[醫如往常] Junior Clerkship Day 29: Pediatrics; lymphadenopathy; Thalassemia; Neonatology

20151013 lymphadenopathy in Children
BCG: axillary node, neck nodeFever persist >5 days Kawasaki diz

PE 記得vital sign

Dental problem

Neoplasm pain: nerve infiltration
Neoplasm ipsilateral
Adhesion: scm 拉著跑
Lymphoma不只一顆 其他可能是reactive hyperplasia

Malignancy 驗
LDH
Ca
p
k
Uric acid

Lymphoma is most common malignancy that presents as a neck mass in children.

Dental problem

Deep neck infection
Rotation severe pain

Or cannot rotation

嘴巴打不開: 咀嚼肌，nerve

Dysphagia without oral ulcer, dysphonia

Saliva

Drainage, max abx

Contrast CT deep neck infection

Viral:

diffuse bilateral, fixation, soft

Liver function
EBV test

Bacteria:

single big

Streptococcus viridans: 口水菌

DM kp gram negative

Neck mass with air tract TB: Tense and big

NTM smear, and culture
HIV

Rickettsia立克次

Plasma

Autoimmune
Juvenile rheumatic
Kawasaki 5 sign

Kikuchi-Fujimoto disease (SLE spectrum)
Cervical and supraclavicular adenopathy, fever, fatigue, weight loss, anemia, and leukopenia

Castleman disease
Fever, hepatosplenomegaly, polyclonal hypergammaglobulinemia

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Drugs

1. Aspirin
2. Allopurinol
3. Atenolol
4. Barbiturates
5. Captopril
6. Carbamazepine
7. Cephalosporins
8. Gold
9. Hydralazine
10. Iodides
11. Isoniazid
12. Phenytoin
13. Pyrimethamine 
14. Primidone
15. Phenylbutazone
16. Phenobarbital 
17. Penicillin
18. Quinidine
19. Sulindac 
20. Sulfonamides
21. Tetracycline

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Approach to Masses of the Head and Neck
Kristi Chang, MD Associate Professor
Department of Otolaryngology-Head and Neck Surgery
University of Iowa Hospitals and Clinics
Neck mass etiologies (History)
Age
Peds ~ 80-90% benign;
     Inflammatory disease is most common cause of neck masses in children • Cervical adenitis

Adult ~ 80% neoplastic    (except thyroid masses)
80% of those are malignant (except thyroid and parotid masses)
LOCATION
New lateral neck mass in an adult > 40 yrs old is likely to be malignant.
Painless neck mass: UADT (upper aerodigestive tract) cancers
Duration: timing of onset –eg present at birth?
          > 2-4 wks
Growth pattern: worrisome if growing
Pain
Recent infection : cervical lymphadenitis more likely
Other similar masses?
Exposures: sick contacts, travel, pets/animals , h/o TB
Prior trauma or surgery in that area

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Associated symptoms?
 Dysphagia
 Odynophagia/sore throat
 Hoarseness
 Otalgia
 Dyspnea/stridor
 Constitutional symptoms
fever/chills
fatigue
weight loss
night sweats

flushing
palpitations
elevated BP

* Must r/o malignancy in any patient with facial or parotid mass
with an associated facial nerve weakness or paralysis.

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Long, et al. Principles and practice of pediatric infectious disease, 2 nd  ed. 2003

Torsiglieri , et al. Int J Pediatr Otol 1988;16(3);199-210

Dulin, et al. Am Fam Physician 2008;78(9);1097-98

Lymphadenopathy in children: refer or reassure?
David King, Jagadeesh Ramachandra and Daniel Yeomanson
Arch Dis Child Educ Pract Ed 2014;99:101–110. doi:10.1136/archdischild-2013-304443

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Thalassemia 

Prof. Lin

北賽普勒斯不能進南部賽普勒斯Republic of Cyprus

要飛伊斯坦堡->雅典->南賽普勒斯

南賽普勒斯可以進北賽普勒斯

骨髓移植：是目前唯一能完全治癒 thalassemia 的方法
TW 1984第一例
越南 1995第一例
七歲以前做就不會長不高
(至於為何 thalassemia 患者身高會矮？可能是由於大量輸血後過多鐵沉積於pituitary gland，破壞其功能。或者是嚴重貧血而輸血仍不足以平衡其貧血的狀態。)

免疫抑制劑Cyclosporine 眉毛粗 

J Dermatol Sci. 1994 Jul;7 Suppl:S47-54. Hair growth-stimulating effects of cyclosporin A and FK506, potent immunosuppressants.Yamamoto S1, Kato R.

"選擇性的immuniphilin ligands如cyclosprin A(CsA)及FK506，它們不僅是免疫抑制劑(immunosuppressants)，也能調節頭髮的生長。在老鼠的身上局部使用CsA及FK506可以刺激頭髮的生長，也能抑制因cyclophosphamide引起的掉髮6。在另一個試驗中，局部使用CsA可以預防老鼠因合併etoposide、cyclophosphamide、cytarabine及doxorubicin引起的掉髮11。Cyclosporine機轉不明，但被認為可能藉由抑制p-glycoprotein做為在化學治療期間的毛囊角質細胞抑制劑(keratinocytes against)，也會增加IL-1受體的表現，因此也許可以增加預防掉髮的能力。"
Ref. 化療引起的掉髮
奇美醫院柳營分院藥劑科藥師 張雅筑、鄭淨黛、蘇郁仁、陳憲煜
http://www.taiwan-pharma.org.tw/JTP/100/066-071.html

原住民海洋性貧血調查

MCV調查

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Neonatology: The High Risk Newborn 

Prof. Hsieh

新生兒的定義爲出生一個月以內的嬰兒。 

周產期（Perinatal period）：從懷孕滿 28 周到出生後七天。 

產下早產兒或低出生體重新生兒的比率為：原住民>本籍配偶>外籍配偶