Pediatric optic neuritis.

Purpose Of Review: Pediatric optic neuritis may be challenging to diagnose and treat. Significant clinical investigation of optic neuritis occurring in adults guides current clinical practices. Differences in presentation and prognosis exist for pediatric patients with optic neuritis when compared with adults including the risk of developing multiple sclerosis.

Resource Utilization in Adolescent Idiopathic Scoliosis Surgery: Is There Opportunity for Standardization?

Introduction: Recent healthcare reforms have raised the importance of cost and value in the management of disease. Value is a function of benefit and cost. Understanding variability in resources utilized by individual surgeons to achieve similar outcomes may provide an opportunity for cutting costs though greater standardization.

Body image in patients with adolescent idiopathic scoliosis: validation of the Body Image Disturbance Questionnaire--Scoliosis Version.

Background: Appearance concerns in individuals with adolescent idiopathic scoliosis can result in impairment in daily functioning, or body image disturbance. The Body Image Disturbance Questionnaire (BIDQ) is a self-reported, seven-question instrument that measures body image disturbance in general populations; no studies have specifically examined body image disturbance in those with adolescent idiopathic scoliosis. This study aimed to validate a modified version of the BIDQ in a population with adolescent idiopathic scoliosis and to establish discriminant validity by comparing responses of operatively and nonoperatively treated patients with those of normal controls.

Lemierre syndrome in a 22-month-old due to Streptococcus pyogenes: a case report.

We report a case of Lemierre syndrome secondary to Streptococcus pyogenes in a 22-month-old girl. This case report and literature review took place at a pediatric intensive care unit at a freestanding tertiary children's hospital. Diagnosis occurred after the discovery of left internal jugular thrombus and multiple metastatic infection sites including the right knee, kidneys, lungs, and brain.

Aortic pseudoaneurysm in a child with a left mainstem bronchial stent.

Objective: To report a case of aortic pseudoaneurysm in a child with a metallic bronchial stent.

Design: Case report and literature review.

Setting: Pediatric intensive care unit at a freestanding tertiary children's hospital.

A warning to physicians: changing landscape of the corporate-provider relationship.

In 2007, the United States federal government recovered $1.54 billion for fraud in the health care industry. The government's unwavering and continuing commitment to enforcement and criminal actions compel the need for a stronger provider understanding of the regulatory framework within which corporate-provider relations must be structured.

Low back pain in pediatric athletes with unilateral tracer uptake at the pars interarticularis on single photon emission computed tomography.

Study Design: Retrospective clinical study with radiographic and medical chart review.

Objective: To study the clinical characteristics and outcome of pediatric athletes with low back pain and unilateral tracer uptake on single photon emission computed tomography (SPECT) at the pars interarticularis but no defect on radiographs.

Summary Of Background Data: Some pediatric athletes with low back pain have no findings on plain radiographs but a unilateral SPECT uptake at the pars interarticularis.

Physiologic implications of helium as a carrier gas for inhaled nitric oxide in a neonatal model of Bethanecol-induced bronchoconstriction.

Objective: To compare heliox to nitrogen-oxygen (nitrox) as a carrier gas for inducible nitric oxide (iNO) in the presence of pharmacologically inhaled bronchoconstriction. We hypothesized that respiratory resistance and gas exchange would improve when iNO is delivered with heliox.

Design: Interventional laboratory study.

Pediatricians knowledge, views, and perspectives on smallpox and smallpox vaccine.

Increasing concerns regarding smallpox as a biologic weapon have led to massive production of vaccinia vaccine and targeted vaccination campaigns. A regional mail survey was conducted among pediatricians to assess their knowledge and perceptions on smallpox and smallpox vaccine. Fifty-nine percent of the responders were unable to differentiate chickenpox from smallpox, and the majority would not accept vaccination in the absence of an outbreak and would not recommend smallpox vaccine to their patients.

Diagnostic utility of Borrelia burgdorferi cerebrospinal fluid polymerase chain reaction in children with Lyme meningitis.

Background: Cerebrospinal fluid (CSF) laboratory tests are frequently collected to help differentiate Lyme meningitis from other causes of aseptic meningitis. Previous studies using Lyme CSF polymerase chain reaction (PCR) have yielded varied results (sensitivity between 10 and 90%). No studies have specifically examined the diagnostic utility of Lyme CSF-PCR in North American children with Lyme meningitis.

Imaging methods used for children with hip dysplasia.

Ultrasound has been used to examine the infant hip for more than 20 years. The Thornbury model for assessing the clinical efficacy of a diagnostic imaging procedure has been used in this review to determine what has been achieved and what remains to be learned. To accomplish the effective and efficient treatment of patients with developmental dysplasia of the hip, orthopaedic, radiologic, and pediatric organizations must collaborate in writing and revising standards of care and guidelines for treatment as our knowledge base grows.

Liver transplantation as definitive treatment for a factor V Leiden mutation.

Liver transplantation (LT) was achieved for factor V Leiden-induced thrombophilia in a neonate with hepatic veno-occlusive disease. Initial LT was performed with a liver segment removed from a child with primary oxalosis. Four months later, a second, definitive LT was performed.

A model of experimental spinal cord trauma based on computer-controlled intervertebral distraction: characterization of graded injury.

Study Design: : A new model of experimental spinal cord injury is detailed based on the application of tensile (distraction) force to the vertebral column of the rat.

Objectives: : To develop an experimental model of graded spinal cord injury by application of tensile forces to the vertebral column.

Summary Of Background Data: : Distraction is frequently an integral component of human spinal cord injury, but the acute application of tensile forces to the spinal cord has not been modeled rigorously.

Tracheal gas insufflation-augmented continuous positive airway pressure in a spontaneously breathing model of neonatal respiratory distress.

Respiratory distress syndrome (RDS) in neonates is characterized by labored breathing and poor gas exchange, often requiring ventilatory support. Continuous positive airway pressure (CPAP) is a preferred intervention to support spontaneous ventilatory efforts by sustaining lung volume recruitment, while it prevents derecruitment during exhalation by maintaining end-expiratory pressure. However, CO2 retention during CPAP often results in the need for mechanical ventilation.

Compliance monitoring of brace treatment for patients with idiopathic scoliosis.

Study Design: Prospective, blinded study to evaluate compliance with treatment.

Objective: To evaluate objectively idiopathic scoliosis patients' compliance with Wilmington brace treatment.

Summary Of Background Data: Patients' compliance with brace treatment for idiopathic scoliosis traditionally has been determined from patient or parent interviews or both; however, the hours reported by patients are subjective and consequently are not accurate.

Autosomal dominant transmission of congenital hypothyroidism, neonatal respiratory distress, and ataxia caused by a mutation of NKX2-1.

Objective: To study the NKX2-1 gene in two half-siblings with elevated thyroid-stimulating hormone (TSH) on state screen, prolonged neonatal respiratory distress despite term gestations, and persistent ataxia, dysarthria, and developmental delay.

Study Design: We amplified and sequenced DNA samples from blood or buccal swab for subjects and their unaffected siblings.

Results: The same mutation that prevents splicing together of exons 2 and 3 of the NKX2-1 gene was present in the affected siblings, their mother, and maternal grandmother but not in their unaffected siblings.

Clotting parameters and thromboelastography in children with neuromuscular and idiopathic scoliosis undergoing posterior spinal fusion.

Study Design: An unblinded comparison of laboratory values between patients with idiopathic and neuromuscular scoliosis.

Objectives: To compare standard tests of coagulation and thromboelastography (TEG) parameters between two groups of patients undergoing posterior spinal fusion (PSF).

Summary Of Background Data: Children with neuromuscular scoliosis such as cerebral palsy have more intraoperative blood loss than children with idiopathic scoliosis during PSF.

Improvement in renal function and rejection control in pediatric liver transplant recipients with the introduction of sirolimus.

Calcineurin inhibitors have dramatically improved the outcomes of pediatric liver transplantation. However, calcineurin inhibitor use is associated with a 50% reduction in glomerular filtration rate in the first year post-transplant. Nephrotoxicity can be difficult to manage, especially in the pediatric population.

Plastic bronchitis: a case report.

We report a case of perioperative management of a toddler with plastic bronchitis complicated by tracheal obstruction. We discuss our management of this case as well as the diverse group of patients who may present with this disease. We also reviewed the literature regarding medical management of cast bronchitis.

Traumatic supraglottitis.

Traumatic supraglottitis may occur after mechanical, thermal, chemical, or other airway injury. It can be managed following the principles used for managing the airways of patients with infectious supraglottitis. A protocol for evaluation and management is described.

Immunocompetence and allergy.

Developed nations are experiencing a marked increase in prevalence of the familial allergic diseases including asthma, allergic rhinitis, atopic dermatitis, and allergic gastroenteropathy, which are often called atopic diseases. No satisfactory explanation for this epidemic is known, but it has been proposed that some facets of modern life tend to bias immune responses away from the Th1 cellular immune responses that protect against many infections and toward Th2 responses that favor atopy. There are 2 hypotheses to explain why this epidemic is occurring now.

Posterior fossa arachnoid cysts can mimic Meniere's disease.

Arachnoid cysts constitute 1% of all intracranial space-occupying lesions. In the posterior fossa, they typically produce vague, nonspecific symptoms. However, a subset of these lesions can produce signs and symptoms indistinguishable from those of Meniere's disease.

Problems in childhood obesity.

Clearly, obesity prevention should be at the forefront of our approach to this epidemic problem and the goal of health care providers, public health officials, community, and families. The problems of the obese child are no longer solely those of increased risk for disease, but of disease itself. Health care providers are increasingly challenged to provide evaluation and treatment for the serious comorbidities and complications of obesity in childhood.

Patellofemoral arthritis in a fused knee with proximal femoral focal deficiency.

A patient with proximal femoral focal deficiency (PFFD) who underwent knee fusion without patella resection and Boyd amputation at age 2.5 years developed severe symptomatic patellofemoral arthritis 10 years later that required excision of her patella. A survey among the 780 members of the Pediatric Orthopaedic Society of North America with a 58% response rate showed that 8 of the 355 pediatric orthopaedists who perform knee fusion without patellar removal in PFFD have experienced problems with patellofemoral degeneration, whereas 57 surgeons excise the patella either routinely or occasionally.

Multimodality monitoring of transcranial electric motor and somatosensory-evoked potentials during surgical correction of spinal deformity in patients with cerebral palsy and other neuromuscular disorders.

Study Design: This prospective, descriptive study determined the reliability of transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials in children with neuromuscular scoliosis.

Objective: To assess the applicability of transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials during surgical correction of neuromuscular scoliosis, particularly with cerebral palsy-related deformity.

Summary Of Background Data: During corrective spinal surgery for neuromuscular scoliosis, intraoperative multimodality spinal cord monitoring is recommended.