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Windschall D.,Klinik fur Kinder und Jugendmedizin
Aktuelle Rheumatologie | Year: 2015

Background: The investigation of juvenile idiopathic arthritis (JIA) as a cause of joint pain needs, in view of the numerous differential diagnoses, a structured and thorough diagnosis in the hands of an experienced examiner. In addition to medical history and clinical examination, laboratory diagnostics and imaging can provide crucial evidence for the existence of JIA. Patients and Methods: Depending on the subcategory of JIA, the disease can manifest itself in different ways. Whereas the main symptom in most subcategories is the inflammation of joints, the first manifestation of systemic arthritis could be fever, a rash, or a significantly reduced general condition. There were hardly any changes in the process of a thorough medical history and clinical examination in the past few years, whereas interesting developments have appeared in imaging and lab diagnostics, which may facilitate the diagnosis and monitoring of patients. These include developments in ultrasound technology and MRI as well as new biomarkers in the blood, which can be determined in patients with JIA. Results and Conclusion: New developments in diagnostic imaging have improved the diagnosis of JIA, as well as the delineation of differential diagnoses in recent years. Additionally in the monitoring of patients new imaging techniques help to assess the disease activity and response to therapy. Biomarkers such as the S100-proteins help especially in the diagnosis of systemic JIA and are increasingly used for the follow-up under treatment. The basis of a successful diagnosis is still a careful history and clinical diagnostic assessment. © Georg Thieme Verlag KG Stuttgart.

Finding the reason for an airway obstruction in children can be difficult, because depending on age many different factors must be considered. Exact recognition of symptoms is crucial to locate the obstruction. During auscultation upper airway obstruction generates inspiratory noises (e.g., stridor), whereas expiratory noises (e.g., rhonchus, wheeze) indicate bronchial obstruction. The most common cause for upper airway obstruction in children is croup, followed by choking on a foreign body. Bronchial obstruction needs further diagnostic, i.e., chest x-ray, sweat chloride testing, allergy tests, and lung function testing, to find the potential cause (e.g., viral infection, cystic fibrosis, congenital immunodeficiency or malformation of the lung, hypersensitivity, and asthma). Therapeutical options vary accordingly, but inhalation therapy is most important. In general, for infants and preschool children nebulizers with spacer and face mask are most suitable, whereas older children should use metered dose inhalers (MDI) and dry powder inhalers (DPI). Besides, the droplet size (MMAD) generated by the inhaler should be taken into account before prescription and correct handling is another prerequisite for successful inhalation therapy (train the patient!). © 2015 Dustri-Verlag Dr. Karl Feistle.

Vagus nerve stimulation has become established as an effective and safe adjuvant therapy for drug-resistant epilepsy. In addition to invasive vagus nerve stimulation (i-VNS), transcutaneous vagus nerve stimulation (t-VNS) is also now available, where electrical pulses are generated by a stimulator unit connected to a special ear electrode. This article reports the case of an 11-year-old girl with Dravet syndrome. A therapy trial with t-VNS together with a combination therapy of zonisamide and phenobarbital was performed. The existing medication was maintained. The NEMOS® t-VNS device developed by the company Cerbomed was used. The child tolerated t-VNS well and for the most part the planned daily 4 h stimulation times were complied with. After 4 months, without changing the drug regimen, a 57 % reduction in seizure frequency (specifically from 30 to 13 seizures per month) was noted. No side effects were observed. © 2015, Springer-Verlag Berlin Heidelberg.

Severien C.,Klinik fur Kinder und Jugendmedizin | Teufel M.,Klinik fur Kinder und Jugendmedizin
Padiatrische Praxis | Year: 2014

We report 81 cases of foreign body ingestion in children managed at the Children's Hospital Böblingen over a 8 year period. Coins (52%) were the most common foreign body ingested. Other objects included food and tablet bolus, button batteries, magnets, safety pins, screws, needles and toy parts. The foreign body was lodged in the esophagus 59%, stomach 27% and gut 14% of cases, confirmed by radiographs in 90% and gastroscopy 10% of cases. Symptomatic children (n = 59) presented with vomiting 22%, retrosternal pain 16%, dysphagia 13%, drooling 9%, cough 8%, abdominal ache 5% and dyspnea 5%. Endoscopic removement of the objects occurred in 69%, surgery was required in 2% of cases. Surgical management was indicated in one child with gastric bezoar and another after swallowing multiple magnets with perforation of stomach and gut. Esophageal injury occurred in a one year old boy with a button battery lodged at the upper esophageal sphincter. No complications was seen in the other patients after endoscopic management. We conclude, that foreign body ingestion requires an immediate medical evaluation. Possible risks must be considered, when button batteries, magnets or sharp and long objects are ingested, particularely in the young or mentally delayed children.

Motivation: With respect to the devastating consequences of the increasing prevalence of diabetes mellitus, the main reason for end stage renal disease and dialysis in industrialized countries, and the very limited diagnostic and therapeutic possibilities to predict, monitor and prevent diabetic nephropathy (DN), new concepts for early recognition and quantification of the prevailing microvascular changes in DN are urgently needed. Materials and Methods: We present the first study of renal cortical tissue perfusion measurement by means of standardized color Doppler sonographic videos evaluated with the PixelFlux software 1 for Dynamic Tissue Perfusion Measurement (DTPM) in 92 patients with DM1 without MA compared to 71 healthy probands. Results: DTPM reveals a highly significant diminution of cortical perfusion in patients with DM1 compared to healthy probands by 31 %, most pronounced in the distal hemicortex (reduction by 50 %) compared to 21 % within the proximal hemicortex. Conclusion: Thus, DTPM offers a novel means of numerically describing the state of the renal microvasculature in DM in a patient-friendly, non-invasive, non-ionizing manner. © Georg Thieme Verlag KG.

Infliximab, a monoclonal antibody against TNFα has been approved for induction and maintenance of remission in moderate to severe pediatric Crohn's disease which is unresponsive to conventional therapy. Regularly scheduled maintenance therapy is recommended. Inflixmab is also at least an equal therapeutic alternative to previous immune suppressants in children with severe ulcerative colitis despite the lack of approval. Adalimumab may be used for attempted therapy in cases of loss of response to infliximab despite the lack of approval. Patients and their parents must be fully informed on short and long-term safety data as well as adverse events with TNFα blockers. © 2010 Springer-Verlag.

Aim of the prospective study was to investigate perinatal parameters and outcome of term SGA neonates. 100 term neonates were enrolled into 2 groups: group 1: 50 SGA neonates with birth weight below tenth percentile, group 2: 50 appropriate-for-gestational-age neonates. Both groups were compared concerning parental anamnesis, perinatal parameters, postnatal adaptation and development during the first days of life. After discharge from the hospital all children were observed during the first 15 weeks. In all infants the gain of weight, length, head circumference and the amount and type of nutrition were recorded. It was observed that only 13% of the SGA neonates were small children of small parents. Most of the SGA neonates had a normal target high. We found a significantly increased number of mothers with disturbed uterine or placental perfusion in the SGA group as well as increased problems in postnatal adaptation. SGA children had a significantly faster increase of gaining weight and a higher amount of nutrition during the first 15 weeks of life. This could be an early sign of catch-up-growth in SGA neonates, which could be regard as a part of the complex risk for developing a metabolic syndrome in formerly SGA children. © Georg Thieme Verlag KG Stuttgart New York.

Von Moers A.,Klinik fur Kinder und Jugendmedizin
Nervenheilkunde | Year: 2011

Duchenne muscular dystrophy is an X-linked recessive disease that affects about 1:3 500 male birth. It is caused by mutations of the DMD gene. Mutations lead to a loss of dystrophin which results in progressive muscle degeneration. The phenotype is characterised by a progressive proximal pronounced muscle weakness. Without intervention a wheelchair is required in the beginning of the teens and death occurs at about 20th year of life because of respiratoy or cardiac failure. Comprehensive multidisciplinary management can improve the course of disease, in particular the implementation of non-invasive ventilation remarkably prolonged life expectancy. Several gene therapeutic approaches are under examination. At present efficacy of exon skipping is investigated in international multicenter clinical trials. © Schattauer 2011.

Windschall D.,Klinik fur Kinder und Jugendmedizin
Zeitschrift fur Rheumatologie | Year: 2016

There has been growing interest in the use of imaging modalities in pediatric rheumatology for the past 15 years. Nowadays, highly sensitive imaging techniques can be used to detect early stages of pediatric rheumatic diseases in addition to the physical examination. Magnetic resonance imaging and musculoskeletal ultrasound play the most important role. Moreover, these two techniques are of great value in differential diagnostics and therapy monitoring. The use of imaging methods with a high radiation exposure could therefore be greatly reduced over the last decade. © 2016 Springer-Verlag Berlin Heidelberg

On the basis of current prognostic data, national and international public discussions and ethical evaluations in various consensus conferences an individualized, non-directive and undetermined approach towards critically ill prematures as well as mature newborns is presented. In these instances any decision-making has to follow both legal and ethical guidelines and should be concurrent within the team and most importantly with the affected parents.

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