Remediation of learning difficulties in children after treatment for a cerebellar medulloblastoma: A single-case study

In the process of establishing a methodology for individualized remediation programmes in children treated for cerebellar tumour, this study followed prospectively over 11 years a young child treated for a medulloblastoma at 18 months of age throughout the rehabilitation process. Repeated neuropsychological and academic evaluations evidenced temporary disruptive behaviour, deficient manual and visual abilities, attention and working memory difficulties, but preserved language abilities, in relation with vermian and left cerebellar damage. However, the described remediation programmes and interventions allowed the child to have fluent progression in school. Limits and benefits of rehabilitation are discussed.

Con el propósito de establecer una metodología para los programas de remedio individualizados en niños tratados por tumores cerebelares, se estudiaron en forma prospectiva durante 11 años a niños de 18 meses de edad tratados por un meduloblastoma, a lo largo del proceso de rehabiitación. En relación al daño cerebelar y vermiano se pusieron en evidencia, a través de evaluaciones académicas y neuropsicológicas aplicadas en forma repetida, una conducta alterada en forma temporal, una deficiencia en las habilidades visuales y manuales, y la presencia de dificultades en la atención y en la memoria de trabajo, pero sin alteraciones en el lenguaje. Sin embargo, los programas de remedio y las intervenciones descritos le permitieron al niño tener una progreso correcto en la escuela. Se discuten los beneficios y los límites de la rehabilitación. Palabras clave: Cerebelo, meduloblastoma, remedio, resultado, rehabilitación en equipo     

肝动脉化疗栓塞术患者的多模式疼痛管理

目的评价多模式疼痛管理方案应用于肝动脉化疗栓塞术患者的效果。方法将166例肝动脉化疗栓塞术患者随机分为对照组80例和干预组86例,对照组采用传统疼痛管理策略,干预组采用多模式疼痛管理策略,包括建立医生、护士、药师及疼痛治疗师多学科团队,实施多模式镇痛知识宣教、超前非甾体抗炎药镇痛、局部浸润渗透、静脉自控镇痛泵、疼痛分级护理等措施。结果干预组术后24h内疼痛严重程度、不良反应(恶心呕吐、便秘腹胀)发生率及睡眠质量显著优于对照组(P0.05,P0.01)。结论多模式疼痛管理方案可有效控制肝动脉化疗栓塞术患者术后疼痛,有利于促进术后恢复。     

中国胰腺癌诊治指南（2021）

正胰腺癌的发病率在世界范围内呈持续上升态势。2021年统计数据显示,在美国所有恶性肿瘤中,胰腺癌新发病例男性居第10位,女性居第9位,占恶性肿瘤相关病死率的第4位~([1])。中国国家癌症中心2017年统计数据显示,胰腺癌位列我国男性恶性肿瘤发病率的第7位,女性第11位,占恶性肿瘤相关病死率的第6位~([2])。作为预后极差的消化道肿瘤,胰腺癌具有早期诊断困难、手术切除率低、术后易复发转移等临床特点,临床诊治极具挑战性。     

Rôle du périnato-sexologue dans une équipe interdisciplinaire périnatale au Canada

Interdisciplinary health care teams are models of health care that are the way of the future. In this model, the sexologist has a unique and important role, particularly in perinatal health care where sexuality is a central component of health. Perinatal sexuality is a newly emerging discipline in which the perinatal sexologist has a double role to play: 1) to train other perinatal health professionals in sexuality; and 2) to educate and to intervene with future and new parenting couples by answering their multiple intimate and sexual questions and concerns during the transition to parenthood.     

How to Apply the Experience from the Diabetes Control and Complications Trial to Children and Adolescents?

The Diabetes Control and Complications Trial (DCCT) taught us to set target blood glucose (BG) and glycohaemoglobin (GHb) goals, to ensure safety regarding hypogly-caemia, to be flexible with insulin and meal planning and to offer frequent contact with diabetes educators, dieticians, psychologists and social workers as well as with diabe-tologists skilled in intensified management. Insulin dosage should be individualized based upon frequent BG monitoring results. Co-ordinated multidisciplinary health care teams provide optimum problem-solving rather than disaster control working with children, adolescents and their families. The patient and the family should form the central core of the diabetes team with outpatient follow-up every month and frequent telephone contact between visits. GHb should be obtained at least every 1–2 months to provide feedback as based on the DCCT intensified treatment cohort. Insulin lispro helps minimize hypoglycaemia and makes insulin administration more convenient and timely. Barriers to improvement should be identified: learning problems, concomitant significant illnesses (epilepsy, coeliac and thyroid disease, asthma) and family problems. Ensure age-appropriate transfer of self-care but continue adult supervision. Educate, motivate and re-educate. Meal planning includes not only carbohydrate counting but also maintaining normal lipids and energy needs for growth and development as well as strategies for activity compensation and hypoglycaemia prevention. Consideration of protein restriction may be required in adolescents with microalbuminuria. Individualized multidose insulin algorithms allow reactive (corrective) decisions based upon capillary BG results plus proactive (anticipatory) decisions to compensate for expected BG changes from changes in activity, food and/or illness using a multidose insulin schedule. The number of insulin injections does not define an intensified insulin treatment programme but rather the ability to target and achieve near-normal BG values as often as possible - without severe episodes of hypoglycaemia. Self BG monitoring is a key to success. Long-term monitoring should include not only frequent GHb but also at least annual fasting lipids, thyroid functions and microalbuminuria as well as dilated retinal exams, blood pressure, growth charting and Tanner staging.