摘要:

AbstractJuvenile myoclonic epilepsy is a relatively common, though under diagnosed, form of epilepsy that commences in adolescence. The distinguishing symptoms, diagnosis and medical management are discussed.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00807.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To describe the reasons why it is difficult to decide whether to attribute some infant deaths to accidents or to SIDS.MethodologyTo extract from infant deaths data in South Australia those where the cause of death is debatable.ResultsThe risks associated with rocking cradles, bed sharing, bedclothes, couch sleeping, unsafe cots or beds and the prone position are presented.Conclusions: Uniform worldwide death scene investigations for all infant deaths should help identify unsafe sleeping conditions for infants.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00808.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To explore the ways asthma may be defined in childhood and consider the current evidence to support these possible definitions.MethodologyThe relationship of symptoms, atopy, bronchial hyperresponsiveness (BHR) and airway inflammation in defining childhood asthma is reviewed.ResultsWhile none of the four proposed methods of defining asthma can stand alone as the ‘gold standard], in childhood asthma, all four, namely clinical symptoms, atopy, BHR and airway inflammation, are intimately related. The degree of atopy and BHR, and the presence of airway inflammation, should be viewed as significant risk factors for persistent wheezing in childhood.ConclusionAt present the clinical diagnosis of asthma in childhood remains largely based on symptoms but it is likely that, with further research, the group of children who are now labelled as having asthma will be subdivided into different subgroups with implications for both treatment and outcom

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00809.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To review the presenting features of tongue‐tie in childhood and indications for frenulotomy, drawing conclusions from a retrospective study of patients encountered in paediatric surgical practice and from the literature.MethodologyA disease index was kept enabling histories to be selected for analysis. All patients were seen by the author and all operations performed by the author or a registrar under supervision in a standard manner. Patients were reviewed 2 weeks after operation.ResultsDuring 18 years of practice, 287 patients with simple tongue‐tie were encountered (two others with true ankyloglossia were not included in this study) and 158 frenulotomies were performed. The presenting symptoms were related to sucking or swallowing (13%), speech (32%), mechanical problems related to restricted tongue movements (14%) and to other problems (3%). In 38% the asymptomatic tongue‐tie was noted incidentally.ConclusionIt is concluded that there is no place for division of tongue‐tie without anaesthesia in the newborn. Speech difficulties related to tongue‐tie are over‐rated and mechanical problems are underestimated. The indications for frenulotomy include articulation difficulties confirmed by a speech pathologist, mechanical limitations such as inability to lick the lips, to perform internal oral toilet or play a wind instrument. There may be rare instances in infancy where problems with feeding and suction can be helped by frenulotomy but evidence for this is anecdotal. Operation requires general anaesthesia except in older, co‐operative teenagers in whom local anaesthetic i

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00810.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:: The literature on the development of frequency analysis of the electroencephalogram (neurometrics) and functional dynamic brain imaging techiques is reviewed. Clinical applications in the diagnosis and treatment of learning disorders of childhood are discussed.ConclusionsWhile questions remain about the sensitivity and specificity of the neurometric method in diagnosing attention deficit hyperactivity disorder (ADHD), if the technique proved predictive of medication response, its importance would be established. However, evoked‐potential studies, cerebral blood flow and cerebral glucose metabolic studies promise a better understanding of underlying psychological processes in ADH

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00811.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00812.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To examine inter‐ and intra‐rater reliability in the assessment of genital findings in cases of suspected child sexual abuse.MethodologyColposcopic photographs of the external genitalia of 70 female children were independently assessed by child sexual abuse teams in Auckland and Sydney. For the Auckland centre, intra‐rater reliability was assessed by making a second independent assessment 6 months following the first. Reliability was quantified using per cent of agreement and Cohen's Kappa statistic.ResultsThere were high levels of inter‐ and intra‐rater agreement. When photographs were classified as normal/non specific or strongly indicative of child sexual abuse, there was 93% agreement between the Auckland and Sydney teams with a kappa score of 0.70. For the two separate ratings made by the Auckland team there was 94% agreement with a kappa score of 0.75.ConclusionsThe high levels of inter‐ and intra‐rater agreement obtained in this study were reassuring. The results obtained compare favourably with the results of reliability studies in other areas of med

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00813.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective:To report ventilation strategies, survival and complications in 39 outborn infants treated with high frequency oscillatory ventilation (HFOV).MethodologyData were collected prospectively between 1 May 1992 and 31 December 1993 on all infants treated with HFOV who had severe respiratory failure despite optimal conventional ventilation.ResultsTwenty‐eight out of 39 (72%) survived. Of the 15 infants with birthweights1500g with hyaline membrane disease (8/8), and meconium aspiration syndrome (7/7). Three infants deteriorated while on HFOV and required extracorporeal membrane oxygenation. Complications were: (i) development of pulmonary interstitial emphysema (1); (ii) recurrence of pneumothorax (3); (iii) hypotension (2); and (iv) bronchopulmonary dysplasia (9). One of the eight infants weighing<1500g who received HFOV in the first week of life developed periventricular haemorrhage.ConclusionThe initial results of HFOV for severe respiratory failure were encouraging although a learning curve was encountered with its introductio

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00814.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives:To report the outcome of a consecutive cohort of neonates treated with high frequency oscillatory ventilation (HFOV).MethodologyProspective cohort study of 22 neonates failing conventional mechanical ventilation (CMV) between October 1992 and August 1993. Outcomes evaluated were in‐hospital survival rate, comorbidities including patent ductus arteriosus (PDA), cerebroventricular haemorrhages (CVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), and acute changes in respiratory status.ResultsEighteen of 22 (81.8%) survived. Of the four children who died, one did not respond to HFOV and died within 24 h of treatment. Two died of respiratory failure complicated by pulmonary haemorrhage. The remaining infant responded to HFOV but later developed severe NEC while on minimal CMV and died at 2 weeks of age.Three subjects were ≥34 weeks' gestation; each responded well to HFOV with no substantial comorbidity. Of the remaining 19 infants<34 weeks' gestation, six (31.6%) had a PDA, and seven (36.8%) had a CVH. One infant developed cystic periventricular leucomalacia. Three infants (15.8%) had NEC. Respiratory failure in the 15 survivors with gestational ages<34 weeks improved dramatically with HFOV. Ten (66.7%) survivors<34 weeks developed BPD and 10 (66.7%) ROP.ConclusionHigh frequency oscillatory ventilation was associated with a survival rate of 81.8%, but with significant comorbid

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00815.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This report examines the extent to which illness‐based individual care and expensive, often unevaluated, technologies in paediatrics have seduced practitioners away from more cost‐effective, population‐based child health activities and examples of new and unevaluated technologies in perinatology and paediatrics are given. The way in which these technologies are introduced and taken up, by ‘creeping incrementalism], is described and a plea is made to implement only those aspects of paediatric care that have been demonstrated to be effective. This would result in only appropriate technologies being used, avoid harm being done to children and ensure that money is available for other effective population‐based activities that improve chi

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1995.tb00816.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY