Sept. 9, 2015
Volume VI, Issue No. 36

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Prenatally-diagnosed neck masses; long-term outcomes and quality of life.
Fetal neck masses (FNM) are fairly rare conditions that include cervical teratomas and lymphangiomas. Typically FNM's do not require fetal intervention, however if large an EXIT (Ex utero Intrapartum Treatment) procedure (which requires a caesarian delivery) may be required.

In a study of 35 fetuses with FNM's (over a 12.5 year period) the following results were found.

1.   A Perinatal mortality of 26%.
2.   69% of survivors require mass resection.
3.   Surviving patients with lymphatic malformations have moderate/severe disfigurement, and a higher rate of persistent/recurrent disease and nerve dysfunction.
4.   Long-term functional and cognitive outcomes are good.
Verbal intellectual ability following childhood glucosteroid therapy
A study evaluated 38 children (7-16 years of age) and healthy matched controls for intellectual ability, memory and behavioral problems 3.5 years after treatment with glucocorticoids for rheumatic disease or nephrotic syndrome.
Significant (median cumulative dose of prednisone: 158mg/kg) glucocorticoid treatment in young children appears to result in significant lower verbal comprehension (without affecting the child's ability to retrieve information form memory - "pattern recognition memory", or cause an increase in behavioral problems).
Treatment of acute traumatic hip instability in the adolescent
Dislocations of the hip due to high energy trauma are on the increase because of vehicular accidents. Most (80%) are traumatic posterior dislocations which may result in acetabular cartilage and/or bone injuries (with/without loose bodies in the joint) and/or femoral head or neck fracture. Closed reduction is usually the initial treatment and is frequently (85%) successful. Indications for open reduction include non-concentric reduction, irreducibility by closed manipulation, intra-articular fragments, etc.
A retrospective analysis of 11 patients (mean age 12.3 years) with nonconcentric reduction due to intra-articular hip pathology following a posterior hip dislocation and treated with a transtrochanteric surgical hip dislocation approach, identifies its safety and efficacy.
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Antibiotic resistance in mother/infant pairs
It appears that individuals acquire antibiotic resistant bacterial organisms early in life.

A small study of paired healthy mothers/infants' gastrointestinal bacterial organisms (identified by stool DNA analysis) indicates that relevant resistance genes in the infants' stool are acquired from their environment at 1-2 weeks of age and are different from their mothers' resistome.  
Immunoglobulin E in irritable bowel syndrome IBS - Another treatment option?
IBS is a multifactorial condition, difficult to treat as the pathophysiology is poorly understood.

A case study describes a patient with severe asthma and IBS who was treated with an anti-Immunoglobulin E ( anti-IgE) monoclonal antibody with significant improvement in both asthma and IBS symptoms. This suggests that in some patients with atopy and IBS (particularly where results of standard management is poor) treatment directed at the allergic diathesis may be of value in improving IBS symptoms.

Video Feature

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Emergency room returns - causation? 

From a study of a large pediatric emergency department (ED), data suggests that 4.1% of patients return within 72 hours of being seen with management in 92.6% being deemed acceptable.

Return visits within 72 hours of discharge from a pediatric ED appear overwhelmingly NOT to be related to the quality of care delivered.
Nasal balloon for otitis media with effusion (OME) 

A Subcommittee of the American Academies of Pediatrics (AAP),  Family Physicians (AAFP), and Otolaryngology-Head and Neck Surgery (AAO-HNS) have published clinical guidelines for the non-surgical management of the child with OME.

      In summary they include:
Otitis media in children
Otitis media in children

1.     Documenting side, duration and severity of symptoms at each assessment.
2.     Identify the child at risk for speech, language or learning problems and promptly evaluate the effect and need for intervention.
3.     For those not at risk for the above, manage with "watchful waiting" for 3 months from onset, and re-examine at 3-6 months' intervals until effusion is no longer present (or hearing loss or structural abnormalities are suspected).
4.     Test hearing if OME persists for >3 months or hearing loss, language problems or learning difficulties suspected.

A meta-analysis from 6 randomized control studies of nasal autoinflation in children to enhance effusion clearance suggests a benefit.

An open randomized control trial of 320 children aged 4-11 years with a confirmed effusion compared nasal autoinflation with a rubber nasal balloon (3 times/day for 3 months) to standard care. Significant improvement occurs by 1 month and continues for 3 months with no significant adverse effects.

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