MedClips

Long-term treatment results of hepatoblastoma at a single institution in Taiwan. Hou JY, Liu HC, Yeh TC, Chen SH, Wang LY, Sheu JC, Liang DC. PMID: 19727010 From 1990 to 2004, 23 patients with Hepatoblastoma were treated at the Mackay Memorial Hospital in Taipei. The basic information of each person is summarized in table 1, and in addition to the surgery, the first line therapy was cisplatin 90 mg / m 2 / d on the first day and epirubicin 25 mg / m 2 / d on the first day to the third day. Each course was repeated every 3 weeks and Epirubicin was chosen because of its low cardiotoxicity. Carboplatin / etoposide, vincristine / cyclophosphamide / 5-fluorouracil were used as secondary agents when the cumulative toxicity of the first-line treatment became a problem. Table 2 lists information about the medicines used to treat people and their current disease status. In the first case of immediate surgical removal, 4-6 courses of post op chemotherapy were performed, of which 3 died due ...

Hepatoblastoma in children with Beckwith-Wiedemann syndrome: does it warrant different treatment? Trobaugh-Lotrario AD, Venkatramani R, Feusner JH. PMID: 24608075 In this paper, we analyzed the cases with hepatoblastoma among 56 BWS patients. Patients with Beckwith-Wiedemann Syndrome (BWS) are 2,000 times more likely to get hepatoblastoma than the average population. At the time of diagnosis of hepatoblastoma, the mean age of the patients was 6 months. Of the 26 patients, 13 were born premature. Of 31 patients, 19 had hemihypertrophy and 32 of 33 had AFP levels at diagnosis. The overall survival rate was about 75%, of which 27 out of 36 survived. Of the 25 survivors, 24 received chemotherapy and surgery. All 9 patients who had undergone routine liver cancer screening were all alive until the time of the report, suggesting a prospective study of whether BWS patients will be regularly screened for further survival after early detection.

Osteomyelitis is an infectious disease localized to the bones. In this disease, especially hematogenous bone microorganisms occur frequently due to traumatic, surgical, sinusitis or periodontal disease. Epidemiplogy In a systematic review in 2012, it is known that one of 5000-700 in developed countries and one in 500-2300 in developing countries is more likely to appear in developing countries. In the United States, osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is increasing. Pathogenesis Although the mechanism of deposition has not been well known, microbial migration of endothelial cells seems to play a major role in the initiation of microbial growth. It also develops as bone marrow or cellulitis, and exudate raises intramedullary pressure to cause rupture. Subacute and chronic osteomyelitis may form intraosseous abscesses and cause suppuration and necrosis. Causes S. aureus is the most common cause of osteomyelitis in children. From 1996 to 201...

ymptoms Asthma is characterized by reversible airway obstruction due to increased airway hyperresponsiveness due to chronic inflammation of the airways. Airway mucosal edema, mucus hypersecretion, airway smooth muscle contraction due to cough, dyspnea is an important symptom of asthma. Diagnosis The diagnosis of asthma is based on a combination of detailed history listening, examination findings, laboratory tests and in vivo tests. However, these diagnostic methods may be limited by age and patient condition. Because of the structural and physiological peculiarities of the respiratory tract, pediatric patients may have symptoms of airway obstruction such as asthma even in children younger than 2 years of age. Skin tests are possible, especially until age 2, but they are very limited, have a high dependence on blood tests, and can not be tested for asthma induction and lung function. Skin tests and maximal expiratory rate can be measured after 4 years of age. By the age of 6, almos...

Mycoplasma pneumonia spreads through the respiratory system and the latency period is about 12-14 days on average. It is prevalent every three to four years, especially in autumn and winter. This is the highest incidence of childhood school children. M. pneumoniae affects respiratory ciliated epithelial cells and causes inflammation. After infection, the cold hemagglutinin response to the red blood cell I antigen begins to appear nonspecifically after one week, and increases by four times over four weeks and becomes negative after four months. The test for M. pneumonia specific antibodies includes complement binding test and immunofluorescence test, but indirect hemagglutination test is most widely used. It increases at the end of the first week after the onset and reaches its peak at 3 ~ 4 weeks and gradually decreases. Symptoms Clinical symptoms of Mycoplasma pneumonia are severe, long-standing cough and fever over 38 degrees. Headache, malaise, fever, runny nose, and sore throat ...

Hemoptysis refers to the bleeding that occurs in the lower extremities and should be differentiated from bleeding from the donor nasopharynx and gastrointestinal tract. It is important to distinguish between hemoptysis and hematemesis. Hemoptysis is bright red or rust, pH is alkaline. Usually accompanied by a cough, mixed with blood in the phlegm, frothy mucus can be seen if you see a hemoptysis. Chest pain may also accompany. On the other hand, blood clots may show crimson or brown with a coffee-ground appearance and may contain food waste. It has an acidic pH, followed by nausea and vomitting. Causes The most common causes of hemoptysis in children are respiratory infections, foreign body aspiration, and bronchiectasis. Bronchiectasis is most common in children with cystic fibrosis. Tuberculosis is the cause of bacterial infection and histoplasmosis, coccidioidomycosis, invasive pulmonary aspergillosis, aspergilloma, and stachybotrys atra are the causes of fungal infection. Trache...

A respiratory infection is the first suspicious symptom when it comes to symptoms of runny nose, cough, sputum and shortness of breath in infants and young children. The most common causative agent is a virus, which causes a cold, nasal congestion, rhinorrhea, throat injection, and cough. Viral respiratory infections are largely divided into upper respiratory infections and lower respiratory infections. Upper respiratory tract infection The infection usually involves the nose and the larynx and is accompanied by a mild or no fever. Croup is a typical disease. It is the most prevalent at 3 to 5 months of age and 2 years of age and is known to be more prevalent in men. In addition, family history is often seen. Parainfluenza was the most common causative organism, and RSV, adenovirus, and influenza were the most common causative organisms of the viral croup. In the bacterial croup, hemophilus influenza was the main causative organism. However, vaccine was developed and Moraxella catar...

Symptoms & Complications Influenza virus infections cause high fever, runny nose, throat, muscle aches, headache, cough, and fatigue. These symptoms typically begin 2 days later and disappear a week later. However, coughing can last for more than two weeks. Zone and vomiting can occur, especially in children. This is a rare condition in adults and has a greater severity in influenza B infection. At first, it is difficult to distinguish between cold and influenza infection, but flu can be classified into high fever and sudden fatigue. The GI symptom may be seen in some adults with H5N1 called bird flu. Complications of Influenza infection include viral pneumonia, secondary bacterial pneumonia, sinus infection, asthma and heart failure. In fact, mycoplasma infection was confirmed in this patient, and we felt the necessity to check whether the complication did not occur in influenza infection patients. If the symptoms appear to improve and then return to high temperature, this may be...

Symptoms Atopic dermatitis is known to be caused by atopic genetics and exposure to the environment. Patients with atopic dermatitis (80 to 90%) were diagnosed before the age of five. The location and shape of the lesion vary with age, and this is very important for diagnosis. Symptoms appear around the mouth, on the cheeks, and on the outside of the limbs when under 2 years of age. There is a lot of friction between the aged 3 and adolescent, or in the folded parts (arms, neck, earlobe, armpits, etc.), and then more on the face and neck. Main symptoms are itching, location and shape of characteristic lesion, history of atopy or family history. Auxiliary symptoms include dry skin, pore keratosis, skin prick test positive, increased IgE, white skin necrosis, nonspecific eczema of the limbs, clefts, itching when sweating, eczema or pigmentation around the eyes, eczema around the ears, There is an increase in infection, papillary eczema, and white nasolacia in women. Atopic dermatitis is...

Symptoms Kawasaki disease is an acute vasculitis that often occurs in young children. When left untreated, coronary aneurysm is known to occur in about 20% of patients. The exact cause of Kawasaki disease has not yet been elucidated, and there is a hypothesis that patients with genetic predisposition, especially those with Asians, are more likely to develop Kawasaki disease. There are characteristic clinical findings, which are diagnostic criteria. First, there is a high fever lasting more than five days. Palms or soles swollen and red. There are rashes of various shapes and sizes in the skin and itchy. Bilateral conjunctival hyperemia is seen, but there is no glare. There may be flushing and cracking of the lips, bleeding, and redness in the strawberry and oral mucous membranes. Cervical lymph node enlargement may also be seen. Treatments IVIg and aspirin are mainly used for treatment. High-dose aspirin and IVIg are given to the acute phase. When the fever completely falls from 48...

Symptoms Bronchiolitis is an inflammation of the bronchiole, which is a clinical symptom of lower respiratory tract infection, dyspnea and wheezing or rale following viral upper respiratory infections in infants under 2 years of age. Occlusive occlusion may cause overexcessing of the lungs and hypoxia (SaO2 <95), accompanied by pharyngitis and acute otitis media. Severe infants can have cyanosis due to difficulty breathing, and even wheezing can become inaudible if the airway is completely blocked. The most common causative organism is RSV, but there are viruses such as metapneumovirus, parainfluenza, and adenovirus, and bacteria such as chlamydia and tuberculosis. Patients with severe symptoms (persistent dyspnea, SpO2 <95%, acute respiratory failure, unable to eat, shrinking, and needing water replenishment) require inpatient treatment. Diagnosis is suspected when the infant under 2 years of age is healthy but wheezing is present for the first time. Hyperinflation on x-ray ma...

Causes & Symptoms When we look at viral meningitis, symptoms are similar to bacterial meningitis, but they are usually much weaker. Neurological symptoms may be relatively low or absent. However, in neonates, herpes simplex virus meningitis is associated with a higher risk of severe systemic diseases such as pneumonia, hepatitis, and myocarditis. When infected with enteroviruses (poliovirus, coxsackievirus, echovirus, numbered enteroviruses), which are the most common cause of viral meningitis, sudden fever of 38 ~ 40 ℃ occurs in more than half of cases. In addition, if the child has symptoms such as conjunctivitis, pharyngitis, rash, and wrist disease, enterovirus may be suspected. Herpes simplex virus, arbovirus, lymphocytic choriomeningitis virus, influenza virus, and mumps virus. Diagnosis The Bacterial Meningitis Score (BMS) can be used to predict if the cause is due to the virus. CSF pleocytosis (WBC count ≥10 cells / μL for CSF) In children who have not received antibiot...

Meningitis is largely divided into viral meningitis (most common) and bacterial meningitis. If it is bacterial, it is a medical emergency, so rapid diagnosis and treatment are needed. Without treatment, mortality is close to 100%. Neurological sequelae may also remain. Because bacterial meningitis is more severe than viral meningitis and has a poor prognosis, it is very important to differentiate between these two. First, let's look at bacterial meningitis. Causes Streptococcus pneumonia, Neisseria meningitidis, and Haemophilus influenza (decreased by preventive vaccine) are the main causative agents. Group B streptococcus is the most common causative organism in infants 1 month to 3 months of age. Neisseria meningitidis is the most common cause among children and adolescents aged 10 to 19 years. Symptoms Symptoms include fever, nausea, vomiting, anorexia and meningeal signs (headache, back pain, neck stiffness). However, because of nonspecific symptoms, all of these symptoms...

Community acquired pneumonia is a leading cause of death in children under five in developing countries and accounts for 29% of all deaths worldwide for children under five years of age. The incidence of pneumonia is ten times higher in developing countries than in developed countries. Between 1939 and 1996 in the United States, children's pneumonia mortality declined by 97%. Haemophilus influenza type b (Hib) has been one of the major causes of bacterial pneumonia, but it has been reduced by the introduction of vaccines, which is thought to have decreased with the expansion of medical insurance for antibiotics, vaccines and children. Causes Most cases of pneumonia are caused by microbial infections, but food, gastric acid, foreign body aspiration, and hypersensitivity reactions are the noninfective causes. It is difficult to find the cause of pneumonia in individual patients. First, lung tissue biopsy is so invasive that it is rarely performed. 2) Sputum does not show the cause...

If it is symptomatic, it will perform advanced imaging soon after surgery. Intralobar sequestration is removed through lobectomy and segmental resection, and extralobar sequestration removes lesions. Since all vessels are connected from the systemic circulation, it is important to ligate all vessels well. Other operations include thoracoscopic lobectomy and arterial embolization. If asymptomatic, early surgical resection is available if: - Large lesion (occupies ≥ 20 percent of the lobe) - Characteristics suggesting risk for pleuropulmonary blastoma (family history, bilateral or multifocal cysts, and pneumothorax) Even if it does not meet the above criteria, elective surgical resection will be done. This will be done mainly at 6 to 12 months, and will be performed for the following reasons. - Therapeutic purpose is strong because it can cause serious complications. Patients with Lung sequestration are more susceptible to infection later. (Especially intralobar sequestration) ...

Lung sequestration is characterized by a non-functioning lung tissue with lower airway congenital abnormality. This non-functioning lung tissue is not normally associated with the tracheobronchial tree, and is supplied by the systemic circulation rather than the pulmonary artery. One congenital lower respiratory tract abnormality is found in 10,000 to 35,000 people, the most common being congenital cystic adenomatoid malformation, and lung sequestration is found in 0.15 to 6.4%. Classification of lung sequestration Lung sequestration is divided into two types according to location. The standard of location is visceral pleura. 1) Intralobar sequestration: Located in the same visceral pleura as the normal lung, accounting for 75% of the total lung sequestration. They are mainly adolescents and adults, who experience repetitive pneumonia while experiencing the same rate of men and women. Approximately 60% of the cases occur in the left lower lobe, mainly hemoptysis and recurrent pneu...

Symptoms Meconium aspiration syndrome is defined as a case in which the amniotic fluid is manifested as a respiratory distress syndrome in a newborn born with meconium staining and the cause of which is unknown. Meconium aspiration syndrome is present in 5% of all cases, and meconium aspiration syndrome occurs in 10% to 15% of total labor. Meconium aspiration syndrome requires mechanical ventilation in 30% of patients and mortality rate is 3-5%. Wrinkled skin, long nails may appear and meconium may be colored on the skin, under the fingernail, and on the umbilical cord. And if the meconium is released and aspirated by the perinatal period, it may be stretched. Symptoms such as rapid respiration, chest wall depression, cyanosis, pneumothorax, and hemiplegia may last for days to weeks and may be accompanied by pulmonary hypertension. On imaging, chest X-ray may show bilateral lung swelling, irregular lung decline, and atelectasis. Treatments If the amniotic fluid is stained in mecon...

Causes The definition of neonatal thrombocytopenia is defined as 150,000 / μL or less, and 1 to 2% may occur in normal children, but most of them have few symptoms and severely decrease to less than 50,000 in some cases. Most causes are classified according to the timing of platelet reduction. Placental dysfunction (preeclampsia, intrauterine growth retardation, etc.) and perinatal history of early onset occurring within 72 hours of birth. It may be considered a perinatal infection (eg E. coli, GBS, Haemophilus infuenzae), DIC, homologous immunity, autoimmune, congenital infection, thrombosis, metabolic disease, hereditary congenital disease and Kasabach-Merritt syndrome. Late onset after 72 hours of birth may be caused by delayed onset sepsis, neonatal necrotizing enteritis, congenital infection, metabolic disease, autoimmune, hereditary congenital disease.  Immune thrombocytopenia is largely autoimmune and allogeneic. Autoimmunity is the case when an anti-platelet antibody is ...

Congenital cystic adenomatoid malformation (CCAM) is the most common congenital lung disease and occurs sporadically regardless of race, age, and other factors. There are no known genetic polymorphisms and are known to cause 1-4 out of 100,000 people. It is a hamartomatous lesion composed of cystic and adenomatous tissue. Unlike pulmonary sequestration, blood is supplied through the pulmonary circulation and mainly affects one lobe of the lung. Because it is abnormally proliferating, not only the lung at the affected site but also the lung at the opposite site is also depressed, making it difficult to function. Diagnosis Among 5 types, the most common type is type 1 (60-70%). Type 1 CCAM exists as a 2 to 10 cm thin walled sac, not multiple. In addition, Type 2 CCAM is associated with congenital diseases of various organs such as esophageal atresia, tracheoesophageal fistula, and renal agenesis, and Type 4 CCAM is capable of malignant transformation. About 75% of children with pree...

Causes The risk factors for perinatal asphyxia can be divided into three categories: prenatal, delivery, and postnatal. Risk factors for uterine pregnancy include maternal hypotension, maternal hypotension, maternal respiratory and cardiovascular disease, fetal congenital anomalies, and premature infants. The risk factors for labor are dystocia, fetal rotation, abnormal placenta, placental exfoliation, And hypotension. Postpartum risk factors include severe pulmonary disease of the newborn, severe recurrent apnea, congenital heart disease, patent ductus arteriosus with cardiac insufficiency, sepsis with cardiovascular collapse, persistent fetal circulation. The risk factors for normal birth and delivery are usually 90% of the perinatal asphyxia. Perinatal asphyxia can be diagnosed by satisfying all four of the following criteria. ① Severe metabolic or mixed acidemia due to arterial blood gas test, ② Apgar scores continuously 0 to 3 even after 5 minutes of birth, ③ Neurological sympto...