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July 1, 2015
Volume VI, Issue No. 26

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Hill-Sachs lesion volume and recurrent instability of traumatic shoulder dislocation (TDS) in adolescents.

A Hill-Sachs lesion or compression fracture is a cortical depression in the posterolateral head of the humerus. It results from the forceful impaction of the head against the edge of the glenoid rim when the shoulder is dislocated anteriorly. Up to 10% of patients have recurrent dislocations. Accurate assessment of HS lesions and their relationships to glenoid bone loss (so-called "glenoid track") appears valuable in the preventive management of recurrent shoulder dislocation.

 

Magnetic imaging (MI) arthrography used to evaluate the glenoid track of 30 adolescents with TSD indicates that as the volume of HS lesions increase so does the number of TSD's and the number of recurrent shoulder instabilities - dislocations.

 

MI arthrography is a useful tool in assessing adolescent shoulder dislocation and the likelihood of recurrences, particularly when focused on the assessment of HS lesions.  

 

Journal of Pediatric Orthopaedics 

Treating acute appendicitis without surgery

Since Fitz (1886) described the pathological changes of appendiceal inflammation (from mild infection progressing to gangrene and perforation) appendectomy has essentially been the established method for appendicitis management.

 

Increasing evidence however appears to support the use of antibiotics instead of surgery for patients with uncomplicated acute appendicitis.

 

A multicenter, open-label non-inferiority randomized clinical trial of 530 patients with uncomplicated acute appendicitis (confirmed by CAT scan) treated either surgically or with antibiotics (IV initially then orally) and followed for 1 year, indicates that for this group of patients most do not require appendectomy.

JAMA via YouTube
via YouTube

JAMA 

Propofol-Ketamine (PK) and Propofol-Fentanyl (PF) combination non-anesthetist administered sedation

A parallel-group, randomized, double-blind comparative study utilizing 95 children examined the need for additional doses of propofol after sedation induction midazolam premedication for esophagogastroduodenoscopy (EGD) using either a PK or PF combination administered by a non-anesthetist. Additional doses of propofol were given as needed.

 

PK and PF sedation appear equally effective and safe. "Non- anesthetist administered propofol sedation is feasible in teaching hospitals".

 

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Transfer of methylprednisolone (MD) and amlodipine into breast milk

 

Two reports document the transport of drugs into breast milk and breast fed infants.

 

One: A mother received a 3-day course of high-dose MD (1,000mg/day - 3 days) to treat an acute relapse of multiple sclerosis. Samples for glucocorticoids obtained 1, 2, 4, 8 and 12 hours following each day's infusion from both breast milk and infant indicate:

 

Infant exposure to MD is low following maternal use (especially if infant is breast fed >2-4 hours after maternal treatment) and mothers may continue to breast feed if treatment is brief.  

 

Journal of Human Lactation 

 

Two: A study of 31 lactating women receiving daily oral amlodipine (mean 6mg/day) for hypertension indicates that while:

 

Mothers on oral amlodipine transfer the drug to their breast milk; ingestion risk to their infant is small.

 

Journal of Human Lactation 

Video Feature

via YouTube   

Hills Sachs Lesion
Hills-Sachs Lesion

Anti-gastroesophageal reflux (GER) surgery in infants with severe bronchopulmonary dysplasia (BPD)

 

"GER may exacerbate lung disease in infants with BPD".

 

A study of 22 infants with severe BPD where anti- reflux surgery was undertaken indicates that surgery appears safe, with modest post-operative reductions in respiratory rate and oxygen requirements. Early post-operative feeding is well tolerated.

 

Pediatric Pulmonology 

Allergen-induced asthmatic responses modified by a GATA3-specific DNAzyme

 

A prevalent phenotype of asthma is one characterized by eosinophil-dominated inflammation that is mediated by a transcription factor GATA3 - (among its many action is the promotion of the secretion of inflammatory cytokines) of the helper T cell (Th2).

 

An inhalation efficacy and safety study in 40 allergic asthmatic patients of a novel DNA enzyme (DNAzyme-SB010) that inactivates GATA3 messenger RNA against a placebo, given daily for 28 days indicates that SB010 significantly attenuates late and early asthmatic responses after allergen provocation and reduces Th2-regulated inflammatory reactions.

 

(Biologics are revolutionizing medicine! Ed.)

 

New England Journal of Medicine

Head Lice (from American Academy of Pediatrics - AAP)

 

Five years after the last AAP clinical report on head lice, a new revised one extensively reviews the etiological agent, epidemiology, transmission, diagnosis, prevention and multiple topical and oral (off-label) and "natural" products available. It fully discusses environmental interventions, control measures and criteria for return to school.

 

This is a "must read" for all Pediatricians (Ed.)

 

Pediatrics
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