Current Opinion in Pediatrics

Deen, Peter M.T.

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In the past year, significant progress has been achieved in the research on aquaporins (AQPs), a family of structurally related molecular water channels. Three novel AQPs were identified, giving a total of ten mammalian AQPs. An important step forward in identifying the aqueous pore in AQP molecules was the determination of the three-dimensional structure of AQP1. The expression pattern of individual AQPs in different tissues was determined in more detail and AQP-knockout mice have been generated. The discovery of a severe urinary concentrating defect in AQP1-knockout mice was remarkable. Only AQP2, the vasopressin-sensitive water channel in the kidney, which is mutated in autosomal recessive and dominant cases of nephrogenic diabetes insipidus, has been shown to be involved in human disease. The finding of changed AQP2 expression in several acquired water balance disorders may pave the way toward developing treatments for these clinical problems.

Knight, John R.

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Addressing adolescent substance abuse presents a tremendous challenge to the practicing clinician. Despite ongoing educational and preventive services, and despite increasing governmental interdiction, substance use by adolescents continues to be a major national problem. Although present rates of use are lower than the peak rates in the late 1970s, drug use among adolescents nearly doubled in the early 1990s and is a significant cause of morbidity and mortality. Pattems of use continue to evolve. Newer drugs make their way to the streets, and older drugs are rediscovered. Behavioral and environmental factors increase the risk for adolescent substance abuse. Identification of use patterns and familiarity with comorbid behaviors and social risks may help the clinician identify the adolescent at risk.

Carpenter, Thomas O.

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Root, Allen

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Chorley, Joseph N.

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Head injuries in sports cause serious long-term problems. Appropriate acute and subacute management of both catastrophic and mild injuries can prevent secondary, potentially disabling or fatal injury. By understanding the mechanism of injury, classification, and epidemiology of sports-related head injury, pediatricians can appropriately care for their athletic patients. The symptoms of a mild head injury may be transient, but the cumulative effect may have permanent long-term sequelae. Continued clinical, epidemiologic, and basic science research is needed to help prevent head injuries and their sequelae in the future.

Bernstein, Henry H.

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This review presents in a clinically relevant context the past year's investigations in three areas of pediatrics that commonly face the office-based pediatric provider. Although transcutaneous quantification of jaundice may help discern which patients warrant further evaluation, thereby saving patients pain and expense, this technology has not yet significantly changed clinical management of the hyperbilirubinemic infant. A brief overview of animal bites demonstrates that although most are innocuous, proper treatment of these potentially serious injuries is critical in preventing further complications. The number of immunizations given in the first 2 years of life has increased, and although new combination vaccines may eventually simplify the schedule, persistent vigilance is more important than ever to avoid delays in vaccine administration.

Honig, Paul J.

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Atopic dermatitis is the most common skin disease of childhood, and its prevalence has steadily increased over the last three decades. A chronic, relapsing condition, atopic dermatitis has a significant impact on affected children, their families, and the community at large. Although the fundamental pathogenesis has remained elusive, intensive research has greatly contributed to our understanding of this disease. As the specific immunobiologic pathways become deciphered, we have seen the propagation of several new therapeutic options that rationally attack specific underlying immune system abnormalities. This article highlights the specific contributions made to the literature over the past year, with particular attention to the immunopathogenesis of atopic dermatitis, as well as some new targeted therapies currently and soon to be available.

Burr, Barbara H.

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Increasing rates of adolescent suicide are a significant health concern and the third leading cause of death for this age group. Recent research into psychiatric, gender-related, family, cultural and neurobiologic riskfactors is reviewed. The effects of suicide exposure and media influences are also examined. Although many risk factors have been identified, the application of this knowledge to clinical practice requires further study. The limited number of studies on prevention and intervention strategies are discussed. High rates of nonadherence to follow-up remain problematic. More research is needed to develop appropriate treatments, prevention programs and outcome measures.

Cunningham, Bari B.

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Numerous advances in surgery and laser therapy applicable to pediatrie dermatologie practice have been made. The use of EMLA (eutectic mixture of local anesthetics; Astra USA, Westborough, MA) cream (lidocaine and prilocaine) is invaluable for office dermatologie procedures in children. Despite high patient tolerance, rare adverse events have been described. Newer topical anesthetics with faster onset and greater efficacy are discussed, with special emphasis on their application to the pediatrie dermatology patient. Appropriately administered, these newer agents may make certain procedures in children painless or minimally uncomfortable. Newer, improved tissue adhesives are under development and may replace and surpass traditional surface suturing. Limitations to the use of the pulsed dye laser for vascular lesions in children are discussed.

Mrazek, David A.

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