Negative payoffs of upper gastrointestinal endoscopy in patients admitted under observation status.

Background: More than 70 million Americans (23% of the USA population) have non-cardiac chest pain at least once in their lifetime with gastroesophageal reflux disease being the leading cause (37-66%). Current guidelines support the use of a proton pump inhibitor (PPI) prior to invasive or noninvasive testing as a diagnostic, therapeutic and cost-effective method as a part of High Value Care recommendations.

Methods: We performed a chart review of 126 patients admitted to the hospital under observation status who underwent upper gastrointestinal endoscopies in the hospital at 3 different urban community hospitals.

Metastatic Cutaneous Melanoma of the Gallbladder.

Metastatic melanoma is an aggressive disease that can spread to many organs of the body. In rare cases, it can spread to the gallbladder causing secondary lesions, yet presenting with little to no symptoms. Therefore, most cases of metastatic melanoma lesions to the gallbladder go undiagnosed.

Neurodevelopmental Outcomes after Pediatric Cardiac ECMO Support.

Purpose: To characterize the neurodevelopmental outcomes and identify factors associated with poor outcomes in pediatric patients undergoing cardiac extracorporeal membrane oxygenation (ECMO).

Methods: Five year retrospective review, including demographics, cardiac lesion, and surgical complexity, reason for ECMO, ECMO complications, and neurodevelopmental status at discharge and latest follow-up. Neurodevelopmental status was determined through the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales.

Exudative retinopathy and detachment: a late reactivation of retinopathy of prematurity after intravitreal bevacizumab.

A 25-week postmenstrual age premature infant was treated with bilateral intravitreal bevacizumab for retinopathy of prematurity at 35 weeks' PMA. Postinjection, the retinal vessels progressed anteriorly within the retina. The patient presented 1 year after injection with bilateral exudative retinal detachments.

Reactivation of retinopathy of prematurity after bevacizumab injection.

Objective: To report late reactivation and progression of retinopathy of prematurity (ROP) after intravitreal bevacizumab monotherapy.

Methods: Retrospective review of 9 patients (17 eyes) with recurrence of ROP after initial treatment with intravitreal bevacizumab monotherapy. Data collected included (1) location and stage of ROP activity, (2) number and timing of treatments, and (3) structural outcomes.

Small cell carcinoma: an unusual location in a young healthy female.

Small cell carcinoma (SCC) is most commonly found in the lung but is occasionally found in the gastrointestinal tract and other extrapulmonary sites. Incidences of SCC in the esophagus and stomach are rare and have been reported almost exclusively in older individuals. The following case presents the discovery of small cell carcinoma of the stomach and esophagus in a 35 year old woman, which is the youngest reported incidence of this to date.

Topical ophthalmic moxifloxacin elicits minimal or no selection of fluoroquinolone resistance among bacteria isolated from the skin, nose, and throat.

Purpose: To investigate whether moxifloxacin therapy of bacterial conjunctivitis in children changes the moxifloxacin susceptibility of bacterial isolates in eyes, cheeks below eyes, nares, and throat.

Methods: Patients (age: 1 to 12 years, n = 105) with bacterial conjunctivitis were treated topically with moxifloxacin three times a day for 7 days. Gender- and age-matched subjects with normal eyes (age: 1 to 12 years, n = 57) served as the control group.

Perioperative use of dexmedetomidine is associated with decreased incidence of ventricular and supraventricular tachyarrhythmias after congenital cardiac operations.

Background: Postoperative tachyarrhythmias remain a common complication after congenital cardiac operations. Dexmedetomidine (DEX), an α-2 adrenoreceptor agonist, can have a therapeutic role in supraventricular tachyarrhythmias for cardioversion to sinus rhythm or heart rate control. Whether routine perioperative use of DEX decreases the incidence of supraventricular and ventricular tachyarrhythmias was studied.

Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease.

Objective: Assessment of electrocardiographic (ECG) effects of dexmedetomidine.

Design: Prospective observational study including children 0-17 years of age with congenital heart disease (CHD) and children following cardiothoracic surgery. Patients who did not receive dexmedetomidine were used as a control group.

Kinetics of kill of bacterial conjunctivitis isolates with moxifloxacin, a fluoroquinolone, compared with the aminoglycosides tobramycin and gentamicin.

Purpose: To compare the kinetics and speed of kill of Streptococcus pneumoniae and Haemophilus influenzae on exposure to three topical ophthalmic antibiotic solutions.

Materials And Methods: Bacterial conjunctivitis isolates of S. pneumoniae and H.

Effect of dexmedetomidine on pulmonary artery pressure after congenital cardiac surgery: A pilot study.

Objective: To characterize the effects of dexmedetomidine on the pulmonary artery pressure in patients after congenital cardiac surgery.

Design: Prospective observational pilot study.

Setting: Pediatric cardiac intensive care unit at a university hospital.

Magnesium supplementation during cardiopulmonary bypass to prevent junctional ectopic tachycardia after pediatric cardiac surgery: a randomized controlled study.

Objectives: We analyzed the role of magnesium sulfate (MgSO(4)) supplementation during cardiopulmonary bypass in pediatric patients undergoing cardiac surgery, assessing the incidence of hypomagnesemia and the incidence of junctional ectopic tachycardia.

Methods: We performed a randomized, double-blind, controlled trial in 99 children. MgSO(4) or placebo was administered during the rewarming phase of cardiopulmonary bypass: group 1, placebo group (29 patients); group 2, 25 mg/kg of MgSO(4) (30 patients); and group 3, 50 mg/kg of MgSO(4) (40 patients).

The association of renal dysfunction and the use of aprotinin in patients undergoing congenital cardiac surgery requiring cardiopulmonary bypass.

Background: The use of large-dose aprotinin during cardiopulmonary bypass (CPB) in adult patients has been linked to postoperative renal dysfunction, but its effect on the pediatric population undergoing complex congenital cardiac operations is not well defined.

Methods: We used a retrospective cohort analysis to evaluate children undergoing cardiac surgery requiring CPB between July 2004 and July 2006. Demographic data and surgical risk quantified by the Aristotle surgical complexity level were analyzed as covariates.

Perception and quality of life associated with the use of olopatadine 0.2% (Pataday) in patients with active allergic conjunctivitis.

This 28-d, open-label, multicenter, single-arm clinical study was designed to evaluate perceptions of olopatadine 0.2% in patients with active ocular allergic signs and symptoms. The study enrolled 330 patients, 5 to 94 y of age, who had previously used olopatadine 0.

An assessment of the tolerability of moxifloxacin 0.5% compared to azithromycin 1.0% in DuraSite.

This subject-masked, randomized, active and placebo-controlled study compared subjects' perceptions of two antibiotic ophthalmic drops. One hundred and twenty-five healthy volunteers received two of the following solutions: moxifloxacin 0.5% ophthalmic solution (Vigamox((R)), Alcon Laboratories, Inc.

Speed of bacterial kill with a fluoroquinolone compared with nonfluoroquinolones: clinical implications and a review of kinetics of kill studies.

It is important to rapidly eradicate bacteria in patients with bacterial conjunctivitis in order to decrease disease transmission, shorten symptom duration, and minimize the emergence of resistant bacteria. This paper presents the results of kinetics of kill studies on 3 commonly isolated pathogens in bacterial conjunctivitis. A more rapid speed of kill with moxifloxacin compared with other nonfluoroquinolone antibiotics (tobramycin, gentamicin, polymyxin B/trimethoprim, or azithromycin) was observed in Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae infections.

Safety and tolerability of olopatadine 0.2% in children and adolescents.

Objective: The aim of this study was to evaluate the safety of olopatadine hydrochloride ophthalmic solution 0.2% in children and adolescents 3-17 years of age.

Methods: In this 6-week, randomized, double-masked safety evaluation, eligible subjects with asymptomatic eyes underwent in-office visits at weeks 1, 3, and 6 and were contacted by telephone at weeks 2, 4, and 5.

Pharmacology, clinical efficacy and safety of olopatadine hydrochloride.

Olopatadine is a multimechanism anti-allergic agent that inhibits H(1) receptor activation and stabilizes mast cell membranes, blocking the release of allergic and inflammatory mediators. Studies in human conjunctival mast cells clearly demonstrate, in the relevant tissue and species, olopatadine's inhibition of histamine release, which was subsequently confirmed in allergen-challenged subjects. Its comfort and tolerability may be related to the absence of perturbation of cell membranes, in contrast to many anti-allergics, whose disruption of membranes lead to histamine release even at therapeutically relevant concentrations.