Computed tomography associated radiation exposure in children with craniosynostosis.

Background: The role of computed tomography (CT) for diagnosis and surgical planning for craniosynostosis (CS) is well-established. The aim of this study was to quantify the cumulative medical radiation exposure from CT in patients with CS at a tertiary care children's hospital.

Methods: Medical records of patients who presented at < 2 years of age and underwent surgical intervention for CS were examined for demographic information.

Implementation of a brain injury screen MRI for infants at risk for abusive head trauma.

Background: Head computed tomography (CT) is the current standard of care for evaluating infants at high risk of abusive head trauma.

Objective: To both assess the feasibility of using a previously developed magnetic resonance imaging (MRI) brain injury screen (MRBRscreen) in the acute care setting in place of head CT to identify intracranial hemorrhage in high-risk infants and to compare the accuracy of a rapid imaging pulse sequence (single-shot T2 fast spin echo [ssT2FSE]) to a conventional pulse sequence (conventional T2 fast spin echo [conT2FSE]).

Materials And Methods: This was a quality improvement initiative to evaluate infants <12 months of age who were screened for intracranial hemorrhage using an MRBRscreen as part of clinical care.

Development and Modification of an Outcome Measure to Follow Symptoms of Children with Sinusitis.

Objective: To develop a parent-reported Pediatric Rhinosinusitis Symptom Scale (PRSS) that could be used to monitor symptoms of young children with acute sinusitis in response to therapy.

Study Design: We developed an 8-item symptom severity scale and evaluated its internal reliability, construct validity, and responsiveness in children 2-12 years of age with acute sinusitis. Parents of 258 children with acute sinusitis completed the PRSS at the time of diagnosis, as a diary at home, and at the follow-up visit at days 10-12.

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma.

Background: Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head.

Development of a screening MRI for infants at risk for abusive head trauma.

Background: Abusive head trauma (AHT) is an important cause of morbidity in infants. Identifying which well-appearing infants are at risk for AHT and need neuroimaging is challenging, and concern about radiation exposure limits the use of head CT. Availability of an MRI protocol that is highly sensitive for intracranial hemorrhage would allow for AHT screening of well-appearing infants without exposing them to radiation.

Multiplanar reconstructed CT images increased depiction of intracranial hemorrhages in pediatric head trauma.

Introduction: The benefits of multiplanar reconstructed images (MPR) of unenhanced axial head computed tomography (CT) data have not been established in trauma patients younger than 3 years old, a population in which a reliable history and physical examination may be most difficult. We retrospectively evaluated unenhanced head CTs in pediatric trauma patients to investigate the various benefits of MPR in this age group.

Methods: A total of 221 unenhanced head CTs performed for any case of head trauma (HT) on children younger than 3 years old were independently reviewed by two radiologists.

Predicting response to antimicrobial therapy in children with acute sinusitis.

Objective: To determine prognostic factors that independently predict response to antimicrobial therapy in children with acute sinusitis.

Study Design: A total of 206 children meeting a priori clinical criteria for acute sinusitis who were prescribed antimicrobial therapy by their primary care provider were included. The severity of symptoms in the 8-12 days after treatment was initiated was followed with the use of a validated scale.

Are nasopharyngeal cultures useful in diagnosis of acute bacterial sinusitis in children?

The diagnosis of acute bacterial sinusitis can be challenging because symptoms of acute sinusitis and an upper respiratory tract infection (URI) overlap. A rapid test, if accurate in differentiating sinusitis from URI, could be helpful in the diagnostic process. We examined the utility of nasopharyngeal cultures in identifying the subgroup of children with a clinical diagnosis of acute sinusitis who are least likely to benefit from antimicrobial therapy (those with completely normal sinus radiographs).

Signs and symptoms that differentiate acute sinusitis from viral upper respiratory tract infection.

Objective: Differentiating acute bacterial sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with acute sinusitis based on clinical criteria likely have an uncomplicated URI. The objective of this study was to determine which signs and symptoms could be used to identify the subgroup of children who meet current clinical criteria for sinusitis but who nevertheless have a viral URI.

Methods: We obtained sinus radiographs in consecutive children meeting a priori clinical criteria for acute sinusitis.

Reading performance correlates with white-matter properties in preterm and term children.

Aim: We used diffusion tensor imaging to investigate the association between white-matter integrity and reading ability in a cohort of 28 children. Nineteen preterm children (14 males, five females; mean age 11 y 11 mo [SD 1 y 10 mo], mean gestational age 30.5 wks (SD 3.

A phase I trial of temozolomide and lomustine in newly diagnosed high-grade gliomas of childhood.

A phase I trial was conducted to determine the maximum tolerated dose (MTD) of temozolomide given in combination with lomustine in newly diagnosed pediatric patients with high-grade gliomas. Response was assessed following two courses of therapy at the MTD. Temozolomide was administered to cohorts of patients at doses of 100, 125, 160, or 200 mg/m(2) on days 1-5, along with 90 mg/m(2) lomustine on day 1.

Oropharyngeal fetus in fetu.

Fetus in fetu is an extremely rare entity and refers to the growth of a "parasitic" twin within a more mature fetus due to its inclusion within cells of the blastocyst. The presence of a vertebral column is considered essential for the diagnosis of a fetus in fetu. The retroperitoneum is the most common location for a fetus in fetu and its location in the mouth is rare.