Pediatrics in review
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Osteosarcoma is principally a disease of the pre-teenager and teenage individual. Pain and swelling of an extremity are the usual initial symptoms. A number of neoplastic and nonneoplastic conditions must be considered in the differential diagnosis. ⋯ Major advances as a consequence of chemotherapy have been achieved during the past decade. Disease-free survival following surgical ablation of the primary tumor and postoperative adjuvant chemotherapy is approximately 60%. The majority of patients undergoing modern forms of treatment are also candidates for limb salvage.
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Evaluation of a limping child requires careful consideration and a basic knowledge of potential problems affecting the child. The most important point is not to miss or delay diagnosis of the septic hip. This is truly an orthopedic emergency. ⋯ It is also important to be aware of how the medical history affects the musculoskeletal system. Many causes of limp are best analyzed by repeat examination and stepwise laboratory and radiographic evaluation. One should realize that a painful limp can be caused by something as mundane as a thorn in the heel or as serious as a tumor of the spine: Be suspicious.
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The fluid and electrolyte management of the infant either before or following surgery is not difficult if the several principles are carefully followed: (1) Fluid requirements include maintenance therapy, correction of ongoing losses, and replacement of deficit losses. (2) Calculation for fluid requirements in the postoperative period will include maintenance therapy, correction of ongoing losses, and provision of fluid lost by internal shifts. (3) Maintenance needs for fluid in infants equals 100 to 120 mL/kg per 24 hours, and Na+ at 3 mEq/kg per 24 hours and K+ at 2 to 3 mEq/kg per 24 hours are needed. (4) Infants with pyloric stenosis should be anticipated to have hypokalemic, hypochloremic metabolic alkalosis, and dehydration. These electrolyte abnormalities should be corrected before surgery is performed. A pyloromyotomy is not an emergency procedure. (5) Ileostomy losses can equal 90 mEq/L of Na+ and up to 110 mEq/L of HCO3. Thus, adequate fluid replacement results in volume depletion and metabolic acidosis. (6) Children whose nutritional status is marginal and whose bowels cannot be used for nutrient absorption should receive their fluid and electrolyte needs as part of a total parenteral nutrition program.