سبد خرید

Congenital Heart Disease in Pediatric and Adult Patients

Congenital cardiac disease encompasses a wide range of disorders that are usually diagnosed in the early infancy. The cardiac pathology may be life-threatening and require immediate intervention and/or surgery, or it may be less severe and allow for a series of interventions over the course of the patient’s early childhood and into adulthood. In Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management, we have collaborated with a vast array of leading cardiac clinicians from around the world who manage this patient population on a daily basis in order to highlight the subtle and not so subtle nuances. Their expertise allows for a practical approach in the management of a complex series of problems and issues.
Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management is organized into six major sections. Each section describes a particular facet unique to this subspecialty and is designed to allow the clinician managing this patient population to rapidly become oriented with the specifc pathologies and care issues. Part I focuses upon the history of pediatric anesthesia as well as embryology and
pediatric physiology and pharmacology. Part II entails the technical requirements for diagnostic methods and for monitoring patients undergoing congenital corrective surgery.

The Eye in Pediatric Systemic Disease

Perhaps the most frequent question which parents ask pertaining to their infant’s eyes is “What does my baby see?” The answer to this question depends in part on the type of method used to assess visual acuity. The majority of babies should show some fxational behavior at term birth. At 4 weeks, the baby looks at their mother’s face while breast feeding . When the mother moves her face, the child will follow it visually. This movement is interrupted if the mother turns her face away so that only her profle is presented . By 2 months the baby is following better but the pursuit movements tend to be jerky rather than smooth . Smooth pursuit eye movements show the most maturation from 2 to 6 months old, and reaching almost an adult-like gain by 18 months old . Pieh and coworkers found that tracking time was highest when a larger stimulus of 4.78° of visual angle was applied (p<0.022) and when the stimulus was moved at a medium stimulus velocity of 15 degree/s (p<0.0002) . Often, the human face is a better stimulus of fxation than a light source . Goren et al. were able to show that 9 min old infants had a preference for a face-like stimulus over a scrambled face image. Both of these were preferred by the infant over a blank face image.

Pediatric Cytopathology

Fine needle aspiration (FNA) is a reliable, minimally invasive, cost effective technique for obtaining samples from superficial and deep mass lesions for pathologic evaluation. Despite these advantages, physicians in the USA have been slow to embrace FNA as a primary diagnostic modality in the pediatric population . Obstacles to the acceptance and use of FNA include diagnostic challenges posed by the overall rarity and spectrum of tumors seen in children and adolescents, the experience and biases of clinicians and pathologists, and practical and technical considerations. Cytopathologists who are experienced in the performance and interpretation of FNAs may have limited familiarity with the spectrum and morphologic appearances of tumors seen in the pediatric population. Conversely, pediatric pathologists who are familiar with the histologic features and differential diagnosis of tumors encountered in children and adolescents often have little experience performing and/or interpreting FNAs. Likewise, clinicians who have extensive experience performing endoscopic or endobronchial ultrasound guided FNAs may have little experience with endoscopy or bronchoscopy of pediatric patients, and vice versa. These factors can impact the quality of the specimen and/or interpretation and lead to the need for a second procedure in order to arrive at a definitive diagnosis, thereby limiting the value of FNA as a diagnostic modality . Practical considerations include the cognitive and emotional maturity of the child or adolescent, and the need for immobilization, sedation, or anesthesia. Alone or in combination, these and other challenges and limitations have contributed to reluctance on the part of both pathologists and clinicians to promote the use of FNA as a primary diagnostic modality in the pediatric population.

Radiation Oncology for Pediatric CNS Tumors

Childhood brain tumors are the most common form of pediatric solid tumors. Signifcant improvements over the decades in the treatment of brain tumors in children have improved outcomes but mortality and morbidity are still high. Pediatric brain tumors are clinically and biologically distinct from those that occur in adults. Our understanding of risk factors in childhood brain tumors remains limited to several exposures of the head and neck to ionizing radiation and well-described hereditary cancer predisposition syndromes. In this chapter ,we review the descriptive and analytic epidemiology of childhood brain tumors, including a discussion of the roles of radiation exposure, established predisposing syndromes, and other suspected risk factors.

Pediatric and Adolescent Plastic Surgery for the Clinician

The primary goal of this book is to share our experience in field of pediatric plastic surgery with health practitioners who are involved in primary practice and for all others who are involved in treatment of these patients .Some fields of pediatric plastic surgery such as clefs, benign and malignant tumors, and vascular anomalies are difficult to present in short chapter, or even in one a book, because of their complexity, especially that they are already described by many other authors. Our idea was to present most important topics in pediatric plastic surgery through 14 chapters with general information about the clinical presentation, diagnostic procedures, treatment options, and complications. Correction of prominent ears is presented because it is the most commonly performed aesthetic procedure in pediatric population, performed by different specialists. Microtia is in opposite extremely difficult to correct, and it is usually performed in specialized centers by highly experienced surgeons. Treatment of these patients by inexperienced surgeons can lead to devastating consequences. Breast anomalies are common in pediatric population, with aesthetic and reconstructive goals tightly connected. Breast augmentation in pediatric population has to be performed with high precautions, and these patients are best to treat at the end of
adolescence. There is high variety of breast anomalies and there is no adequate classification yet. Fortunately breast tumors in pediatric population are mostly benign. Gynecomastia is the most commonly treated breast anomaly in male pediatric population and in most cases with minimally invasive procedures.

Pediatric Electromyography

In constructing a historical context in which to view the discipline of electrodiagnostic medicine, it is diffcult to determine a logical starting point. It is an elementary argument to assert that the biological underpinnings of the discipline date easily back to Galvani and Volta in the eighteenth century. Although these scientifc pioneers played seminal roles in characterizing the role of electricity in the function of muscle and nervous tissue, some would credit even earlier observers with reporting the phenomenology that Galvani characterized as “the energy of life”. Ultimately, it is the translational process of applying fundamental biological principles to the investigation of human disease, which has permitted the evolution of our discipline. Admitting a large measure of arbitrariness reinforced by a limited historical perspective of the scientifc zeitgeist of successive eras of neurobiologists, I have cobbled together a decidedly imperfect, but well intentioned, snapshot of the conceptual ontogeny of electrodiagnostic medicine and its adaptation to pediatrics. I should apologize to bioengineers who will note that I have given short shrift to the technical aspects of the development of clinical electrophysiology. The evolution of our discipline has not been predominantly hypothesis driven but rather has been a captive of technology and has grown at a logarithmic pace as new methodologies have been adapted to investigate human neuromuscular physiology. Let me add one further disclaimer; I have not attempted to acknowledge the role of individual contributions to the body of knowledge but rather the evolution of our ongoing integration of basic scientifc information into the understanding of the biological substrate of neuromuscular disease.

Good Practice in Pediatric and Adolescent Gynecology

Vulvovaginal complaints account for 80–90% of outpatient pediatric gynecologic visits . Most cases may be attributed to vulvovaginitis but other less common conditions, such as vulvar diseases or vulvar manifestations of systemic disease, should be taken into account. Rare causes of vulvovaginitis have to be considered especially when symptoms are recurrent or not responsive to standard treatment. In this chapter, the causes, manifestations, and management options of vulvovaginitis in childhood will be reviewed. Furthermore, common vulvar diseases affecting children were outlined, since their knowledge is essential for differential diagnosis. The prepubertal child is particularly susceptible to vulvovaginitis for anatomic, physiologic, and behavioral factors: absence of hair and minimal labial development; close oximity of the vagina to the anus; physiological hypoestrogenism which causes atrophic genital mucosa; neutral pH and unbalanced vaginal flora; absence of cervical mucus; and lack of antibodies ; furthermore, children’s tendency to have poor local hygiene and to explore their bodies increases the risk of developing this conditions. Germs may easily reach the genital area as a result of contiguity from the rectum, urethra, or the surrounding skin. Diffusion of bacteria from the upper airways is also possible through autoinoculation and occasionally hematic spread . Obesity, diabetes, anatomic anomalies, and use of antibiotics may play a role in
facilitating vulvovaginitis.

Patient Safety and Quality in Pediatric Hematology/ Oncology and Stem Cell Transplantation

A family takes their 4-year-old girl into the hospital for concerns of new bruising and lower extremity pain. The child has been symptomatic for a few weeks, but the symptoms signifcantly worsened over the past few days. The parents anxiously wait for the lab results to return, not knowing what to expect. The emergency room physician enters the room with a solemn face and explains that their child likely has leukemia and would need to be admitted to the hospital. The words hang in the air, “your child has cancer.” The parents do not yet know the massive lifestyle change in store for them. They do not realize the amount of time they will spend in the clinic, in the inpatient unit, and in a waiting room while their child undergoes yet another procedure. They do not know, at this time, the number of medications their child will take on a daily basis for the next several years and how easy it will be to confuse these complicated-sounding medications. There are many long days and sleepless nights ahead for them, but they will do it. They will give their complete trust to the physicians, nurses, pharmacists, and hospital staff to care for their girl.

Pediatric Lens Diseases

The crystalline lens, which is derived from the surface ectoderm in contact with the optic vesicles, is the most important refractive media of the eye. The embryonic lens plays a regulatory role in the process of eye development and anterior segment formation. Any abnormality in embryonic development may lead to the occurrence of lens diseases such as congenital cataracts or even affect normal eye development. Gene transcription regulation is one of the most important factors for lens development and is involved in the whole development process. This chapter focuses on the process of embryonic lens development and its regulatory factors and also discusses the regulatory effect of the embryonic lens on eye development, which will help us understand the nature of lens diseases and explore the possibility of genetic intervention at the early stage of lens development.


The feld of pediatric psychology includes both research and clinical practice that address a range of issues related to physical and psychological development, health, and illness among children, adolescents, and their families. As part of a multifaceted feld, scientist-practitioners in pediatric psychology explore the relationships among psychological and physical health and the welfare of children and adolescents within a developmental perspective, considering the contexts of families, caregivers, health care systems, schools, peers, and community (Steele & Aylward, 2009). This chapter provides a brief history of the feld, including organizational developments; describes research and training in the feld; and makes projections for the future of pediatric psychology.

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