolescents with craniopharyngeoma at the time of diagnosis

AIM: Hormonal deficiencies, visual disturbances, or cerebral symptoms are often the symptoms through which craniopharyngiomas (CP) first become clinically manifest. As these symptoms can exist for a long period of time various specialists are often consulted before the final diagnosis is made. PATIENTS AND METHODS: Between the years 1970 and 1998, 37 children and adolescents with CP were treated in Erlangen. The documents of 35 patients (22 male, 13 female) were evaluated retrospectively. RESULTS: The median age of the children at diagnosis was 9,3 years (1,3 - 15,6 years). The most frequently documented symptoms were: headache 57 % (median duration 7 months; varying from 1 week to 6 years), visual disturbances 45 % (median duration 2 months, range 2 weeks to 10 years), and reduced growth 40 % (median duration 1 year, range 3 months to 5 years). On average the reported symptoms were present for 15 months (median 5 months, time span 1 week to 10 years). CONCLUSION: The clinical symptoms of CP are non-specific and highly varied. Endocrine disturbances are the primary objective finding. Correct interpretation of the symptoms are required for the early diagnosis of CP.     

Psycho-social aspects of children and adolescents with diabetes

The diagnosis of diabetes mellitus, a life-long disease with many possible complications, has a dramatic impact upon the entire family, precipitating a state of “shock”. The psychological problems in diabetes should be divided in 3 periods : at diagnosis (other diseases or tension existing in the family and not related to diabetes, socio-economic state); initial adaptation period (acceptance to be “different”, adjustment to rules of control such as daily injection of insulin, self blood glucose monitoring or urine testing, changing of nutritional habits, etc.), and long term coping (self-image, family dynamics, social activities, school achievements, vocational rehabilitation and continuing compliance. Counselling of the psychological problems is an ongoing need and is best delivered when the treating team included psychologists and social workers     

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??Objective??To explore the value of clinical manifestations and routine examinations for the diagnosis of intrathoracic tuberculosis in children. Methods??The medical records of children under 16 years of age due to intrathoracic diseases in Shanghai Pulmonary Hospital affiliated to Tongji University School of Medicine from January 2009 to December 2011 were collected. According to the final diagnosis??the patients were divided into 2 groups??intrathoracic tuberculosis and non tuberculosis. The clinical manifestations and routine auxiliary examination results of the 2 groups were retrospectively analyzed. The children were divided according to age??10 years and over 10 years old in 2 groups??and the clinical data were also compared. Results????1??Pathological diagnoses were confirmed at 72.30% of proportion at whole patients??70.73% in TB group. The positive rate of tuberculosis bacteriology was 21.85% in TB group. ??2??The middle course of history accounted for 56.30% in TB children. At the onset of illess??the proportion of fever and predisposition to tuberculosis??positivity of tuberculin skin test??TST?? and serumal tuberculosis antibody??and average value of ESR??CRP??PLT and D-Dier in blood were significantly higher in TB group than those in non-TB group. ??3??About 59% of patients in the non-TB group were cured or were markedly improved by antibiotic treatment??which was effective in 10% of the TB group. ??4??Diagnostic accordance rate by radiology was 53.36% and the rate of misdiagnosis as tuberculosis accounted for 11.71% in non-TB group. Conclusion??Clinical features combined with medical history and laboratory results are helpful for the identification of tuberculosis in children under 16 years old.     

Psychosocial aspects of compliance in children and adolescents with asthma

Thirty-eight children and adolescents (ages 7-17 years) with chronic asthma were evaluated on three measures of psychosocial and family adjustment. The children's average theophylline level and percentage of noncompliant theophylline levels (theophylline level less than 5 mg/dl) were correlated with behavior problems, perceived self-competence in controlling their conduct, general feelings of self-worth, and family climate (cohesiveness vs. conflict; level of family organization and control). Regression analyses indicated that a combination of psychological adjustment, degree of family conflict versus cohesiveness, and the interaction of these two variables were predictive of compliance as measured by mean theophylline levels. Only psychological adjustment was associated with percent of noncompliant theophylline levels. Measures of self-worth, self-competence in controlling conduct, and family organization were not related to medication compliance measures.     

Low-intensity fetal lungs on MRI may suggest the diagnosis of pulmonary hypoplasia

Background: Pulmonary hypoplasia is a common cause of neonatal death. Despite the recent advances in prenatal diagnosis with US, the diagnosis of pulmonary hypoplasia is difficult. The recent application of fast MR imaging may provide additional valuable information. Objective: To evaluate pulmonary hypoplasia in the fetus with MRI. Materials and methods: The subjects comprised 23 fetuses (18–40 weeks' gestation), including major anomalies diagnosed on fetal ultrasonography (n = 20), maternal abnormality (n = 2) and one normal twin. MRI was performed with a 1.5-T magnet and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. MR images were interpreted by three radiologists with special attention to the intensity of the lungs. The lung-to-liver intensity ratio was calculated by means of region-of-interest (ROI) analysis. The diagnosis of pulmonary hypoplasia depended on clinical, surgical and autopsy findings. Results: All fetuses with normal pulmonary development showed high intensity in the lung except for one fetus at 24 weeks' gestational age. All fetuses with pulmonary hypoplasia showed lung of low intensity. Conclusions: Low-intensity fetal lung on MRI imaging indicates pulmonary hypoplasia after 26 weeks' gestation. Received: 10 January 2000 Revised: 28 June 2000 Accepted: 6 March 2001