Nov. 9, 2016
Volume VII | Issue No. 45

The significance of tubulointerstitial lesions in Henoch-Schönlein nephritis (HSN)
Henoch-Schönlein purpura (HSP) is a systemic vasculitis involving vessels of the skin, mucus membranes and other organs (usually kidney) of unknown origin resulting from deposition of IgA complexes on small vessels. Kidney disease is usually mild (nephritic or nephrotic presentations) and frequently resolves completely. A few patients will have persistent kidney disease that might go onto renal failure. "Little information is available on the development of tubulointerstitial lesions in children with HSN".

A study of 28 children with HNP with nephritis in whom serial renal biopsies were obtained before and after immunosuppressant therapy indicates that serum albumin levels negatively correlate with changing tubulointerstitial pathology, the longer the proteinuria the worse the renal lesion.

Interventions intended to support breast feeding
The latest US Preventive Services Task Force Statement on "Primary Care Interventions to Support Breast Feeding" has now been published. An excellent accompanying editorial is "MUST READ" for all pediatricians. Discussing some of the controversial recommendations (many without good data) it highlights the importance of individualized input to lactating mothers (vs. "system approach") and discusses the role of pacifiers and non-exclusive breast feeding practices.

Posterior spinal fusion (with pedicle screws) in patients with idiopathic scoliosis and open triradiate cartilage (OTRC)
"Anterior-posterior spinal fusion (APSF) is the traditional treatment for patients with idiopathic scoliosis with open triradiate cartilage".

A prospective multicenter database comparative study of all children with APSF or posterior-only spinal fusion (with pedicle screws) (PSF) indicates that PSF results in more operated children having curve progression and less stable fusion.
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Evaluating patients for concussion 
Two new computerized tests to help clinicians evaluate a child's cognitive function after a suspected brain injury have been approved by the FDA. The tests assess for example word memory, reaction time and word recognition.

The ImPACT software program for adolescents and adults (12-59 years) can be run on a desktop or laptop computer; the pediatric version for children aged 5-11 years runs on an iPad. With a baseline test performed on all children playing contact sports, post injury testing comparisons enhances the clinician's ability to diagnose concussion.

Oligodendrogliomas in children

Oligodendrogliomas while occurring primarily in adults, are also found in children (4% of all primary brain tumors). A retrospective analysis of 20 affected treated children (median age 9.2 years at diagnosis) indicates: 
  1. 90% are located in the cerebral hemispheres.
  2. Presenting symptoms include seizures, headaches, visual disturbances, limb weakness and vomiting.
  3. 45% are pure Oligodendrogliomas while 55% are anaplastic.
Total tumor resection regardless of histologic grade offers best survival.

Video Feature
Nervous System Tumors
Effect of ginger on breast milk volume 

Many natural and synthetic substances have been utilized to enhance milk production in breast feeding women. Herbal and food products appears to have little (or no) scientific evidence of efficacy.  A variety of synthetic ones ( e.g. dopamine receptor blockers), antipsychotics and certain hormones are also available, all however have potential adverse effects.
Ginger is a popular natural galactagogue among breast feeding mothers in Thailand, though used to date with little evidence of efficacy.

A randomized, double-blind control trial of 63 matched breast feeding women randomly assigned to receive either 500mg dried ginger twice daily (or a placebo) indicates that ginger ingestion significantly increases immediate (3 day) breast milk volume without adverse effects.

Secondary signs to improve diagnostic accuracy of equivocal ultrasound (USs) for suspected appendicitis

"US is the preferred imaging modality for evaluating appendicitis", however 64% (of 530 children in a retrospective review) presenting with right lower quadrant (RLQ) pain and possible appendicitis have equivocal US results.

It appears that in children with RLQ pain, suspected appendicitis and equivocal abdominal US results that secondary US signs of free fluid, hyperemia and the presence of an appendicolith enhances specificity (96%) and accuracy (88%) of acute appendicitis diagnosis significantly.

Did you know? 
Nicklaus Children's Moves Patients into its New Advanced Pediatric Care Pavilion
Patients of Nicklaus Children's three intensive care units and its hematology-oncology and neurology-neurosurgery units have moved into the hospital's newly opened Advanced Pediatric Care Pavilion, a six story 213,000-square-foot tower featuring the latest technical and family-centered advancements.
"This move is a major milestone for our organization," said Dr. Narendra Kini, CEO of Miami Children's Health System, parent organization of Nicklaus Children's Hospital.
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