ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Lung development requires a complex series of developmentally controlled interactions that involve mechanical forces, genetic and endocrine influences, and cell-cell communication. At each step, cell-matrix or cell-cell signaling mediated by peptide growth factors and extracellular matrix components is crucial in directing cell proliferation, differentiation, and migration. Although a comprehensive understanding of how these components interact to guide lung organogenesis has been elusive, the action and control of peptide growth factors in autocrine and paracrine signaling, mesenchymal-epithelial interactions in controlling branching morphogenesis, cell-cell communication in the regulation of cellular differentiation, and factors regulating pattern formation are being clarified.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Gastroesophageal reflux and pulmonary disease have become causally associated owing to reports of improved pulmonary function in patients with asthma or stridor following antireflux pharmacotherapy or surgery. Mechanisms by which reflux causes pulmonary disease include direct aspiration and neural reflex arcs. A novel additional mechanism for acute life-threatening episodes implicates increased β-endorphin levels resulting from acid-mediated esophageal pain in the depression of respiratory drive. Diagnostic modalities used in the evaluation of reflux have often been inadequate to demonstrate a cause-and-effect relationship between reflux and pulmonary disease. Recent studies using multiple site pH-metry have attempted to provide evidence for cause and effect but have achieved mixed results. Aggressive antireflux pharmacotherapy and, sometimes, surgery help those patients with chronic pulmonary disease mediated by gastroesophageal reflux.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Current contributions to the literature on disorders of respiratory control in infancy and childhood are reviewed. These encompass studies of cardiorespiratory control in preterm and term infants, apparent life-threatening events in infants, and obstructive sleep apnea including etiology, diagnosis, and alternatives to surgical management. In addition, alveolar hypoventilation is discussed in children with congenital central hypoventilation syndrome, myelomeningocele, and Prader-Willi syndrome.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Home oxygen and ventilation therapies are used to treat children who have varying degrees of chronic respiratory insufficiency from many causes. Potential sequelae to even mild or intermittent respiratory insufficiency have been identified. Infants with bronchopulmonary dysplasia who still require oxygen can be discharged earlier from hospitals with appropriate discharge planning and family support. Children with progressive diseases may eventually require oxygen or ventilation therapies to improve the duration or quality of their lives. Obstructive sleep apnea has been treated with supplemental oxygen and nasal continuous positive airway pressure. Guidelines exist for initiation and home management of oxygen and invasive or noninvasive mechanical ventilation.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Asthma is a common and debilitating problem in children. Its many costs to society include morbidity, hospitalization and treatment expenses, and a rising mortality rate. This paper examines recent trends in therapy for status asthmaticus. Oxygen, inhaled β-adrenergic agonists, and corticosteroids remain the cornerstones of therapy for the child with a severe exacerbation of asthma. Ipratropium bromide provides additional bronchodilatation in the patient who does not respond to standard therapy. Theophylline may have a role in chronic outpatient management of asthma, but the data supporting the addition of this medication in acute therapy for status asthmaticus are inconclusive. Antibiotics are only indicated in children with asthma complicated by infection, such as sinusitis or pneumonia. Magnesium sulfate and heliox may have a role in helping the asthmatic child who is critically ill and for whom other interventions have failed. Mechanical ventilation has many complications. The concept of permissive hypercapnia may be important in limiting barotrauma. Prevention of exacerbations of asthma include limiting environmental exposure to allergens and tobacco, using corticosteroids, and reinforcing compliance with therapy.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The importance of pediatric interhospital transport has increased dramatically in the past 5 to 10 years. Reasons include improved capabilities of tertiary care centers receiving transported patients, advances in availability of portable equipment that functions well in moving vehicles, and widespread recognition that pediatric transport differs from that of adult transport. Practitioners of pediatric transport must deal with adaptation to previously developed models for adult and neonatal transport. National medical, regulatory, and educational organizations have recently focused attention on medical transport in general and pediatric issues in particular. Research in the field remains preliminary but is increasing rapidly, both in quantity and quality, with major progress being made in the areas of triage, training nonphysician personnel in expanded practice roles, and establishing baseline national standards.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Fires continue to be a major killer of children, accounting for as many as 34% of fatal injuries in those younger than 16 years of age. Recent advances in burn care have improved to the extent that attention is being refocused on the initial resuscitation period as a time when significant improvements in mortality and morbidity may be achieved. Early invasive monitoring in selected patients may help children survive very severe burn injury. Carbon monoxide poisoning remains a common and controversial problem. Although it is clear that venous carboxy-hemoglobin levels are similar to arterial levels, the treatment of children with significant poisoning has not been well studied. Hyperbaric oxygen therapy may be helpful in preventing serious central nervous system injury, but studies in children are lacking. Prevention of burns is far superior to treatment of burns.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Opioids and benzodiazepines are two of the most common exposures that cause depressed mental status in children. Establishing a diagnosis of these intoxications may be difficult and is complicated by drugs from these two classes that are tot detectable by routine toxicologic screening techniques. Naloxone and flumazenil can be used as diagnostic as well as herapeutic medications in these ingestions. We present a brief review of the mechanism of action, administration recommendations, and adverse effects of naloxone and flumazenil. Although the empiric use of naloxone and flumazenil in the comatose adult patient who presents to the emergency department is being reexamined, many of the concerns do not apply to children. There is still an important role for empiric administration of both naloxone and flumazenil.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID