Evaluation of monitoring strategies for childhood asthma.

INTRODUCTION: The goal of monitoring pediatric asthma is to obtain and maintain asthma control, which is defined as minimizing asthma symptoms, restrictions to daily activities and the use of rescue medication. Long term goals include reducing the risk of fixed airflow limitation, and preventing asthma exacerbations and side effects of treatment. Several monitoring tools are available but no consensus exists on how to monitor patients in the most optimal way. Areas covered: In this review, we provide an overview of different tools and address general considerations on monitoring childhood asthma. Asthma care should be tailored to the individual patient. The health care professional should decide which monitoring strategy and frequency is optimal for the individual patient. Expert commentary: Personalized medicine should be the key issue in monitoring asthma in children. It is crucial to monitor disease activity and deterioration but there is no monitoring strategy that is clearly superior compared to others: The optimal strategy and frequency will vary between patients. Actually, both treatment and monitoring of pediatric asthma probably benefit from a personalized approach.

Bilateral ureteral obstruction after appendectomy in children.

Five cases of bilateral ureteral obstruction after appendicectomy are presented. All five patients were boys (age range, 9 to 15 years). All of them had had severe appendicitis. Based on the urethrocystoscopy findings, edema of the posterior bladder wall appeared to be the cause of obstruction of both distal ureters. This is confirmed by the immediate recovery of renal function after installation of bilateral uretercatheters. It is known that contamination of the peritoneal cavity can occur by organisms leaking from a gangrenous or perforated appendix. This can cause localized inflammatory edema of the posterior bladder wall. It is remarkable that through ultrasound investigation, only mild to moderate dilatation of the urinary tract was observed. An explanation can be obtained from animal models, wherein acute obstruction of the ureter leads only to a transient increase in ureteral pressure, followed by a decline toward the preobstruction level. It is important to be aware that this complication can occur after appendectomy; bilateral uretercatheters can be installed, and irreversible renal damage can be avoided.

Serum sodium levels and probability of recurrent febrile convulsions.

UNLABELLED: In a prospective study of 69 children with febrile convulsions, serum sodium levels were often lower than normal (52% had levels < 135 mmol/l). The mean level (134.4 +/- 0.4 mmol/l) was significantly lower as compared to a group of children without fever (140.6 +/- 0.4 mmol/l, n = 23) and as compared to a group with fever but without convulsions (137.6 +/- 0.6 mmol/l, n = 31). The probability of a repeat convulsion within the same febrile period appeared to be significantly related to the serum sodium level. CONCLUSION: Measurement of the serum sodium is a valuable investigation in the child with a febrile convulsion. The lower the serum sodium level, the higher the probability of a repeat convulsion. This knowledge may be of practical value in deciding whether to admit the child or allow it to return home and in advising parents or carers of the risk of a repeat convulsion.

[Antenatally determined nephro-urological anomalies: correctness of diagnosis and influence on management]. / Antenataal vastgestelde nefro-urologische afwijkingen: juistheid van diagnose en invloed op beleid.

On the basis of the experience of 52 antenatal diagnoses of foetal urinary tract abnormalities we discuss the influence of these diagnoses on antenatal and postnatal management. A correct diagnosis was established in only 34 of the 52 cases (65%). Therefore, in utero intervention should be used with utmost restrictiveness. Moreover, the antenatal diagnosis is usually not made in the first half of the pregnancy (which most authors consider necessary) and the benefits of prenatal intervention are not yet established. The data emphasize the importance of a thorough postnatal investigation and, necessary, early treatment before severe infections may occur. Antenatal ultrasound can make an important contribution to the prevention of kidney damage.