May 25, 2016
Volume VII | Issue No. 21

Isolated traumatic skull fractures - inpatient neurological observation required?
A retrospective review of 71 children (ages one week to 12.4 years) presenting in the Emergency Department (ED) with an isolated skull fracture only and normal neurological examination indicates that most (77.5%) are admitted for neurological observation with none requiring neurosurgical intervention.

"Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications... and can be discharged safely from the ED" with significant cost savings.
Clinical features of mesenteric lymphatic malformation (MLS) in children
MLS is a heterogeneous, rare group of benign diseases of the lymphatic system that presents with dilated lymphatics in the mesentery.

Median age of MLS diagnosis is 5 years with abdominal pain being the most common symptom. Surgical management appears to dependent on the relationship between MLS and surrounding organs, the size and the location of the cyst.

Journal of Pediatric Surgery

See related video HERE>>
Management of pediatric parapneumonic effusion and empyema
It appears from a study of 239 children (aged 4 months - 19 years) that the majority of children with empyema are successfully managed with antibiotics alone (27%) or with a fine-bore chest drain and urokinase (71%).



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Renal vascular thrombosis in the newborn
Though rare, renal vascular thromboses have substantial sequelae. In the neonate renal artery thrombosis presents primarily with hypertension while renal vein thrombosis ( more common) usually presents with an abdominal mass, macroscopic hematuria and thrombocytopenia.

Evaluation for maternal (lupus anticoagulant and anticardiolipin antibody) and infant prothrombotic abnormalities is usual, as is contrast angiography or Doppler ultrasound.

Treatment includes prophylactic heparin (with thrombolytics appearing to be reserved for bilateral thrombosis).

Pediatric Nephrology
Adolescent reproductive knowledge, attitudes and beliefs, and future fatherhood
From a 20 year database of reproductive knowledge, attitudes and beliefs of young men (National Longitudinal Study of Adolescent Health) and their association with reproductive pathways it appears that being an adolescent father, having a higher risky behavior score and pregnancy attitude increases the likelihood of being an nonresident father, while using birth control methods significantly reduces the odds of being an adolescent and nonresident father.

Young men's knowledge, attitudes and beliefs, predict their reproductive future. Reproductive education is needed to prevent unintended pregnancies.

Video Feature 
Dyshemoglobinemia: Methemoglobin and Carbon Monoxide Poisoning
Dyshemoglobinemia: Methemoglobin and Carbon Monoxide Poisoning
Hemoglobin M disease as a cause of cyanosis in the newborn

Methemoglobinemia is a disorder characterized by high levels of methemoglobin (metHb) (the iron in the hemoglobin is in the ferric (Fe3+) rather than ferrous (Fe2+]) form, which has a decreased ability to bind oxygen, and the presence of which shifts the oxyhemoglobin dissociation curve to the left resulting in an increased propensity for tissue hypoxia. When metHB levels rise above 1%, cyanosis, shortness of breath, fatigue, headache results with changes in mental status occurring with levels >50%.

A case presentation of methemoglobinemia presenting as cyanosis in the newborn is utilized in this article to provide an up-to-date review of the literature.

Early clinical diagnosis of PC1/3 (proprotein convertase 1/3) deficiency
"PC1/3 is an endoprotease that processes many prohormones expressed in endocrine and neuronal cells".

PC1/3 deficiency is an autosomal-recessive disorder caused by rare mutations in the proprotein convertase subtilisin/kexin type 1 (PCSK1) gene which presents clinically in an age-dependent manner. Neonates frequently present with severe malabsorptive diarrhea and failure to thrive. As children age they may develop diabetes insipidus, growth hormone deficiency, hypogonadism, hypothyroidism and adrenal insufficiency; sometimes associated with obesity and severe polyphagia.

An interesting case description of PC1/3 deficiency in a 4 month old girl presenting with congenital diarrhea and polyuria describes the genomic identification of a novel homozygous PCSK1 mutation.

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