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Clippings Indian Pediatrics 2001; 38: 813-814 |
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Clippings |
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Treatment of ureteral calculi in the pediatric population represents a unique challenge. In this study done between 1989 and 1999, 21 boys and 17 girls (range 8 months to 14 years) with ureteral stones were treated with extracorporeal shock wave lithotripsy (ESWL). Of the 38 patients, 31 (81.5%) were free of stones after 1 session; the stone-free rate following 1 ESWL session was 100% for ureteral calculi 10 mm or smaller regardless of location. Of the 12 patients with stones larger than 10 mm, 8 (67%) were free of stones following 1 ESWL session. The overall success rate of ESWL was 97.3%. No child had postoperative urinary infection or ureteral obstruction. Thus ESWL is an efficient and safe modality for the treatment of pediatric ureteral stones (J Urol 2001;165: 2316). The short-term beneficial effect of hydroxyurea (HU) in sickle cell disease (SCD) has been proven by randomized studies in children and adults. To evaluate its long-term efficacy and toxicity, analysis of the 22 patients with a minimum of 5 years of follow-up was done revealing a significant decline in the number of hospitalizations (p = 0.0002) and days in the hospital (p < 0.01) throughout the treatment. No important adverse effect occurred. Long-term chronic treatment with HU for patients with SCD appears feasible, effective, and devoid of any major toxicity. In patients with a history of stroke, HU may be a valid alternative to chronic transfusion support (Blood 2001; 97: 3628). The arterial switch operation is judged the best palliative operation for neonates with transposed great arteries. This study reviewed all 432 neonates (mean age at operation 7 days, mean weight 3·25 kg) who underwent an arterial switch operation between 1987 and 1999. Follow-up (mean time: 4·9 years) was complete in 412 patients. Survival probability and freedom from reoperation was 94% and 78% at 10 years, respectively. Twenty six patients died, 16 because of myocardial ischemia. At last follow-up, 90% of patients had normal life without treatment, and 94% a normal heart function on echocardiography. Although confirmation is needed, these results allow anticipation of a favorable long-term prognosis (Lancet 2001; 357: 1826). Open spina bifida is the most complex congenital abnormality compatible with long-term survival. This report outlines the 20- to 25-year outcome of patients with a myelomeningocele treated in a nonselective, prospective manner. Of the initial 118 children, 71 patients were available for the most recent review. Nineteen patients had been lost to follow-up and 28 subjects had died. Mortality (24%) continued to climb into young adulthood. Sixteen patients (23%) had had at least one seizure. Eighty-five per cent were attending or had graduated from high school and/or college. More than 80% of young adults had social bladder continence. To conclude, at least 75% of children born with a myelomeningocele can be expected to reach their early adult years. Late deterioration is common (Pediatr Neurosurg 2001; 34: 114). There is little information on the effects of Helicobacter pylori eradication in patients with a primary diagnosis of gastro-esophageal reflux disease (GERD). A double-blind, randomized, placebo-controlled study was conducted in 70 patients with GERD (3 groups). Patients were followed up for 6 months at 2-week intervals for GERD symptoms and 58 of 70 patients completed the study. When results were corrected for the affect of esophagitis grade, H. pylori positive patients relapsed earlier (p = 0·086) than H. pylori eradiated patients and controls (p = 0·001). Eradication of H. pylori could, therefore, help to prolong disease-free interval in patients with GERD (Lancet 2001; 357: 1738). An electronic stethoscope and a computer program trained to recognize complex patterns can accurately distinguish innocent heart murmurs from pathological murmurs in children, report US researchers. DeGroff and co-workers used the stethoscope to record heart sounds of 37 children with abnormal heart murmurs and 32 with innocent heart murmurs. The sounds were fed into the computer program technically, an artificial neural network so that it "learned" to discriminate between the different types of murmurs, and eventually achieved 100% sensitivity (ability to identify an abnormal murmur) and 100% specificity (ability to identify an innocent murmur) (Circulation 2001; 103: 2711). During the past five decades there has been increasing interest in the potential anti-inflammatory effects of macrolide antibiotics. Low-dose macrolide therapy has dramatically increased survival in patients with diffuse panbronchiolitis, a disease with many similarities to cystic fibrosis (CF). This has led to further investigation into the potential use of macrolides in chronic lung diseases with an inflammatory component. This review summarizes the proposed anti-inflammatory mechanisms for this group of antibiotics, and examines the effect of macrolides on modulation of the inflammatory pathways, neutrophil function, and bronchoconstriction. It discusses the current status of clinical studies in children with CF, bronchiectasis, and asthma. The benefits and potential side effects need to be determined before routine use can be advised (Pediatr Pulmonol. 2001; 31: 464). Gaurav
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