RESUMO
Many parents do not realize their child has stool retention when they bring him or her for an office visit. Some complaints that may be a tip-off and should prompt questioning about stool frequency and underwear soiling are vague abdominal pain, urinary incontinence, and stools so large they plug the toilet. A rectal examination is usually adequate to confirm the diagnosis. Management begins with educating parents that leaking of liquid stool around impaction and onto underwear is completely involuntary, so the child should never be scolded or embarrassed. Stool retention may begin because of unpleasant or unavailable toilet facilities, constipation, or painful elimination and often becomes self-perpetuating. Impaction must be removed immediately; magnesium citrate solution is usually effective. To allow the rectum to return to its normal size, which can take an extended time, stool must be kept soft and movable with administration of mineral oil and appropriate dietary choices (eg, fruit, juice, fiber). Recurrence is common, so ongoing measures and follow-up are important.
Assuntos
Encoprese/etiologia , Encoprese/terapia , Impacção Fecal/terapia , Catárticos/uso terapêutico , Criança , Doença Crônica , Fibras na Dieta/administração & dosagem , Encoprese/prevenção & controle , Impacção Fecal/diagnóstico , Impacção Fecal/etiologia , Impacção Fecal/prevenção & controle , HumanosRESUMO
Most rashes that occur on the feet are due to eczema, infections, or shoe dermatitis. But which are which? Fortunately, distinguishing among these common skin diseases requires just a little basic knowledge of dermatology and familiarity with two simple diagnostic tests. Two case reports illustrate the authors' approach to diagnosis, treatment, and patient education.
Assuntos
Dermatoses do Pé/diagnóstico , Adulto , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Dermatoses do Pé/etiologia , Dermatoses do Pé/microbiologia , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Exame Físico , Sapatos/efeitos adversosRESUMO
A case of hypervitaminosis A (HVA) as a complication of therapy for stage-IV neuroblastoma is presented. The patient was randomized to a trial of 13-cis -retinoic acid (a vitamin A-related compound) after completing routine chemotherapy. This acid was given as a means of maturing potential minimal residual disease. A routine follow-up bone scan revealed areas of increased activity, initially along the midshaft of the right ulna and subsequently bilaterally, which were ultimately found to be due to HVA. Hypervitaminosis A has not been previously reported in this setting, and awareness of the condition is important in centers where this treatment is contemplated.
Assuntos
Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Hipervitaminose A/etiologia , Isotretinoína/efeitos adversos , Neuroblastoma/tratamento farmacológico , Osso e Ossos/diagnóstico por imagem , Pré-Escolar , Humanos , Hipervitaminose A/diagnóstico por imagem , Isotretinoína/uso terapêutico , Masculino , RadiografiaAssuntos
Medicina de Família e Comunidade/economia , Custos de Cuidados de Saúde/tendências , Reforma dos Serviços de Saúde/economia , Renda , Laboratórios/economia , Programas de Assistência Gerenciada/economia , Análise Custo-Benefício , Medicina de Família e Comunidade/tendências , Reforma dos Serviços de Saúde/tendências , Laboratórios/tendências , Programas de Assistência Gerenciada/tendências , Estados UnidosRESUMO
The prognosis for pediatric patients with hepatocellular carcinoma is poor, except for fewer than half the patients, who can be rendered disease-free with conventional liver resection. Multicentric, bilobar liver cancer remains unresectable, even after radiation and chemotherapy. Liver transplantation alone for primary hepatic cancer has had limited success. Chemotherapy has been reserved for use after transplantation, with little demonstrable benefit. A pilot program of pretransplant chemotherapy was undertaken. Four adolescent patients with unresectable, multicentric, bilobar hepatocellular carcinoma were staged noninvasively, underwent chemotherapy followed by a final staging laparotomy, and then had liver transplantation. Three of the four patients survived and have no evidence of recurrence 84, 67, and 47 months after diagnosis and 76, 65, and 44 months after transplantation. Pretransplant chemotherapy has four potential advantages: (1) minimized risk of posttransplant opportunistic infections, (2) less tumor bulk at the time of transplantation, (3) fewer local recurrences, and (4) a lower rate of metastasis.