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https://www.readbyqxmd.com/read/28331936/ultrasound-guidance-for-difficult-lumbar-puncture-in-children-pearls-and-pitfalls
#1
REVIEW
Prakash Muthusami, Ashley James Robinson, Manohar M Shroff
Pediatric lumbar puncture can be challenging or unsuccessful for several reasons. At the same time, the excellent sonographic window into the pediatric spine provides a distinct opportunity for ultrasound-guided lumbar puncture. Minimal cerebrospinal fluid and thecal displacement by subdural or epidural hematomas are common after failed clinical attempts. Ultrasound is useful for determining a safe infraconal level for subarachnoid access. Real-time guidance increases not only the success rate but also the safety of diagnostic lumbar puncture and injections for chemotherapy and myelography...
March 22, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28328674/the-value-of-the-injury-severity-score-in-pediatric-trauma-time-for-a-new-definition-of-severe-injury
#2
Joshua B Brown, Mark L Gestring, Christine M Leeper, Jason L Sperry, Andrew B Peitzman, Timothy R Billiar, Barbara A Gaines
BACKGROUND: The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS>15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and AIS to predict mortality and define optimal thresholds of severe injury in pediatric trauma. METHODS: Patients from the Pennsylvania trauma registry 2000-2013 were included...
March 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28328564/variation-in-national-acgme-case-log-data-for-pediatric-orthopaedic-fellowships-are-fellow-coding-practices-responsible
#3
Philip K McClure, Marcella Woiczik, Lori Karol, Wudbhav N Sankar
BACKGROUND: The introduction of the 80-hour work week for Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship programs initiated many efforts to optimize surgical training. One particular area of interest is on recording and tracking surgical experiences. The current standard is logging cases based on Current Procedural Terminology codes, which are primarily designed for billing. Proposed guidelines from the ACGME regarding logging exist, but their implementation is unknown, as is the variation in case volume across fellowship programs...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28323913/accrual-of-bone-mass-in-children-and-adolescents-with-cystic-fibrosis
#4
Sonakshi Sharma, Mirjana Jaksic, Sheryl Fenwick, Catherine Byrnes, Tim Cundy
Context: Low bone density is a recognised complication of cystic fibrosis (CF). Hypothesis: Accrual of bone mass is most impaired in the sickest children, as judged by nutritional status and pulmonary function. Design: Retrospective analysis of correlation between lumbar spine BMD, BMI and FEV1 z-score in children and adolescents with CF. Setting: Specialist CF service at a pediatric hospital. Patients: 60 participants aged 5...
February 22, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28321993/metatropic-dysplasia-a-skeletal-dysplasia-with-challenging-airway-and-other-anesthetic-concerns
#5
Mary C Theroux, Martha Lopez, Patricia J Olszewsky, Sabina DiCindio, Lynda Arai, Colleen Ditro, Michael B Bober, Olubukola Opeyemi Olla, Tetsu Uejima, David W West, William G Mackenzie
BACKGROUND: Metatropic dysplasia is a rare form of skeletal dysplasia requiring multiple anesthetics for surgical and imaging procedures, most of which are orthopedic procedures. We provide centralized care to patients with skeletal dysplasia at our tertiary care pediatric hospital, and we were able to collect the largest number of metatropic dysplasia patients reported to date. AIM: The aim of this retrospective study was to describe and characterize the anesthetic difficulties in this high-risk population...
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321954/anaphylactic-reaction-to-tranexamic-acid-in-an-adolescent-undergoing-posterior-spinal-fusion
#6
Jennifer Chiem, Iskra Ivanova, Andrew Parker, Walter Krengel, Nathalia Jimenez
Tranexamic acid is an anti-fibrinolytic agent frequently used in pediatric surgery. Common side effects include nausea, flushing, and headache, but in rare instances, it may produce anaphylaxis; with only one previously reported case in a 72-year-old man. We report a case of a delayed anaphylactic reaction in a pediatric patient undergoing posterior spine fusion; and discuss the intraoperative management of the acute event, immunologic confirmation, and subsequent anesthetic approach.
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321388/association-of-atlanto-occipital-dislocation-retroclival-hematoma-and-hydrocephalus-management-and-survival-in-a-pediatric-patient
#7
Isaac L Lee, Luis F Vasquez, Alan H Tyroch, Todd T Trier
Atlanto-occipital dislocation (AOD) is an injury with high morbidity and mortality. We present a case of survival of a pediatric patient with the diagnoses of AOD, retroclival hematoma, and resulting hydrocephalus. The patient's cervical spine was stabilized until occipital-cervical fusion provided definitive treatment, and the hydrocephalus was treated with a ventriculostomy. The patient survived with no neurological deficits. A better understanding and awareness of the radiologic criteria of AOD will lead to earlier recognition of AOD and improved outcomes, even in the presence of complications from AOD...
January 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28319509/a-high-preoperative-pain-and-symptom-profile-predicts-worse-pain-outcomes-for-children-after-spine-fusion-surgery
#8
Terri Voepel-Lewis, Michelle S Caird, Alan R Tait, Shobha Malviya, Frances A Farley, Ying Li, Matthew D Abbott, Tara van Veen, Afton L Hassett, Daniel J Clauw
BACKGROUND: Preoperative pain predicts persistent pain after spine fusion, yet little is understood about the nature of that pain, related symptoms, and how these symptoms relate to postoperative pain outcomes. This prospective study examined children's baseline pain and symptom profiles and the association between a high symptom profile and postoperative outcomes. METHODS: Seventy children (aged 10-17 years) scheduled for correction of idiopathic scoliosis completed pain and symptom surveys during their preoperative visit (ie, pain intensity [0-10 numeric rating scores], a pediatric version of the 2011 fibromyalgia survey criteria [including pain locations and symptom severity scale], neuropathic pain symptoms [painDETECT], and Patient-Reported Outcome Measurement System measures of fatigue, depression, function, pain interference, and pain catastrophizing)...
March 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28306628/pediatric-spinal-cord-injury-without-radiographic-abnormality-in-the-era-of-advanced-imaging
#9
Caitlin A Farrell, Megan Hannon, Lois K Lee
PURPOSE OF REVIEW: The current review describes the current evidence on pediatric spinal cord injury without radiographic abnormality (SCIWORA) with attention to the definition, epidemiology, and clinical presentation of the condition, as well as common MRI findings, management strategies, and outcomes. RECENT FINDINGS: Recent literature demonstrates that with more widespread MRI use, our understanding of SCIWORA has improved. The new literature, although still limited, provides a more granular conceptualization of patterns of injury as well as potential prognostic stratification of patients based on MRI findings...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28301365/preserving-the-legitimacy-of-board-certification
#10
Michael S Hanemann, Holly C Wall, John A Dean
OBJECTIVES: The aims of this discussion were to inform the medical community about the American Board of Cosmetic Surgery's ongoing attempts in Louisiana to achieve equivalency to American Board of Medical Specialties (ABMS) member boards so that its diplomates may use the term "board certified" in advertising and to ensure public safety by upholding the standards for medical board certification. BACKGROUND: In 2011, Louisiana passed a truth in medical advertising law, which was intended to protect the public by prohibiting the use of the term "board certified" by improperly credentialed physicians...
March 16, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28291142/lower-extremity-avulsion-fractures-in-the-pediatric-and-adolescent-athlete
#11
Jonathan Schiller, Steven DeFroda, Travis Blood
Lower extremity avulsion fractures are uncommon in the pediatric population and can be misdiagnosed without proper imaging and/or clinical suspicion for these injuries. The most common locations of avulsion injuries are the ischial tuberosity, anterior superior iliac spine, and anterior inferior iliac spine. Less often, avulsion fractures occur in the tibial tubercle, calcaneus, and greater and lesser trochanters. When treated properly with rest and altered weight bearing, most of these injuries heal without complication...
April 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28288046/fdg-pet-ct-in-pediatric-neurolymphomatosis
#12
Carole de Vaugelade, Henri de Clermont-Gallerande, Marie Meyer, Aude My Duyen Tiphaine, Alice Benjamin, Stephane Ducassou, Jean-François Chateil, Philippe Fernandez
An 8-year-old girl presented with back and leg pain and left arm and leg paresis. Lumbar puncture was suggestive of lymphocytic meningitis without identified organism. A second lumbar puncture demonstrated a large number of lymphoid B cells, with positive immunohistochemical staining for CD20 and CD25, proving the diagnosis of neurolymphomatosis. Brain and spine MRI demonstrated involvement of cervical and lumbosacral nerve roots. FDG PET/CT showed multiple bone metastases in addition to nerve involvement. Postchemotherapy FDG PET/CT demonstrated complete metabolic response...
March 10, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28277467/high-energy-pediatric-scapula-fractures-and-their-associated-injuries
#13
Steven F Shannon, Nicholas M Hernandez, Stephen A Sems, Annalise N Larson, Todd A Milbrandt
OBJECTIVES: The purpose of this study was to evaluate pediatric scapula fractures occurring in high-energy motorized vehicle accidents and their associated injury patterns in a pediatric patient population. METHODS: One thousand nine hundred sixty-eight pediatric patients who presented after either on-road or off-road motorized vehicle accidents between 1996 and 2015 were retrospectively reviewed. Thirty-eight patients were found to have scapula fractures and the remaining 1930 were identified as controls...
March 8, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28274487/manipulation-peak-forces-across-spinal-regions-for-children-using-mannequin-simulators
#14
John J Triano, Steven Lester, David Starmer, Elise G Hewitt
OBJECTIVE: The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose-response and safety studies on therapeutic benefit. METHODS: The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children...
March 5, 2017: Journal of Manipulative and Physiological Therapeutics
https://www.readbyqxmd.com/read/28272111/disability-risk-in-pediatric-motor-vehicle-crash-occupants
#15
Andrea N Doud, Samantha L Schoell, Ashley A Weaver, Jennifer W Talton, Ryan T Barnard, John K Petty, Joel D Stitzel
BACKGROUND: Mortality rates among children in motor vehicle crashes (MVCs) are typically low, however non-fatal injuries can vary in severity by imposing differing levels of short- and long-term disability. To better discriminate the severity of non-fatal MVC-injuries, a pediatric-specific disability risk (DR) metric was created. METHODS: The National Automotive Sampling System (NASS-CDS) 2000-2011 was used to define the top 95% most common Abbreviated Injury Scale (AIS) 2+ injuries among pediatric MVC occupants...
March 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28263228/pain-is-the-greatest-preoperative-concern-for-patients-and-parents-prior-to-posterior-spinal-fusion-for-adolescent-idiopathic-scoliosis
#16
Priscella Chan, David Skaggs, Austin Sanders, Gabriela A Villamor, Paul D Choi, Vernon Tolo, Lindsay M Andras
STUDY DESIGN: Prospective cross-sectional study OBJECTIVE.: To evaluate patients' and parents' concerns so they can be addressed with appropriate preoperative counseling. SUMMARY OF BACKGROUND DATA: Despite much research on outcomes for posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS), little is available about preoperative fears or concerns. METHODS: AIS patients undergoing PSF, their parents, and surgeons, were prospectively enrolled and asked to complete a survey on their fears and concerns about surgery at their preoperative appointment...
March 3, 2017: Spine
https://www.readbyqxmd.com/read/28258940/low-bone-mineral-density-and-fractures-are-highly-prevalent-in-pediatric-patients-with-spinal-muscular-atrophy-regardless-of-disease-severity
#17
Halley M Wasserman, Lindsey N Hornung, Peggy J Stenger, Meilan M Rutter, Brenda L Wong, Irina Rybalsky, Jane C Khoury, Heidi J Kalkwarf
Patients with Spinal Muscular Atrophy (SMA) are at risk for poor bone health. The prevalence of fractures, low areal bone mineral density (aBMD; Z-score ≤-2.0) of the lateral distal femur and of osteoporosis by SMA subtype is not known. We aimed to describe the natural history of bone health in patients with SMA prior to bisphosphonate treatment. We reviewed data from 85 eligible patients with SMA ages 12 months to 18 years, seen at a single institution between January 2005 and July 2016. Fracture history was reported at annual clinic visits...
February 1, 2017: Neuromuscular Disorders: NMD
https://www.readbyqxmd.com/read/28258886/cross-calibrated-dual-energy-x-ray-absorptiometry-scanners-demonstrate-systematic-bias-in-pediatric-and-young-adult-females
#18
Jodi N Dowthwaite, Kristen A Dunsmore, Dongliang Wang, Paula F Rosenbaum, Tamara A Scerpella
Consistency of dual-energy X-ray absorptiometry (DXA) scan results is critical for data integrity. For pediatric subjects, the extent to which cross-calibration of DXA scanners alleviates model-to-model scanner differences is unclear. In the current study, DXA bone outcomes were compared for same-day measurements performed using different scanners, cross-calibrated to alleviate discrepancies (Hologic; Discovery A [DISCO] and QDR 4500W [QDR]). Interscanner differences were evaluated in approximately 130 females aged 8-24 yr...
February 28, 2017: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/28253948/-long-term-outcomes-of-the-treatment-of-pediatric-femoral-shaft-fractures-treated-with-bryant-s-vertical-traction
#19
J Urban, P Toufar, M Kloub
PURPOSE OF THE STUDY The paper aimed to evaluate the long-term outcomes of the treatment of diaphyseal femur fractures in children treated with Bryant's vertical traction. Moreover, we also assessed the size of overgrowth in the injured femur. MATERIAL AND METHODS The study included 23 patients with 23 femoral shaft fractures treated with Bryant's vertical traction at our department in 2009-2014. The following parameters were assessed: sex, ïnjured side, weight, age, mechanism of injury, potential abuse, type of fracture, duration of traction, and total length of hospital stay...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28247113/management-of-eosinophilic-granuloma-in-pediatric-patients-surgical-intervention-and-surgery-combined-with-postoperative-radiotherapy-and-or-chemotherapy
#20
Zhenhai Zhou, Hongqi Zhang, Chaofeng Guo, Honggui Yu, Longjie Wang, Qiang Guo
BACKGROUND: Eosinophilic granuloma (EG) of spine in pediatric patients presents kinds of clinical manifestation and a difficult management scenario. The choice of treatment, issues of surgical intervention versus conservative treatment, combination therapy or single treatment, all these factors, including neurological deficits, spinal stability, long-term complications, and continued skeletal growth, must be considered. METHODS: From 2008 to the 2015, 31 pediatric patients of spinal EG were retrospectively reviewed...
February 28, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
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