Home About us Contact
|
Home About us Contact | ||
|
|
||
Pediatric Patients (pediatric + patient)
Selected AbstractsTHE UNIDENTIFIED PARASITE: A PROBABLE CASE OF NORTH AMERICAN CUTEREBRID MYIASIS IN A PEDIATRIC PATIENTPEDIATRIC DERMATOLOGY, Issue 4 2004ALEXANDRA H. AHMET M.D., B.SC. No abstract is available for this article. [source] Localized Hypertrichosis in a Pediatric Patient,What Is the Mechanism for Excess Hair Growth?PEDIATRIC DERMATOLOGY, Issue 3 2007Kyle Wagamon M.D. We highlight an instance of localized hypertrichosis due to an underlying diffuse neurofibroma in a patient with known neurofibromatosis 1. The classification and possible underlying pathogenic mechanisms of localized hypertriehosis in pediatric patients is discussed. [source] Vitiligo-Like Lesions and Diffuse Lightening of the Skin in a Pediatric Patient Treated with Imatinib Mesylate: A Noninvasive Colorimetric AssessmentPEDIATRIC DERMATOLOGY, Issue 2 2006Valeria Brazzelli M.D. It acts as a potent and selective inhibitor of BCR-ABL tyrosine kinase. It also inhibits both c-kit and platelet-derived growth factor receptor tyrosine kinases. Hypopigmentation of the skin in patients receiving this drug has been recently reported. We report a 17-year-old Caucasian patient affected by chronic myeloid leukemia in therapy with imatinib mesylate who developed hypopigmented vitiligo-like patches and generalized lightening of the skin. In order to evaluate the lightening observed clinically, we measured the progressive skin color hypopigmentation by using a colorimeter over several months. The colorimetric evaluation confirmed the generalized and gradual lightening of patient's skin over treatment with imatinib mesylate. We believe that this is the first reported instance of vitiligo-like lesions in a pediatric patient treated with imatinib mesylate, and the second in a Caucasian patient. [source] Ectopic Hamartomatous Cervical Thymoma Presenting as a Posterolateral Neck Mass in a Pediatric PatientTHE LARYNGOSCOPE, Issue S1 2009Eric M. Jaryszak MD PhD No abstract is available for this article. [source] Visual Development, Diagnosis, and Treatment of the Pediatric PatientCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 5 2007Article first published online: 9 AUG 200 No abstract is available for this article. [source] The Risk of Intra-abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed TomographyACADEMIC EMERGENCY MEDICINE, Issue 5 2010Jeffrey Hom MD Abstract Objectives:, This review examines the prevalence of intra-abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma. Methods:, MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs. Results:, Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion. Conclusions:, The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT. ACADEMIC EMERGENCY MEDICINE 2010; 17:469,475 © 2010 by the Society for Academic Emergency Medicine [source] Role of Mucin Lewis Status in Resistance to Helicobacter pylori Infection in Pediatric PatientsHELICOBACTER, Issue 4 2010Sara Lindén Abstract Background:,Helicobacter pylori causes gastritis, peptic ulcer and is a risk factor for adenocarcinoma and lymphoma of the stomach. Gastric mucins, carrying highly diverse carbohydrate structures, present functional binding sites for H. pylori and may play a role in pathogenesis. However, little information is available regarding gastric mucin in children with and without stomach diseases. Materials and Methods:, Expression of mucins and glycosylation was studied by immunohistochemistry on gastric biopsies from 51 children with and without H. pylori infection and/or peptic ulcer disease. Results:, In all children, MUC5AC was present in the surface epithelium and MUC6 in the glands. No MUC6 in the surface epithelium or MUC2 was detected in any section. The Leb and Lea blood group antigens were present in the surface epithelium of 80% and 29% of children, respectively. H. pylori load was higher in Leb negative children than in Leb positive individuals (mean ± SEM 17.8 ± 3.5 vs 10.8 ± 1.5; p < 0.05), but there was no correlation between Lea or Leb status and gastritis, nodularity, and gastric or duodenal ulcer (DU). Expression of sialyl-Lex was associated with H. pylori infection, and DU. Conclusions:, Mucin expression and glycosylation is similar in children and adults. However, in contrast to adults, pediatric H. pylori infection is not accompanied by aberrant expression of MUC6 or MUC2. Furthermore, the lower H. pylori density in Leb positive children indicates that H. pylori is suppressed in the presence of gastric mucins decorated with Leb, the binding site of the H. pylori BabA adhesin. [source] Implantable Cardioverter Defibrillators in Pediatric Patients:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2005Off-Label Devices for Orphan Diseases No abstract is available for this article. [source] The Effectiveness of Transtelephonic Monitoring of Pacemaker Function in Pediatric PatientsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2007SCOTT A. FOX M.B.B.S. Background:To determine the sensitivity and specificity, rate of compliance, and predictors of failure of telephone transmission of pacemaker function in a pediatric population. Methods:A total of 2,638 pacemaker transmission records were reviewed retrospectively. Standard calculations of sensitivity, specificity, and positive and negative predictive values were performed. Longitudinal data analysis was used to detect factors influencing the effectiveness of transtelephonic monitoring. The proportion of missed transmissions was calculated, thus enabling assessment of compliance. Logistic regression was performed to determine predictors of poor compliance. Results:Telephone transmission of pacemaker function, as a diagnostic tool, had a sensitivity of 94.8%, specificity of 99.2%, positive predictive value of 82.1%, and negative predictive value of 99.9%. Longitudinal analysis failed to show any significant predictors of transmission failure. Compliance with a prescribed transmission reached 84.5% in our patient population. Logistic regression analysis failed to identify any predictors of noncompliance. Conclusion:Values for sensitivity and specificity indicate that telephone transmission is a useful diagnostic tool for assessing pacemaker function at a distance. Negative predictive value is 99.9%, indicating that normal telephone transmissions are very reassuring of normal pacemaker function. Telephone transmission is equally successful in all age groups, genders, distances from a tertiary referral center, underlying diagnoses, pacing modes, and pacemaker models. Compliance with telephone transmission follow-up was higher in our population than in previous studies. [source] Low Energy Biphasic Waveform Cardioversion of Atrial Arrhythmias in Pediatric Patients and Young AdultsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2006LEONARDO LIBERMAN M.D. Background: Low-dose biphasic waveform cardioversion has been used for the termination of atrial arrhythmias in adult patients. The energy required for termination of atrial arrhythmias in pediatric patients is not known. The objective of this study is to determine the minimum energy required for successful external cardioversion of atrial arrhythmias in pediatric patients using biphasic waveform current. Methods: Prospective study of all patients less than 24 years of age with and without congenital heart disease undergoing synchronized cardioversion for atrial arrhythmias. Patients were assigned to receive an initial biphasic energy shock of 0.2,0.5 J/kg and if unsuccessful in terminating the arrhythmia, subsequent sequential shocks of 1 and 2 J/kg would be administered until cardioversion was achieved. The end point of the cardioversion protocol was successful cardioversion or delivery of three shocks. Results: Between June 2005 and June 2006, 16 patients underwent biphasic cardioversion for atrial flutter or fibrillation. The mean age was 14.7 ± 6.4 years (range: 2 weeks to 24 years). The mean weight was 51 ± 21 kg (range: 3.8,82 kg). Seven patients had normal cardiac anatomy, three had a single ventricle (Fontan), two had a Senning operation; the remaining four patients had varied forms of congenital heart disease. The median length of time that the patients were in tachycardia was 12 hours (range: 5 minutes to 2 months). Using either transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), no thrombi were identified in any patient. All patients were successfully cardioverted with biphasic waveform energy. The successful energy shock was 0.35 ± 0.19 J/kg (range: 0.2,0.9 J/kg). All but one patient were successfully cardioverted with less than 0.5 J/kg. The transthoracic impedance range was between 41 and 144 ,; one patient had an impedance of 506 , (2-week-old infant with a weight of 3.8 kg). The mean current delivered was 5.4 ± 2.2 A (range: 1,11 A). Conclusion: Low-dose energy using biphasic waveform shocks can be used for successful termination of atrial arrhythmias in pediatric patients with and without congenital heart disease. [source] Abnormality of the Left Ventricular Sympathetic Nervous Function Assessed by I-123 Metaiodobenzylguanidine Imaging in Pediatric Patients with Neurocardiogenic SyncopePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2003RANA OLGUNTÜRK The purpose of this study was to assess the left ventricular sympathetic nervous system function in the patients with neurocardiogenic syncope (NCS) using I-123 metaiodobenzylguanidine (MIBG) imaging of the heart, and to compare the plasma noradrenaline (NA) and MIBG results of tilt positive and tilt negative patients following a head-up tilt test (HUT). The study included 30 patients. Their physical and laboratory examinations did not show a pathology that may be the cause of their syncope. HUT test was positive in 13 patients and negative in 17 patients. Plasma NA concentrations were higher in the HUT positive than the HUT negative group at the beginning and at the 10th minute of the test. Specific I-123 MIBG uptake assessed as the cardiac to mediastinal activity ratio in the delayed image was significantly higher in HUT positive group. The higher levels of MIBG uptake and plasma NA observed in HUT positive patients may reflect the greater capacity of NA storage in cardiac adrenergic neuronal tissue in patients with NCS. The results of this study support the critical role of autonomic nervous system in the pathophysiology of NCS and the excessive sympathetic nervous stimulation as the trigger of paradox reflex. (PACE 2003; 26:1926,1930) [source] The Safety and Efficacy of Tacrolimus Ointment in Pediatric Patients with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 5 2010Alexandra D. McCollum M.D. It is a chronic disorder, characterized by intermittent flares and phases of remission. Treatment regimens often require multiple therapies. These can vary between patients, and in an individual patient, depending on the state of disease. The traditional treatment for AD flares is topical corticosteroids, which are fast acting and effective for relief of symptoms, but may cause adverse effects, including those resulting from systemic absorption, particularly in children. Topical calcineurin inhibitors (TCIs) are alternative treatments for AD. Tacrolimus ointment, a TCI, is approved for patients aged 2 years and older. Multiple studies have shown that tacrolimus is effective for short-term relief of symptoms in pediatric patients with AD. Long-term trials have demonstrated that the effectiveness of tacrolimus is maintained for up to 4 years in children. Additional studies have revealed that long-term intermittent use of tacrolimus as part of maintenance therapy can prevent AD flares. Tacrolimus has a low potential for systemic accumulation, and analysis of long-term studies indicates that it has a good safety profile. Treatment with tacrolimus, alone or in combination with topical corticosteroids for acute flares, may be a useful option for long-term management of AD in pediatric patients. [source] Immunologic Changes in TNF-alpha, sE-selectin, sP-selectin, sICAM-1, and IL-8 in Pediatric Patients Treated for Psoriasis with the Goeckerman RegimenPEDIATRIC DERMATOLOGY, Issue 6 2007Lenka Borska M.D., Ph.D. The present study investigated changes in the serum levels of proinflammatory cytokines and soluble forms of adhesion molecules in children with psoriasis. The observed patient group of 26 children was treated with the Goeckerman regimen. This therapy combines dermal application of crude coal tar with ultraviolet radiation. The Psoriasis Area Severity Index decreased significantly after treatment by with the Goeckerman regimen (p < 0.001). Serum levels of the proinflammatory cytokine TNF-alpha and adhesion molecules sICAM-1, sP-selectin and sE-selectin decreased after the Goeckerman regimen. The TNF-alpha and sICAM-1 decreased significantly (p < 0.05). Our findings support the complex role of these immune parameters in the immunopathogenesis of psoriasis in children. The serum level of IL-8 increased after the Goeckerman regimen. This fact indicates that the chemokine pathway of IL-8 activity could be modulated by this treatment, most likely by polycyclic aromatic hydrocarbons. [source] The Anatomic Relationship Between the Common Femoral Artery and Common Femoral Vein in Frog Leg Position Versus Straight Leg Position in Pediatric PatientsACADEMIC EMERGENCY MEDICINE, Issue 7 2009Jennifer W. Hopkins MD Abstract Background:, Overlap of the femoral artery (FA) on the femoral vein (FV) has been shown to occur in pediatric patients. This overlap may increase complications such as arterial puncture and failed insertions of central venous lines (CVLs). Knowledge of the anatomic relationship between the FV and FA may be important in avoiding these complications. Objectives:, The objective was to evaluate the anatomic relationship of the FA and FV in straight leg position and frog leg position. Methods:, This was a prospective, descriptive study of a convenience sample of 80 total subjects (16 subjects from each of five predetermined stratified age groups). Each subject underwent a standardized ultrasound examination in both the straight and the frog leg positions. The location of the FA in relation to the FV was measured at three locations: immediately distal, 1 cm distal, and 3 cm distal to the inguinal ligament. Overlap of the FA on the FV and the diameter of the FV was noted at each location. Measurements were repeated in both the straight leg and the frog leg positions. Results:, For the left leg, immediately distal to the inguinal ligament, the FV was overlapped by the FA in 36% of patients in straight leg position and by 45% of patients in frog leg position. At 1 cm distal to the ligament, overlap was observed in 75% of patients in straight leg position and 88% of patients in the frog leg position. At 3 cm distal to the ligament, overlap was observed in 93% of patients in straight leg position and 86% of patients in the frog leg position. The percentage of vessels with overlap was similar in the right leg at each location for both the straight and the frog leg positions. Pooled mean (±SD) FV diameters for the left leg immediately distal to the inguinal ligament were 0.64 (±0.23) cm in the straight leg position and 0.76 (±0.28) cm in the frog leg position; at 1 cm distal to the ligament, 0.66 (±0.23) and 0.78 (±0.29) cm; and at 3 cm distal to the ligament, 0.65 (±0.27) and 0.69 (±0.29) cm. FV diameters for the right leg were similar to the left. Conclusions:, A significant percentage of children have FAs that overlap their FVs. This overlap may be responsible for complications such as FA puncture with CVL placement. Ultrasound-guided techniques may decrease these risks. Placing children in the frog leg position increases the diameter of the FV visualized on ultrasound. [source] Left Ventricular Assist for Pediatric Patients With Dilated Cardiomyopathy Using the Medos Vad Cannula and a Centrifugal PumpARTIFICIAL ORGANS, Issue 11 2009Shu-Chien Huang Abstract Ventricular assist devices for small pediatric patients are expensive and commercially unavailable in Taiwan. We used the Medos ventricular assist device cannula (Medos, Aachen, Germany) and a centrifugal pump to support pediatric patients with dilated cardiomyopathy and decompensated heart failure. From January 2007 to December 2008, three pediatric patients with dilated cardiomyopathy were supported using a centrifugal pump as the left ventricular assist device. The Medos arterial cannula was sutured to the ascending aorta, and the Apex cannula was fixed into the left ventricular apex. When the patient was weaned off of cardiopulmonary bypass, the left ventricular assist device pump was started. The pump flow was gradually titrated according to the filling status of the left ventricle. All the left ventricular assist devices were successfully implanted and functioned well. Two patients on extracorporeal membrane oxygenation had severe lung edema before left ventricular assist device implantation. Both patients required extracorporeal membrane oxygenation for the postoperative period until the pulmonary edema was resolved. Among the three patients, two successfully bridged to heart transplantation after support for 6 and 11 days, respectively. The first patient (10 kg) expired due to systemic emboli 30 days after left ventricular assist device support. In summary, these results suggest that the Medos ventricular assist device cannula and a centrifugal pump is an option for temporary left ventricular assist device support in patients with intractable heart failure and as a bridge to heart transplantation. [source] The Anatomic Relationship of Femoral Vein to Femoral Artery in Euvolemic Pediatric Patients by Ultrasonography: Implications for Pediatric Femoral Central Venous AccessACADEMIC EMERGENCY MEDICINE, Issue 5 2008Fred H. Warkentine MD Abstract Background:, Knowledge of the femoral vein (FV) anatomy in pediatric patients is important in the selection of appropriate size central line catheters as well as the approach to central venous access. This knowledge may avoid potential complications during central line access. Objectives:, To describe the relationship of the FV to the femoral artery (FA). To measure FV diameter and FV depth using ultrasonography (US) in newborns, infants, and children up to 9 years of age. Methods:, This study was a prospective descriptive study at a tertiary care children's hospital. A convenience sample of euvolemic children was enrolled aged 0,9 years presenting to an urban pediatric emergency department. All patients underwent a standardized US evaluation using a Sonosite Titan bedside machine by a single emergency physician. The FA and FV were identified by four criteria: relative positions, FV compressibility, FV enlargement by Valsalva maneuver, and absence of FV pulsatility. The position of the FV relative to the FA was described as being completely overlapped by the FA, having partial (<50%) overlap by the FA, and having no overlap by the FA. The FV depth was measured from the skin to the superior border of the vein using the US machine's caliper function. Results:, A total of 84 patients were studied. The FV was found to be completely overlapped by the FA in 8% of subjects and partially overlapped by the FA in 4% of subjects. The mean FV diameter ranged from 4.5 mm in young infants to 10.8 mm in patients 9 years of age. The mean FV depth ranged from 6.5 mm in neonates to 11.2 mm in patients 9 years of age. Conclusions:, External landmarks were not always predictive of internal anatomy. The FV was completely or partially overlapped by the FA in 12% of cases. Thus, visualization of femoral vessels should be recommended prior to attempting pediatric femoral central venous access. [source] Therapeutic drug monitoring of tacrolimus in pediatric liver transplant patientsPEDIATRIC TRANSPLANTATION, Issue 2 2001Gordon D. MacFarlane Abstract: The clinical utility of tacrolimus monitoring in adults has been well documented. The present study compared tacrolimus monitoring in a pediatric population of 34 liver transplant patients in four US centers with an adult population of 111 patients in six US centers. Subjects (adult and pediatric) were evaluated, at defined intervals over 12 weeks post-transplantation (Tx), for tacrolimus trough concentrations and 12 additional laboratory chemistries. Pediatric patient and graft survival for the 12 weeks were 91% and 88%, respectively, as compared to 97% and 93%, respectively, for the adult population. The mean oral dosage of tacrolimus for pediatric patients was 0.13 ± 0.1 mg/kg/day at week 1, increased to 0.30 ± 0.3 mg/kg/day by week 3 and remained constant for the remainder of the study. These dosages were two- to three-fold higher than the dosage used in the adult population. In contrast, the mean whole-blood trough concentration, as determined by PRO-TracÔ II enzyme-linked immunosorbent assay (ELISA), decreased from 11.3 ± 5.1 ng/mL at week 1 to 6.3 ± 3.7 ng/mL by week 12 and was not significantly different from the trough concentration in adults. The incidence and distribution of the clinical end-points for the pediatric subjects (rejection, nephrotoxicity, death, re-Tx) were different from those observed in adults. The total percentage of pediatric subjects reaching any end-point was 74%, as compared to 54% in the adult population. These data indicate several differences between the adult and pediatric populations in their response to tacrolimus. [source] Pediatric atopic dermatitis: should we treat it differently?DERMATOLOGIC THERAPY, Issue 2 2006Robert Sidbury ABSTRACT:, Atopic dermatitis is an extremely common childhood skin disease that can have far-reaching impact on patients and families. Pediatric patients, particularly infants, pose special concerns for parents and providers, and equal emphasis must be placed on both nonpharmacologic and prescription interventions. Concerns for adverse effects of prescription therapies and a universal parental fear of an undetected allergy are hallmarks of pediatric atopic dermatitis care. The purpose of the present study is to highlight important educational and therapeutic strategies designed to optimally care for this patient population. [source] Evaluation of a Pediatric-sedation Service for Common Diagnostic ProceduresACADEMIC EMERGENCY MEDICINE, Issue 6 2006Wendalyn K. King MD Abstract Background: Pediatric patients often require sedation for diagnostic procedures such as magnetic resonance imaging and computed tomography scanning. In October 2002, a dedicated sedation service was started at a tertiary care pediatric facility as a joint venture between pediatric emergency medicine and pediatric critical care medicine. Before this service, sedation was provided by the department of radiology by using a standard protocol, with high-risk patients and failed sedations referred for general anesthesia. Objectives: To describe the initial experience with a dedicated pediatric-sedation service. Methods: This was a retrospective analysis of quality-assurance data collected on all sedations in the radiology department for 23-month periods before and after sedation-service implementation. Study variables were number and reasons for canceled or incomplete procedures, rates of referral for general anesthesia, rates of hypoxia, prolonged sedation, need for assisted ventilation, apnea, emesis, and paradoxical reaction to medication. Results are reported in odds ratios (OR) with 95% confidence intervals (95% CI). Results: Data from 5,444 sedations were analyzed; 2,148 before and 3,296 after sedation-service activation. Incomplete studies secondary to inadequate sedation decreased, from 2.7% before the service was created to 0.8% in the post,sedation-service period (OR, 0.29; 95% CI = 0.18 to 0.47). There also were decreases in cancellations caused by patient illness (3.8% vs. 0.6%; OR, 0.16; 95% CI = 0.10 to 0.27) and rates of hypoxia (8.8% vs. 4.6%; OR, 0.50; 95% CI = 0.40 to 0.63). There were no significant differences between the groups in rates of apnea, need for assisted ventilation, emesis, or prolonged sedation. The implementation of the sedation service also was associated with a decrease in both the number of patients referred to general anesthesia without a trial of sedation (from 2.1% to 0.1%; OR, 0.33; 95% CI = 0.06 to 1.46) and the total number of general anesthesia cases in the radiology department (from 7.5% to 4.4% of all patients requiring either sedation or anesthesia; OR, 0.56; 95% CI = 0.45 to 0.71). Conclusions: The implementation of a dedicated pediatric-sedation service resulted in fewer incomplete studies related to inadequate sedation, in fewer canceled studies secondary to patient illness, in fewer referrals for general anesthesia, and in fewer recorded instances of sedation-associated hypoxia. These findings have important implications in terms of patient safety and resource utilization. [source] Cardiocerebral Resuscitation Is Associated With Improved Survival and Neurologic Outcome from Out-of-hospital Cardiac Arrest in EldersACADEMIC EMERGENCY MEDICINE, Issue 3 2010Jarrod Mosier MD Abstract Background:, Recent studies have shown that a new emergency medical services (EMS) protocol for treating patients who suffer out-of-hospital cardiac arrest (OHCA), cardiocerebral resuscitation (CCR), significantly improves survival compared to standard advanced life support (ALS). However, due to their different physiology, it is unclear if all elders, or any subsets of elders who are OHCA victims, would benefit from the CCR protocol. Objectives:, The objectives of this analysis were to compare survival by age group for patients receiving CCR and ALS, to evaluate their neurologic outcome, and to determine what other factors affect survival in the subset of patients who do receive CCR. Methods:, An analysis was performed of 3,515 OHCAs occurring between January 2005 and September 2008 in the Save Hearts in Arizona Registry. A total of 1,024 of these patients received CCR. Pediatric patients and arrests due to drowning, respiratory, or traumatic causes were excluded. The registry included data from 62 EMS agencies, some of which instituted CCR. Outcome measures included survival to hospital discharge and cerebral performance category (CPC) scores. Logistic regression evaluated outcomes in patients who received CCR versus standard ALS across age groups, adjusted for known potential confounders, including bystander cardiopulmonary resuscitation (CPR), witnessed arrest, EMS dispatch-to-arrival time, ventricular fibrillation (Vfib), and agonal respirations on EMS arrival. Predictors of survival evaluated included age, sex, location, bystander CPR, witnessed arrest, Vfib/ventricular tachycardia (Vtach), response time, and agonal breathing, based on bivariate results. Backward stepwise selection was used to confirm predictors of survival. These predictors were then analyzed with logistic regression by age category per 10 years of age. Results:, Individuals who received CCR had better outcomes across age groups. The increase in survival for the subgroup with a witnessed Vfib was most prominent on those <40 years of age (3.7% for standard ALS patients vs. 19% for CCR patients, odds ratio [OR] = 5.94, 95% confidence interval [CI] = 1.82 to 19.26). This mortality benefit declined with age until the ,80 years age group, which regained the benefit (1.8% vs. 4.6%, OR = 2.56, 95% CI = 1.10 to 5.97). Neurologic outcomes were also better in the patients who received CCR (OR = 6.64, 95% CI = 1.31 to 32.8). Within the subgroup that received CCR, the factors most predictive of improved survival included witnessed arrest, initial rhythm of Vfib/Vtach, agonal respirations upon arrival, EMS response time, and age. Neurologic outcome was not adversely affected by age. Conclusions:, Cardiocerebral resuscitation is associated with better survival from OHCA in most age groups. The majority of patients in all age groups who survived to hospital discharge and who could be reached for follow-up had good neurologic outcome. Among patients receiving CCR for OHCA, witnessed arrest, Vfib/Vtach, agonal respirations, and early response time are significant predictors of survival, and these do not change significantly based on age. ACADEMIC EMERGENCY MEDICINE 2010; 17:269,275 © 2010 by the Society for Academic Emergency Medicine [source] Reduced-intensity allogeneic hematopoietic cell transplantation: Graft versus tumor effects with decreased toxicityPEDIATRIC TRANSPLANTATION, Issue 3 2003Jennifer E. Schwartz Abstract: The potentially curative role of allogeneic hematopoietic cell transplantation (HCT) in neoplastic and non-neoplastic diseases is offset by the substantial risks of morbidity and mortality from complications of the intensive myeloablative and immunosuppressive preparative regimen. These regimen-related toxicities have restricted allogeneic HCT to young, otherwise healthy individuals without comorbid diseases. Pediatric patients undergoing conventional allogeneic HCT have lower procedure-related mortality but are at risk for non-fatal late effects of the high-dose pretransplant chemoradiotherapy, such as growth retardation, sterility and other endocrine dysfunction. Evaluation of reduced-intensity preparative regimens is the major focus of current clinical research in allogeneic HCT. Reduced-intensity HCT (RI-HCT) relies on the use of immunosuppressive but non-myeloablative agents that allow engraftment of donor cells, which provide adoptive allogeneic cellular immunotherapy and graft versus tumor (GVT) effects, with decreased regimen-related toxicities. Although the experience with RI-HCT in pediatric patients is very limited at this time, results in adults indicate that attenuated-dose preparative regimens allow older patients and those with organ dysfunction to undergo successful allogeneic HCT with acceptable morbidity and mortality. In adults, the potency of the allogeneic GVT effect varies among neoplastic diseases, with better results observed in patients with indolent hematological malignancies or renal cell carcinoma. The effectiveness of RI-HCT as treatment for children with hemoglobinopathies, chronic granulomatous disease and cellular immunodeficiencies is encouraging, and the role of reduced-intensity preparative regimens for allogeneic HCT in pediatric malignancies is under investigation. [source] Zoledronic acid for the treatment of osteopenia in pediatric Crohn's diseasePEDIATRICS INTERNATIONAL, Issue 5 2010Anne Marie Sbrocchi Abstract Background:, Pediatric patients with Crohn's disease often have low bone mass (osteopenia) for age. No randomized, placebo-controlled trials using zoledronic acid have ever been performed in this population. The objective of this study was to assess the efficacy of zoledronic acid in children with Crohn's disease and osteopenia. Methods:, A double-blind, randomized, placebo-controlled design was used. Thirteen adolescents received either a single intravenous dose of zoledronic acid (0.066 mg/kg, max 4 mg, n= 7) or saline placebo (n= 6). The primary outcome was change in lumbar spine bone mineral density (LSBMD) z-score at 6 months. Secondary outcomes included bone markers and adverse events. Results:, At 6 months, the change in LSBMD z-score was significantly higher in the zoledronic acid group compared to placebo (0.7 vs 0.1, P < 0.001). Volumetrically adjusted LSBMD z-score also significantly increased in the treated group. This significant difference persisted until 12 months. With zoledronic acid, urinary C-telopeptide excretion decreased by 50% at 6 months and remained suppressed at 12 months (P= 0.02), but no changes were observed with placebo. Both groups had similar adverse events which included transient fever, arthralgias, and nausea (3/7 treated, 2/6 placebo, P= NS). Conclusions:, In this study, zoledronic acid demonstrated a significant increase in LSBMD at 6 and 12 months following a well-tolerated infusion. [source] Colistimethate sodium therapy for multidrug-resistant isolates in pediatric patientsPEDIATRICS INTERNATIONAL, Issue 3 2010Solmaz Celebi Abstract Aim:, The aim of the present study was to assess the efficacy and safety of colistimethate sodium therapy in multidrug-resistant nosocomial infections caused by Pseudomonas aeruginosa or Acinetobacter baumannii in neonates and children. Methods:, Pediatric patients hospitalized at the Uludag University Hospital who had nosocomial infections caused by multidrug-resistant P. aeruginosa or A. baumannii, were enrolled in the study. Colistimethate sodium at a dosage of 50,75 × 103 U/kg per day was given i.v. divided into three doses. Results:, Fifteen patients received 17 courses of colistimethate sodium for the following infections: ventilator-associated pneumonia (n= 14), catheter-related sepsis (n= 1) and skin and soft-tissue infection (n= 2). The mean age of patients was 53.2 + 74.7 months (range, 8 days,15 years) and 60% were male. Mortality was 26.6%. Conclusion:, Colistimethate sodium appears to be safe and effective for the treatment of severe infections caused by multidrug-resistant P. aeruginosa or A. baumannii in pediatric patients. [source] Central nervous system effects of natural and synthetic glucocorticoidsPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2009Pierluigi Fietta MD Natural glucocorticoids (NGC) physiologically modulate body homeostasis and coordinate adaptive responses to stress, involving almost all organs and tissues, including brain. Since their therapeutic availability, synthetic GC (SGC) have been successfully prescribed for a variety of diseases. Mounting evidence, however, demonstrated pleiotropic adverse effects (AE), including central nervous system (CNS) disturbances, which are often misdiagnosed or underestimated. The aim of the present study was therefore to review and discuss the CNS effects of both NGC and SGC. A detailed search was carried out of the available literature using the PubMed (US National Library of Medicine) database. Cortisolemia plays a crucial role in control of behavior, cognition, mood, and early life programming of stress reactivity. Hypercortisolemia or SGC treatments may induce behavioral, psychic and cognitive disturbances, due to functional and, over time, structural alterations in specific brain target areas. These AE are generally dose and time dependent (infrequent at prednisone-equivalent doses <20 mg/day) and usually reversible. Pediatric patients are particularly susceptible. Behavioral changes, including feeding and sleeping modifications, are common. Psychic AE are unpredictable and heterogeneous, usually mild/moderate, severe in 5,10% of cases. Manic symptoms have been mostly associated with short SGC courses, and depressive disorder with long-term treatments. Suicidality has been reported. Cognitive AE peculiarly affect declarative memory performance. Physiologic levels of NGC are essential for efficient brain functions. Otherwise, hypercortisolemia and SGC treatments may cause dose-/time-dependent neuropsychic AE and, over time, structural alterations in brain target areas. Clinicians should carefully monitor patients, especially children and/or when administering high doses SGC. [source] Living-Donor Liver Transplantation for HepatoblastomaAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2005Mureo Kasahara Hepatoblastoma is the most common malignant liver tumor in children. Recently, liver transplantation has been indicated for unresectable hepatoblastoma. We retrospectively reviewed 14 children with a diagnosis of hepatoblastoma who had undergone living-donor liver transplantation (LDLT) at Kyoto University Hospital. During the period from June 1990 to December 2004, 607 children underwent LDLT. Of these interventions, 2.3% were performed for hepatoblastoma. Based on radiological findings, the pre-treatment extent of disease (PRETEXT) grouping was used for pre-treatment staging of the tumor. There were grade III in seven patients and grade IV in seven patients. Thirteen patients received chemotherapy, and seven underwent hepatectomy 11 times. Immunosuppressive treatment consisted of tacrolimus monotherapy in 11 patients. Actuarial 1- and 5-year graft and patient survival rates were 78.6% and 65.5%. The poor prognostic factors were macroscopic venous invasion and extrahepatic involvement with 1-year and 5-year survival rates of 33.0% and 0%. Pediatric patients without these factors showed an acceptable 5-year survival rate of 90.9%. LDLT provides a valuable alternative with excellent results in children with hepatoblastoma because it allows optimal timing of the liver transplantation, given the absence of delay between the completion of chemotherapy and planned liver transplantation. [source] Intensive chemotherapy improves survival in pediatric high-grade glioma after gross total resection: results of the HIT-GBM-C protocol,CANCER, Issue 3 2010Johannes E.A. Wolff MD Abstract BACKGROUND: The authors hypothesized that intensified chemotherapy in protocol HIT-GBM-C would increase survival of pediatric patients with high-grade glioma (HGG) and diffuse intrinsic pontine glioma (DIPG). METHODS: Pediatric patients with newly diagnosed HGG and DIPG were treated with standard fractionated radiation and simultaneous chemotherapy (cisplatin 20 mg/m2 × 5 days, etoposide 100 mg/m2 × 3 days, and vincristine, and 1 cycle of cisplatin + etoposide + ifosfamide 1.5 g/m × 5 days [PEI] during the last week of radiation). Subsequent maintenance chemotherapy included further cycles of PEI in Weeks 10, 14, 18, 22, 26, and 30, followed by oral valproic acid. RESULTS: Ninety-seven (pons, 37; nonpons, 60) patients (median age, 10 years; grade IV histology, 35) were treated. Resection was complete in 21 patients, partial in 29, biopsy only in 26, and not performed in 21. Overall survival rates were 91% (standard error of the mean [SE] ± 3%), 56%, and 19% at 6, 12, and 60 months after diagnosis, respectively. When compared with previous protocols, there was no significant benefit for patients with residual tumor, but the 5-year overall survival rate for patients with complete resection treated on HIT-GBM-C was 63% ± 12% SE, compared with 17% ± 10% SE for the historical control group (P = .003, log-rank test). CONCLUSIONS: HIT-GBM-C chemotherapy after complete tumor resection was superior to previous protocols. Cancer 2010. © 2009 American Cancer Society. [source] Use of a balloon-expandable vascular metal stent for palliation of obstructive jaundice in a post-surgical pediatric patientDIGESTIVE ENDOSCOPY, Issue 3 2010Gabriele Curcio No abstract is available for this article. [source] Inflammatory myopathy and hepatitis C in a pediatric patient: Role of liver biopsy in evaluating the severity of liver diseaseHEPATOLOGY, Issue 4 2001Parvathi Mohan M.D. No abstract is available for this article. [source] Extensive venous thrombosis in a pediatric patient with Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 6 2009John F. Pohl MD No abstract is available for this article. [source] Regional caudal blockade in a pediatric patient affected by the Joubert syndromeACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009D. Galante No abstract is available for this article. [source] | |||||||||||||||||||||||||||||||||||||