Pediatric clinics of North America
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Pediatr. Clin. North Am. · Aug 2014
Transitions to and from the acute inpatient care setting for children with life-threatening illness.
Children with life-threatening illnesses (LTIs) are hospitalized more often and spend more days in the hospital than children without LTIs. Hospitalizations may be associated with changes in health status of children with LTIs and thus alter their care needs significantly. Transitional care is particularly relevant for this population. Pediatric palliative care clinicians and teams are well-positioned to improve transitional care of children with LTIs by facilitating communication between clinicians and educating clinicians about issues related to children with LTIs.
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Pediatr. Clin. North Am. · Apr 2014
ReviewDiagnosis and management of morphea and lichen sclerosus and atrophicus in children.
Morphea (localized scleroderma) is a rare fibrosing disorder of the skin and underlying tissues characterized by skin thickening and hardening due to increased collagen deposition. The significance of the disease depends on the extent of the lesions, potential for functional disability or cosmetic disfigurement, and presence or absence of extracutaneous manifestations. Treatment is tailored; circumscribed forms may require only topical treatment, while forms causing functional impairment or severe cosmetic change may require systemic treatment. Although localized scleroderma has a good prognosis, some clinical subtypes can be deforming and irreversibly disabling, especially when affecting the extremities or the face.
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The spectrum of blunt cardiac trauma ranges from asymptomatic myocardial contusion to fatal cardiac arrhythmias and/or cardiac rupture. Although cardiac rupture is common in fatal traffic accidents, these patients rarely reach hospital care. ⋯ Most cases are dead at the scene and never reach hospital. The incidence of cardiac sequelae in survivors is high, and these patients should be evaluated with early and late echocardiography to detect anatomic or functional cardiac involvement.
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Pediatr. Clin. North Am. · Dec 2013
ReviewInherited abnormalities of coagulation: hemophilia, von Willebrand disease, and beyond.
Bleeding disorders are broadly classified into primary and secondary hemostatic defects. Primary hemostatic disorders (disorders of platelets and von Willebrand factor) mainly result in mucocutaneous bleeding symptoms such as epistaxis, menorrhagia, petechiae, easy bruising, and bleeding after dental and surgical interventions. Secondary hemostatic disorders (congenital or acquired deficiencies of coagulation factors) typically manifest with delayed, deep bleeding into muscles and joints. This article provides a generalized overview of the pathophysiology, clinical manifestations, laboratory abnormalities, and molecular basis of inherited abnormalities of coagulation with a focus on hemophilia, von Willebrand disease, and rare inherited coagulation disorders.