1/7. Late presentation of upper airway obstruction in Pierre Robin sequence.A retrospective review was carried out of 11 consecutive patients with the Pierre Robin sequence referred to a tertiary paediatric referral centre over a five year period from 1993 to 1998. Ten patients were diagnosed with significant upper airway obstruction; seven of these presented late at between 24 and 51 days of age. failure to thrive occurred in six of these seven infants at the time of presentation, and was a strong indicator of the severity of upper airway obstruction. growth normalised on treatment of the upper airway obstruction with nasopharyngeal tube placement. All children had been reviewed by either an experienced general paediatrician or a neonatologist in the first week of life, suggesting that clinical signs alone are insufficient to alert the physician to the degree of upper airway obstruction or that obstruction developed gradually after discharge home. The use of polysomnography greatly improved the diagnostic accuracy in assessing the severity of upper airway obstruction and monitoring the response to treatment. This report highlights the prevalence of late presentation of upper airway obstruction in the Pierre Robin sequence and emphasises the need for close prospective respiratory monitoring in this condition. Objective measures such as polysomnography should be used, as clinical signs alone may be an inadequate guide to the degree of upper airway obstruction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Perinatal tuberculosis.Perinatal tuberculosis is insufficiently understood. Its early diagnosis is essential but often difficult as the initial manifestations may be delayed. Improved screening of women at risk and sensitivity of the medical community are necessary. A coherent system of cooperation between the hospital and community services and between pediatricians and adult physicians is indispensable to find the index adult case to break the chain of contagion as well as to offer prophylactic therapy to the children at risk. We hereby report a baby with perinatal tuberculosis who was not offered any prophylactic therapy inspite of the mother being diagnosed to have pulmonary tuberculosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. failure to thrive in a ten-year-old girl.A 10-year-old girl was followed over an 18-month period for vague gastrointestinal complaints, failure to thrive, and anemia. She was evaluated by several primary care physicians and consultants who failed to diagnose her problem or alleviate her symptoms. The treatment of an acute illness, a consequence of her presenting problem, resulted in the diagnosis of an unusual entity with important psychological and somatic features.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. A febrile child with seizure and hemiparesis.Febrile seizures are the most common neurological disorders in children and are among the more common symptoms that lead to an emergency department visit. Although most febrile seizures are simple and benign, these seizures can infrequently create a diagnostic dilemma. The diagnosis of cerebral venous thrombosis is challenging to emergency physicians because it can mimic the presentation of many other disorders, including ischemic and hemorrhagic stroke, tumor, and abscess. In addition, the broad variety of signs and symptoms makes the clinical diagnosis difficult. The patients may be presented with signs of increased intracranial pressure or focal neurological deficits. It is an uncommon but potentially dangerous cause of hemiparesis after seizure. Early recognition of this condition and appropriate management may reduce the mortality rate. We present a young child with dural sinus thrombosis who presented with seizures associated with fever and subsequent hemiparesis, and explained a possible mechanism of focal neurological deficit.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. infant mental health and biological risk.parents seldom seek help directly for infant mental health problems. parents enter the health care system seeking advice for identified or presumed biological problems in their infants. Many of these biological problems, however, have major psychosocial components of importance to infant mental health. It is important that physicians deal directly with the psychosocial issues and avoid converting them into biological medical problems unintentionally. Three common types of problems and appropriate methods of management are discussed to ensure special recognition and effective handling by the physician of psychosocial problems and the promotion of mental health. The problems discussed are the following: Infants seen with defined medical conditions that generally have associated psychosocial problems including child abuse. Infants seen who have fully recovered from critical illnesses but are considered "at risk" for later developmental disability. Infants seen with normal variations of behavior that are misinterpreted by their parents or physicians as due to a medical problem. In infancy medical and psychosocial issues are so closely interwoven that it is critical that physicians learn to recognize the major psychosocial consequences of primary medical problems and the medical manifestations of primary psychosocial problems and their management.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
6/7. Environmental failure to thrive: the need for intervention.Evaluation of the child with failure to thrive consists of a comprehensive history, a thorough physical examination and appropriate laboratory tests. The behavioral characteristics of the infant and mother, as well as the social characteristics of the family, may point to the diagnosis of environmental failure to thrive. Appropriate management strategies are influenced by the psychosocial assessment. The physician must maintain an advocacy role for the child throughout this time, even if community agencies are providing most of the care.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. 'The dwindles'. failure to thrive in older patients.Geriatric failure to thrive has three elements: deterioration in the biological, psychological, and social domains; weight loss or undernutrition; and lack of any obvious explanation for the condition. It results from the combined effects of normal aging, malnutrition, and specific physical, social, or psychological precipitants (eg, chronic disease, dementia, medication, dysphagia, depression, social isolation). failure to thrive can be managed with a commonsense approach by primary care physicians and healthcare providers such as social workers and dietitians; extensive referral is not necessary. The key to effective care is to identify all of the precipitants and intervene early to prevent progression.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |