Diagnostic Utility of Three-Dimensional Rotational Angiography in Congenital Cardiac Catheterization.

We evaluated the diagnostic utility of the three modalities of three-dimensional rotational angiography (3DRA): rotational angiography (RA), multiplanar reformat (MPR) and three-dimensional angiographic reconstruction (3D-R) in pediatric cardiac catheterization. The 3DRA studies were classified by anatomy of interest based on our injection protocol: pulmonary arteries (PA), aorta, cavopulmonary connection (CPC), and others. Retrospective review of 3DRA images by two reviewers for each modality was conducted with grading as inferior, similar, or superior in comparison with the diagnostic quality of fixed-plane angiography (FPA).

Multiple-Breath Washout as a Lung Function Test in Cystic Fibrosis. A Cystic Fibrosis Foundation Workshop Report.

The lung clearance index (LCI) is a lung function parameter derived from the multiple-breath washout (MBW) test. Although first developed 60 years ago, the technique was not widely used for many years. Recent technological advances in equipment design have produced gains in popularity for this test among cystic fibrosis (CF) researchers and clinicians, particularly for testing preschool-aged children.

Extra-corporeal membrane oxygenation in a patient with Fusobacterium sepsis: a case report and review of literature.

An adolescent female was admitted to the pediatric intensive care unit in septic shock. She developed multisystem organ dysfunction including pancreatitis with myocardial dysfunction and hemodynamic instability unresponsive to medical management necessitating veno-arterial extracorporeal support. Streptococcus Constellata and Fusobacterium necrophorum were isolated from blood cultures.

Effects of airway pressure release ventilation on blood pressure and urine output in children.

Objective: Increased intrathoracic pressures during airway pressure release ventilation (APRV) may compromise systemic venous return resulting in decreased cardiac output and renal perfusion. We sought to study the short-term effect of APRV on blood pressure (BP) and urine output (UO) in children with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

Design: Retrospective cohort study.

Robotic fundoplication in children: resident teaching and a single institutional review of our first 50 patients.

Background: Robotic surgery is a new technology that may eventually replace laparoscopy in treating many surgical issues in children. Resident education using robotic surgery has been a concern for many institutions. We present our first 50 consecutive robotic fundoplications in children and our teaching experience with this procedure.

Robotic repair of a Bochdalek congenital diaphragmatic hernia in a small neonate: robotic advantages and limitations.

Minimally invasive repair for a Bochdalek congenital diaphragmatic hernia has been performed over the last few years with mixed results. Although the anomaly has been approached from both the abdomen and the chest, the defect can be difficult to close as the posterolateral region may be difficult to reach with precise suturing using standard rigid laparoscopic instruments. The articulating instruments of robotic surgery offer a substantial improvement in degrees of freedom and may help over come these obstacles.

Infant feeding attitudes and knowledge among socioeconomically disadvantaged women in Glasgow.

Objectives: This study: (1) investigated infant feeding attitudes and knowledge among socioeconomically disadvantaged mothers in an urban community with historically low breastfeeding rates, (2) examined the influence of women's social networks on infant feeding attitudes and decisions, and (3) validated a measure of infant feeding attitudes and knowledge in this population (Iowa Infant Feeding Attitude Scale, IIFAS).

Methods: Women attending a prenatal clinic (n=49) reported on: (1) demographics, (2) infant feeding attitudes and knowledge (IIFAS), (3) feeding intent, (4) opinions about breastfeeding in public, and (5) social networks. Feeding method at discharge was abstracted from hospital charts.

Robotic repair of congenital duodenal atresia: a case report.

Although repair of duodenal atresia has been performed laparoscopically, it can be a difficult procedure using rigid handheld laparoscopic instruments. Only a few pediatric surgeons are performing this operation with a minimally invasive approach. Robotic surgery may help overcome the obstacles presented by the use of traditional rigid laparoscopic instruments.

Pediatric robotic surgery: A single-institutional review of the first 100 consecutive cases.

Background: Robotic surgery is a new technology which may expand the variety of operations a surgeon can perform with minimally invasive techniques. We present a retrospective review of our first 100 consecutive robotic cases in children.

Methods: A three-arm robot was used with one camera arm and two instrument arms.

Transcatheter cryoablation with 3-D mapping of an atrial ectopic tachycardia in a pediatric patient with tachycardia induced heart failure.

Atrial ectopic tachycardias (AET) are often resistant to medical management and can lead to a significant reduction in cardiac function. Transcatheter cryoablation, a definitive therapy, to our knowledge has yet to be described in the pediatric population. A three-year-old male presented with AET induced heart failure which persisted despite medical management.

Presence of plasticizer di-2(ethylhexyl)phthalate in primed extracorporeal circulation circuits.

Many centers advocate the use of a standby wet-primed extracorporeal membrane oxygenation (ECMO) circuit for rapid deployment during cardiopulmonary resuscitation. However, concerns with regard to the potential health hazards associated with the release of the plasticizer di-2(ethylhexyl)phthalate (DEHP) from the polyvinyl chloride (PVC) tubing exist. The purpose of this study was to determine the time course of DEHP release from a preprimed ECMO circuit and to evaluate the effect of PVC tubing coatings on DEHP release.

Prenatal office practices regarding infant feeding choices.

The objective of this study was to determine the obstetric care providers' roles in breast-feeding promotion during prenatal care. A questionnaire addressing breast-feeding issues was sent to family practitioners (FP), obstetric-gynecologists (OB/GYN), and nurse midwives (NM) in Iowa, USA. All NM, 97% of FP, and 85% of OB/GYN reported asking infant feeding preference-usually only at the first prenatal visit.

Evolution of thiopurine use in pediatric inflammatory bowel disease in an academic center.

Objectives: We evaluated how our use of thiopurines was altered by determination of thiopurine methyltransferase (TPMT) level and drug dose adjustment guided by a 6-mercaptopurine metabolite assay. We further examined whether these resulted in better selection of the drug dose, improved control of disease, and decreased corticosteroid use in pediatric inflammatory bowel disease (IBD).

Patients And Methods: This is a retrospective review of 101 pediatric patients with IBD receiving a stable dose of azathioprine (AZA) for 4 months or longer.

Varicella zoster virus: out of Africa and into the research laboratory.

This review updates on numerous topics relating to the evolutionary origins of varicella zoster virus (VZV), the replication cycle, virion assembly and the recent genomic analyses. VZV is one of eight human herpesviruses that have existed for at least 400 million years. It has co-evolved with humankind and is present in all nationalities globally.

Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart.

Background: Junctional ectopic tachycardia in the normal heart is rare and often is resistant to pharmacologic management. Transcatheter ablation using radiofrequency energy places the AV node at risk.

Objectives: The purpose of this study was to report our experience with transcatheter cryothermal ablation using three-dimensional mapping in six patients with junctional ectopic tachycardia.

Repeat surfactant therapy for postsurfactant slump.

Objective: To evaluate repeat surfactant therapy for the treatment of respiratory failure associated with postsurfactant slump in extremely low birth weight infants (ELBW) by characterizing the population of premature infants who develop postsurfactant slump and measuring their response to a secondary course of surfactant therapy.

Study Design: A retrospective analysis of a cohort of all patients admitted over a 3-year period with birth weights <1000 g (ELBW infants). Information was collected by chart review and the patients were categorized into three distinct groups for analysis.

Shrinking lung syndrome in a 14-year-old boy with systemic lupus erythematosus.

Pulmonary complications occur frequently in people with systemic lupus erythematosus. We report on an adolescent with an acute onset of dyspnea and pleuritic chest pain with severe restrictive lung physiology on pulmonary function testing (forced vital capacity, 20% of predicted) who had no evidence of parenchymal lung or pleural disease. He was found to have restricted diaphragmatic movement as assessed by fluoroscopy, without evidence of generalized respiratory muscle weakness.

Securing a faculty position: a practical guide for residents, fellows, junior faculty, and their mentors.

Applying for a faculty position can appear to be a daunting project for many residents, fellows, and junior faculty due, in large part, to the lack of readily available information on the process of interviewing and negotiating for faculty appointment in academic medicine. Although this process may seem mystifying to first-time applicants, it has a structure. This article discusses the framework of the application process and recommends an action plan from initial contact to acceptance of an offer.

Erythropoietin in sports: a new look at an old problem.

Erythropoietin (EPO) is found naturally in the human body and has been commercially available as recombinant human EPO (rEPO) for almost 20 years. Although the positive benefits of rEPO cannot be denied for those who suffer from anemia, athletes have also used the drug as an ergogenic aid. It has replaced conventional "blood doping" as the drug of choice to improve performance in contests requiring aerobic potential.

Attenuated pediatric electrode pads for automated external defibrillator use in children.

Objective: This post-market, observational study is intended to evaluate reported uses of pediatric pads that reduce the energy delivered by some adult automated external defibrillators (AEDs) so that they may be used with pediatric patients.

Methods: Users of the pediatric pads were asked to report any use of the pads, even if no shock was delivered and to provide detailed information about the event, caregiver and the patient.

Results: Reports of the use of pediatric pads have been received and confirmed for 27 patients, age range 0 days to 23 years, median 2 years.

Newborn lamb coronary artery reactivity is programmed by early gestation dexamethasone before the onset of systemic hypertension.

Exposure of the early gestation ovine fetus to exogenous glucocorticoids induces organ-specific alterations in postnatal cardiovascular physiology. To determine whether early gestation corticosteroid exposure alters coronary reactivity before the development of systemic hypertension, dexamethasone (0.28 mg x kg(-1) x day(-1)) was administered to pregnant ewes by intravenous infusion over 48 h beginning at 27 days gestation (term, 145 days).