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The skeleton which supports the structure of the human body is composed of bone; this consists of protein materials in which a calcium phosphate and carbonate combination constitutes the hard material. The bone is naturally fed with blood, and the blood removes material from the bony skeleton.
Various diseases may seriously damage the system by which the bone is formed and may also bring about destruction of bone. Certain general disturbances of the body chemistry may also influence the bones unfavorably. People who have remained long infirm will have changes in the bone structure of lower parts of the body, whereas the bones of the jaw and other bones which are active will not degenerate. The bones of the spine are the ones chiefly affected.
There are other diseases of bones, such as “Paget’s” in which 95 per cent of the skeleton of the body may be involved.
Bone disorders in adult human beings are divided into two main groups in relationship to whether there is too much calcified bone or too little calcified bone. Since the discovery of the X-ray it has become possible to study the bones much more carefully than previously. Frequently, conditions are detected which formerly were passed unnoticed.
In cases of loss of calcium from the bones, they may become porous. If the loss affects the bones during the growing period, they may bend, so that bowlegs will occur. Softening of the bones by the condition called osteoporosis may occur also, from disuse of the body generally. This happens sometimes following the long retention of a plaster cast. Frequently osteoporosis is found in cases of excessive action of the thyroid and in other instances in which nutrition has been inadequate, particularly when the diet is deficient in calcium and in phosphorus. Osteoporosis has been found when there is deficiency of vitamin C – particularly in growing children. Finally, osteoporosis is seen in old age when all of the tissues of the body begin to lose their ability to function in a normal manner. No one knows just how much of the breakdown in old age is due to lack of function of the sex glands. Senile osteoporosis is more common in women than in men.
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The innumerable treatments of arthritis over the years have reflected the lack of certain knowledge as to the causes and mechanisms concerned in its development. Iodides, sulfur, salicylates and, more recently, gold have been used. Vaccines, serums, and non-specific proteins have been tried. Antibiotics and sulfonamides have been used but have been unavailing, since the condition is not an infection that could be controlled with these drugs. For many years aspirin has been the main drug for relief of pain in arthritis. Drugs based on quinine derivatives are also reportedly helpful. The greatest promise of any medical treatment thus far known has come from ACTH and Cortisone. A new form called Prednisone sold as Meticorten, Sterane, or Deltra is superior because it does not disturb water and salt balance. The dosage and duration of use must be strictly controlled by the doctor.
People do not die of rheumatoid arthritis but complications may occur which are especially serious for the arthritic patient. Troubles with the lungs including pneumonia, damage to the heart and secondary infections are a threat.
Rheumatoid arthritis may be especially serious for children because of deformities that persist throughout life. A severe form of rheumatoid arthritis in childhood is known as “Still’s disease.” Another form of rheumatoid arthritis is associated with psoriasis, and there are arthritic manifestations that affect women in the menopause.
Rheumatoid arthritis affecting the spine is a crippling condition responsible for much disability. This condition usually occurs in men rather than in women. Pains in the back, soreness on bending over, painful buttocks, and shooting pains in the sciatic nerve area are accompaniments. With spasms of the spinal muscles comes a tendency to avoid movement and in some instances the stiff-poker spine develops. The X-ray reveals changes in the spine as the condition progresses, but early in the disease nothing significant may be observed. These are the patients who are helped by sleeping in a bed with a firm mattress. Hot, wet packs help to relieve the spasm of the muscles. X-ray treatments may also help these patients.
Degenerative joint disease hits people past middle age. The changes may be part of the aging process and associated with injury. The condition occurs all over the world and particularly in certain occupations such as porters, those who stand long at work, scrub-women and janitors. In diagnosis of these cases X-ray is of great importance. Use of salicylates and of aspirin, for relief, heat, mild massage and liniments are reported beneficial in securing relief for those with degenerative arthritis.
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Myoclonic seizures (myo, meaning muscle—clonic, meaning jerk) are abrupt jerks of muscle groups. A hand may suddenly fling out, a shoulder may shrug, the foot may kick. Occasionally an entire body may jerk, as in a startle response. All myoclonic jerks are not seizures. Myoclonic jerks can come from the spinal cord, not just from the brain. They need not be abnormal. Normal individuals who are falling asleep may suddenly experience a jerk of the body and startle awake. This is a normal phenomenon called sleep myoclonus and is not a seizure.
Myoclonic seizures (formerly called minor motor seizures) may take many different forms. They probably arise, or at least the jerk arises, from deep structures in the brain stem that control posture and tone in the body.
An abrupt increase in tone in a muscle group will cause a sudden movement of that part of the body. An abrupt increase in tone in the flexor muscles will cause the body to bend forward at the waist, the head to drop down on the chest, the arms to bend at the elbow, or the knees to come up to the chest. Any or all of these movements may occur during a myoclonic jerk or during myoclonic seizures. If they occur when a child is standing, she may suddenly be thrown to the ground, perhaps hitting her face, breaking a tooth, or cutting her forehead. If the tone is suddenly increased in the extensor muscles, the head may be thrown back, the back may arch, the legs extend, and the arms stiffen. A child who is standing may be thrown backward to the ground.
Myoclonic seizures are serious because they may be difficult to control and because they are often only one manifestation of a mixed seizure disorder commonly associated with mental retardation.
Myoclonic seizures are like being jolted by an electric shock. They are single jolts. On rare occasions, infants and young children may experience a series of these jolts, sometimes even many series per day. Such a series of myoclonic jerks constitutes a special, serious form of epilepsy called “infantile spasms”.
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An absence seizure, formerly called petit mal, is a very special and uncommon type of seizure. It starts suddenly and without warning. The child assumes a glazed look and stares. She doesn’t know what is happening and usually cannot recall things that occurred during the seizure. Occasionally, there is a little eye-blinking or head-bobbing. The episode usually lasts just seconds, occasionally as long as fifteen seconds, and ends just as abruptly as it started. When the seizure ends, the child is immediately alert. There is no confusion afterward. These seizures may occur many times a day and are often mistaken for daydreaming.
It is usually easy for the physician to produce an absence seizure in his office by making such a child take deep breaths. Usually fifteen to thirty deep breaths (hyperventilation) will produce a typical spell. (Don’t worry, exercise, such as running, swimming, or bike riding, which may make someone “out of breath,” does not produce one of these spells.)
A parent may only see a few seizures because the brain’s activity must be interrupted for more than one second before a spell is apparent. Thus, very brief electrical events (less than one second in duration) are observable only on the EEG. But, in a sense, the child’s awareness may be being interrupted frequently, and the child may miss some of what is going on around him.
Occasionally a person with these spells describes life “like a movie in which brief segments have been cut out.” Teachers describe the child as daydreaming. Friends may call the child “spacey.”
Atypical absence seizures are similar to absence seizures, but may have more pronounced motor symptoms, such as tonic or clonic spells, or may have automatisms as seen in complex partial seizures. The EEG does not have the classic three-per-second spike and wave pattern seen in simple absence seizures. Atypical absence seizures are more commonly seen in children with a damaged nervous system and are often associated with other types of seizures.
Absence seizures may superficially be confused with complex partial seizures because both involve staring. Since they both may require different treatments and have different outcomes, the differentiation may be important.
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АТОПИЧЕСКИЙ ДЕРМАТИТ У ДЕТЕЙ
Атопический дерматит объединяет такие нозологические формы аллергических заболеваний, как детская экзема и нейродермит, которые характеризуются хроническим течением и клинически проявляются развитием воспалительных очагов на коже, расположенных симметрично и сопровождающихся зудом. Ранним проявлением атопического дерматита у детей является экзема. Она развивается, в основном, на первом году жизни, в последующие два-три года прогрессирует при отсутствии адекватного лечения, а затем у большинства трансформируется в нейродермит.
Наиболее важным в лечении атопического дерматита является, во-первых, раннее выявление аллергенных продуктов и назначение ребенку индивидуальной диеты с временным их исключением, что обеспечивает ремиссию (исчезновение симптомов) заболевания, снижает чувствительность больного к «виновным» аллергенам; во-вторых, адекватное лечение патологии пищеварительного тракта, что обусловливает нормализацию процессов пищеварения и всасывания и в последующем позволяет расширить диету; в-третьих, противорецидивное лечение.

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This is a stressful transition for everyone involved, including parents (see Chapter and other siblings. There is a major disruption in routine for the whole family. Sleep is invariably disrupted as the baby’s needs are attended to, and tiredness may result in increased tension within the family. There may be increased expectations of other siblings, who will be required to take on increased responsibility and help with the new arrival, and around the house generally.

Sibling rivalry is especially common with the birth of a new sibling. An elder child will often resent the arrival at home of a new sibling. Frequently he will regress in his behaviour. Competencies he has acquired, such as being dry at night, will be lost temporarily. He may begin to suck his thumb, wet the bed at night, and will request drinks in a bottle or a nappy at night. He may resent the attention paid to the new baby and want his mother’s attention during feeding time. All of this is normal behaviour, and parents should not be overly concerned.

Sometimes the sibling rivalry may be expressed physically, with a toddler actually hitting the baby, out of anger at the intruder. After a time, this usually settles down, but may resurface again when the new baby becomes mobile at around 12 months of age. Again the new sibling’s ability to interfere with the older child’s activities may give rise to feelings of irritation and anger. This sets the scene for what often seems an ongoing battle.

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