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Borough of Bronx, NY, United States

Chambers S.,Childrens Hospital at Montefiore
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing | Year: 2011

Lead failure is a common complication of pacemaker placement in the pediatric population and is often due to insulation breaks or lead fracture. Usually these leads are replaced with new leads. This study describes the surgical technique of lead repair and investigates the longevity of such repairs. Retrospective review of lead repairs performed in the pediatric population (<21 years old) between December 1995 and December 2008. Operative records, pre-operative interrogation data, and most recent follow-up data were reviewed. Twenty-one lead repairs were performed on 17 patients. Sixteen were ventricular leads and five were atrial leads. There were 14 insulation defect repairs, six new lead tip splicings, and one lead extender splicing. The repaired leads were followed for a mean time of 3.6±3.0 years (range, 0.3-10.6 years). The freedom from repaired lead failure by Kaplan-Meier survival analysis was 89% at 5 years and 22% at 10 years. One atrial lead and two ventricular leads have been replaced since the repairs. One atrial lead has had a repeat insulation break repair since the initial repair. One of the five atrial leads had an elevated threshold at follow-up. Five of 16 ventricular leads had elevated thresholds at follow-up. All leads had normal impedance at follow-up. The option of pacemaker lead repair, if surgically feasible, offers an alternative to lead replacement in the pediatric population and may extend the longevity of pacemaker leads in this population. Source


Dodson N.A.,Childrens Hospital at Montefiore
Current Opinion in Pediatrics | Year: 2016

Purpose of review This review will focus on recent research, initiatives, and legislation regarding the issue of gun violence as it pertains to adolescents. Recent findings Homicide and suicide continue to be major killers of adolescents in the United States. Gun homicide kills teens in the most urban areas of the United States at the same rate as suicide kills teens in the most rural areas of the United States. Research on assault-injured youth sheds light on risk factors for teen gun homicide, and has found high rates of illegal gun carrying and retaliatory attitudes among at-risk teens. Suicide research continues to show a strong correlation between gun ownership and accessibility, and risk of completed suicide. Stand Your Ground laws and campus carry laws present unique threats to different populations of American teens. Summary Given the enormous toll that gun violence takes on adolescent lives, pediatricians should ask about guns in the home and become involved in efforts to strengthen laws that would decrease gun violence. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source


Fradin K.N.,Childrens Hospital at Montefiore | Rhim H.J.H.,Yeshiva University
Journal of Adolescent Health | Year: 2013

A 16-year-old boy presented with a 6-day history of fevers and myalgias and a 4-day history of diffuse crampy abdominal pain. On admission, his sclerae were icteric and he had diffuse abdominal tenderness. Erythrocyte sedimentation rate was elevated to 40; the γ-glutamyl transferase level was elevated to 168 U/L; indirect bilirubin was 5.6 mg/dL; and direct bilirubin was 3.3 mg/dL. During the next 2 days, he developed many stigmata of Kawasaki disease (KD), including conjunctivitis, desquamating rash, mucosal changes, swelling of the hands and feet, and lymphadenopathy. KD is commonly seen in young children but can also occur in adolescents and adults. Providers should be aware that these age-groups are at risk for KD and may present with atypical symptoms. Delays in diagnosis can put these adolescents at increased risk of coronary artery aneurysms, and, accordingly, a high index of suspicion is essential. © 2013 Society for Adolescent Health and Medicine. Source


Cantinotti M.,CNR Institute of Neuroscience | Assanta N.,CNR Institute of Neuroscience | Murzi B.,CNR Institute of Neuroscience | Lopez L.,Childrens Hospital at Montefiore
Heart | Year: 2014

Haemodynamically insignificant left-to-right shunts are frequently discovered when screening for congenital heart disease, resulting in significant economic and psychosocial impact. A literature search was performed within the National Library of Medicine using the keywords small/insignificant/silent atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) and patent foramen ovale (PFO). The search was refined by adding the keywords definition, classification and follow-up. Our analysis revealed significant heterogeneity in the evaluation and management of innocent left-to-right shunts. The definitions for small defects vary greatly, making it difficult to distinguish between physiologic and pathologic lesions (eg, a PFO vs a true ASD). Most small defects will partially or completely resolve spontaneously early in life. If spontaneous resolution does not occur, the risk for long-term complications (such as embolic events and endocarditis) is low but poses several practical and ethical issues: immediate discharge versus long-term follow-up, duration and frequency of followup, and content and method of discussions with the parents. Additionally, there is controversy pertaining to treatment for PDAs and VSDs, particularly among interventional cardiologists, even though risk/benefit analyses are lacking. Standards and guidelines using consensus opinion for the management of insignificant left-to-right shunts are needed to address the heterogeneity in diagnosis and management as well as use of resources, ethical and psychosocial issues. Source


Katikaneni R.,Childrens Hospital at Montefiore
The journal of investigative dermatology. Symposium proceedings / the Society for Investigative Dermatology, Inc. [and] European Society for Dermatological Research | Year: 2013

Alopecia areata is a common form of hair loss in which autoimmune-mediated destruction of hair follicles causes patchy hair loss, for which there is no adequate therapy. Parathyroid hormone (PTH) induces the hair cycle and promotes hair growth. PTH-CBD is a fusion protein of PTH and a bacterial collagen-binding domain (CBD), leading to targeted delivery to and retention in the skin collagen. We tested the effects of a single dose of PTH-CBD (low or high dose) on an animal model for alopecia areata, the C3H/HeJ engrafted mouse. In all the treated animals, there was a rapid (1-4 days) increase in hair growth, with sustained effects observed over a 2-month period (7/10 total treated mice<40% hair loss based on gray scale analysis, vs. 2/5 in vehicle control animals). Histological examination revealed massive stimulation of anagen VI hair follicles in treated animals despite an ongoing immune response. PTH-CBD thus shows promise as a therapy for alopecia areata, likely in conjunction with a mild immune suppressant, such as hydrocortisone cream. Source

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