ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Dehydration is responsible for the morbidity and, rarely, mortality secondary to vomiting and diarrhea from acute gastroenteritis. Despite the abundance of literature in the last 20 to 30 years focused on the treatment of dehydration with oral rehydration therapy, few studies have focused on the actual clinical diagnosis of dehydration. Conventional classification systems for assessing dehydration have not been subjected to rigorous prospective validation until recently. This article reviews the recent clinical evidence that validates the use of clinical signs and symptoms in assessing dehydration in children. The utility and limitations of measuring capillary refill time as a sign are also reviewed. In addition, the scant literature examining the utility of laboratory studies in evaluating dehydration is summarized. Oral rehydration therapy for the management of dehydration in children is reviewed. Finally, recent literature examining the effectiveness and advantages of rapid intravenous rehydration in the outpatient setting is discussed.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The field of arrhythmias in children has recently seen major advances in several aspects, including diagnosis (event monitoring systems) and treatment (very effective acute and longterm medications) and, more importantly, in the definitive cure of supraventricular tachycardia with the use of catheter ablation techniques. These procedures are very successful and can be performed with a low complication rate. The indications for radiofrequency ablation are expanding and the technical aspects improving rapidly, so a larger number of patients will benefit from this curative treatment.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Increasing parental participation in their child's health and health care is an important process by which the health care system can effectively address and service the needs of its patients. Clinicians need to have an appreciation of parental understanding, beliefs, and expectations. This paper reviews the recent literature regarding parental needs, concerns, decision- making strategies, and expectations for their children's health and health care.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Many pediatricians are beginning to sign capitated contracts that require them to provide services to children on an annual basis for a predetermined price. However, not all children have the same expected cost. Children with chronic illnesses, for example, are much more likely to incur higher costs than their healthy peers. This article summarizes the recent literature on payment systems that have been developed to establish capitated rates. It also summarizes other methods for reducing the risk that pediatricians face when they accept capitated payments. Finally, it discusses physicians' perceptions of how capitation affects their practice.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The number of children who are homeless or in foster care has risen dramatically during the past two decades. Poverty, substance abuse, lack of education and employment, and the failure of the social “safety net” to catch all those in need of support and financial assistance are root causes of this increase. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, popularly know as the “welfare reform” act, will likely have a powerful impact on levels of child poverty in the future and place even greater numbers of children at risk for becoming homeless or entering foster care over the next decade. Recent studies provide increased understanding of the health care and educational needs of children who are homeless or in foster care.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Liver transplantation is accepted therapy for acute or chronic liver failure. Advances in preoperative and postoperative management and surgical techniques have extended the indications for transplantation and refined selection, particularly for fulminant hepatic failure. Radiologic techniques, such as magnetic resonance imaging and placement of transjugular intrahepatic portosystemic shunts, have improved preoperative assessment and management. Successful split liver and living related transplantation may reduce waiting list deaths and relieve the organ donor shortage. Auxiliary liver transplantation, although technically difficult, is now accepted management for Crigler-Najjar type I disease but remains controversial for the treatment of organic acidemias and fulminant hepatic failure. Microsurgical techniques have reduced the incidence of postoperative hepatic thrombosis, and radioiogic management of portal vein thrombosis and stenosis has decreased operative intervention and improved survival. Immunosuppressive drugs such as cyclosporine microemulsion and tacrolimus have the potential to improve rejection rates and reduce sepsis in the future. There are now good data confirming that long-term survival is achieved with nutritional rehabilitation and good quality of life.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Inflammatory bowel diseases remain a significant chronic disease affecting children and adolescents. Although corticosteroids remain the standard form of therapy for many patients, an era of biological agents for therapy in inflammatory bowel diseases is upcoming with human trials using these agents now forthcoming. In addition, studies on maintenance of remission are beginning to address the selection of those patients most likely to benefit from aminosalicylate therapies, the risks of relapse from using cyclooxygenase inhibitors, the lack of benefit from lipoxygenase inhibitors, and possible future methodologies to examine the effectiveness of the immunosuppressive agent 6-mercaptopurine. Further development of the hypothesis that new-onset disease may be different than longstanding disease can be appreciated with reports of cytokine analysis in new-onset inflammation and the high risk of progression of disease in new-onset ulcerative proctitis in children. With more reports on the role of intestinal epithelial cells in intestinal diseases, it is now clear that this cell layer is not a passive bystander with regard to the interactions between the luminal contents and immune system components found within the lamina propria; new studies suggest that novel therapeutic strategies may be possible. This review summarizes recently reported aspects of Crohn's disease and ulcerative colitis, with an emphasis on issues pertinent for younger patients.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In the past year, major advances in understanding pancreatic disease have been made through the tools of molecular biology. Genes responsible for both hereditary pancreatitis and pancreatic agenesis have been identified. The first description of magnetic resonance cholangiopancreatography, a new noninvasive imaging study of the pancreatobiliary tree, was reported in children. Reviews of autoimmune pancreatitis, a newly described condition, pancreatitis in inflammatory bowel disease, tropical pancreatitis, and pancreatitis following liver transplantation were also published, as well as surgical and endoscopic therapy of pancreatitis.

ISSN:1040-8703    

出版商:OVID    

年代:1998

数据来源: OVID