Piatt Jr. J.H.,St Christophers Hospital For Children |
Piatt Jr. J.H.,DuPont Company
Journal of Neurosurgery: Pediatrics | Year: 2010
Object. Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. Methods. A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. Results. Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. Conclusions. Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.
Carey A.J.,St Christophers Hospital for Children |
Long S.S.,St Christophers Hospital for Children
Clinics in Perinatology | Year: 2010
Staphylococcus aureus is a continuously evolving and formidable pathogen that has been a problem for both healthy and sick neonates for decades. Much focus over the past 20 years has been on hospital-associated methicillinresistant S aureus (HA-MRSA); however, a global epidemic because of virulent community-associated MRSA (CA-MRSA) that has no " fitness cost" for carrying antibiotic-resistance genes has moved into neonatal intensive care units (NICUs). Recently, methicillin-susceptible S aureus has adopted some of the virulence factors of CA-MRSA and is an increasingly common cause of hospital-acquired infections in NICUs. This article reviews the changing epidemiology, clinical manifestations, and treatment of S aureus in neonates. © Elsevier Inc.
Abzug J.M.,University of Maryland Baltimore County |
Herman M.J.,St Christophers Hospital For Children
Journal of the American Academy of Orthopaedic Surgeons | Year: 2012
Supracondylar humerus fractures are the most common elbow fractures in the pediatric population. Type I fractures are managed nonsurgically, but most displaced injuries (types II, III, and IV) require surgical intervention. Closed reduction and percutaneous pinning remains the mainstay of surgical management. Numerous studies have reported recent alterations in important aspects of managing these fractures. Currently, many surgeons wait until 12 to 18 hours after injury to perform surgery provided the child's neurovascular and soft-tissue statuses permit. Increasingly, type II fractures are managed surgically; cast management is reserved for fractures with extension displacement only. Two to three lateral pins are adequate for stabilizing most fractures. Evolving management concepts include those regarding pin placement, the problems of a pulseless hand, compartment syndrome, and posterolateral rotatory instability.
White J.C.,Pediatric Residency Program and |
Appleman S.,St Christophers Hospital for Children
Pediatrics | Year: 2014
Vanishing bile duct syndrome (VBDS) is a rare disorder characterized by loss of interlobular bile ducts and progressive worsening cholestasis. The acute presentation of this disease is typically associated with a drug hypersensitivity and Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN). The mainstay of treatment has been ursodeoxycholic acid with mixed results from immunosuppressive regimens. Anti-tumor necrosis factor-α and plasmapheresis have been speculated to be of potential benefit. It is hoped that early identification and intervention in VBDS secondary to Stevens-Johnson syndrome/TEN with continued reporting will lead to better regimens and outcomes. Our case report details the first reported use of infliximab and plasmapheresis, in addition to steroids, in a patient with VBDS secondary to TEN, as well as a literature review that supports a mechanism for why these modalities could be effective treatments. Unfortunately, our patient died, and the use of these therapies had an unclear benefit on his liver and skin disease. We hope that additional work can be published to confirm or refute their utility in the treatment of these diseases. Copyright © 2014 by the American Academy of Pediatrics.
Adirim T.A.,St Christophers Hospital for Children
Pediatric Emergency Care | Year: 2015
The purpose of this article is to commemorate the 30th anniversary of the Emergency Medical Services for Children (EMSC) program. For the last 30 years, the EMSC has had a significant impact on transforming emergency care for children. The program has contributed to the creation of pediatric emergency medicine as a subspecialty and, importantly, has institutionalized pediatrics into the nation's emergency medical services systems.This article describes the history of the program, its components, and the return on investment over the years. The EMSC has undergone many changes since its inception, and now, because the health care system is rapidly changing, the EMSC must continue to ensure that children and their families receive the best emergency care possible. The EMSC community is poised to envision and adapt its mission to leverage opportunities in this rapidly changing environment to ensure that children receive and continue to receive high-quality emergency care services. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Long S.S.,Drexel University |
Long S.S.,St Christophers Hospital For Children
Advances in Experimental Medicine and Biology | Year: 2011
Significant advances, especially in microbiologic diagnostics and brain imaging, have broadened our understanding of the etiology, pathogenesis, and natural history of acute encephalitis. In some instances this had led to specific therapies and preventive measures. The clinical hallmark of acute encephalitis is the triad of fever, headache, and altered mental status. Common neurologic features include disorientation or depressed level of consciousness; disturbances of behavior, speech, or executive function; and diffuse or focal neurologic signs such as cranial nerve dysfunction, hemiparesis, or seizures. These features distinguish the unusual patient with encephalitis from the more commonly encountered patient with uncomplicated meningitis who has fever, headache, and nuchal rigidity but lacks abnormal global or focal neurologic signs. Etiologies of acute encephalitis are myriad. Most are viral infections. Table 1 shows a robust but not exhaustive list of viral etiologies. Beyond this there is another robust but not exhaustive list (Table 2) of important considerations in the differential diagnosis. These include infectious agents (bacterial, fungal, parasitic, and amebic) as well as non-infectious etiologies (parainfectious, post-infectious, autoimmune, neoplastic, cerebrovascular, systemic, and other conditions). The challenge for the clinician is to rapidly hone the list and make critical management decisions by considering the specific features of the setting of the patient's illness, host susceptibility, clinical and neurologic findings, and results of laboratory and imaging studies. © 2011 Springer Science+Business Media, LLC.
Carvalho K.S.,St Christophers Hospital For Children |
Carvalho K.S.,Drexel University
Seminars in Pediatric Neurology | Year: 2013
Dysfunction of the mitochondrial (mt) system is thought to play an important role in the mechanism of progression of various neurodegenerative disorders, including demyelinating disorders. They are characterized by neuroinflammation, ultimately leading to neurodegeneration. Mitochondria (mt) dysfunction is closely related to the mechanism of neuroinflammation, causing increased production of reactive oxygen species, which is detrimental to neurons and glia. Vice versa, neuroinflammation is increasingly recognized to produce mt failure, which then contributes to further neuronal injury and degeneration. Multiple sclerosis and X-linked adrenoleukodystrophy are examples of neurodemyelinating diseases that despite having a diverse etiology have in common a progressive course and significant neuroinflammation and neurodegeneration, leading to severe neurologic disability. The scientific community has become increasingly interested in how mt dysfunction relates to neuroinflammation and demyelination and what role it may play in the natural history of progressive demyelinating diseases. Research studies investigating how mt failure contributes to the progression of these conditions are emerging. A better understanding of the role of oxidative stress in progressive inflammatory demyelinating diseases might generate new potential neuroprotective therapeutic approaches for these devastating neurologic conditions. © 2013 Elsevier Inc.
Wolf M.,St Christophers Hospital for Children
Pediatrics in Review | Year: 2016
On the basis of primarily consensus due to lack of relevant clinical studies, the most important evaluative step for knee pain is to identify any emergent conditions, including limb- And life-threatening disorders (septic arthritis, osteomyelitis, and malignancy), hip pathology, or conditions associated with effusions. (2)(3)(6)(8)(11)(13)(14). Copyright © 2016 by the American Academy of Pediatrics. All rights reserved.
Wolf M.,St Christophers Hospital for Children
Pediatrics in Review | Year: 2016
On the basis of primarily consensus, due to lack of relevant clinical studies, the information obtained from the history and physical examination is the key to establishing a diagnosis and directing initial management of knee pain. (1) · By applying history and physical examination findings to a diagnosis and management algorithm, clinicians can efficiently and effectively determine the potential cause of the knee pain. · On the basis of primarily consensus, due to lack of relevant clinical studies, the most important step of the evaluation of knee pain is to identify emergent conditions, including limb- and life-threatening conditions (eg, septic arthritis, osteomyelitis, and malignancy), hip pathology, or conditions associated with effusions. (2)(3)(4)(5)(6)(7)(8).
Herman M.J.,Drexel University |
Martinek M.,St Christophers Hospital For Children
Pediatrics in Review | Year: 2015
Educational Gap: Limping is a common chief complaint among children seeking medical attention. Results of a thorough history and physical examination can narrow possible etiologies significantly. Knowledge of the following orthopedic emergencies can prevent further complications: septic arthritis, compartment syndrome, vascular compromise, open fractures, and unstable slipped capital femoral epiphysis. Objectives: After completing this article, the reader should be able to: 1. Gain an understanding of the normal and abnormal pediatric gait patterns. 2. Distinguish between septic arthritis and toxic synovitis of the hip. 3. Recognize orthopedic emergencies. 4. Understand and differentiate between the following causes of limp: developmental hip dysplasia, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis. 5. Diagnose common overuse injuries in children. 6. Formulate a differential diagnosis of the limping child based on the patient's age. © 2015 Elsevier B.V.