Klinische Pädiatrie
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Klinische Pädiatrie · May 2008
Case ReportsChemotherapy as a therapeutic option for congenital neuroblastoma complicated by paraplegia.
Spinal compression can be a complication of neuroblastoma (NBL). Delayed or insufficient treatment of this condition may lead to permanent neurological sequelae. Therefore, appropriate treatment should be introduced promptly. Therapeutic options include neurosurgery, chemotherapy, and radiation therapy. ⋯ Rapid initiation of chemotherapy was safe and effective in a neonate with NBL complicated by spinal cord compression.
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Klinische Pädiatrie · May 2008
[Preparation and monitoring of sedation and analgosedation carried out by pediatricians and pediatric training assistants].
Sedation and analgosedation form part of the every-day work in the clinical care of pediatric patients. The American Academy of Pediatrics (AAP), the American Society of Anesthesiologists (ASA) and the German Society for Anesthesiology and Intensive Care (DGAI) have established guidelines outlining the general conditions for sedating/analgosedating measures. Since the provisions of the specialist associations diverge in some respects, we have developed an own standard. This takes into account the existing guidelines, aiming at maximum safety for our patients and maximum practicability. ⋯ The standard we have developed and applied provides a practicable and safe protocol to regulate the preparation and monitoring of sedations and analgosedations for pediatric patients. A specific guideline to be issued by the Deutsche Gesellschaft für Kinder- und Jugendmedizin (German Pediatric Society) is considered desirable.
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Klinische Pädiatrie · May 2008
Parents' perspective on symptoms, quality of life, characteristics of death and end-of-life decisions for children dying from cancer.
In the present study, we investigated the situation of children who had succumbed to their malignancy in Germany as perceived by their parents. Specifically, we were interested in bereaved parents' perspective on five essential areas: 1) symptoms and quality of life, 2) characteristics of the child's death, 3) anticipation of their child's death and care delivery, 4) end-of-life decisions and 5) impact of the child's death on the parents and perceived social support by the health care team. ⋯ The present study demonstrated that psychological symptoms (e.g. anxiety) are frequent symptoms in the end-of-life care period and cause severe suffering in the children. Questions in terms of benefits and costs of cancer-directed therapy in the end-of-life care period need to be addressed in future prospective studies. Parents' perspective on their child's death and related end-of-life decisions highlighted the importance of communication between parents and the health care team. Future studies need to investigate potential barriers in the communication between parents and the team to optimise end-of-life decisions and hence, reduce parents' long-term distress. In line with the previous, the present data demonstrated that there is still a lack of routine contact from the health care team following the child's death despite existing guidelines. Research is therefore needed into the implementation of guidelines for routine contact into clinical practice following a child's death.
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The purpose of imaging of the elbow region in children after acute trauma is the diagnosis of injuries that require further treatment. Basic diagnostic consists of standard X-rays of the elbow in two planes. Exceptions can be made in the case of nursemaid's elbow lesion (subluxation of the radial head; pronation douloureuse; Chassaignac lesion) with unambiguous mechanism of the trauma where no X-ray imaging is needed and in heavily dislocated fractures for which one plane can be sufficient. ⋯ Follow-up X-ray imaging is only allowed if consequences for the further treatment are expected. Ultrasound may partially replace X-rays in the future if further standardization of this technique can be achieved. MRI provides additional information in acute trauma which, however, remains currently without consequences for the further treatment strategy.