Current opinion in pediatrics
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Curr. Opin. Pediatr. · Feb 2010
ReviewCrossing the blood-brain barrier: clinical interactions between neurologists and hematologists in pediatrics - advances in childhood arterial ischemic stroke and cerebral venous thrombosis.
The past year has marked a period of growing awareness of the need for improved diagnosis and treatment in children with arterial ischemic stroke (AIS) and cerebral sinus venous thrombosis (CSVT). Here we review these conditions, highlighting the importance of the intersection between hematologic abnormalities and pediatric stroke as they impact clinical management. ⋯ Progress in caring for children with AIS and CSVT requires greatly improved awareness of cerebrovascular disease among primary providers, who are most often the first point of contact, more rapid and specific diagnosis using appropriate advanced neuroimaging technologies, comprehensive hematologic evaluation for inherited and acquired thrombophilias, and multidisciplinary approaches to treatment. Additional large cohort studies and clinical trials are greatly needed to further clarify these issues.
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Osteogenic sarcoma, also known as osteosarcoma, is a primary malignancy of the bone in which spindle cells produce osteoid. Although rare in the general population, these tumors are the most common primary malignancies of bone and the fifth most common primary malignancy of adolescence. This paper aims to provide a general overview on the presentation, radiographic evaluation, and treatment of osteosarcoma as it presents in the pediatric patient population. Particular focus is placed on the importance of a comprehensive team of physicians, including the pediatric oncologist and orthopedic surgeon, to ensure prompt diagnosis and treatment. ⋯ Advancement in chemotherapeutic regimens has allowed improved survival and limb-sparing surgery in the treatment of osteosarcoma.
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The field of pediatric cardiac arrest experienced recent advances secondary to multicenter collaborations. This review summarizes developments during the last year and identifies areas for further research. ⋯ Therapeutic hypothermia and extracorporeal membrane oxygenation continue to be the only treatment modalities over and above conventional care for pediatric cardiac arrest. New approaches to monitoring, treatment, and rehabilitation after cardiac arrest remain to be explored.
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Curr. Opin. Pediatr. · Dec 2009
ReviewClinical management and functional neuromonitoring in traumatic brain injury in children.
Traumatic brain injury is the main cause of childhood disability and death. In this review, we highlight recent original findings and emerging themes from published literature on children with serious traumatic brain injury. ⋯ We suggest expanding clinical functional neuromonitoring to help clinicians understand the burden of exposure to physiological variables and response to therapies during intensive care in order to enhance the management of critically ill children with traumatic brain injury.
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Neurocritical care in adults with life-threatening neurological disease is a distinct discipline that has developed out of critical care medicine and neurology. This review considers whether it is time for such a specialized service to be developed in pediatrics. ⋯ Pediatric neurocritical care is the new frontier for pediatric critical care medicine and pediatric neurology. There is sufficient specialist interest and momentum for the development of a multidisciplinary collaboration that has the aim of improving patient care.