Providence, RI, United States
Providence, RI, United States

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Tompkins M.,Alpert Brown Medical School | Bliss J.,Scripps Research Institute | Villarreal R.,Alpert Brown Medical School | Solga P.,Alpert Brown Medical School
Journal of Orthopaedic Trauma | Year: 2010

Posterior sternoclavicular joint disruptions are rare, and a concomitant fracture is even less common in the pediatric population. This case report concerns a posterior sternoclavicular joint disruption and ipsilateral medial clavicle fracture in a 9-year-old male hockey player. We describe the various imaging modalities that may be necessary for this injury, the complications to be considered in dealing with this injury as well as an internal fixation technique using FiberWire. Copyright © 2010 by Lippincott Williams & Wilkins.


Tompkins M.,Alpert Brown Medical School
American journal of orthopedics (Belle Mead, N.J.) | Year: 2012

If left uncorrected, valgus ankle deformity in multiple hereditary exostoses can cause significant disability in skeletally immature children and in adults. Various management methods have been described, including hemiepiphyseal stapling, transphyseal screw placement, fibular-Achilles tenodesis, distal tibial osteotomy, and ablative epiphyseodesis. In this article, we report the cases of 3 skeletally immature children who had undergone hemiepiphyseal stapling of the medial distal tibial epiphysis for correction of valgus ankle deformity in multiple hereditary exostoses. Correction of the tibiotalar axis, in relation to chronological and bone age, was evaluated. Hemiepiphyseal stapling of the medial distal tibial epiphysis provides ipsilateral corrective potential while allowing staple removal for reversal of growth retardation. This procedure is useful in the management of ankle valgus in multiple hereditary exostoses.


Stephens B.E.,Alpert Brown Medical School | Liu J.,NICHD Neonatal Research Network | Lester B.,Alpert Brown Medical School | Lester B.,NICHD Neonatal Research Network | And 7 more authors.
Journal of Pediatrics | Year: 2010

Objective: To determine whether Neonatal Intensive Care Unit Network Neurobehavior Scales (NNNS) at 44 weeks predict motor outcome at 2 years in preterm infants from the Maternal Lifestyles Study (MLS). Study design: Data were collected on all preterm infants (<36 weeks) in the MLS who underwent an NNNS at 44 weeks (n = 395) and neurologic examination at 12 to 36 months or Bayley Psychomotor Development Index (PDI) at 24 months (n = 270). Logistic regression analyzed NNNS summary scores associated with cerebral palsy (CP) or PDI <70, while controlling for birth weight ≤1250 g. Results: Eighteen of 395 infants (5%) had CP; 24 of 270 infants (9%) had PDI <70. CP was associated with low quality of movement (odds ratio [OR], 1.95; 95% CI, 1.24-3.06; P = .004) and high lethargy (OR, 1.67; 95% CI, 1.01-2.76; P = .045). The model contributed 19% of the variance in CP diagnosis at 12 to 36 months (R2 = .19, P < .001). Low PDI was associated with low handling (OR, 1.83; 95% CI, 1.12-2.99; P = .017), low quality of movement (OR, 2.16; 95% CI, 1.38-3.38; P = .001), and hypotonia (OR, 1.63; 95% CI, 1.14-2.32; P = .007). The model contributed 26% of the variance in PDI <70 at 24 months (R2 = 0.26, P < .001). Conclusions: The neurobehavioral profile of under-arousal in 44-week-old preterm infants may predict poor motor outcome. © 2010 Mosby, Inc. All rights reserved.


Yen S.,Alpert Brown Medical School | Fuller A.K.,Loyola University Chicago | Solomon J.,Butler Hospital | Spirito A.,Alpert Brown Medical School
Journal of Psychiatric Practice | Year: 2014

This study examines treatment utilization in a sample of 99 adolescents who were psychiatrically hospitalized due to a risk of suicide and followed for 6 months. Descriptive information regarding participants' use of various forms of outpatient and intensive treatment, including emergency, inpatient, and residential care is presented. In addition, the relationships between utilization of mental health services and various characteristics of the adolescents and their families were assessed. Overall treatment engagement was high, with 78 participants (79%) receiving some care for the duration of the follow-up period and 91 (92%) participating in at least one session of outpatient treatment, although the extent of utilization was highly variable. In addition, 28 participants (28%) were rehospitalized during follow-up. Both family and individual characteristics were associated with differences in adolescents' participation in follow-up treatment. Specifically, adolescents with a family history of mood disorders were more likely to participate in outpatient treatment and less likely to require intensive treatments. Conversely, more impaired baseline functioning and suicide attempts during the follow- up period were associated with greater utilization of intensive treatments and less utilization of outpatient therapy. Given that 19 participants (19%) in our sample attempted suicide during the follow-up interval, the findings of this study suggest that, in spite of high rates of outpatient treatment engagement, rates of suicide attempts and use of intensive treatment services remain high. These results suggest the need for improved outpatient care, as well as possibly longer inpatient stays and more elaborate discharge and transition planning. Copyright ©2014 Lippincott Williams &Wilkins Inc.


PubMed | Alpert Brown Medical School
Type: Case Reports | Journal: American journal of orthopedics (Belle Mead, N.J.) | Year: 2012

If left uncorrected, valgus ankle deformity in multiple hereditary exostoses can cause significant disability in skeletally immature children and in adults. Various management methods have been described, including hemiepiphyseal stapling, transphyseal screw placement, fibular-Achilles tenodesis, distal tibial osteotomy, and ablative epiphyseodesis. In this article, we report the cases of 3 skeletally immature children who had undergone hemiepiphyseal stapling of the medial distal tibial epiphysis for correction of valgus ankle deformity in multiple hereditary exostoses. Correction of the tibiotalar axis, in relation to chronological and bone age, was evaluated. Hemiepiphyseal stapling of the medial distal tibial epiphysis provides ipsilateral corrective potential while allowing staple removal for reversal of growth retardation. This procedure is useful in the management of ankle valgus in multiple hereditary exostoses.


PubMed | Alpert Brown Medical School
Type: Journal Article | Journal: The Journal of pediatrics | Year: 2010

To determine whether Neonatal Intensive Care Unit Network Neurobehavior Scales (NNNS) at 44 weeks predict motor outcome at 2 years in preterm infants from the Maternal Lifestyles Study (MLS).Data were collected on all preterm infants (<36 weeks) in the MLS who underwent an NNNS at 44 weeks (n = 395) and neurologic examination at 12 to 36 months or Bayley Psychomotor Development Index (PDI) at 24 months (n = 270). Logistic regression analyzed NNNS summary scores associated with cerebral palsy (CP) or PDI <70, while controlling for birth weight

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