摘要:

Diagnostic open lung biopsy was performed in 40 pediatric patients with diffuse pulmonary disease and underlying malignancy or immunosuppression. Specific diagnoses on which therapy could be based were made in 32 patients and there was only one false-negative result.Pneumocystis cariniiwas diagnosed antemortem in 28 patients. Complications of surgery occurred in six patients (15%), but no patients died as a result of the procedure. Open lung biopsy appears to be a safe and effective diagnostic procedure in immunocompromised pediatric patients with diffuse pulmonary disease of uncertain etiology.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

From 1971 through 1980, 65 infants were born into 395 families who had a child diagnosed with cancer. Of these 65 infants, four born at or above the 50th percentile for weight (on standardized charts) have failed to thrive, with a decrease in weight below the fifth percentile at some time during the first 18 months. One was born 1 month prior to her brother's death, one was born at a time when the patient was doing poorly 6 months prior to death, one was born 18 months after his sister's death and was expected to be a “replacement” child. The fourth infant was born 2 1/2 years after the diagnosis of leukemia in the firstborn son. The mother's anxiety increased in the 6-month period prior to the anticipated termination of chemotherapy. The infant's weight dropped dramatically during this period and fell off the curve at about the same time that a testicular relapse was discovered. Five additional babies had weight below the tenth percentile at some time during the first 18 months of life. For all nine babies, periods of inadequate weight gain were associated with significant events or anniversaries of events (e.g. diagnosis, death, relapse) in the course of the patient's illness. These events and their anniversaries are times of sadness and tension for the families of children with cancer. Failure to thrive in infants born into these families is seen as a reflection of the parents' inability to care for and feed their newborn infants because of the stresses associated with cancer in another child in the family.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

To determine the most reliable method of following the progress of disease in children with primary intracranial neoplasms, the noninvasive diagnostic procedures in 92 children were analyzed. Computerized tomographic (CT) scanning was found to be significantly superior to all other testing procedures in sensitivity, specificity, and overall accuracy. This superiority was seen regardless of tumor location or pathological subtype. When results in follow-up were compared to initial findings at diagnosis, the sensitivity of CT scanning was again significantly more reliable than the other procedures. Cerebrospinal fluid analysis was unreliable and added little information to that obtained from simultaneous CT and Radionuclide (RN) scanning. It is recommended that combined CT and RN scanning be used for management of intracranial neoplasms until a reliable method for detecting microscopic disease is available.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In vivo neutrophil phagocytosis was demonstrated by transmission electron microscopy (TEM) in the peripheral blood of two half-sibs with hereditary thrombocytopenia. These sibs have had a lifetime documented history of thrombocytopenia. Light microscopy morphology and histochemistry studies of blood and marrow were normal, similar studies of blood from available members of the kinship were also normal. Scanning electron microscopy (SEM) of platelets from each member of the kinship showed normal dendritic and spreading formation. In the TEM thin sections of platelet huffy coats, neutrophil ingestion of platelets was common and all stages of the phagocytic process were noted—from platelet-neutrophil intimacy to the formation of myelin bodies in phagosomes. The clinical courses over a 10-year period were mild, requiring rare therapeutic interventions. The chronic thrombocytopenia, lengthy mild course, modestly elevated platelet-associated immune globulin, normal aggregation and survival studies, and autoimmune neutrophil reaction to platelets allowed classification of these patients as hereditary thrombocytopenia purpuras.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A variety of neurological complications occur with sickle cell hemoglobinopathy. The most striking and most common is cerebral infarction. It is also the most devastating. Because of the high recurrence rate in untreated patients, cerebral infarction is the most debilitating neurological complication. The observed frequency varies from 6% to as high as 34% in different reports. The pathogenesis, clinical features, and demography are discussed. Diagnostic procedures should include a spinal tap to rule out potentially treatable lesions. CT scan and cerebral angiography may also be helpful in certain cases. Transfusion therapy remains the mainstay of management in the acute phase of cerebral infarction. There is considerable evidence to indicate that long-term transfusion programs are effective in the prevention of recurrences.Intracranial hemorrhage, spinal cord infarction, isolated neuropathies due to anatomical proximity to infarcted bones, lead neuropathy, auditory problems, and ocular manifestations are other neurological problems which can affect patients with sickle cell disease.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The use of transfusion therapy in sickle cell anemia must be guided by an understanding of the rheology and a knowledge of the risks involved. Simple transfusion should not be used to achieve a hematocrit greater than 35%; hematocrits greater than 35% carry a risk of hyperviscosity unless the percentage of sickle cells is extremely low. Under no circumstances should the hematocrit go above 40 % even with low levels of sickle cells.Transfusion appears to be rapidly effective in correcting problems such as priapism and severe pneumonia with hypoxia and is indicated in these circumstances. Prophylactic transfusion is only generally accepted for the prevention of repeated cerebrovascular accidents and possibly in the preparation of patients for surgery. For other indications, such as prevention of painful crisis and healing of leg ulcers, transfusion can be effective, but because of its risks and inconvenience, transfusion therapy should be reserved for cases that fail to respond to all other methods of management.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Pneumococcal sepsis and/or meningitis are major causes of morbidity and mortality in young children with sickle cell disease. Abnormal complement activity, poor splenic function and a lack of type-specific pneumococcal antibody are responsible for the severity and frequency of these infections. A program consisting of early institution of antibiotic therapy for febrile episodes, antimicrobial prophylaxis, and administration of pneumococcal vaccine may be effective in reducing the incidence of pneumococcal disease. Specific guidelines for infection prevention are presented.Other infections that are more frequent or more severe in children with sickle cell disease (e.g. Salmonella, Haemophilus and mycoplasma infections) are also discussed.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Recent discussions in the public press had multiple overtones indicating that there are major ethical problems in the “war on cancer”, especially in pediatric oncology. Several factors have contributed to the current dilemma: the quest for a cure by society, and the patient's hope to be cured, are often not compatible; research has become a mode of care at the expense of compromising scientific rigor; and a generation of new oncologists—who do not understand the basic precepts of science—has begun practice.Uncertainty of outcome is an unavoidable consequence of prospective randomized trials, forcing patients to rely totally on the objective tools of medicine. This destroys a major principle of medicine, namely that patient and doctor alike must have faith in the method of care, in the outcome, and in each other. It is nearly impossible to be a healer and a researcher without encountering major ethical conflicts. When the separate-ness of care and research are again recognized, the inherent ethical absurdity that is now unknowingly espoused will no longer be perpetuated.

ISSN:0192-8562    

出版商:OVID    

年代:1982

数据来源: OVID