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Pediatric lower extremity

Branislav Kollar, Sotirios Tasigiorgos, Miguel I Dorante, Matthew J Carty, Simon G Talbot, Bohdan Pomahac
In the past 20 years, reconstructive transplantation (RT) has emerged as a viable reconstructive option for carefully selected patients. More than 100 upper extremity and 40 face transplants have been performed worldwide to date. Concomitantly, the portfolio of reconstructive transplantation has been extended by additional procedures such as lower extremities, abdominal wall, neck, uterus, genitourinary, and pediatric transplants. In the present review article, we aim to summarize the current state of knowledge about this exciting field...
August 11, 2018: Journal of Surgical Oncology
Royce W Woodroffe, Mario Zanaty, Patricia Kirby, Brian J Dlouhy, Arnold H Menezes
This video is a case presentation and demonstration of surgical approach to a pediatric intramedullary spinal cord tumor (IMSCT). IMSCT can be associated with significant morbidity and aggressive resection is associated with more favorable long-term outcome. A 13-yr-old male presented to clinic for evaluation of rapidly progressive scoliosis to the left. A contrasted MRI revealed expansion of the spinal cord with edema from approximately T3 to T9 and an enhancing lesion at T6-7 associated with a small cyst...
July 31, 2018: Operative Neurosurgery (Hagerstown, Md.)
William D Gerull, Ugochi C Okoroafor, Jason Guattery, Charles A Goldfarb, Lindley B Wall, Ryan P Calfee
BACKGROUND: This study was designed to quantify the performance of the pediatric Patient-Reported Outcome Measurement Information System (PROMIS) when delivered as part of routine care to children with upper extremity (UE) fractures. METHODS: This cross-sectional study analyzed 964 new pediatric patients presenting with an UE fracture. All patients completed PROMIS computer adaptive tests for pain interference, peer relationships, UE function, and mobility domains at clinic registration...
August 6, 2018: Hand: Official Journal of the American Association for Hand Surgery
Jacqueline T Bangma, Evan Kwiatkowski, Matthew Psioda, Hudson P Santos, Stephen R Hooper, Laurie Douglass, Robert M Joseph, Jean A Frazier, Karl C K Kuban, Thomas M O'Shea, Rebecca C Fry
OBJECTIVE: To assess the development of a Positive Child Health Index (PCHI) based on 11 adverse outcomes and evaluate the association of PCHI with quality of life (QoL) scores in a preterm cohort. STUDY DESIGN: A total of 889 children enrolled in the Extremely Low Gestational Age Newborn (ELGAN) study in 2002-2004 were followed up at 10 years of age. A parent/caregiver completed questionnaires for child QoL, asthma, visual or hearing impairment, gross motor function impairment, epilepsy, attention deficit/hyperactivity disorder, anxiety, and depression...
August 2, 2018: Journal of Pediatrics
Eldad Elnekave, Eli Atar, Shirah Amar, Elchanan Bruckheimer, Michael Knizhnik, Isaac Yaniv, Tal Dujovny, Meora Feinmesser, Shifra Ash
Systemic doxorubicin is effective for desmoid fibromatosis (DF), but its use is limited by dose-dependent cardiotoxicity. A protocol of selective intra-arterial doxorubicin drug-eluting embolization (DEE) was designed to maximize target tissue efficacy of doxorubicin, while minimizing systemic exposure. Four children with recurrent or refractory DF were treated between 2014 and 2017. Tumor volumes were reduced by 54%-97% over a follow-up interval of 6-32 months. A single patient experienced transient lower extremity paresthesia (Common Terminology Criteria for Adverse Events grade I)...
July 31, 2018: Journal of Vascular and Interventional Radiology: JVIR
Maria L Avila, Brian M Feldman, Suzan Williams, Leigh C Ward, Madeline I Montoya, Jennifer Stinson, Alex Kiss, Jennifer Vincelli, Celeste Lumia, Leonardo R Brandão
Background: Pediatric tools for diagnosis of post-thrombotic syndrome (PTS) include the assessment of limb edema as a symptom (patient/proxy-reported) and as a sign. However, it is unclear whether these two approaches refer to the same clinical aspect of PTS. This could result in overestimation of disease severity. We sought to evaluate the correlation among different techniques to assess limb edema as a sign and as a symptom in children who sustained upper extremity (UE) or lower extremity (LE) deep vein thrombosis (DVT) and were, therefore, at risk of PTS...
July 2018: Research and Practice in Thrombosis and Haemostasis
Maria L Avila, Jennifer Stinson, Celeste Lumia, Suzan Williams, Madeline I Montoya, Brian M Feldman, Leonardo R Brandão
Essentials: <AbstractText Label="Background" NlmCategory="UNASSIGNED">Symptoms and function in pediatric post-thrombotic syndrome (PTS) remain poorly characterized. Methods: The present cross-sectional study describes the characteristics of pain, other symptoms, and impaired function in pediatric PTS in a cohort of children with history of upper or lower limb deep vein thrombosis and PTS diagnosis. The frequency of clinical findings was compared between patients with and without pain, and between patients with upper and lower extremity PTS...
April 2018: Research and Practice in Thrombosis and Haemostasis
Yin Wu, Xian-Ming Fu, Xiao-Bo Liao, Xinmin Zhou
RATIONALE: Cerebral stroke with peripheral embolism due to left atrial myxoma is very rare in children. Misdiagnosis may occur because of nonspecific symptoms in the heart. PATIENT CONCERNS: We present a case of a 16-year-old boy who presented with ischemic stroke and embolisms in the lower extremity, caused by a giant left atrial myxoma. DIAGNOSES: Left atrial myxoma. INTERVENTIONS: A giant gelatinous mass was completely excised, and the histopathological findings confirmed the diagnosis of atrial myxoma...
July 2018: Medicine (Baltimore)
Corey Montgomery, Austin Porter, Christopher Parks, Brant Sachleben, R Dale Blasier, Brien Rabenhorst
Football remains a popular sport in the United States despite sometimes significant injuries, such as fractures and dislocations, occurring. The objective of this study was to evaluate pediatric extremity fractures and dislocations related to football. A retrospective review was conducted at a level 1 pediatric trauma center to identify patients who were treated specifically for American football-related injuries (International Classification of Diseases, Ninth Revision, code E007.0). All patients with football-related injuries presenting to the emergency department during a 6-year period (2007-2012) were reviewed for inclusion in the study...
July 1, 2018: Orthopedics
Ivan Baltadzhiev, Ina Geneva, Nedialka Popivanova
Guillain-Barré syndrome (GBS) belongs to the group of peripheral immune-mediated neuropathies often preceded by an inflammatory episode. GBS is rarely associated with hepatitis A virus (HAV) infection, the latter as a rule antecedent of the neurological disorders. This association is quite rare in childhood, and so far, only isolated cases have been described. We report an unusual case of pediatric GBS which development coincided with the development of HAV IgM (+) viral hepatitis A. From the second to the 14th day after admission to the hospital for mild jaundice of the skin and sclera in a 12-yr-old boy, the following neurological disorders have developed: absent Achilles and knee-jerk reflexes, diminished brachioradialis reflex, moderately decreased muscle power in the upper extremities and more pronounced power loss in the lower extremities...
2018: Iranian Journal of Child Neurology
Yunlan Xu, Jingxia Bian, Kaiying Shen, Bin Xue
The treatment of children between 5 and 12 years of age suffering from subtrochanteric femoral fracture is challenging. The optimal choice of internal fixation for these patients is controversial. The purpose of this study is to compare the outcomes and complications of titanium elastic nail and open reduction with plate fixation of subtrochanteric femur fractures in school-aged children.A total of 67 children aged 5 to 12 years with subtrochanteric femur fractures treated with titanium elastic nails or open plating were identified at our institution from January 2007 to December 2017...
July 2018: Medicine (Baltimore)
Matthew T Houdek, Peter S Rose, Todd A Milbrandt, Anthony A Stans, Steven L Moran, Franklin H Sim
INTRODUCTION: Lower extremity intercalary allograft reconstruction has traditionally been used to facilitate limb salvage. Combing the allograft with a vascularized fibula graft (FVFG) has been described; however there is a paucity of data comparing the outcome of these reconstructions. MATERIAL AND METHODS: 29 pediatric patients (15 males, 14 females) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12 years...
July 10, 2018: Plastic and Reconstructive Surgery
Kevin R Schwartz, Jennifer M Hanson, Alison M Friedmann
A previously healthy 10-year-old girl presented to the emergency department (ED) with a headache and vomiting which resolved with oral NSAIDs. The patient returned two days later unable to ambulate with mental slowing and lower extremity bruising. Labs demonstrated marked leukocytosis, severe anemia and thrombocytopenia, and disseminated intravascular coagulation (DIC). Brain MRI showed multiple intracranial hemorrhages. A peripheral blood smear demonstrated blasts with many Auer rods. A diagnosis of acute promyelocytic leukemia (APL) was made and therapy including all-transretinoic acid (ATRA) was initiated...
2018: Case Reports in Emergency Medicine
Sergio Verd, Diego de Sotto, Consuelo Fernández, Antonio Gutiérrez
Background: The definition for lower limit of safe birthweight loss among exclusively breastfed neonates is arbitrary. Despite this, in cases of great in-hospital weight loss, breastfeeding adequacy is immediately questioned. The aim of this study was to examine the relationship between weight loss at discharge from hospital, when babies are ready to go home, and eventual cessation of exclusive breastfeeding since birth. Methods: This is a secondary analysis of a cohort study...
2018: International Breastfeeding Journal
Young Mee Choi, Kristen Campbell, Claire Levek, John Recicar, Steven Moulton
INTRODUCTION: Antibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds...
June 18, 2018: Journal of Pediatric Surgery
Emily Foxen-Craft, Eric L Scott, Kristin A Kullgren, Reilly Philliben, Caroline Hyman, Marianna Dorta, Anne Murphy, Terri Voepel-Lewis
BACKGROUND: Pain location and widespread pain are important but underexamined dimensions of pediatric pain. Body map tools to assess pain location in youth have been used for several decades, but few studies have established reliability and validity of these measures. The purpose of this study was to explore the reliability and validity of a pain body map among youth with orthopedic conditions before surgery. METHOD: Youth ages 10-17 years completed the body map and other self-reported outcomes at their preoperative clinic visit and at their day of surgery...
July 5, 2018: European Journal of Pain: EJP
Kathleen D Rickert, Pooya Hosseinzadeh, Eric W Edmonds
BACKGROUND: Skeletal trauma is a primary tenet of pediatric orthopaedics. Many high-quality studies have been published over the last few years with substantial relevance to the clinical practice of pediatric orthopaedic trauma. Because of the volume of literature on the subject, this review excludes upper extremity trauma and focuses on the publications affecting the lower extremity. METHODS: An electronic search of the PubMed database was performed utilizing keywords for pediatric lower extremity trauma: pelvic injuries, femur fractures, tibial shaft fractures, femur fractures, ankle fractures, and foot fractures...
July 2, 2018: Journal of Pediatric Orthopedics
Keri R Hainsworth, Xue Cheng Liu, Pippa M Simpson, Ann M Swartz, Nina Linneman, Susan T Tran, Gustavo R Medrano, Bryant Mascarenhas, Liyun Zhang, Steven J Weisman
Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11⁻17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes)...
July 4, 2018: Children
Esra Isik, Huseyin Onay, Tahir Atik, Bilcag Akgun, Ozgur Cogulu, Ferda Ozkinay
L1 syndrome is a rare X linked recessive disorder caused bygene mutations in the L1 cell adhesion molecule (L1CAM), and characterized by hydrocephalus, intellectual disability, adducted thumbs and spasticity of the legs. The gene encodes a protein which plays an important role in neuronal development. Two unrelated L1 syndrome cases, with global developmental delay and hydrocephalus, were referred to pediatric genetics subdivision for genetic counseling. Bilateral adducted thumbs and spasticity in the lower extremities were also observed in both patients...
June 18, 2018: Clinical Neurology and Neurosurgery
Rajan R Murgai, Edward Compton, Akash R Patel, Deirdre Ryan, Robert M Kay
BACKGROUND: Although postoperative cast immobilization is routinely used in children, it is not without complications. Few studies have focused on interventions to decrease their frequency. The purpose of this study was to determine if foam padding in postoperative lower extremity casts decreased the rate of cast complications. METHODS: A retrospective review of patients who underwent lower extremity casting after elective surgery at a tertiary pediatric hospital from 2006 to 2013 was conducted...
September 2018: Journal of Pediatric Orthopedics
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