Bruising and bleeding are common events in children. The pediatrician must be able to determine whether a child's symptoms are normal or perhaps indicative of hemorrhagic disorders. A thorough medical history and physical examination should enable the pediatricians to identify those patients warranting further evaluation. This review describes the characteristics of the medical history, physical examination, and clinical laboratory testing that are important in recognizing clinically significant bleeding disorders. This review will help the pediatrician to perform the initial laboratory evaluation, differentiate for patients with bleeding tendency and make the correct diagnosis for a variety of cases.
Child ; Diagnosis ; Diagnosis, Differential* ; Hemorrhage ; Hemorrhagic Disorders* ; Humans ; Physical Examination

No abstract available.

Iron deficiency anemia (IDA) frequently occurs in infants and adolescents. IDA is the result of an interplay between increased host requirements, limited external supply, and increased blood loss. In outpatient clinics, we often see children with iron deficiency anemia. Most cases in children are caused by incomplete nutrient supplements and growth spurts. However, we can occasionally see patients with poor response despite iron supplementation. Failure of iron therapy occurs when a child does not receive the prescribed medication, when iron is given in a form that is poorly absorbed, or when there is a continuing unrecognized blood loss such as intestinal or pulmonary loss, or loss with menstrual periods. In addition, the therapeutic failure of iron medication may indicate that the original diagnosis of nutritional iron deficiency was incorrect. In this situation, we have to evaluate other etiologies of anemia. Recently, many cases relating H.pylori infection to iron deficiency anemia have been described in the literature and H.pylori infection has emerged as a cause of refractory iron deficiency anemia that is unresponsive to oral iron therapy. Also, iron deficiency anemia induced by athletics in adolescent females has been reported several times. In this article, the author reviews various etiologies of childhood iron deficiency anemia. The most important consideration in treatment of iron deficiency anemia is disclosure of the underlying cause and its recovery. Dietary habits should also be corrected. To supplement iron, 6 mg/kg of oral iron supplements (elemental iron) is recommended in ferrous salt form. If oral administration is not feasible, intravenous supplementation is recommended using forms such as iron dextran, iron gluconate, or iron sucrose.
Administration, Oral ; Adolescent ; Ambulatory Care Facilities ; Anemia ; Anemia, Iron-Deficiency ; Child ; Dextrans ; Disclosure ; Female ; Ferric Compounds ; Food Habits ; Glucaric Acid ; Gluconates ; Humans ; Infant ; Iron ; Sports ; Sucrose

When pulmonary nodules are detected in children receiving chemotherapy for osteosarcoma, it is often assumed that they have metastatic disease. However, these pulmonary nodules do not always represent metastatic disease. There are considerable similarities in the computed tomography (CT) images of benign pulmonary nodules and those of malignant nodules. Therefore, we have to be careful when diagnosing pulmonary metastases based on chest CT scan alone. We report a case of benign multiple pulmonary nodules in a patient with osteosarcoma.
Child ; Humans ; Multiple Pulmonary Nodules ; Neoplasm Metastasis ; Osteosarcoma ; Thorax

The histiocytosis is rare disorder characterized by the accumulation of macrophages, dendritic cells, or monocyte-derived cells in various tissues and organs of children and adults. Classifying histiocytic disorders is difficult and has changed over time as an understanding of the biology of these cells has evolved. The most recently revised 2016 WHO classification of histiocytosis and neoplasms of the macrophagedendritic cell lineages has proposed grouping this diverse group of over 100 clinical entities into five main groups based on clinical, histologic, and molecular relevance. Comprehensive genomic studies for histiocytosis have been described and our understanding of the pathogenesis and biology has increased over the past decade. These advances will be able to make precision medicine and targeted therapy possible in patients with histiocytosis. Among the histiocytosis, this review mainly focuses on the updated diagnosis and treatment of Langerhans cell histiocytosis (LCH) and hemophagocytic lymphohistiocytosis (HLH) in children.

Respiratory distress is not uncommon in children and adolescents, who are at higher risk of progressing into respiratory failure than adults. When managing dyspneic pediatric patients, a clinical history and physical examination should be performed simultaneously and must be followed up by prompt first aid, including oxygen supplementation. Prior to initiating an invasive therapy such as endotracheal intubation, noninvasive positive pressure ventilation should first be considered. This method may be effective in patients with chronic respiratory distress and failure. The prevention and proper management of respiratory infections are also important in affected patients. If chronic respiratory distress deteriorates into respiratory failure, a portable home mechanical ventilator may be needed.
Adolescent* ; Adult ; Child* ; First Aid ; Humans ; Intubation, Intratracheal ; Oxygen ; Physical Examination ; Positive-Pressure Respiration ; Respiratory Insufficiency ; Respiratory Tract Infections ; Ventilators, Mechanical

PURPOSE: This study examined the outcomes of children with chronic immune thrombocytopenia (ITP). MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients diagnosed with ITP from January 1992 to December 2011 at our institution. RESULTS: A total of 128 patients (64%) satisfied the criteria for newly diagnosed ITP, 31 (15%) for persistent ITP, and 41 (21%) for chronic ITP. The median age at diagnosis was 4.5 years (range, 1 month to 18 years). The median platelet count at diagnosis was 32x109/L. A comparison of the initial treatment data from 2001 to 2011 with those from 1992 to 2000 showed that the number of bone marrow examinations decreased, whereas observation increased. Chronic ITP presented at an older age than newly diagnosed and persistent ITP (6.6 years vs. 3.8 years vs. 4.1 years, respectively); however, the difference did not reach statistical significance (p=0.17). The probability of complete remission of chronic ITP was 50% and 76% at 2 and 5 years after diagnosis, respectively. Patients aged <1 year at diagnosis had a significantly better prognosis than did older patients (hazard ratio, 3.86; p=0.02). CONCLUSION: Children with chronic ITP showed a high remission rate after long-term follow-up. This study suggests that invasive treatments such as splenectomy in children with chronic ITP can be delayed for 4 to 5 years if thrombocytopenia and therapeutic medication do not affect the quality of life.
Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Female ; Follow-Up Studies ; Humans ; Male ; Platelet Count ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic/*diagnosis/drug therapy ; *Quality of Life ; Remission Induction ; Retrospective Studies ; Treatment Outcome

Biotherapy, often called biological therapy or immunotherapy, aims at supporting and helping in the treatment of human disease without chemical drugs and invasive therapies, by restoring the natural immune system. It is also used to reduce certain side effects that may be caused by some treatments against cancer, autoimmune diseases, or other diseases. Biotherapy employs substances called biological response modifiers (BRMs). The term BRM is often used synonymously with the terms immunomodulator and immunostimulant. BRMs are agents that modify the host's response to pathogens with resultant beneficial prophylactic or therapeutic effects. The use of BRMs had rapidly expanded since the introduction of the first diagnostic antibodies. They are now employed in oncology, autoimmune diseases, inflammatory diseases, and transplantation medicine. BRMs used in biological therapy include interferones, interleukins, colony-stimulating factors, monoclonal antibodies, differentiation agents, tyrosine kinase inhibitor, tumor necrosis factor, vaccines, and nonspecific immunomodulating agents. BRMs are widely accepted in the treatment of certain types of cancer and rheumatoid arthritis, while others are being tested in research studies. This article reviewed the clinical use and side effects of BRMs in cancer and other diseases.
Antibodies ; Antibodies, Monoclonal ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Biological Therapy ; Colony-Stimulating Factors ; Humans ; Immune System ; Immunologic Factors ; Immunotherapy ; Interferons ; Interleukins ; Protein-Tyrosine Kinases ; Rheumatic Diseases ; Transplants ; Tumor Necrosis Factor-alpha ; Vaccines

PURPOSE: To evaluate the clinical results of a unilateral balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures (VCFs). MATERIALS AND METHODS: Twenty patients, 23 cases of osteoporotic VCFs who failed to respond to nonoperative treatments and who were confirmed by a consultant radiologist, were enrolled in this study. Times between injury and operation varied from 2 weeks to 2 months. All patients except two (18 female, 2 male patients), were female, and mean patient age was 71.7 (58-82) years. Follow-ups were conducted at least 12 months (12-27, mean 18.3). All patients underwent unilateral balloon kyphoplasty. Roentgenographic assessments were perform to evaluate fractured vertebra restoration and reduction loss. A ten-point visual analogue scale was used to measure pre- and postoperative pain severity. RESULTS: Preoperative anterior, middle and posterior heights of vertebra bodies were 57.8%, 66.1% and 85.3% of normal at presentation and these increased to 76.2%, 80.1%, 88.7% respectively at immediately after operation and at last follow-up, heights of each portion were 74.4%, 78.6%, 87.3%. Mean preoperative kyphotic angles of 17.6 degrees at presentation improved to 8.9 degrees at immediately after operations and to 9.1 degrees at last follow-ups. Loss of reduction was 1.8%, 1.5%, 1.4% and 0.2 degrees. Mean pain scores were 8.5 before surgery, 2.5 immediately after operations and 2.7 at last follow-ups. Statistical analysis showed a significant decrease in kyphotic angle (p=0.03) but VAS scores were no different (p=0.056). Anterior, middle and posterior body height was decreased with a statistical significance between two period (p<0.001). PMMA leakage occurred in 3 cases, but they did not cause neurologic deficits. CONSLUSION: Balloon kyphoplasty using a unilateral approach is a good treatment method for osteoporotic vertebral compression fractures and an alternative to the substitute bilateral approach.
Body Height ; Consultants ; Female ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Male ; Neurologic Manifestations ; Osteoporosis ; Pain, Postoperative ; Polymethyl Methacrylate ; Spine

BACKGROUND: Neutropenia can be easily found in previously healthy children associated with various medical conditions, and the clinical course ranges from transient benign to life threatening. This study aimed to investigate the etiology, clinical characteristics, and clinical courses of neutropenia in previously healthy children. METHODS: We evaluated 215 previously healthy children under aged 18 years who diagnosed with neutropenia in two hospitals. Clinical and laboratory features were analyzed retrospectively based on the medical records. RESULTS: Transient infectious neutropenia (TIN) accounted for 97.7% of cases and chronic neutropenia (CN), for 2.3%. An infectious agent was identified in 128/210 (61%) patients with TIN, and the most frequent agents were viruses (46.5%). The most common viral agent was respiratory syncytial virus (RSV) (29%). TIN subgroups exhibited no differences in severity according to infectious agent (virus, bacteria, Mycoplasma); however, neutropenia severity differed among viral agents [mild-to-moderate neutropenia in the RSV group (857.3±293.3/µL) and moderate-to-severe neutropenia in the parainfluenza group (567.3±198.1/µL); P=0.017]. All patients with CN had anti-neutrophil antibody positivity (autoimmune neutropenia, AIN), and moderate-to-severe neutropenia predominated. The median duration of TIN was 8 days (range, 3–286 days), and it was significantly longer for AIN at 330 days (range, 217–730 days) (P=0.000). The median duration of neutropenia was also different according to each viral agent, with 4 days (range, 3–11 days) for the RSV group and longer durations for 3 other groups (influenza, parainfluenza, other respiratory viruses) (P=0.015). CONCLUSION: Neutropenia in previously healthy children is usually of transient infectious origin, with mild-to-moderate severity, and it resolves spontaneously without complications.
Autoimmune Diseases ; Bacteria ; Child* ; Humans ; Medical Records ; Neutropenia* ; Paramyxoviridae Infections ; Respiratory Syncytial Viruses ; Retrospective Studies ; Tin