Maligne Knochentumoren bei Kindern und Jugendlichen

Zusammenfassung Maligne primäre Knochentumoren sind mit einem Anteil von nur 0,1% aller Krebserkrankungen insgesamt selten, gehören aber bei Kindern und Jugendlichen zu den häufigsten soliden malignen Tumoren. Jährlich erkranken in Deutschland etwa 300–400 Patienten, mehr als die Hälfte davon im 2. Lebensjahrzehnt, Jungen etwas häufiger als Mädchen. Histologisch stellen die malignen Knochentumoren eine uneinheitliche Gruppe dar, im Kindes- und Jugendalter sind sie jedoch fast immer den Osteosarkomen oder den Tumoren der Ewing-Familie zuzuordnen. Aktuelle multimodale Therapiekonzepte bestehen aus einer neoadjuvanten systemischen Polychemotherapie, gefolgt von chirurgischer und beim Ewing-Sarkom auch strahlentherapeutischer Lokaltherapie und adjuvanter Fortführung der Chemotherapie. Durch diese intensive Behandlung kann heute in >60% der Patienten ein langfristiges Überleben erreicht werden. Die interdisziplinäre Therapie stellt hohe Ansprüche an Onkologie, operative Disziplinen, Radiologie und Pathologie. Sie sollte daher an spezialisierten Zentren im Rahmen prospektiver Therapiestudien erfolgen.     

Autoimmunthyreopathien bei Kindern und Jugendlichen

Although autoimmune thyroid diseases are generally rare in children and adolescents, Hashimoto’s thyroiditis is more common than Graves’ disease. The clinical appearance of Hashimoto’s thyroiditis is nonspecific and highly variable; there is no typical cardinal symptom. Antibodies against thyroidal peroxidase are verifiably increased by a high percentage. The metabolic situation is euthyroidism in most patients and hypothyroidism in approximately 20–40% of the patients. For treatment of both subclinical and apparent hypothyroidism, L-T4 substitution therapy is used. In contrast, the clinical appearance of Graves’ disease is clear. Antithyroid drug therapy is the first-choice treatment for children and adolescents, but it must be closely monitored because of potential serious side effects. It should not be continued on a long-standing basis due to a long-term remission rate of only 20–40%. Surgical success largely depends on the surgeon’s skill and experience. Hence, surgical intervention in children and adolescents with Graves’ disease should be limited to specialised centres. Radioiodine therapy holds little prospect of success, but – based on today’s standards – does not cause an increased risk of malignancy in children and adolescents.     

Hirntumoren bei Kindern und Jugendlichen

Every year in Germany, around 380 children younger than 16 years of age are diagnosed with a brain tumor. Compared with adults, different types of brain tumors are found in children. The diagnosis is often delayed despite presentation with characteristic symptoms. Nonspecific persistent symptoms must be followed with further diagnostics. Since the 1980s, multimodal therapeutic regimens have been developed systematically by the Society for Pediatric Oncology and Hematology (GPOH) in the context of treatment optimization trials. Neurosurgery, chemotherapy, and irradiation are applied according to the histology, stage of metastasis, and age of the child. Currently, 80–90% of the children diagnosed with brain tumors in Germany are treated according to the respective trial in the context of the treatment network HIT. The principle aims are improved survival and quality of life, reduction of therapy-associated toxicity and late effects, and better diagnostic and therapeutic standards. In this article, typical clinical symptoms and diagnostic recommendations are described, and the structure of the HIT treatment network is illustrated.     

Anti-IgE-Therapie bei Kindern und Jugendlichen

Immunoglobulin E (IgE) plays a key role in mediating allergic reactions to food and environmental allergens, which are relevant for the expression of allergic symptoms of the airways (rhinoconjunctivitis, bronchial asthma), the skin (urticaria, atopic dermatitis), as well as the gastrointestinal tract (food allergens). The recombinant humanized antibody omalizumab, which became available in Germany in 2005 for the treatment of severe allergic asthma for children aged 12 years and above, has proved its therapeutic efficacy for special cases,as well as its safety in all age groups. In addition to bronchial asthma, anti-IgE offers interesting perspectives for the treatment of complex allergic diseases which have a strong impact on quality of life and have so far been difficult to control.     

Parodontalerkrankungen bei Kindern und Jugendlichen

Dental diseases of milk teeth

In children and adolescents periodontal diseases occur considerably less often than in adults. Plaque-associated inflammation of the gingiva (gingivitis) predominates. Severe forms of periodontitis with bone and attachment loss already occurring in the first dentition and leading to a premature loss of teeth are rare and usually associated with defects in the host immune response. Genetic abnormalities in particular and certain systemic diseases can promote the onset and progression of severe periodontal diseases.

Adolescence

In adolescent patients aggressive periodontitis is of special importance, which develops during puberty and affects the first molars and central incisors. The disease is characterized by a rapid loss of attachment and bone in otherwise healthy patients.

Prophylaxis and therapy

In children and adolescents early diagnosis together with prophylactic measures and therapy are essential for treatment success, especially in cases of aggressive forms of periodontitis.     

Non-Hodgkin-Lymphome bei Kindern und Jugendlichen

The annual incidence of non-Hodgkin’s lymphoma (NHL) in Germany is 0.8/100,000 children under 15 years of age. The dominant forms of NHL in childhood are Burkitt’s lymphoma, lymphoblastic and anaplastic large cell lymphomas. The commonest main symptom of NHL in children and adolescents is painless lymph node swelling. The diagnosis can be confirmed without the necessity of an operation when malignant effusions or significant bone marrow participation occur, otherwise an operative intervention is necessary. An exact classification of NHL is an absolute priority for selection of a suitable form of therapy as different chemotherapy strategies are employed for the three subgroups lymphoblastic lymphoma, peripheral B cell lymphoma and anaplastic large cell lymphoma by which ≥80?% of patients survive. Cured oncological patients need a lifelong follow-up for recognition of recurrent or late complications of therapy.     

Leitlinie zur Behandlung des Asthma bronchiale bei Kindern und Jugendlichen

Due to new insights into asthma management, the consensus recommendations on treatment of bronchial asthma in children and adolescents originally published in 1999 and amended in 2003 needed updating. It was decided that the recommendations should be replaced with guidelines which would standardize patient management and provide assistance to all caregivers. First of all, evidence grades were included. Particular emphasis was attributed to practicability, feasibility, compliance, and costs. A further focus is the concept whereby patient-oriented therapy is carried out according to symptom control and includes asthma self-management strategies. Since a recommendation on the treatment of recurrent obstructive bronchitis and bronchial asthma in pre-school age was issued in 2006, the present guidelines are restricted to patients over the age of 5. To guarantee their implementation, the Austrian Society for Pediatrics and Adolescent Medicine is offering modules on “Asthma” and “Asthma training” in the framework of a diploma program.     

Insektengiftallergie bei Kindern und Jugendlichen

Ohne Zusammenfassung     

Rheuma bei Kindern und Jugendlichen

Juvenile idiopathic arthritis (JIA) is an important cause of chronic joint inflammation in children and adolescents. Detailed evaluation of the patient history, a complete physical examination and some lab tests lead to the sub-classification into 1 out of 7 JIA subtypes. Other systemic diseases or secondary causes arthritis have to be excluded. Physical examination of the joints includes inspection, palpation and testing the range of movement. Disease activity and treatment responses should be evaluated following standardized criteria, e.g. visual analogue scale (VAS), child health assessment questionnaire (CHAQ) and the American College of Rheumatology (ACR) criteria. An interdisciplinary approach is mandatory. JIA patients should be seen frequently by an ophthalmologist and treatment should follow evidence and consensus-based guidelines including drug therapy and other treatment modalities. Drugs regularly used in the treatment of JIA are, non-steroidal antirheumatic drugs, methotrexate and intraarticular corticoid injections. The prognosis of JIA varies depending on the subtype.     

Leitlinie zur Behandlung des Asthma bronchiale bei Kindern und Jugendlichen

Ohne Zusammenfassung     

Psoriasis vulgaris bei Kindern und Jugendlichen

The prevalence of psoriasis vulgaris in childhood ranges from 0.12?% in infants to 1.2?% in adolescents. Psoriasis is a polygenic disease triggered by external factors and influenced by comorbidities such as obesity, metabolic syndrome, chronic inflammatory bowel diseases and rheumatic diseases. Its clinical presentation is variable. Typical complications include erythroderma, disseminated pustulosis and arthropathy. Amongst a wide range of topical or systemic therapeutical options, individualized treatment is based on severity, site and extent of cutaneous involvement, age, potential side-effects and comorbidities.     

Laktat und Trainingssteuerung bei Kindern und Jugendlichen

Background

Lactate is the product of anaerobic glycolysis, a metabolic carbon intermediate with high energy content and a substrate of cellular respiration and gluconeogenesis. Additionally, lactate modulates glycolytic energy production and oxidative combustion of lactate in mitochondria.

Blood lactate concentration and intensity zones

The blood lactate concentration (BLC) increases with increasing exercise intensity which is termed the lactate power curve (LPC). The LPC discriminates between subjects with different performance capacities and distinct testing protocols. During prolonged constant power exertion the BLC can remain close to the resting level (intensity zone I), show a steady state above resting BLC (intensity zone II) or increase continuously until termination of physical exertion (intensity zone III). The maximal lactate steady state (MLSS) depicts the transition from intensity zone II to III. Lactate thresholds detect LPC points which indicate the transition from intensity zone I to II or II to III.

Intensity zones in the training process

Intensity zone I serves for training sessions lasting up to 6 h. Intensity zone II is utilized for extensive and intensive endurance training sessions sustainable for between 30 min and 90 min. Interval and tempo training sessions are performed at intensity zone III.

Blood lactate concentration measurement for training control

Measurement of BLC not only detects performance changes under laboratory and field conditions but can also be used to assess the metabolic stress of selected training sessions. If adolescents perform training volumes which require a training intensity distribution comparable to adult high performance athletes then BLC monitoring of selected training sessions is advised. Corresponding training BLC measurements are not required in performance-oriented training of prepuberty and early puberty children.