ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Endocrinopathies are significant consequences of childhood cancers and their treatments. The risk of developing these adverse events is related to the underlying disease and its treatment with cytotoxic drugs and radiation therapy. This article will explore the current literature about endocrine late effects of hypothalamic-pituitary, thyroid, and gonadal dysfunction, as well as osteoporosis and obesity.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Although childhood Hodgkin disease is sensitive to the treatment regimens devised for Hodgkin disease in adults, long-term toxicity is enhanced in the developing individual. As a result, there have been dual goals in the design of clinical trials for pediatric Hodgkin disease: 1) to reduce long-term organ injury; and 2) to increase efficacy. Radiation dose and field has been reduced by enhanced reliance on chemotherapy, thus limiting the risks of hypoplasia, hypothyroidism, secondary cancers, and valvular and atherosclerotic heart disease. Multiagent, chemotherapeutic regimens for children have been developed to avoid the risks of sterility, leukemia, and cardiopulmonary toxicity. Newer approaches advocate for early dose intensity to limit cumulative therapy using response-based paradigms. Targeting molecular mechanisms specific for the Reed-Sternberg cell may allow for less toxic and more efficacious treatments in the future.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Thrombocytopenia remains a common problem in sick newborns. A quarter of all neonates admitted to neonatal intensive care units develop thrombocytopenia, and in 20% of episodes the thrombocytopenia is severe (platelets <50 × 109/L). Practical and clinically relevant classifications of neonatal thrombocytopenia have now been developed which, by highlighting the principal conditions precipitating severe thrombocytopenia (eg, sepsis, necrotizing enterocolitis, perinatal asphyxia, and the immune thrombocytopenias), aid the practicing neonatologist. Recent reviews demonstrate that many neonates with severe thrombocytopenia receive repeated platelet transfusions, although evidence of their clinical benefit is lacking, and there exists a significant variation in platelet transfusion practice between centers. These facts support the need for the development of evidence-based protocols for platelet transfusion in the newborn and stimulate continued interest in the potential of hemopoietic growth factors (eg, thrombopoietin and interleukin-11) to prevent or treat neonatal thrombocytopenia.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Hereditary anemias caused by &bgr;-thalassemia and sickle cell disease are the most common genetic diseases worldwide. Supportive therapies such as chronic lifelong transfusions, iron chelation for thalassemia, and transfusions or hydroxyurea for sickle cell anemia have significantly ameliorated clinical manifestations of these diseases but cannot eliminate disease and treatment-related complications that result in end-organ damage. Allogeneic hematopoietic stem cell transplantation is the only cure for patients with hemoglobinopathies. Results of transplants have steadily improved over the last few decades due to effective control of transplant-related complications and development of new preparative regimens. Our understandings of mixed chimerism in patients with hemoglobinopathies provide a rationale for the use of less intensive conditioning regimens and gene therapy in these disorders. Although the role of stem cell transplantation for thalassemia major is well defined, few transplants have been carried out in sickle cell disease, and, in light of recent advances, the role of stem cell transplantation in this disease should be revised. This review summarizes the current status of stem cell transplantation for hemoglobinopathies.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The central tenet of stem cell biology is that within tissues there reside stem cells with the capacity for both self-renewal and terminal differentiation to the multiple lineages of that tissue. Over the last few years, numerous studies have challenged this paradigm by showing that tissue stem cells can differentiate to unexpected cell lineages, suggesting an enormous plasticity of differentiation. The hematopoietic stem cell, which resides within bone marrow and gives rise to all blood cells, has been the focal point of these efforts. However, recent studies have disputed the notion of hematopoietic stem cell plasticity. In truth, stem cell plasticity, strictly defined, has yet to be rigorously proven. Both animal models to carefully address outstanding issues and pilot clinical trials to explore the therapeutic potential will be key elements to advance science for the benefit of patients.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Osteochondritis dissecans is a term used to describe the separation of an articular cartilage subchondral bone segment from the remaining articular surface. Juvenile osteochondritis dissecans describes an osteochondritis dissecans lesion found in skeletally immature children with a maximum incidence occurring between the ages of 10 and 20. It is found more frequently in children who are active athletically and involved in organized sports and is twice as common in males as in females. Although the etiology of these lesions is unclear, it is believed that repetitive microtrauma may interrupt the already tenuous epiphyseal blood supply in the growing child and contribute to the development of osteochondritis dissecans lesions. Treatment is dependent upon age at presentation, fragment size, fragment location, and fragment stability. Stable lesions in skeletally immature patients are generally amenable to conservative management. Failed conservative management or unstable lesions will more likely require surgical intervention. Lesions in skeletally mature patients have a more unpredictable course and may require surgery. This review article discusses the anatomy, etiology, evaluation, classification, treatment, and expected outcome of osteochondritis dissecans lesions.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

As our society's interest in competitive athletics has grown, so has the participation of our youth. Unfortunately, along with this increase in participation has come a predictable increase in rate of injury. More specifically, anterior cruciate ligament injury in the skeletally immature individual is being recognized with increasing frequency and currently poses an unsolved clinical problem. Conservative management of midsubstance anterior cruciate ligament tears in the skeletally immature population has been shown to have an unfavorable prognosis related to functional knee instability, subsequent meniscal tears, and the development of early degenerative arthritis. Despite poor outcomes following conservative treatment, many orthopaedic surgeons have been reluctant to perform anterior cruciate ligament reconstructions in skeletally immature patients due to the potential for physeal injury and resultant growth disturbance. Although there is growing evidence in the literature suggesting that anterior cruciate ligament reconstruction in the adolescent population may be safely performed using anatomic, transphyseal techniques, there are insufficient data to provide concrete guidelines in treatment of anterior cruciate ligament injuries in the prepubescent population. Management of these injuries, therefore, must be based on the physiologic and skeletal maturity of the child. Anterior cruciate ligament reconstruction in the skeletally immature individual still poses a clinical problem with the safest and most effective techniques still evolving.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

When children present for evaluation of bone tumor, great anxiety often occurs among the family. Usually the diagnosis of a benign bone tumor can be made easily with plain radiographs without biopsy. Most have a good outcome. However, occasionally, serious complications can develop. Moreover, the physician must be aware of the possibility of the malignant tumors. To avoid errors in the evaluation and treatment of this heterogeneous group of tumors, the clinician should have a good knowledge base of common bone neoplasms and correlate the clinical, radiographic, and pathologic findings.In this article, history, diagnosis, evaluation, treatment, and management of common types of benign tumors of bone commonly seen in children and adolescents are reviewed in the light of current literature.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID