Childhood asthma is a major problem in office practice. For an acute life threatening attack (which is indicated by presence of severe distress, pulsus paradoxus, oxygen saturation less than 93%, cyanosis, peak expiratory flow rate of less than 50% of predicted) child should be directly admitted in intensive care unit. If it is a non life threatening attack the child can be managed in the office. Initially, the child should be given b2 agonists by inhalation route with either metered dose inhaler (MDI), MDI with spacer or nebuliser. It there is severe bronchospasm or inhalation therapy is not possible then epinephrine of b2 agonists may be given subcutaneously. The medications can be repeated 2-3 times. If response is adequate the child may be sent home on b2 agonist by oral or inhalation route at an interval of 406 hours. In case of inadequate response the child is started on oral or parenteral corticosteroids. Even after steroids if inadequate response the child is started on intravenous theophylline. Once the acute exacerbation is controlled the child is assessed for starting maintenance therapy. For this purpose his illness is graded from stage I to V depending on the severity. For stage I and II b2 agonists are prescribed as and when required. For stage III sodium cromoglycate by inhalation should be prescribed. For stage IV inhalation steroids in usual doses and for stage V inhalation steroids in higher doses are prescribed along with a minimum dose of oral steroids is added. For symptomatic control slow release theophylline or long acting b2 agonists may be added along with maintenance therapy as and when required. Apart from medications a proper education of parents and patients is necessary to improve the outcome of asthma by increasing the compliance and better control of environment.

Administration, Inhalation↗

PubMedDate not supplied

Endoscopic balloon dilation of esophageal strictures in children.

A total of 17 patients, ages 3 weeks to 14 1/2 years, had 20 esophageal strictures develop after repair of esophageal atresia (9 strictures); primary gastroesophageal reflux (3 strictures); Nissen fundoplication (4 strictures); epidermolysis bullosa congenita dystrophica (1 stricture); congenital esophageal stenosis (2 strictures); or colonic interposition (1 stricture). These strictures were treated with 132 endoscopic balloon catheter dilations (average, 6.6/patient, range, 1 to 24) during a period of 42 months (average, 8 months; range, 2 to 42 months). Fifteen of the 17 patients are now asymptomatic. Thirteen of the 17 patients had documented reflux esophagitis and were also medically treated. The two residually symptomatic patients included a patient with severe proximal esophagitis secondary to epidermolysis bullosa congenita dystrophica who had only a temporary response to dilations and another patient with a tight Nissen fundoplication who did not improve after dilation but is now asymptomatic after corrective surgery. The 10 patients with tracheoesophageal fistula repair were asymptomatic within 3 to 21 months (average, 10.8 months). Only one patient had perforation develop as a result of the procedure. Sixteen of 17 patients had the procedures performed as outpatients. All patients were given oral feedings throughout the course of dilation and had normal growth.

Adolescent↗

PubMedDate not supplied

Pulmonary hypertension associated with portal hypertension in a child with Williams syndrome--a case report.

A 14-year-old white female with Williams syndrome and portal hypertension presented in shock; at autopsy she was found to have grade II to VI vascular changes of pulmonary hypertension. This case demonstrates the association of portal hypertension and pulmonary hypertension in a pediatric patient.

Abnormalities, Multiple↗