Pediatric clinics of North America
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Myocarditis and pericarditis are rare but important causes of pediatric chest pain. The diagnostic criteria, clinical course, causes, and treatment of myocarditis is reviewed. ⋯ The identification and treatment of pericarditis with associated large pericardial effusion can be lifesaving. This article reviews the important clinical features that might lead the clinician to diagnose either myocarditis or pericarditis and thus separate the few patients with either of these conditions from the legions of children with noncardiac chest pain.
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Sport-related concussion is a common problem encountered by pediatricians and other primary care physicians. Assessment of concussion is based on clinical evaluation. The Zurich consensus statement provides a basic framework to guide concussion management decisions and recommends an individualized approach and the exercising of clinical judgment in return-to-play decisions. This article reviews practice aspects of concussion for the adolescent athletes who present in the primary care office or clinic setting.
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The risk of developing cancer after solid organ transplantation (SOT) is about 5- to 10-fold greater than that of the general population. The cumulative risk of cancer rises to more than 50% at 20 years after transplant and increases with age, and so children receiving transplants are at high risk of developing a malignancy. ⋯ Among children, most cases are associated with Epstein-Barr virus infection. This article reviews the pathology, immunobiology, epidemiology, and clinical aspects of PTLD, underscoring the need for ongoing systematic study of complex biologic and therapeutic questions.
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Pediatr. Clin. North Am. · Dec 2009
ReviewInjuries and injury prevention among indigenous children and young people.
Throughout the world, injuries and violence are a leading cause of mortality and suffering among Indigenous communities. Among American Indian and Alaska Native children aged 1 to 19 years, 71% of deaths are from injuries. ⋯ For Indigenous populations in middle- and low-income countries, trauma caused by motor-vehicle accidents, agricultural injuries, interpersonal violence, child labor, and the ravages of war are priorities for intervention. To be effective, injury-prevention efforts should be based on scientific evidence, be developmentally and culturally appropriate, and draw on the inherent strengths of Indigenous communities.
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Pediatr. Clin. North Am. · Dec 2009
ReviewAcute rheumatic fever and rheumatic heart disease in indigenous populations.
Acute rheumatic fever and rheumatic heart disease are diseases of socioeconomic disadvantage. These diseases are common in developing countries and in Indigenous populations in industrialized countries. ⋯ Inexpensive medicines, such as aspirin, are the mainstay of symptomatic treatment of rheumatic fever; however, antiinflammatory treatment has no effect on the long-term rate of progression or severity of chronic valvular disease. The current focus of global efforts at prevention of rheumatic heart disease is on secondary prevention (regular administration of penicillin to prevent recurrent rheumatic fever), although primary prevention (timely treatment of streptococcal pharyngitis to prevent rheumatic fever) is also important in populations in which it is feasible.