Multiple personality disorder: a risk indicator, diagnostic marker and psychiatric outcome for severe child abuse

Recent studies suggest that multiple personality disorder (MPD) is not as rare as previously believed. Indeed, it may represent a relatively common (as many as 25% of cases) outcome of severe physical and sexual abuse of children. Because diagnosis and treatment offer the best prognosis, it is important for the pediatric clinician to become familiar with both the at risk situations (such as cult practices and multigenerational sexual abuse) as well as the more unusual behavioral presentations of this disorder.     

Pediatric hypertension: recent literature

This article reviews selected recent literature specifically concerning pediatric hypertension, much of which has focused on measurement and monitoring of blood pressure, as well as on evaluating antihypertensive medications. Normative data for blood pressure in children have been widely available for some time, based upon seated in-office measurements. In recent years, ambulatory blood pressure monitoring (ABPM), facilitated by user-friendly instrumentation, has become more commonplace, though norms are not based on large populations. However, ABPM has important uses in assessing blood pressure as well as in monitoring antihypertensive. This review discusses issues involved in determining blood pressure, as well as the utility of ABPM in several situations. Recent developments concerning pediatric antihypertensive therapy are considered, as well as new information relevant to the diagnosis, course and treatment of hypertension in children and adolescents.     

Efficacy and safety of oral poliovirus vaccine and inactivated poliovirus vaccine.

Inactivated poliovirus vaccine (IPV) is the vaccine of choice for protection against paralytic poliomyelitis provided that it is used within the context of a program to increase and sustain the level of uptake to as close to 100% as possible. This means targeting the disadvantaged in society as well as those who have their own pediatrician. The reasons are that enhanced-potency killed polio vaccine is safe, whereas oral poliovirus vaccine (OPV) is associated with a low, but definite, risk of paralysis, especially after the first dose. The immunity, as measured by antibody concentrations, is at least as good as and, in some circumstances, such as in the tropics or for booster doses, better than that provided by OPV. IPV reduces the replication of living poliovirus and produces herd immunity, as exemplified by experience in Sweden and Holland. The immunity, whether induced by OPV or IPV, involves memory cells and is long lasting, as seen by the rapid secondary response to a booster dose. IPV also can be mixed with other vaccine components to provide immunity against an increasing range of childhood infections.     

Update on pediatric nutrition: breastfeeding,infant nutrition,and growth

Recent studies continue to point out the critical nature of a patient's nutritional status in helping to determine important health outcomes in pediatrics. We review recent data concerning the composition of breast milk and its adequacy to support infant growth in the first six months of life, as well as trials that support breastfeeding as an important method to delay or reduce the incidence of atopic diseases such as eczema, allergies, and asthma. Studies have also been published that show how physician education and training about breastfeeding can be optimized. Studies showing how nutritional status is measured (using standard anthropometric techniques as well as more modern measures of basal metabolic rate) are highlighted, as well as the role of micronutrient supplementation of patients with the human immunodeficiency virus infection and diarrheal diseases.     

Pediatric trauma in the rural and low resourced communities

Death and disability associated with traumatic injury can be significantly decreased with timely and appropriate care. Patients in rural areas tend to have disproportionately decreased access to this care, with the pediatric age group acting as a particularly difficult challenge for pre-hospital and rural hospital settings due to the unfamiliarity of those trauma response teams with pediatric age specific management guidelines as well as a disparity in resource availability. In this review, we attempt to discuss the challenges facing pediatric trauma care in the rural and low resourced communities, as well as initiatives that are being carried out to optimize this kind of care, such as pediatric readiness, rapid transportation to higher levels of care, availability of blood in rural centers as well as in transit, and the utility of telemedicine in improving rural pediatric trauma care.     

儿童基底节病变17例临床分析

目的总结儿童基底节病变的临床特征。方法对17例经头颅CT和/或MRI证实的存在基底节病变的患儿临床资料进行分析。结果17例中起病时分别为肢体活动障碍7例,手震颤2例,惊厥5例,智力运动落后3例。所有患儿影像学检查均存在基底节区病变。17例患儿诊断分别为特发性甲状旁腺功能低下1例,线粒体脑肌病4例(1例具体诊断为Leigh病),Hyalinebody肌病1例,Aicardi-Goutieres综合征1例,偏侧惊厥-偏瘫综合征1例,脑肿瘤1例,风湿性舞蹈病2例,特发性基底节钙化4例,2例未做出具体诊断。结论基底节病变是影像学上的一个征象,涉及的疾病种类很多,对其病因进行探讨,将有助于提高对本组疾病的诊断。     

Hygienehypothese: Schlüssel zur Ätiologie und Pathogenese von CED?

The hygiene hypothesis postulates that the increased incidence of allergies and autoimmune-mediated diseases, as well as inflammatory bowel disease (IBD) observed in recent decades is caused by strongly changing environmental factors. The hygiene hypothesis explains epidemiological data in the context of evolutionary adaptation, genetic predisposition and dysregulated immune responses as a result of lifestyle changes (less contact with farm animals, smoking), intensified medical and sanitary measures (antibiotic use, reduced helminth colonisation) as well as changes in diet (breast feeding, fast food). Understanding the immunological consequences of parasite colonisation, contact with farm animals or breast-feeding may help to develop immunomodulatory therapies as well as preventive measures for IBD.     

What's new in pediatric dermatology: update for the pediatrician

PURPOSE OF REVIEW: Common pediatric skin conditions such as infantile atopic dermatitis, vitiligo, hemangiomas of infancy, warts, and molluscum contagiosum do not always respond to standard therapy. In some settings pediatricians will use "off-label" medications if the benefit-to-risk ratio is favorable. This article reviews important literature from the past year related to "off-label" immune-based treatment of skin disease, using the topical immunomodulators tacrolimus, pimecrolimus, and imiquimod, as well as intravenous Ig. RECENT FINDINGS: The topical immunomodulators tacrolimus and pimecrolimus have been embraced by pediatricians as long awaited alternatives for treating atopic dermatitis in children 2 years of age and older. Their unique appeal as nonsteroidal topical agents with good safety profiles has led to their frequent use for unapproved indications. A number of recent publications detail their use in infantile atopic dermatitis in children as young as 3 months of age, as well as use in other conditions such as vitiligo. Imiquimod, another topical immunomodulator, approved for genital wart treatment in adults, has also been examined for "off-label" pediatric use in nongenital warts, molluscum contagiosum, hemangiomas of infancy, and basal cell carcinoma. Finally, "off-label" use of intravenous Ig has been evaluated for the life-threatening dermatoses Stevens-Johnson syndrome and toxic epidermal necrolysis. SUMMARY: In the absence of larger controlled trials, pediatricians must consider the cumulative weight of smaller studies with their personal experience when assessing any role for "off label" therapy. The recent literature reviewed herein will facilitate such assessments of the non-steroid topical immune modifiers tacrolimus, pimecrolimus, and imiquimod as well as intravenous immunoglobulin.     

Skeletal development in premature infants: a review of bone physiology beyond nutritional aspects

Bone development is usually seen as a process of bone mineral accretion or increase in bone mass, and treatment of bone disorders usually consists of attempts to maximise bone mass accumulation by nutritional means only. However, from a functional perspective, bones should not be as heavy as possible, but rather as stable as necessary. It is therefore important to create conditions that stimulate bones to become more stable.     

Vasculitis treatment – new therapeutic approaches

In childhood, vasculitis carries with it a not inconsequential morbidity and mortality. Current therapy is usually effective in inducing remission, but there is a penalty in terms of significant and serious side effects as well as concerns about long-term maintenance regimens. Additionally, some patients are recalcitrant to treatment and options have, hitherto, been limited in relation to alternative therapy. In view of this, novel therapeutic approaches are being explored that include the better use of long-established agents as well as the utilization of newer immunosuppressive and immunomodulatory strategies. Blockade of circulating mediators and surface receptors as well as lymphocyte depletion and immunoablation are being introduced predominantly in adults but increasingly also in children. With greater understanding of the pathogenetic mechanisms involved in the disease processes it is becoming possible to utilize much more focussed therapy for these serious and life-threatening disorders with, hopefully, a decrease in long-term morbidity and mortality as well as a diminution of drug-induced adverse effects.     

Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: nasal continuous positive airway pressure in young children

Two groups of prepubertal children with severe obstructive sleep apnea syndrome received continuous positive airway pressure (CPAP) treatment using a nasal mask. The five children in group A had nasal CPAP only in a hospital setting; the five children in group B received the treatment at home as well. Four of these five children, who have now been followed for as long as 10 months, have adapted well to the treatment at home. The problems encountered with nasal CPAP as a home treatment, such as poor cooperation from parents, allergic rashes, eye irritation resulting from air leaks, are discussed. Despite the problems, nasal CPAP is a valid alternative to tracheostomy in children as young as 3 years of age.     

Optical imaging in vivo with a focus on paediatric disease: technical progress,current preclinical and clinical applications and future perspectives

To obtain information on the occurrence and location of molecular events as well as to track target-specific probes such as antibodies or peptides, drugs or even cells non-invasively over time, optical imaging (OI) technologies are increasingly applied. Although OI strongly contributes to the advances made in preclinical research, it is so far, with the exception of optical coherence tomography (OCT), only very sparingly applied in clinical settings. Nevertheless, as OI technologies evolve and improve continuously and represent relatively inexpensive and harmful methods, their implementation as clinical tools for the assessment of children disease is increasing. This review focuses on the current preclinical and clinical applications as well as on the future potential of OI in the clinical routine. Herein, we summarize the development of different fluorescence and bioluminescence imaging techniques for microscopic and macroscopic visualization of microstructures and biological processes. In addition, we discuss advantages and limitations of optical probes with distinct mechanisms of target-detection as well as of different bioluminescent reporter systems. Particular attention has been given to the use of near-infrared (NIR) fluorescent probes enabling observation of molecular events in deeper tissue.     

Osteoporosis in children: pediatric and pediatric rheumatology perspective: a review

It is increasingly recognized that osteoporosis affects children as well as adults both as a primary problem and as secondary to various diseases, medications, and lifestyle issues. In this review, we emphasize the correct diagnosis of osteoporosis in children as opposed to adults, etiology, and pharmaceutical and non-pharmaceutical treatments. We especially focus on rheumatologic conditions associated with osteoporosis and management issues.     

The role of growth factors in intestinal regeneration and repair in necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a devastating intestinal disease resulting in major neonatal morbidity and mortality. The pathology is poorly understood, and the means of preventing and treating NEC are limited. Several endogenous growth factors have been identified as having important roles in intestinal growth as well as aiding intestinal repair from injury or inflammation. In this review, we will discuss several growth factors as mediators of intestinal regeneration and repair as well as potential therapeutic agents for NEC.     

Probiotika in der Prävention und Behandlung der akuten Gastroenteritis bei Kindern

Probiotics are live microbial food supplements (bacteria, yeast) with a beneficial effect on health. They have been studied mainly for the prevention and treatment of acute infectious diarrhea in children. In recent years there have been preliminary reports that probiotic bacteria may also play a role in the prevention and treatment of inflammatory bowel diseases as well as allergic conditions. Most randomized controlled clinical studies as well as a recently published meta-analysis and a systematic review confirm a modest but significant effect of probiotics, in particular of Lactobacillus GG, in the treatment of acute infectious diarrhea in children. However, it is premature to give practical recommendations for the use of probiotics for several reasons such as limited numbers of controlled studies as well as heterogeneity concerning study design und probiotic strains.     

Acquired nonscarring diffuse hair loss in a 3-year-old girl

A 3-year-old girl showed fine, sparse, and brittle scalp hair without signs of cicatricial cutaneous alterations. Dermoscopy as well as scanning electron microscopy revealed elliptical nodes as well as constricted regions along the hair shaft.     

Branched-chain amino acid carbon and nitrogen arteriovenous concentration differences across the ovine fetal hindlimb

During fasting, branched-chain amino acids (BCAA) are thought to be major sources of nitrogen for myocyte synthesis of alanine (Ala) and glutamine (Gln), as well as possible sources of carbon skeleton for Gln synthesis. To study the relationships between Ala, Gln, and BCAA, we utilized the chronic fetal lamb preparation and measured arteriovenous concentration differences of Ala, Gln, BCAA, and branched-chain alpha-keto acids across the fetal hindlimb. Studies were performed when the ewe was fed and repeated after 1 and 5 days of complete maternal fasting. Ala and Gln are released from fetal hindquarters during fasting (arteriovenous -9.6 +/- 5 and -8.8 +/- 4.1 mumol/liter), while arteriovenous differences for BCAA simultaneously increase by 65% as compared to the fed state. During fasting, total nitrogen exiting fetal hindlimb as Ala and Gln equals nitrogen entering as BCAA. Branched-chain alpha-keto acids are released from fetal hindquarters during the fed state as well as after 1 day of fasting; at 5 days of fasting only keto-isovalerate had a net negative arteriovenous difference. In all cases, the release was much smaller than the entry of the corresponding amino acid, as determined by simultaneously measured arteriovenous concentration differences. These results indicate: Ala and Gln are released from fetal hindlimb, as in postnatal animals, during fasting, shuttling nitrogen and carbon to liver and/or other tissues. There is negligible movement of BCAA carbon as the branched-chain alpha-keto acids from hindlimb to other tissues in the fetus. BCAA carbon taken up is utilized within the hindquarters. It may be used for tissue synthesis, as an energy source, or possibly for Gln synthesis.     

Developmental disorders of activity dependent neuronal plasticity

A number of neurodevelopmental disorders are caused by defects in activity dependent neuronal plasticity, the process by which neuronal activity shapes developing neuronal circuits. These disorders are caused by genetic mutations or other factors that disrupt intracellular signaling pathways that link the cell surface with the nuclear machinery for gene expression. The signaling pathways disrupted by these disorders are involved in learning, memory and behavior as well as in the synaptic proliferation and pruning that occurs during normal development. Examples of neurodevelopmental disorders that target plasticity include X-linked disorders such as Rett, Fragile-X and Coffin-Lowry Syndromes as well as acquired disorders such as cretinism. Several other X-linked mental retardation syndromes as well as autosomal disorders including neurofibromatosis type 1 and tuberous sclerosis also involve signaling pathways involved in neuronal plasticity. Disruption of neuronal plasticity is a mechanism that may underlie a diverse group of neurodevelopmental disorders.     

Plague: a review of its history and potential as a biological weapon

The increased threat of terrorism has revealed the importance of various diseases as potential weapons of destruction. Among the diseases that have been identified by the Centers for Disease Control and Prevention as being caused by category A organisms is plague. An ancient disease, it has played a role in both natural disasters and war and has been used as a weapon since at least medieval times. This article provides a brief historical overview of the disease in its natural occurrence and in its use as a biological weapon, as well as its potential for future use.     

A panorama of medical history of acute iron poisoning (author's transl)]

The paper describes briefly the fatal course taken by some of the 720 acute cases of poisoning with iron compounds as documented in literature between 1826 and the present time. The various concomitant conditions and the genesis, as well as the fatal disease pattern, are communicated. The various pathogenetic factors and nosological variants of acute iron poisoning, as well as the epidemiology of juvenile iron poisoning, are discussed. Finally, the paper points to numerous deficiencies in the exact diagnosis of acute cases of iron poisoning.