Posttraumatic growth among Norwegian children and adolescents exposed to the 2004 tsunami.

This study examined posttraumatic growth (PTG), positive change experienced as a result of the struggle with trauma, in children and adolescents exposed to a high-impact disaster, after which their experience of secondary adversity was minimal. The study also examined whether reduction in posttraumatic stress symptoms (PTSS) over time related to reports of PTG. There were 105 participants, age 6 to 17 years, who were directly exposed to the 2004 tsunami in Southeast Asia. They were interviewed 10 and 30 months after the disaster—PTSS was assessed at both time points, and PTG was assessed at 30 months. The individual's subjective reactions to the event and concurrent PTSS (30-months post-tsunami) were independently and positively related to PTG, whereas the decrease in PTSS was not related to growth. Children and youth in this study reported lower absolute levels of PTG than those in other studies. Taken in sum, findings suggest that secondary adversities may influence posttraumatic reactions and ongoing distress, which are hypothesized to play a key role in the development of PTG. In the absence of such secondary stressors, continued distress in the form of PTSS may serve to catalyze the growth process. Implications for clinical practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Seizure outcome after epilepsy surgery in children and adolescents

Development of efficient imaging techniques to trace neuronal connections would be very useful. Manganese ion (Mn2+) is an excellent T1 contrast agent for magnetic resonance imaging (MRI). Four reports utilizing radioactive Mn2+ in fish and rat brain indicate that Mn2+ may be useful for tracing neuronal connections. Therefore, the purpose of this work was to determine if Mn2+ can be used as an in vivo MRI neuronal tract tracer. The results indicate that topical administration of MnCI2 solution to the naris of mice as well as to the retinal ganglion cells via intravitreal injection leads to enhancement of contrast along the respective pathways. Therefore, application of Mn2+ to neurons allows the use of MRI to visualize neuronal connections.     

Loneliness among children and young adolescents.

Investigated differences in loneliness involving parents and peers and the relations between loneliness, choices of a "first comfort figure" (FCF), and social sensitivity as perceived by peers. 60 female and 52 male 5th graders, 97 female and 45 male 7th graders, and 66 female and 73 male 9th graders were given a loneliness scale and a sociometric measure of perceived social sensitivity. Results indicate that age differences in parent-related loneliness were marginally significant. Seventh graders seemed to have fewer loneliness experiences in their relationships with parents than 5th and 9th graders. Boys more frequently reported those feelings than girls. Ss who indicated both parents as their FCFs had the lowest scores for parent-related loneliness, whereas those who indicated friends as their FCFs had the highest scores for parent-related loneliness. With respect to peer-related loneliness, no age or sex differences were found. However, girls who chose both parents as their FCFs were more lonely than boys who did the same, and boys who chose their fathers as their FCFs mentioned more peer-related loneliness feelings than the girls who made this choice. Ss perceived as socially sensitive by their classmates less frequently mentioned peer-related loneliness feelings. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surgical treatment for epilepsy: a retrospective Swedish multicenter study

The characteristics of patients suffering from drug resistant epilepsy, including the results of the preoperative evaluation and epilepsy surgery were retrospectively analyzed in a Swedish multicenter 10-year cohort of children and adults. Altogether 152 patients (65 children and 87 adults) treated during the period 1980-1990 in three epilepsy centers were included and followed-up 2 years after surgery. Median age at onset of seizures was 4 years for the children and 12 years for the adults. A localization related epilepsy was present in 85% of the children and in 95% of the adults. The mean number of seizure types in the children was 1.7 (range 1-4) and in the adults 1.8 (range 1-4). The median monthly seizure frequency was 52 and 15 for children and adults respectively. Resective surgery was performed in 143 cases (94 temporal, 31 extratemporal, 9 multilobar and 9 major resection procedures) and palliative procedures in 16 cases (13 callosotomies and 3 stereotactic amygdalotomies). Postoperative neurological deficits were detected in 9% of the patients after temporal lobe resections and in 15% of the patients after extratemporal and multilobar resection procedures. Two years after resective surgery 53% of the children and 49% of the adults were seizure free. Another 25% of the patients had a more than 50% reduction of seizure frequency. In the postoperative non seizure free group of patients there was a negative correlation between decrease in weighted seizure severity and decrease in seizure frequency. This finding stresses the need for including other parameters than seizure frequency when evaluating the outcome of epilepsy surgery.     

Pharmacologic treatment for children and adolescents with anxiety disorders

Pediatric anxiety disorders are common illnesses that, if left untreated, may induce academic, family, and interpersonal problems. Cognitive-behavioral techniques and other psychotherapeutic interventions may be adequate for the treatment of most anxiety disorders. For patients with severe symptoms or for whom psychotherapeutic approaches are not adequate, medications are indicated. Among the available medications, the SSRIs are currently the first choice; however, other medications, such as the benzodiazepines and the TCAs, may be used alone or sometimes in combination with the SSRIs. Caution with respect to medication interactions and side effects is indicated. In particular, long-term side effects in these medications have not been well studied.     

Surgical treatment of Crohn disease in children and adolescents; how conservative can the paediatrician be?

Thirty-eight children (21 male, 17 female, age 3-18 years), treated for Crohn disease in two Dutch university centres, were retrospectively studied in order to evaluate the results of conservative treatment and to find out in what way surgical treatment in this age group may have differed from treating adults with this disease. Both groups had an equal distribution of age and sex. Diarrhoea with discharge of blood and mucus, abdominal pain, nausea/vomiting, weight loss, fever and general discomfort were the most frequent presenting symptoms. Twenty-three children (60%) showed signs of malabsorption; 4 children (10%) had growth retardation. In 27 children (70%), 63 surgical procedures were performed (2.4 operations per child). There was no surgical mortality. Most operations were performed for ileocolitis and colon-only localizations needed most re-operations. Of the surgical procedures performed, 55% were excisional procedures. Already 3 years after the onset of symptoms, 50% of all children had had their first resection, whereas in adults, 50% of the patients undergo surgery 8 years after disease onset. Eight children were treated with split ileostomy. In only one of these children, operated for non-toxic colitis and severe steroid-dependent growth retardation, could the colon eventually be saved. The time between the onset of symptoms and the first operation seems to be shorter in children compared to adults. Severe malabsorption and growth retardation are additional specific indications for surgery for Crohn disease in childhood. The latter combined with non-toxic colitis, may perhaps be the only indication left for performing split ileostomy in Crohn disease.     

Control-related beliefs and depression among clinic-referred children and adolescents.

Does childhood depression involve a perceived lack of control? The answer may depend on which dimension of control one examines. Here, building on recent theory, we distinguished between two dimensions: beliefs about the contingency of outcomes and beliefs about one"s own competence to perform outcome-relevant behavior. Three separate groups of clinic-referred children (aged 8–17) were sampled, one before therapy and two afterward. In all three groups, low levels of perceived competence were significantly correlated with children"s Childhood Depression Inventory (CDI) scores. Multiple regression analyses with several predictors revealed that, in each sample, competence beliefs accounted for substantial unique variance in CDI scores. In contrast, contingency beliefs were not correlated with CDI scores in any of the samples. Finally, CDI scores were consistently correlated with attributions of success and failure to "unknown"" causes. Overall, the results link childhood depression to perceived incompetence and to "contingency uncertainty,"" but not to perceived noncontingency. This suggests, in turn, that children may be more susceptible to "personal helplessness"" forms of depression than to forms identified with "universal helplessness."" (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Radiofrequency treatment of tachyarrhythmias in children and adolescents

INTRODUCTION: Radiofrequency ablation has been extensively used in adults to treat supraventricular and ventricular tachycardia. In children and adolescents few data are available on its safety and efficacy. METHODS: 28 patients (mean age 12.8) with symptomatic tachyarrhythmias underwent catheter ablation; 21 children had atrioventricular accessory pathways (11 right connections, 9 lef connections and one midseptal pathway), 3 had intranodal tachycardia, 2 had ventricular tachycardia and 2 had atrial tachycardia. Only four patients had associated structural anomalies. RESULTS: Success rate was 71.4% (20 patients). The success per cents in each group were: in intranodal tachycardias 100%; we failed in the two patients with ventricular tachycardias; in accessory pathways 76.1% and 50% in atrial tachycardia. There were no recurrences of arrhythmia in a mean chase period of 24 months (12-46). Major complications were only observed in one patient who developed a Wallenberg syndrome after ablation. CONCLUSIONS: Radiofrequency catheter ablation appears to be a safe and effective method to treat arrhythmias in children and adolescents, which in most cases can supersede surgery. Alow incidence of complications is reported, although long term damage on endocardial structures remains yet to be determined.     

Surgical treatment of hyperthyroidism in children

During the past ten years, subtotal thyroidectomy for hyperthyroidism was performed upon 43 children at Childrens Hospital of Los Angeles. There were no deaths, no recurrent laryngeal nerve injuries and no permanent hypoparathyroidism. During the one to ten year follow-up period, one patient had recurrent hyperthyroidism develop and was treated with 131I. Twenty-five patients are hypothyroid and require thyroid supplement; 14 are euthyroid and receiv no medication. Postoperative thyroid function did not correlate well with gland remnant size, degree of fibrosis or the extent of lymphoid follicle formation. Lymphocytic infiltration was more severe in patients who had hypothyroidism develop postoperatively. Transient hypocalcemia developed in 22 patients. The effectiveness and safety of the surgical treatment for hyperthyroidism in children is reaffirmed, and it is advocated for consideration over 131I or prolonged medical therapy.     

Surgical treatment of lymphadenopathy in children

Clinical observations of 1365 children with the lymph nodes affection were summarized. The diagnosis verification was conducted using the broad arsenal of general clinical and special methods of investigation. In complicated situations the histochemical and immunogenetic methods were applied for the diagnosis. The structure and dynamics of children's morbidity with lymphadenopathies (LAP) was studied up, the age, sexual and seasonal peculiarities were systematized, the analysis of primary localizations and clinico-morphological comparisons was conducted. The basic thesises of the standardized approach were elaborated on the ground of the diagnostical and tactical mistakes results analysis.     

Residential treatment for emotionally disturbed children & adolescents in Tennessee

In some cases the differential diagnosis of the torsion of the testicles may be difficult also for the experienced clinician. It is reported on a new method of the delimitation of the torsion of the testicles compared with inflammatory changes of the testicles and the epididymis. By means of the ultrasound-Doppler-method the blood supply of the vasa spermatica is registered. Missing Doppler-signals in the direct measurement above the spermatic cord in comparison to the collateral side are typical for a complete torsion of the testicles.     

Motivation for smoking cessation among the Norwegian public

We evaluated eight children with thoracic or high lumbar-level paraparesis for metabolic performance while ambulating with custom fabricated thermoplastic hip-knee-ankle-foot orthoses (HKAFOs) and reciprocating-gait orthoses (RGOs). Seven of the eight children had myelomeningocele. Each patient was tested in both systems at self-selected speeds in a crossover study design. At self-selected speeds, the level of exercise intensity for both thoracic and high-lumbar patients with either orthosis was lower than that for normal children. The average metabolic cost of walking in the RGO was twice that of normal children, as compared with six times normal in HKAFOs. For the four thoracic-level patients, there was a significantly higher oxygen cost of ambulation in using HKAFOs versus RGOs. No significant difference in metabolic performance was found for the high-lumbar patients. Velocity of ambulation was faster in the RGOs than in the HKAFOs. For thoracic-level patients, our data suggest that an RGO will provide a faster, more energy-efficient gait than a statically locked HKAFO. For high-lumbar patients, no significant difference was found between the two orthoses. Seven of eight children preferred the RGO over the HKAFO.     

Surgical treatment of lung abscesses in children

The authors report their clinical observations of 44 patients, aged from 2 months to 14 years, with acute pulmonary abscesses. As evidenced by the authors a roentgenological examination in dynamics is of great value in establishing the diagnosis of pulmonary abscess, since it makes possible to follow the destruction of lung tissues and the formation of cavities. For treatment of lung abscesses different methods were employed: toilet bronchoscopy with antibiotics perfusion, puncture and drainage of the abscess, in case of pulmonary hemorrhage a resection of the lung portion involved, the complex conservative therapy.     

Surgical treatment of epilepsy due to cortical dysplasia: clinical and EEG findings

Seventeen patients with cortical dysplasia who had surgical resection for medically intractable partial epilepsy were studied. Compared with two groups of surgically treated patients with intractable epilepsy due to tumour (n = 20) and mesial temporal sclerosis (n = 40), patients with cortical dysplasia showed significantly more frequent extratemporal lesions, more frequent non-epileptiform EEG abnormalities and less favourable surgical outcome for seizure control. Patients with cortical dysplasia were younger at onset of seizures and had a lower detection rate of CT abnormalities compared with the tumour group, and lower IQ compared with the mesial temporal sclerosis group. MRI was abnormal in five of seven patients. Six patients became seizure-free or almost seizure-free but eight did not experience relief of seizures. Surgical outcome related to the extent of pathology but not to the histological abnormality. Lesions outside the temporal and frontal lobes were correlated with poor surgical outcome, as were generalised interictal EEG abnormalities, which may reflect extensive or multiple lesions. Ictal intracranial recordings were not useful for presurgical evaluation of cortical dysplasia.