Showing papers in "Pediatric Annals in 1992"

Thyroiditis and acquired hypothyroidism.

Abstract: Chronic lymphocytic thyroiditis or Hashimoto's thyroiditis is the most common childhood cause of goiter and hypothyroidism in iodine-sufficient geographic regions.

The resurgence of acute rheumatic fever in the United States.

Abstract: Several areas in the United States have experienced significant outbreaks of acute rheumatic fever Reasons for the reappearance of acute rheumatic fever are incompletely understood but may relate to changes in the organism Fortunately, however, GABHS has remained exquisitely susceptible to penicillin Given the resurgence in cases of acute rheumatic fever, the practicing physician needs to be vigilant in diagnosing and ensuring adequate treatment of acute streptococcal pharyngitis In addition, acute rheumatic fever must be considered in a patient who presents with a new onset murmur, a migratory polyarthritis, chorea, or a rash suggestive of erythema marginatum

Anabolic-androgenic steroids and the adolescent.

Abstract: This article has reviewed some of the hormonal and behavioral maturation that occurs during adolescence, which are characterized by remarkable physical changes and behavioral vulnerability. Risk taking of many varieties is common and drugs (including anabolic-androgenic steroids) form a part of the prevailing culture in many places. These steroids probably are not severe health hazards when taken intermittently and in low to moderate doses. The 17-alkylated derivatives are clearly the more likely to cause hepatotoxicity. Thus, the scare tactics formerly used (severe constitutional side effects) are doomed to failure. The tenuous link between these drugs and objective behavioral and addictive effects must be strengthened before health strategies based on this issue can be validated. Clearly, the lack of scientific information has impeded, if not precluded, the formulation of an effective health education strategy. The most potent deterrent to the use of steroid drugs by athletes must be the moral issue of fair play and maintaining a "level playing field." We strongly support directed research in these areas and hope that the credibility of the scientific community can be regained after its faulted "stop steroid use" campaigns based on the lack of steroid efficacy in bringing about desired results or on their dire consequences have been replaced with credible evidence to refute their use on these and other grounds.

Ischemic stroke syndromes in childhood.

Abstract: Cerebral ischemic injury is uncommon in children, but the effects are long-lasting with significant implications for the child's development. The precipitating event in ischemic infarct is generally occlusion of the cerebral vessels. This occlusion may the result of direct injury of the cerebral vasculature, thrombus formation, or emboli from more distant sources. A wide variety of conditions are known to predispose to cerebral infarcts in children. However, even in recent studies, the underlying condition is unknown in as many as half the children who suffer an ischemic stroke. To care for these children effectively, it is imperative that extensive evaluations be performed to determine the cause of the cerebral infarct. Furthermore, increasing attention will need to be directed toward the metabolic events of cerebral ischemia. A better understanding of these mechanisms may provide clues to some of the causes of ischemic injury and should lead to more effective treatments.

Thyrotoxicosis in Childhood

Abstract: Evidence supports the presence of a genetic predisposition to an abnormality in immune surveillance, with environmental factors precipitating the development of Graves' disease.

When too much is not enough.

Abstract: Introducing a new hobby for other people may inspire them to join with you. Reading, as one of mutual hobby, is considered as the very easy hobby to do. But, many people are not interested in this hobby. Why? Boring is the reason of why. However, this feel actually can deal with the book and time of you reading. Yeah, one that we will refer to break the boredom in reading is choosing too much is not enough as the reading material.

Nodular Thyroid Disease and Thyroid Carcinoma

Abstract: The primary challenge in the management of a solitary nodule of the thyroid or a multinodular thyroid gland is to rule out a malignancy.

Risk and prevention of youth suicide.

Abstract: The rate of fatal suicide attempts among males rose dramatically between 1950 and 1980 and has continued to rise significantly during the 1980s among 15- to 19-year-old youth. Nonfatal suicide attempts, although far more frequent among females, appear to share similar risk factors with completed suicide. The most important preconditional risk factors for both fatal and nonfatal suicide attempts are a history of a previous attempt, major affective and conduct disorders, chronic substance abuse, and a history of personal losses, including experience of suicide attempts by peers and family members. Risk factors for the acute precipitation of an attempt include the acute disruption of an interpersonal relationship, alcohol intoxication, and access to firearms. Preventive efforts can be enhanced by pediatricians both in the office and the community. Clinical case finding of individuals thought to be at high risk will continue to identify some potential victims. Families with household firearms should be counseled regarding the risk of firearm injury and death, particularly in a home with an individual with other risk factors. Community campaigns to improve the mental health of youth and to reduce firearm ownership may hold future promise for the reduction of the unacceptable morbidity and mortality associated with adolescent suicide attempts.

Sports injuries in childhood.

Abstract: Participation in youth sports is relatively safe. Injuries become more frequent as the child gets older, bigger, and achieves higher skill levels. At the high school and collegiate levels, football has the highest injury rate followed by wrestling and gymnastics. There is no risk-free sport, and children tend to select the sports they wish to participate in without considering injury rates. Pediatricians should take an active role in injury prevention when covering sporting events as team physicians and as spectators. Language: en

Clinical evaluation of the floppy infant.

Abstract: The list of possible diagnoses for floppiness in infancy is extensive, with potentially hundreds of rare diseases. Nonetheless, most floppy infants have distinctive features in the history, the family history, or the physical examination that quickly narrow the list to central or motor unit disorders, and often to specific diagnoses within these broad groups. Accurate diagnosis is important, as outcomes are similarly protean, genetic implications are frequent, and in some cases specific treatments are possible.

Sexually transmitted diseases and child abuse.

Abstract: The diagnosis in a child of any infection that is usually sexually transmitted in adults should raise the suspicion of possible sexual abuse. We know sexual abuse is a common childhood experience. The American Academy of Pediatrics Committee on Child Abuse and Neglect has rated the implications of sexually transmitted diseases for diagnosing sexual abuse (Table 6). Language: en

Allergy, intolerance, and other adverse reactions to foods.

Abstract: Adverse reactions (sensitivity) to foods are categorized as either allergic (immunologic) or intolerance (nonimmunologic). Some medical conditions caused by intolerance reactions have immunologic features, but these have not adequately explained the basis of these conditions. Idiosyncratic, toxic, and anaphylactoid reactions may resemble allergic reactions clinically even though they are not based on specific immunologic events. Complaints about adverse reactions to foods are common but most cannot be reproduced by challenge studies. This fact reflects the transient nature of many of these reactions and should prompt the pediatrician to be objective when diagnosing chronic or persisting conditions. Without objectivity, dietary avoidance measures potentially can have profound nutritional and psychosocial consequences. Negative skin-prick tests with foods have a high negative predictive value to rule out IgE-mediated mechanisms being operative. Skin-prick testing with cow's milk and hydrolysate formulas is useful in distinguishing mild "topical reactors" from the more severe "systemic reactors" and in selecting "hypoallergenic" formulas for their management. However, the DBPCFC is the "gold standard" that helps distinguish between reality and strongly held erroneous beliefs. This diagnostic test has established cow's milk, egg, peanut, and soybean as the foods most commonly responsible for allergic and intolerance reactions in children. The principles of management of these food-related conditions are similar. However, each food presents unique management issues to the pediatrician.

Myths about childhood obesity

Abstract: Childhood obesity is a multifactorial and complex disease. Myths such as those that we have described may distract our patients from the underlying behaviors that contribute to the disease or may deflect the blame perceived by obese patients and their parents. Myths that suggest that the obese are inactive, eat differently, or eat more junk food suggest that obese individuals are socially deviant and justifies the intense discrimination directed against them. The myth that obesity represents an untreatable disease helps free health-care professionals from the responsibility to understand and care for obese children. Dispelling the myths about childhood obesity represents a critical step in prevention and treatment.

The care of alcohol- and drug-affected infants.

Abstract: When addicted families remain untreated, infants and children born into and raised by these families are at high risk of abuse and neglect. Early intervention appears to mitigate neurodevelopmental damage caused by drugs and alcohol. It is unclear whether the high risk of abuse and neglect in these families can also be modified. Early intervention and ongoing supervision may be costly, but the long-term costs will be much higher if the multigenerational cycle of both diseases is not broken. A multidisciplinary team approach is essential to free children from the double burden of substance abuse and its frequent consequence, child abuse.

Incorporating nutrition into pediatric practice: physicians and dietitians working together to improve children's health.

Abstract: Clinicians are needed to include nutrition in the routine care of infants and children in office practice. Physicians play an important role in assessing nutritional status, diagnosing nutritional problems, providing a rationale for treatment, prescribing, performing brief counseling, referring to other resources if needed, and following up on the progress of their patients. Registered dietitians are the consultants of choice to assist pediatricians in the care of patients with nutrition-related disorders and are skilled in providing pediatric health promotion and disease prevention information. Consultant dietitians in the community can be found through contacting the local department of health or local hospital outpatient department. The American Dietetic Association also maintains a list of consulting dietitians throughout the United States. Funding mechanisms for engaging dietetic services vary from contracting with dietitians in private practice, local health departments, or hospital outpatient clinics, to employing dietitians on-site to provide counseling services in the office. Availability for third party payment for nutrition services varies with insurance carriers, individual policies, and region of the country. Incorporating nutrition into pediatric practice is important. Together, physicians and dietitians can work together to improve children's health.