Low Back Pain in Children and Adolescents: an Algorithmic Clinical Approach

Low back pain (LBP) is common among children and adolescents. In younger children particularly those under 3, LBP should be considered as an alarming sign for more serious underlying pathologies. However, similar to adults, non specific low back pain is the most common type of LBP among children and adolescents. In this article, a clinical algorithmic approach to LBP in children and adolescents is presented.     

Chest Pain: Characteristics of Children/Adolescents

Chest pain (CP) in children/adolescents is a common referral for the pediatric cardiologist. A group of 263 patients (141 males/122 females, mean age = 13.4 years, range = 5-22 years) with the primary complaint of CP underwent evaluation in the cardiac stress lab at Children's Hospital of Wisconsin. Echocardiograms at rest were obtained in 70% of patients with no significant cardiac abnormalities identified. Endurance time (EXT) and oxygen consumption (VO(2)/kg) were below predicted in 26% and 46%, respectively. Reactive airway disease (RAD) as a preexisting condition was reported in 19% of patients, but abnormal resting pulmonary function (PFTs) were found in 26% (n = 68), with 48/68 never having the diagnosis of RAD. At risk of overweight (BMI >85th percentile), was seen in 28% of the cohort, with 16% identified as being overweight (BMI >95th percentile). A significant difference in RAD (p < 0.01) was seen in African Americans (AA) and decreased EXT (p = 0.01) was seen in Hispanics (H). VO(2)/kg was significantly reduced in both AA and H (p < 0.01). These results identify both racial and age-related differences in the etiology of CP in children. Most importantly, true cardiac pathology is extremely rare. AOW, deconditioning, and respiratory compromise play important roles in CP. The need for comprehensive cardiopulmonary monitoring is emphasized by these findings.     

儿童青少年2型糖尿病的诊断及治疗

随着世界范围肥胖者的增加,2型糖尿病(T2DM)在儿童及青少年中的发病率也明显上升.儿童青少年T2DM的病因也是由遗传、环境等多因素相互作用的结果.重要的危险因素包括肥胖、T2DM家族史、高危种族及胰岛素抵抗表型.为及早诊断及治疗,对具有危险性的儿童应进行T2DM筛查.筛查的指征包括肥胖和其他2个危险因素.儿童青少年T2DM的诊断标准同成人,基于空腹、随机血糖及口服糖耐量试验的标准值.防治T2DM的重要措施是改善生活方式、减低或控制体质量.此外,还可应用二甲双胍和(或)胰岛素.控制高血压及血脂紊乱及监测微血管并发症也很必要.实用儿科临床杂志, 2009, 24(8 ): 638-640     

美国儿童青少年高血压最新诊治指南

近年来儿童青少年高血压发病率不断上升,儿童高血压诊断、评估和治疗方面也取得了相当大的进展。美国国家高血压教育项目(NHBPEP)儿童青少年工作组最近对1996年的指南进行了更新,并发布了儿童青少年高血压诊断、评估和治疗的第4次报告。该报告刊登在2004年8月出版的Pedi-atrics     

儿童青少年血脂异常的诊断与筛查

儿童青少年期血脂异常往往与成年期血脂异常及心血管系统疾病发生密切相关,因而对血脂异常及早进行筛查与诊断,显得十分重要。美国国家胆固醇教育计划(NCEP)发布的儿童青少年血脂异常诊断标准以及基于家族史和高危因素的选择性筛查方案一直被人们所采用。近年来依据美国国家健康与营养调查(NHANES)数据对青少年不同年龄的血脂异常界值点做了建议;同时血脂普遍筛查方案较选择性筛查方案具有更高的准确性。然而,对儿童青少年血脂异常筛查诊断界值点的选择以及血脂筛查方案的制定,需根据儿童人群整体血脂水平、其与成年高脂血症及心血管系统等疾病的关系、种族差异等因素综合考虑后进行完善。     

Diagnosis and Management of Rhabdomyosarcoma in Children and Adolescents: ICMR Consensus Document

Rhabdomyosarcoma (RMS) is a highly malignant tumor which is thought to originate from the pluripotent mesenchyme. It is the most common soft-tissue sarcoma of childhood. This review article summarizes the recent and older published literature and gives an overview of management of RMS in children. RMS can arise in a wide variety of primary sites, some of which are associated with specific patterns of local invasion, regional lymph nodal spread, therapeutic response and long term outcome, hence requiring physicians to be familiar with site-specific staging and treatment details. Most common primary sites include the head and neck region, genitourinary tract, and extremities. Prognosis for children and adolescents with RMS has recently improved substantially, especially for patients with local or locally extensive disease because of the development of multi-modal therapy incorporating surgery, dose-intensive combination chemotherapy, and radiation therapy. Despite aggressive approaches the outcome for patients who present with metastatic disease remains unsatisfactory. Clinical trials are ongoing to reduce toxicity and improve outcomes of such patients; newer agents in combination are being investigated.     

小儿再发性腹痛的基础与诊断思维

再发性腹痛指发生在3岁或3岁以上儿童的一种反复发作、病程＞3个月,发作次数＞3次的症状.分为功能性和器质性,器质性RAP是由各种病因所致的腹痛;功能性RAP指疾病的发作不能从组织结构及生化方面变化解释,但又客观存在.腹痛产生的结构基础包括受体、传导纤维与三级传导神经元;目前接受的内脏疼痛的调控机制是"阀门"学说.此外,功能性腹痛与遗传、环境、内脏高敏感有关.在腹痛的诊断程序中首先要根据病史、体格检查和必要的实验室检查,排除器质性疾病,但又要避免过多的不必要的检查.     

儿童髌骨骨折的诊断与处理

１０例儿童髌骨骨折，其中４例横行骨折行张力带钢丝内固定，５例袖形骨折行缝合修复，１例粉碎性骨折行手法复位管形石膏外固定。随访３个月～１年，９例患儿的患膝伸０°　屈９０～１００°，１例粉碎性患膝达伸０°　屈９０°范围。儿童髌骨骨折中袖形骨折容易误诊，临床上需同髌韧带撕裂伤进行鉴别。手术指征取决于骨折呈开放或闭合性以及骨折程度。髌骨骨折属关节内骨折，治疗需达到解剖复位，应力求及时、准确的手术治疗，以避免膝关节功能障碍的发生。     

Practitioner Review: Assessment and Treatment of Sleep Disorders in Children and Adolescents

Sleep disorders in children are diverse in type, common, often serious in their effects yet neglected in professional education. They complicate many psychiatric disorders and can cause various cognitive and behavioural problems as well as more widespread difficulties in the family as a whole. Accurate assessment allows an appropriate choice from the various types of treatments that are now available but often under used. Diagnostic points and treatment approaches are outlined for the three main categories of childhood sleep disorder: sleeplessness; excessive sleepiness; and episodic disturbances related to sleep (parasomnias). The need for more widespread awareness of and provision for sleep disorders is emphasized.     

脓毒症的诊断与治疗

1992年公布的美国胸科医师协会与危重病学会确定的有关成人SIRS、脓毒症、多器官功能障碍综合征、脓毒性休克等定义。2002年加拿大、德国、荷兰、英国、美国等国家的儿科专家们在上述基础上结合儿童不同年龄的生理特点确定了SIRS、感染、脓毒症、严重脓毒症、脓毒性休克的定义，并于2005年正式修订了SIRS的诊断标准，将脓毒症更新为感染加SIRS的概念。脓毒症即SIRS出现在感染中，或为感染的结果。严重脓毒症即脓毒症加下列之一：心血管功能障碍，急性呼吸窘迫综合征，2个或更多其他器官功能障碍。脓毒性休克即脓毒症伴心血管功能障碍。对于上述诊断目前尚缺乏确切的实验室诊断依据，但近年来发现降钙素原水平的变化对评价脓毒症有一定价值。治疗方面，过去曾在调理凝血纤溶系统功能障碍和抗炎性反应方面做了大量研究，但均未获得降低病死率的预期效果，现采用活化蛋白C与血液净化治疗取得了初步疗效。肾上腺皮质激素的使用不主张使用大剂量，应采用小剂量中疗程疗法。     

小儿输尿管囊肿的诊断与治疗

目的探讨小儿输尿管囊肿诊断与治疗的方法及效果。方法输尿管囊肿39例进行总结分析。病例均行B超和静注尿路造影（IVU）检查。IVU不显影者行CT检查14例，行MRI检查8例。行膀胱镜检查10例。结果13超确诊31例，IVU确诊17例。行CT、MRI、膀胱镜检查者均得到确诊。输尿管囊肿39例中行上肾段及输尿管切除26例。行囊肿切除加输尿管膀胱移植术7例，经尿道行囊肿电切开窗术6例。并发症：膀胱输尿管返流3例，囊肿边缘出血、输尿管残端感染各1例。结论B超适于囊肿的筛选。IVU可了解肾脏功能及畸形情况。CT、MRI对IVU不显影有帮助。膀胱镜对了解囊肿大小、位置起确诊作用。囊肿侧肾发育不良或伴严重积水者行上肾段及输尿管切除；囊肿大者宜行囊肿切除加输尿管膀胱移植术，较小囊肿可经尿道电切开窗术。     

儿童发绀的诊断和治疗

发绀是儿科常见症状,按发病机制不同,分为中心性发绀、周围性发绀及变性血红蛋白血症3类.发绀的诊断有赖于详细询问病史、体格检查及实验室资料的综合分析;治疗目的是改善缺氧症状,保证重要器官的供氧;预后与病因密切相关.现就发绀的临床表现、诊断治疗及预后进行阐述.     

儿童甲状腺功能亢进症的诊断与治疗

儿童甲状腺功能亢进症（甲亢，hyperthyrodism）是由于甲状腺激素（T3、T4）分泌过多所致，临床上常有甲状腺弥散性肿大、突眼、基础代谢率增高等表现。