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Month-old Girl (month-old + girl)
Selected AbstractsA Distinct Asymmetrical Pattern of Cortical Malformation: Large Unilateral Malformation of Cortical Development with Contralateral Periventricular Nodular Heterotopia in Three Pediatric CasesEPILEPSIA, Issue 8 2005Annapurna Poduri Summary:,Purpose: To describe a distinct asymmetrical pattern of cortical malformation with large focal malformations of cortical development (MCDs) and contralateral periventricular nodular heterotopia (PNH). Methods: We identified three patients with epilepsy and focal EEG abnormalities. Each patient underwent 1.5-Tesla magnetic resonance imaging (MRI) to obtain sagittal T1 -weighted, axial fluid-attenuated inversion recovery (FLAIR), fast spin-echo (FSE) T2 -weighted, and coronal fast spin-echo inversion recovery (FSEIR) T2 -weighted images; coronal spoiled gradient recalled (SPGR) T1 -weighted images were obtained in two cases. Results: Patient 1, an 18-year-old right-handed man, had a 4-year history of intractable seizures. MRI revealed a right frontal subcortical heterotopia (SH) and a single left anterior PNH. Patient 2, a 10-year-old left-handed boy, had a 4-year history of epilepsy. MRI revealed a large region of SH in the left temporal, parietal, and occipital lobes and three right-sided PNH. Patient 3, a 16-month-old girl, had medically refractory infantile spasms. MRI revealed a large MCD in the left parietal lobe with contiguous underlying periventricular heterotopia as well as a small contralateral PNH. Conclusions: These cases together illustrate a distinct asymmetrical pattern of a large focal MCD with small contralateral PNH. The asymmetrical involvement of the two hemispheres suggests that the stage of maximal disruption of cortical development may differ between the two hemispheres. Further study into the mechanisms underlying such asymmetrical patterns of cortical malformation should enhance our understanding of cortical development as well as hemispheric lateralization. [source] Elevated plasma bile acid concentrations in two sisters with tyrosinaemia type IJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2000JO Sass Abstract: A 21-month-old girl suffering from tyrosinaemia type I and undergoing treatment with 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC) presented with pruritus which rapidly ceased with administration of high doses of ursodeoxycholic acid. Determination of plasma bile acids revealed clearly elevated levels both in samples taken before and after the onset of NTBC therapy, thus indicating, that the increase was not related to the administration of this drug. This result is corroborated by data from the first patient's newborn sister, diagnosed with the same disease, who showed elevated plasma bile acid concentrations in all samples examined, except for the cord plasma. This is the first report on altered bile acid concentrations in tyrosinaemia type I, and underlines the need for thorough investigation of bile acid metabolism in this disease. [source] Perioperative management of a child with short-chain acyl-CoA dehydrogenase deficiencyPEDIATRIC ANESTHESIA, Issue 9 2005BRIAN TURPIN BS Summary Short-chain acyl-CoA dehydrogenase (SCAD) is a mitochondrial enzyme that catalyzes the dehydrogenation of short chain fatty acids (4 to 6 carbons in length) thereby initiating the cycle of , -oxidation. This process generates acetyl-CoA, the key substrate for hepatic ketogenesis or ATP production by the Kreb's cycle. A deficiency of SCAD results in the build-up of potentially cytotoxic metabolites including ethylmalonic acid, methylsuccinyl CoA and butyryl-carnitine. The end-organ involvement is heterogeneous, but most commonly includes hypotonia with possible lipid myopathy and developmental delay. Other reported complications include dysmorphic craniofacial features, hypoglycemia, seizures, scoliosis, hypertonia and hyperreflexia, cyclic vomiting and myocardial dysfunction. We present a 23-month-old girl with SCAD deficiency, who required posterior fossa decompression for type 1 Chiari malformation. The potential perioperative implications of SCAD deficiency are reviewed. [source] Recurrence of hepatic artery thrombosis following acute tacrolimus overdose in pediatric liver transplant recipientPEDIATRIC TRANSPLANTATION, Issue 6 2005Soshi Takahashi Abstract:, Acute overdose of tacrolimus appears to cause no or minimal adverse clinical consequences. We encountered a pediatric case who underwent liver transplantation associated with hepatic artery thrombosis (HAT), which recurred following acute tacrolimus overdose. A 10-month-old girl underwent living-related liver transplantation because of biliary atresia. To reconstruct the hepatic artery, the right gastroepiploic artery of the donor was interposed between the right hepatic artery of the recipient (2.5 mm in diameter) and the left hepatic graft artery (1 mm in diameter) under microscopy. On postoperative day 4, Doppler ultrasonography showed a remarkable reduction in hepatic arterial flow, which was consistent with HAT. The patient underwent immediate hepatic arteriography and balloon angioplasty. The stenotic sites were dilated by the procedure. Tacrolimus was infused intravenously after transplantation and the infusion rate was adjusted to achieve a target concentration of 18,22 ng/mL, which remained stable until the morning of day 6. An unexpectedly high blood concentration of tacrolimus (57.4 ng/mL) was detected at 6:00 pm on day 6, and tacrolimus was discontinued at 9:00 pm; however, the tacrolimus level reached 119.5 ng/mL at 0:00 h on day 7. While the concentration decreased to 55.2 ng/mL on the morning of day 7, the hepatic arterial flow could not be observed by Doppler ultrasonography. Emergent hepatic arteriography showed stenosis of the artery at the proximal site of the anastomosis. Balloon angioplasty was again performed and the stenotic site was successfully dilated. High level of tacrolimus exposure to the hepatic artery with injured endothelium by preceding angioplasty may have been related to the recurrence of HAT in the present case. [source] Oral administration of tacrolimus in the presence of jejunostomy after liver transplantationPEDIATRIC TRANSPLANTATION, Issue 3 2001Toshimichi Hasegawa Abstract: The feasibility of oral administration of tacrolimus in the presence of an intestinal stoma after liver transplantation (LTx) has not been adequately demonstrated. A 10-month-old girl underwent LTx with biliary reconstruction using a Roux-en Y loop. She developed intestinal perforation and underwent a jejunostomy at 40,50 cm distal to the jejunojejunostomy of the Roux-en Y loop on day 8 post-LTx. Tacrolimus was given twice daily via a nasogastric tube or orally; the initial dose of tacrolimus was 0.10 mg/kg/day. Until the time of intestinal perforation, the trough level of tacrolimus ranged from 13.0 to 19.6 ng/mL. The dose-normalized trough concentration (DNTC) of tacrolimus ranged from 130 to 196 ng.kg.daypermg.mL (control: 80,145 ng.kg.daypermg.mL). For a 2-week period when the patient was septic, the tacrolimus dose was reduced to 0.05 mg/kg/day, with a subsequent trough level of 3.6,5.1 ng/mL (DNTC: 72,102 ng.kg.daypermg.mL). After 3 weeks, the dose was increased to 0.175 mg/kg/day with the disappearance of infection; the trough level ranged from 8.5 to 9.7 ng/mL with a peak level of 26.3 ng/mL (DNTC: 48.5,55.4 ng.kg.daypermg.mL). After the initiation of oral feeding, the dose was slightly increased to 0.20 mg/kg/day with the trough level ranging from 8.1 to 9.8 ng/mL (DNTC: 40.5,49 ng.kg.daypermg.mL). After closure of the jejunostomy, the dose of tacrolimus was reduced to 0.075 mg/kg/day to maintain the same trough level (7.9,9.1 ng/mL) and the DNTC ranged from 105 to 121 ng.kg.daypermg.mL. In conclusion, oral administration of tacrolimus may achieve the therapeutic level, even in the presence of jejunostomy after LTx, although the bioavailability is decreased. [source] Oral 2, Silver hair in a 3-year-old childBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2007R. Batchelor A 32-month-old girl of Pakistani origin presented to the paediatricians with a short history of abdominal pain, decreased appetite and lethargy and a history of developmental delay. She was referred to us when it was noted that her hair and eyebrows were silver in colour. While in hospital, she became progressively more unwell, developed neck stiffness and refused to walk. A diagnosis of acute meningitis was made and a prelumbar puncture computed tomographic scan showed hydrocephalus with enlarged third and lateral ventricles. She underwent a third ventriculostomy and insertion of a reservoir. Magnetic resonance imaging showed multiple focal ill-defined enhancement with larger enhancing masses in the cerebellum. These appearances were initially thought suggestive of widely disseminated lymphoma or leukaemia. Surgical biopsy of these lesions was performed and histology showed some evidence of histiocytic tumour with a degree of erythrophagocytosis and lymphophagocytosis. In view of the histology and the phenotypic features, Griscelli syndrome was considered. Blood and hair from the patient were analysed and she was confirmed to be homozygous for a mutation in the RAB27A gene, which has been described in Griscelli syndrome. She has subsequently undergone bone marrow transplantation. Griscelli syndrome is a rare autosomal recessive disorder resulting in partial albinism and a combined immunodeficiency.1 Our case is unusual in that the presentation was neurological with no evidence of cytopenia. Reference 1 Mancini AJ, Chan LS, Paller AS. Partial albinism with immunodeficiency: Griscelli syndrome: report of a case and review of the literature. J Am Acad Dermatol 1998; 38:295,300. [source] Task-to-Task Vagal Regulation: Relations With Language and Play in 20-Month-Old ChildrenINFANCY, Issue 3 2000Patricia E. Suess In this article we report patterns of task-to-task vagal tone change across multiple language and play tasks as well as associations between these patterns of task-to-task vagal tone change and language and play performance in 20-month-old girls and boys. Although initially different in vagal tone suppression during solitary play, girls and boys exhibited similar group patterns of vagal reengagement during successive language and play tasks with their mothers and with an experimenter. In terms of individual differences, vagal suppression during solitary play and vagal reengagement during social interactive tasks predicted language and play performance. Gender differences emerged in patterns of predictive relations: Task-to-task vagal changes predicted primarily play performance in girls and language performance in boys. These findings expose the effects of social context on directional changes in task-to-task vagal tone and speak to the functional role of appropriate vagal regulation in young children's language and play performance. [source] | ||||||||||