Ciguatera has been successfully treated with IV mannitol, which appears to abbreviate (if not stop) the symptoms of ciguatera fish poisoning. Preliminary evidence suggests that the earlier a victim is diagnosed and treated with IV mannitol, the more likely the success. Mannitol has been shown to be safe and effective in children as young as four years of age.
Untreated, ciguatera is usually a self-limited disease lasting one to two months, but symptoms can persist for months to years.
circumcision Surgical removal of the foreskin of the penis. This operation is usually performed for religious and ethnic reasons. Widespread infant circumcision is a relatively recent phenomenon in the United States. Prior to the 1930s when babies were often born at home, infant boys were rarely circumcised except for religious reasons. After World War II, however, nearly all babies were born in hospitals, and for a number of reasons almost all baby boys were circumcised, often immediately after birth. The United States is the only country in the world that routinely circumcises most of its male infants for nonreligious reasons; more than 80 percent of the world's males are not circumcised.
However, in the past 25 years, major cultural changes have altered the birth experience, with a movement toward natural childbirth and improvements in pain control. Likewise, cultural changes have begun to alter American attitudes on circumcision as well. Until recently, circumcision was the most frequently performed surgery in the United states. Even today, infant circumcision in the United States costs about $200 million a year.
Experts, including the american academy of pediatrics, believe there are no medical reasons to recommend routine and universal newborn circumcision, because circumcision does not prevent sexually transmitted diseases, it does not appear to prevent cancer of the penis, and it does not prevent cancer of the cervix in women. There is a slightly higher chance that an uncircumcised boy will have a urinary tract infection in the first six months of life, but since only 1 percent of uncir-cumcised baby boys develop these infections, it is hard to justify universal circumcision on that basis alone. Today, most experts believe that infants do indeed feel pain, and that the pain of circumcision is considerable.
In the end the decision to circumcise is a religious, cultural, or personal decision. Boys who are not circumcised do not require any special care for the penis and foreskin until the foreskin is completely retractable, which occurs any time from four months to five years of age or later. No one— not even the baby's doctor—should ever pull the foreskin back forcibly. Once the child grows, the foreskin will begin to retract easily with gentle manipulation. When the boy is old enough to bathe himself, he can be taught to pull back the foreskin and wash gently in the shower or bath. Until then, the flow of urine under the foreskin and a gentle swish of the penis in the bath is enough to keep the penis and foreskin clean.
Most experts believe that parents who want to have their baby circumcised should find a doctor who uses local anesthesia.
cleft lip and palate A fissure in the midline of the lip and/or palate caused by a failure of the two sides to fuse together before birth. Facial clefts affect nearly one of 800 births in the United States, making it one of the most common birth defects in the nation.
in the early weeks of fetal development, the right and left sides of the lip and the roof of the mouth normally grow together. Occasionally, those sections do not quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, or palate, is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.
A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose, and can occur on one or both sides of the upper lip. In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth.
Clefts of the lip and palate are complex conditions that affect not only the child's appearance and self-esteem, but also how well a child can speak, hear, and eat. Many children with cleft lip or palate develop hearing problems as a result of chronic ear infections, which, if left untreated, will create speech and language problems.
An immediate problem after birth is feeding, but special nipples and prostheses are available to ensure that children with oral clefts receive adequate nutrition until surgical treatment is provided.
The causes of cleft lip/palate are not well understood. Studies suggest that a number of genes, as well as environmental factors such as drugs (including antiseizure drugs), infections, maternal illnesses, maternal alcohol use, and possibly, B vitamin folic acid deficiency may be involved. Clefts are more common in Asian, Latino, and Native American ethnic groups. in most cases, however, there is no identifiable cause or risk factor.
Up to 13 percent of babies with cleft lip/palate have other birth defects. Some cases involve genetic syndromes which may pose other specific problems for the baby. For this reason, babies with cleft lip/palate should be thoroughly examined by a doctor soon after birth.
The causes of isolated cleft palate are not well understood either, although a number of genes as well as environmental factors also may play a role. in the case of cleft palate alone, however, neither antiseizure drugs nor maternal alcohol use appear to contribute to the problem, though deficiency of folic acid may do so. isolated cleft palate appears to be associated with genetic syndromes more often than the combined cleft lip/palate. Babies with isolated cleft palate are more likely than babies with cleft lip/palate to have other birth defects; in fact, up to half of babies with isolated cleft palate may have other birth defects.
if normal parents have a child with a cleft, the chance that a subsequent baby will have a cleft is 2 to 4 percent. These risk figures are the same for cleft lip/palate and isolated cleft palate. However, a second baby is at risk for only the same type of cleft that affected the first child.
If either parent has an oral-facial cleft but no affected children, the risk of the same type of cleft in any subsequent pregnancy is about 3 to 4 percent. If more than one of the parents and/or children are affected, the risk for future offspring is higher.
A plastic surgeon can repair a cleft lip shortly after birth (usually at two to three months of age). The cleft palate can be repaired by 12 months of age, before the child's first spoken words. At the time of the cleft repairs, tubes may also be placed in the child's ears to help treat ear infections and maximize hearing sensitivity. In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.
Surgery is generally done when the child is about 10 weeks old. To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. The surgeon turns the dark pink outer portion of the cleft down and pulls the muscle and the skin of the lip together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.
The child may be restless after surgery, but medication can relieve any discomfort. Elbow restraints may be necessary for a few weeks to prevent the baby from rubbing the stitched area. If dressings have been used, they will be removed within a day or two, and the stitches will either dissolve or be removed within five days.
It is normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it is barely noticeable because of the shadows formed by the nose and upper lip.
Repairing a cleft palate involves more extensive surgery than repairing a cleft lip. This surgery is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery. To repair a cleft palate, the surgeon makes an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so that the child can eat and learn to speak properly.
For a day or two, the child will feel some soreness and pain that is easily controlled by medication. Because a child will not eat or drink as much as usual during recovery, an intravenous line will be used to maintain fluid levels. Elbow restraints may be used to prevent the baby from rubbing the repaired area.
At about age three, the child's speech is assessed by a speech/language pathologist. If treatment is needed, the speech pathologist works with the parent and the child. In about 20 percent of cases, children with cleft palate will require a second operation on the palate to improve speech. The need for extra surgery cannot be predicted at the time of the original palate surgery. This surgery may be needed if speech therapy alone cannot improve the child's ability to speak normally. Surgery involves improving the function of the palate and throat where the air needed for sound is directed.
Before the child begins school, any significant residual cleft deformities involving the lip and nose are surgically corrected to help lessen the psychological effects of the problem.
Pediatric dental and orthodontic services begin to play a more important role as the teeth develop during the later years in childhood. Surgery to restore the residual cleft in the dental arch is frequently done at this time.
While nearly all cleft children will need braces as they enter adolescence, some will also need jaw surgery. For these children, the growth of the upper jaw lags behind the lower jaw and the face develops a sunken appearance. The surgery repositions the jaws to improve the child's bite and appearance. Once the facial bones are in correct relationship to each other, the final nose and lip surgery can be completed.
Many children with clefts involving the gum line need an operation called an alveolar bone graft to put extra bone in the gum, which allows the permanent teeth to come in better. This operation is done sometime between the ages of six and 10, depending on how fast the permanent teeth are developing.
Children with clefts of the lip may need or want another operation to improve the appearance of the scars. As teenagers, some need nasal surgery to
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.