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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.

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.

Gappa M.,Klinik fur Kinder und Jugendmedizin
Pneumologe | Year: 2010

Bronchial asthma is the most common chronic pulmonary disease in childhood and adolescence, but still underdiagnosed. In comparison to adults an atopic disposition is more common in children. The diagnosis is based primarily on clinical criteria. Treatment follows a stepwise treatment plan in which inhaled corticosteroids form the basis of anti-inflammatory therapy. In comparison to adults a combination with another substance class is recommended even at lower doses of inhaled corticosteroids. Montelukast is more important for baseline treatment. A definitive diagnosis is difficult in pre-school age, therefore the risk of asthma later on is estimated and therapy is guided by current symptomas. The aim of treatment at all ages is to achieve and maintain good control of the asthma and to ensure that physical and psychological development is not affected by the disease. Copyright © Springer-Verlag 2010.

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.

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