Pediatric clinics of North America
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The prognosis for the child with cancer has improved dramatically over the past decades. With this success comes the need for recognition and proper treatment of emergencies. Respiratory or circulatory failure may arise from compression of the SVC or airway. ⋯ Life-threatening metabolic abnormalities are observed at presentation in children with leukemia and lymphoma. Hypercalcemia, although rare, may be a difficult situation to correct. Immediate attention to these emergencies and appropriate treatment may save the life of a child with cancer or make his or her subsequent course just a little smoother.
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Over the last several decades, significant advances have been made in our ability to understand and treat osteosarcoma. In this article we describe the diagnosis, evaluation, and treatment of patients with this disease. ⋯ We review the major clinical trials that have led to our current level of understanding. The current studies for the treatment of osteosarcoma are described.
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Pediatr. Clin. North Am. · Apr 1997
ReviewPediatric obesity. An overview of etiology and treatment.
Pediatric obesity is a chronic and growing problem for which new ideas about the biologic basis of obesity offer hope for effective solutions. Prevalence of pediatric and adult obesity is increasing despite a bewildering array of treatment programs and severe psychosocial and economic costs. The definition of obesity as an increase in fat mass, not just an increase in body weight, has profound influence on the understanding and treatment of obesity. ⋯ Identification of the biochemical pathways causing obesity by genetic approaches could provide the theoretic foundation for novel, safe, and effective obesity treatments. The cloning of leptin in 1994 has already led to testing the efficacy of leptin in clinical trials that are now underway. Although novel treatments of obesity are being developed as a result of the new biology of obesity, prevention of obesity remains an important goal.
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Pediatr. Clin. North Am. · Feb 1997
ReviewRecent advances in the treatment of bronchiolitis and laryngitis.
Progress has been made in the treatment for patients with croup and bronchiolitis in the past decade. By intervening with pharmacologic agents, a better outcome has been documented in children with these diseases. A lower probability of hospital admission means that fewer health care dollars need to be expended in this area. ⋯ Use of intramuscular dexamethasone is difficult to justify in patients with croup who are able to ingest oral medications. Future studies need to examine dosing of glucocorticoids for inpatients with croup. In addition, an important question remains as to whether very mild croup patients (those with no evidence of respiratory distress) might benefit from glucocorticoids administered in the physician's office or the emergency department.
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The resuscitation of children from cardiac arrest and shock remains a challenging goal. The pharmacologic principles underlying current recommendations for intervention in pediatric cardiac arrest have been reviewed. Current research efforts, points of controversy, and accepted practices that may not be most efficacious have been described. ⋯ Lidocaine is the drug of choice for ventricular dysrhythmias, and bretylium, still relatively unexplored, is in reserve. Many pediatricians use dopamine for shock in the postresuscitative period, but epinephrine is superior. Most animal research on cardiac arrest is based on models with ventricular fibrillation that probably are not reflective of cardiac arrest situations most often seen in pediatrics.