摘要:

Gene transfer into hematopoietic stem cells may provide a novel treatment for a number of congenital hematologic and immunologic diseases. Retroviral vectors are currently the most effective gene transfer system, but they have significant limitations. New approaches using other vector systems, stem cells from umbilical cord blood, or cytokine-mobilized peripheral blood stem cells may increase gene transfer efficiency. The current capabilities and obstacles to successful implementation of gene therapy with hematopoietic stem cells are discussed.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Brain tumors are the most common form of solid neoplasm of childhood. Progress in the treatment of childhood brain tumors has been frustratingly slow, especially in comparison with other pediatric malignancies. The biology of primary pediatric brain tumors of childhood is just being unraveled. Chemotherapy is a major component of the treatment of many forms of childhood primary central nervous system tumors and is being used in attempts to improve survival and to delay or decrease the amount of radiotherapy needed. Despite the use of more aggressive radiotherapy approaches and intensified chemotherapy approaches, outcome remains dismal for brain stem gliomas and high-grade cortical gliomas. Many unsettled issues exist concerning the treatment of childhood low-grade gliomas.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The continued diagnosis of cases of late developmental dysplasia of the hip reaffirms the failure of initial clinical neonatal screening programs. Even the identification of an “at risk” patient profile will not eliminate the late diagnoses, but referral of these patients will ensure that up to 50% of late diagnoses can be eliminated. The role of ultrasound as a screening diagnostic tool has not, at this time, been confirmed to eliminate late diagnoses. Its use, however, has lead to an increased incidence of treatment with the recognition of the sonographic “immature hip.” This, in turn, will increase the number of complications of treatment with iatrogenic avascular necrosis. Therefore, the ideal elimination of all late developmental dysplasia of the hip referrals remains the unattained goal.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Injury is our children's greatest health problem, and pediatricians will frequently see finger and hand injuries in the office and emergency room. Many of these will be fingertip crush injuries, which are quite common in toddlers and are often undertreated. Pediatric finger and wrist fractures and sprains generally do well but require proper diagnosis and treatment. Innocent-looking wounds from glass lacerations may disguise extensive damage to underlying nerves, arteries, and tendons. Advances in microsurgery allow replantation of distal amputations even in young children and infants, although often not without complications. Thermal injuries and animal bites require early and aggressive treatment. As with many pediatric hand injuries, these injuries should be preventable, and the adverse consequences can be minimized with appropriate diagnosis and management.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The limping child is a common and often challenging problem for the pediatrician. A practical guide is given to the evaluation of normal and abnormal gait, important historical and physical findings, and laboratory and radiographic studies. The differential diagnosis is quite variable, ranging from benign to very serious life- or limb-threatening possibilities. Some of the more common and important conditions are summarized.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Two new classification schemes have been described for slipped capital femoral epiphysis (SCFE); both involve the question of stability and are probably more prognostic than the traditional acute or chronic classification. The prevalence of bilaterality is approximately 33%, and two recent series regarding bilateral SCFE recommend frequent follow-up after a child presents with a unilateral SCFE, but they do not recommend prophylactic pinning of the normal hip. In the case of a child with an underlying endocrine disorder who presents with a unilateral SCFE, however, strong consideration should be given to prophylactic pinning of the opposite hip. The most commonly accepted method of fixation at this time is in situ pin fixation with a single central screw. The screw head should be no more than 1.5 cm from the cortex of the femur to prevent windshield-wiper loosening. Chondrolysis, a complication of both untreated and treated SCFE, has a more favorable prognosis than idiopathic chondrolysis.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

As recently as 1986, limb lengthening in children was considered by most North American orthopedic surgeons to be both dangerous and impractical. Previous attempts were plagued by unacceptably high rates of serious complications such as nerve palsy, deep infection, malunion, broken hardware, and stiff joints. With the recent introduction of the Russian llizarov method and apparatus for limb lengthening, a tremendous groundswell of interest has risen. Despite a steep learning curve, many Western centers have now reproduced llizarov's clinical results. The important advances over prior methods are partly biologic and partly hardware related, llizarov's principles require a minimally invasive, low-energy osteotomy, stable external fixation, a latency period before commencing distraction, and gradual lengthening of 1 mm/d in divided doses (0.25 mm four times per day). This article reviews the background of this new technique and provides an update on results reported over the past year. There is disagreement regarding precise indications for limb salvage (lengthening) of congenital limb deficiencies versus amputation. The role of extended lengthening in dwarfism also remains controversial.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. David Bachman reviews recent literature about lower respiratory tract infection in children and focuses on community-acquired lower respiratory infections and respiratory syncytial virus. Eugene Shapiro discusses literature concerning several infectious diseases commonly seen in office settings and concerning which recent developments are of interest: the hemolytic-uremic syndrome and enterohemorrhagicEscherichia coli. Streptococcus pneumoniaeresistant to penicillin, infections in day care centers, and new antimicrobial drugs. Michael Baron reviews recent literature about gastroenteritis and diarrhea of infancy and early childhood and discusses diagnosis, complications, pathogenesis and physiology, epidemiology, and treatment.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID