Conservative Management of Transitional Ankle Fractures in Adolescents: A Pilot Study to Determine Whether Type of Immobilization Affects Outcome.

Intra-articular Tillaux and triplane ankle fractures are treated surgically when displaced. Minimally displaced fractures are treated with immobilization alone. Long leg casts (LLCs) are the most traditional method of immobilization because they can prevent weight bearing by flexing the knee and control ankle rotation.

Alendronate Improves Bone Mineral Density in Children and Adolescents Perinatally Infected With Human Immunodeficiency Virus With Low Bone Mineral Density for Age.

Background: Children and adolescents with perinatal human immunodeficiency virus (HIV) infection and with low bone mineral density (BMD) may be at higher risk of osteoporosis and fractures in later life than their uninfected peers. Bisphosphonate therapy has been shown to reduce fractures in adults with osteoporosis, but has not been formally studied in youths living with HIV.

Methods: Fifty-two children and adolescents (aged 11-24 years) perinatally infected with HIV with low lumbar spine (LS) BMD (Z score < -1.

Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings.

Background: Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia.

Methods: Between January 2012 and September 2013, we consecutively enrolled children aged 2-59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru.

Neuroimaging Findings in Pediatric Genetic Skeletal Disorders: A Review.

Genetic skeletal disorders (GSDs) are a heterogeneous group characterized by an intrinsic abnormality in growth and (re-)modeling of cartilage and bone. A large subgroup of GSDs has additional involvement of other structures/organs beside the skeleton, such as the central nervous system (CNS). CNS abnormalities have an important role in long-term prognosis of children with GSDs and should consequently not be missed.

Extensively drug-resistant tuberculosis in a young child after travel to India.

Extensively drug-resistant (XDR) tuberculosis is becoming increasingly prevalent worldwide, but little is known about XDR tuberculosis in young children. In this Grand Round we describe a 2-year-old child from the USA who developed pneumonia after a 3 month visit to India. Symptoms resolved with empirical first-line tuberculosis treatment; however, a XDR strain of Mycobacterium tuberculosis grew in culture.

Diagnosis of rare association of orthotopic multicystic dysplasia with crossed fused renal ectopia.

Orthotopic multicystic dysplastic kidney with crossed fused ectopia is a rare congenital anomaly. This congenital anomaly may give an appearance of a solitary kidney morphology during the initial imaging evaluation. A solitary kidney should be carefully evaluated for the presence of duplication, horseshoe configuration, or crossed renal ectopy.

Clinicoradiological correlation of scoliosis in children with Jarcho-Levin and Escobar syndromes: associated "flat bone or wing-like" imaging findings.

Unlabelled: Congenital or early onset scoliosis may be the lead clinical feature in several rare syndromes. In this paper, we present the imaging findings in two children with early onset scoliosis related to the Jarcho-Levin and Escobar syndromes and an osseous plate or wing-like bar extending along the posterior elements of the spine on computed tomography. The clinical phenotypes in these syndromes are variable.

Neonatal head ultrasonography today: a powerful imaging tool!

Head ultrasonography (HUS) remains an important tool in the initial evaluation of intracranial abnormalities in infants. In experienced hands, HUS is an outstanding tool to detect brain abnormalities in preterm and full-term infants, to follow the progression of these lesions, and to describe the maturation of the infant brain. We believe it is a safe and cost-efficient alternative to magnetic resonance imaging and computerized tomography in many cases.

Mucus removal is impaired in children with cystic fibrosis who have been infected by Pseudomonas aeruginosa.

Objective: To determine if mucus removal is impaired in children with cystic fibrosis (CF) who have been recently infected with Pseudomonas aeruginosa.

Study Design: We compared mucociliary clearance (MCC), cough clearance (CC), lung morphology, and forced expiratory volume in 1 second (FEV1) in 7- to 14-year-old children with CF and mild lung disease (FEV1 ≥ 80%). Children were either P.

Evaluation of the ischemic penumbra focusing on the venous drainage: the role of susceptibility weighted imaging (SWI) in pediatric ischemic cerebral stroke.

Background And Purpose: Susceptibility weighted imaging (SWI) allows the study of the intracranial venous vasculature based on the paramagnetic susceptibility effects of deoxygenated blood. Prominent hypointense draining veins have been revealed in ischemic brain tissue by SWI. The goal of our study was to evaluate whether a match or mismatch between territorial changes in the venous drainage of ischemic brain tissue, as identified by SWI and diffusion restriction, can show a 'venous ischemic penumbra'.

Acute ataxia in children: approach to clinical presentation and role of additional investigations.

Acute ataxia is a fairly common emergency that confronts the pediatric neurologist in daily life. The differential diagnosis of acute pediatric ataxia is wide, but informed history and careful clinical examination can narrow it and help target investigations. This review discusses various etiologies of acute pediatric ataxia, focusing on clinical presentation, diagnostic considerations, and approach to investigation.

Macrocerebellum: significance and pathogenic considerations.

Macrocerebellum is a rare finding characterized by an abnormally large cerebellum. Only few patients with a syndromal or isolated macrocerebellum have been reported so far. This article aims to categorize the magnetic resonance imaging (MRI) findings, quantitate the macrocerebellum by volumetric analysis, characterize the neurological and dysmorphic features and cognitive outcome, and report the results of genetic analyses in children with macrocerebellum.

Neuro-orthopedic manifestations of the omphalocele exstrophy imperforate anus spinal defects complex.

Purpose: The omphalocele-exstrophy-imperforate anus-spinal defects complex is a severe multisystem congenital defect. To comprehensively care for these patients one must appreciate the neurological and orthopedic impact on the overall health of the child.

Materials And Methods: We retrospectively reviewed the medical records of 73 children with omphalocele-exstrophy-imperforate anus-spinal defects who were treated at our institution, identifying neurological and orthopedic anomalies, ambulatory ability and voiding status.

History and current status of newborn screening for hemoglobinopathies.

The impact of hemoglobinopathies on healthcare in the United States, particularly sickle cell disease (SCD), has been significant. Enactment of the Sickle Cell Anemia Control Act in 1972 significantly increased the federal interest in the SCDs and other hemoglobinopathies. Only since May 1, 2006, have all states required and provided universal newborn screening for SCD despite a national recommendation to this effect in 1987.

Hormonal contraception, sickle cell trait, and risk for venous thromboembolism among African American women.

Objective: We evaluated the effect of oral and other hormonal contraceptive (HC) use on venous thromboembolism risk among African American women and investigated whether the association was modified by the sickle cell trait.

Study Design: We report the findings of a case-control study that included 60 African American women with an idiopathic, first episode of venous thromboembolism and 196 African American controls.

Results: The odds of current HC use compared with noncurrent use contrasting cases and controls is 3.

Spontaneous resolution of diffuse persistent pulmonary interstitial emphysema.

Persistent pulmonary interstitial emphysema (PPIE) is a rare condition that occurs in both preterm and term infants. It is thought to arise from a disruption of the basement membrane of the alveolar wall allowing air entry into the interstitial space. The characteristic CT scan appearance of PPIE can be used to differentiate it from other congenital cystic lesions that may present similarly.

Sickle cell trait and the risk of venous thromboembolism among blacks.

People with sickle cell disease have a chronically activated coagulation system and display hemostatic perturbations, but it is unknown whether they experience an increased risk of venous thromboembolism. We conducted a case-control study of venous thromboembolism that included 515 hospitalized black patients and 555 black controls obtained from medical clinics. All subjects were assayed for hemoglobin S and hemoglobin C genotypes.

Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs.

Background: A World Health Organization (WHO) working group in 2001 developed a method for standardizing interpretation of chest radiographs in children for epidemiologic purposes. We reevaluated radiographs from the Kaiser Permanente Pneumococcal Efficacy trial using this method.

Methods: Seven-valent pneumococcal conjugate vaccine was evaluated in a randomized, controlled study including 37,868 infants.

Elevated factor VII as a risk factor for recurrent fetal loss. Relationship to factor VII gene polymorphisms.

Haemostatic abnormalities can be detected in a portion of the women who have recurrent fetal loss. We measured factor VII coagulant activity (FVII:C) in 65 women with 3 or more fetal losses (recurrent cases), 31 women with one 2nd or 3rd trimester loss (late loss cases), and 81 women with only live births (controls). FVII:C was greater than 2 standard deviations above the mean for controls in 9 recurrent cases (13.

Intracranial neonatal neurosonography: an update.

This article reviews salient features of a normal neonatal cranial ultrasound examination with suggestions concerning techniques that take advantage of new developments in ultrasound technology. It also illustrates pathologic findings in such areas as congenital abnormalities, intracranial hemorrhage, and infection. Recent publications on the subject of neurodevelopmental outcome are explored, pointing out how varying descriptions of intraventricular hemorrhages affect their results.

Radiographic evaluation for suspected cerebrospinal fluid shunt obstruction.

Objective: To measure the predictive value of plain radiographs (shunt series) and computed tomography (CT) scans in a group of children undergoing evaluation for suspected shunt obstruction in a tertiary care pediatric emergency department (ED).

Methods: Radiology reports were reviewed for all ED patients who underwent a shunt series over an 18-month period. Two investigators categorized all reports as normal, possibly abnormal (eg, kink in shunt tubing, no prior CT scan for comparison), or abnormal (with definite evidence of shunt dysfunction, such as shunt tubing disconnection and increase in ventricular size since prior CT scan).