Current concepts in pediatric liver tumors

Liver tumors in children can be classified into benign or malignant; some of the benign lesions can have the potential of malignant transformation, and therefore the therapeutic approach may change. These neoplasms account for nearly 1-2% of all pediatric tumors and they have gained significant attention in the last decades due to data suggesting that the incidence may be increasing 5% annually. We know that with new and improved imaging modalities some of these lesions may be detected more often than before. Recent studies showed that liver cancer represented 2% of malignancies in infants by 1980s and this was doubled in incidence to 4% in the following 10 yr. In this review our aim is to discuss all primary liver tumors in children with attention to their clinicopathological and immunohistochemical features followed by the current standard of care.     

Management of pediatric migraine: Current concepts and controversies

Migraine in children and adolescents is a common condition. Emerging knowledge about the pathophysiology of migraine is leading to new targeted treatments toward specific mechanisms of migraine. This review explores the evidence for different treatments for pediatric migraine including the periodic syndromes of childhood that commonly represent precursors to migraine.     

Current concepts in the acute management of severe pediatric head trauma

Head injuries are a substantial problem in children. These injuries can be the result of intentional or unintentional trauma. Traumatic brain injury can range from focal lacerations and contusions to diffuse axonal injury with intracranial hypertension. Brain injury can he either primary or secondary in nature. Primary brain injury occurs at the time of injury and, although preventable, is not treatable. Secondary injury occurs from insults that occur after the injury event such as hypotension, hypoxia, and/or intracranial hypertension. The outcome of children with traurmatic brain injury can be improved by preventing or minimizing these secondary injuries. For emergency medicine physicians, the cornerstones of management are early recognition and treatment of these secondary injuries. This article reviews current principles in the management of pediatric traumatic braid injury.     

Current concepts in pediatric burn care: surgery of severe burns.

Optimal surgical therapy of severe burns in children has been controversial for a long time. A review of the current literature shows that prompt surgical excision of necrotic tissue and immediate autografting have become the standard in most burn centers. The authors present a concept based on prompt excision of third degree burns and discuss the problems of intermediate cover arising in massive burns.     

Current concepts on interstitial lung disease in children.

Pediatric interstitial lung disease comprises a diverse group of rare conditions characterized by an infiltrative process, abnormal gas exchange, and restrictive lung disease. Although the disorder is similar to its adult counterpart, its course is complicated by the continued need for lung growth and differentiation in infants and children. Knowledge about the pathogenesis, prognosis, and treatment of pediatric interstitial lung disease is limited. Investigators are focusing on defining the cellular mediators of the interstitial damage and describing the role of viral infections in and possible genetic predisposition to interstitial lung disease. Clinicians continue to define the various types of interstitial lung disease and to evaluate the roles of bronchoalveolar lavage, radiography, and biopsy in diagnosis. Together, investigators are working toward the development of specific, targeted therapy that will reduce the significant morbidity and mortality seen in pediatric interstitial lung disease.     

Bisphosphonate treatment of pediatric bone disease

The science of measuring bone mineral density has developed rapidly and, with it, an improved understanding of the efficacy and safety of various therapeutic interventions in adults. In contrast, the meaning and precision of such measurements in children are equivocal, and the concept of treatment for low bone density in the young patient is still largely undecided. In this report we review the present state of knowledge regarding the use of bisphosphonates during childhood to ameliorate the skeletal abnormalities associated with osteogenesis imperfecta, idiopathic juvenile osteoporosis, fibrous dysplasia of bone and cerebral palsy. Because of the paucity of long-term studies among children regarding the safety and efficacy of these drugs, it is difficult to formulate strong evidence-based recommendations for their use, except perhaps in children with osteogenesis imperfecta.     

Current concepts in pediatric burn care: general management of severe burns.

Severe burns and scalds are still frequent. If the burn victim is a child, it should ideally be taken care of in a pediatric burn center, where both the burn and child-related needs are specifically met. The goals of burn care are to preserve life, to preserve function, to limit physical and psychological sequelae and to provide social reintegration. The system of burn care essentially consists of adequate initial resuscitation followed by early surgery aimed at rapid and definitive wound closure. Vigorous nutritional support as well as early rehabilitation and continuous psychosocial care are of paramount importance. The paper summarizes the essentials of pediatric burn care (burn surgery excluded).     

Current concepts of respiratory complications of neuromuscular disease in children

Chronic neuromuscular diseases affect the respiratory muscles in varying patterns and degrees. As a result, patients with these disorders develop restrictive pulmonary disease, ineffective cough, atelectasis and pneumonia, and chronic respiratory insufficiency leading to respiratory failure. Therapeutic strategies are evolving to augment cough and airway clearance, improve lung volumes, and support the patient with progressive ventilatory failure. These techniques have improved longevity and quality of life for many patients with neuromuscular disease.     

New concepts in pediatric rhinitis

Rhinitis—and especially allergic rhinitis (AR)—remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.     

Current management of pediatric inflammatory bowel disease

Inflammatory bowel disease (IBD) is a relatively rare condition of childhood, although the wide range of presenting complaints, scope of complications, and choices of therapy for this condition make it particularly difficult to treat in children. Novel approaches to the management of Crohn's disease and ulcerative colitis have gained recent favor. This report summarizes the current medical and surgical management of IBD, recent advancements in clinical therapies, and particular aspects of IBD care for children.     

Current concepts in radiologic assessment of pediatric brain tumors during treatment,part 1

Pediatric Radiology - Pediatric brain tumors differ from those in adults by location, phenotype and genotype. In addition, they show dissimilar imaging characteristics before and after treatment....     

Current concepts in adolescent smoking

This review discusses important research findings regarding adolescent tobacco use reported from April 1999 to March 2000. Although the vast majority of adult smokers began before 1 8 years of age, a significant number of college students seem to be initiating smoking behaviors. Recent literature reviews pointed to cultural as well as neurochemical factors that lead to increased tobacco consumption while creating barriers to quitting. Psychosocial and behavioral correlates of cigarette smoking revealed the role that tobacco use plays in coping with cultural, social, and intrapsychic demands. In addition to understanding why and how adolescents initiate and maintain cigarette smoking, recent studies also attempted to uncover the correlates of quitting behavior. However, recent reports of school-based intervention trials revealed that reproducible, long-term success rates may not be achievable with a single program or approach. Finally, several recent studies explored the role that health care providers play in prevention and intervention, as well as the pitfalls of well-meaning office interventions.     

Current concepts in pediatric burn care: the biology of cultured epithelial autografts: an eight-year study in pediatric burn patients.

An 8-year histopathological study of skin regeneration and wound healing in 22 pediatric patients treated with cultured epithelial autografts (CEA) grafted to full-thickness burn wounds excised to muscle fascia is reported. Biopsies of CEA have been analyzed by light microscopic, immunohistochemical, morphometric, electron microscopic and ultrastructural immunolabelling techniques and compared to controls of meshed split-thickness autograft (MSTA) interstices at comparable times postgrafting. At transplantation, CEA are undifferentiated and lack both granular and cornified cell layers. By 6 days postgrafting, CEA differentiate all normal epidermal strata but lack rete ridges. De novo formation of a confluent basal lamina and mature hemidesmosomes is complete by about 3 weeks. Anchoring fibrils appear sparse and immature (as in MSTA controls) compared to normal skin until about 6-12 months. CEA develop rete ridges and a neodermis with normal stromal and vascular organization at about 6-12 months, whereas MSTA interstice controls do not. At 4-5 years, elastin expression is also observed in the CEA neodermis, completing the dermal regeneration process. Normal epidermal differentiation is maintained long-term. These long-term results indicate that CEA regenerate a stable normal epidermis and are capable of inducing dermal regeneration from wound bed connective tissue.     

Current concepts in pediatric burn care: management of burn wounds with cultured epidermal autografts.

Our experience with CEA is based on 21 patients operated on from 1986 to 1991. The areas covered with CEA measured 500 cm2 to 3160 cm2. At one setting no more than 40 sheets of 40 cm2 CEA have been transplanted. The take of CEA is over 75% when applied to dermis. The same holds true when covering "deepithelialised" skin homografts on immunosuppressed patients. Scar formation has not been a problem, and the overall results have been good.