Tube Shunt Related Complications in Pediatrics

2013 ◽  
Author(s):  
Megan M. Geloneck ◽  
Robert M. Feldman
Keyword(s):  
Anterior Chamber ◽  
Therapeutic Option ◽  
Pediatric Population ◽  
Adult Population ◽  
Insertion Site ◽  
Young Patients ◽  
Integral Role ◽  
Tube Migration ◽  
Tube Malposition ◽  
Tube Shunt

Although medical therapy is usually an excellent therapeutic option in the adult population, in children it is often ineffective or associated with an undesirable risk:benefit ratio. Therefore, surgical intervention is frequently required for adequate control of glaucoma in young patients. The initial surgical approach for management of glaucoma in children includes goniotomy and trabeculotomy, each with a high success rate. When these interventions fail or have a high likelihood of failure (i.e., in patients with Sturge-Weber syndrome, aniridia, anterior chamber dysgenesis, or congenital glaucoma), tube shunt procedures are often required. Tube shunts were first used in the pediatric population by Molteno and colleagues in 1973 and have since grown in popularity and secured an integral role in the treatment of refractory glaucoma in infants and children. Possible complications and causes for failure of tube shunt devices in children are very similar to those in adults; however, issues such as tube migration and retraction must be anticipated in the child’s growing eye. One of the most frustrating, and unfortunately the most common, complications is tube malposition. While tube malposition is not entirely specific to the pediatric population, it occurs far more frequently in children than in adults. (See Chapter 30 for information about tube malposition in adults.) Incidence of tube malposition in pediatric patients ranges from 3% to 35%. In infants and young children, the tube tends to retract from the eye and/or migrate towards the cornea in the anterior chamber. The initial presentation of tube migration is often tube-cornea touch at the proximal end of the tube near the insertion site. In severe cases, tube migration can lead to transcorneal extrusion of the tube. Secondary complications, including corneal decompensation, cataract, iris abnormalities, and endophthalmitis, can result from these initial insults if tube malposition is not identified early and appropriately addressed. The cause of tube migration and retraction is likely multifactorial, but there are 2 basic mechanisms thought to be at fault: 1) somatic growth causing concomitant tube migration and 2) elasticity of the buphthalmic eye, allowing shrinkage as intraocular pressure (IOP) decreases and tube straightening due to “memory.”

scholarly journals Correction to: Retrobulbar tube shunt: anterior chamber to back of the eye (A2B) efficacy in glaucomatous eyes with uncontrolled IOP

2021 ◽  
Vol 259 (3) ◽  
pp. 801-801
Author(s):  
Mario Montelongo ◽  
Francesc March de Ribot ◽  
Earl Randy Craven ◽  
William Eric Sponsel
Keyword(s):  
Anterior Chamber ◽  
Tube Shunt

scholarly journals Kaposiform Hemangioendothelioma: clinicopathological characteristics of 8 cases of a rare vascular tumor and review of literature

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qurratulain Chundriger ◽  
Muhammad Usman Tariq ◽  
Jamshid Abdul-Ghafar ◽  
Arsalan Ahmed ◽  
Nasir Ud Din
Keyword(s):  
Pediatric Population ◽  
Adult Population ◽  
Correct Diagnosis ◽  
Kaposi Sarcoma ◽  
Minor Component ◽  
Vascular Tumor ◽  
Giant Cells ◽  
Clinicopathological Characteristics ◽  
Multinucleated Giant Cells ◽  
Kaposiform Hemangioendothelioma

Abstract Background Kaposiform Hemangioendothelioma (KHE) is a rare vascular tumor of intermediate malignant potential which shows locally aggressive growth but only rarely metastasizes. It is mostly considered to be a tumor of pediatric population but its occurrence in the adults is not uncommon as once considered. Histologically, KHE can mimic other soft tissue neoplasms of different behaviors (e.g. Kaposi Sarcoma, hemangioma) and establishing the correct diagnosis is important for appropriate treatment. Herein, we describe the clinicopathological features of 8 cases of KHE which will be helpful in making their diagnosis. Methods We reviewed pathology reports, microscopy glass slides and obtained follow up information about 8 cases of KHE which were diagnosed at our institution from January 2008 till June 2020. Immunohistochemical stain for HHV8 was also performed. Results Age ranged from 7 months to 25 years. Seven patients were less than 20 years of age and one patient was 25 years old. Equal gender distribution was observed. Extremities were the most common sites of involvement, followed by head and neck, pancreas and ischiorectal region. 2 cases were resection specimen and all others were incisional biopsies. The largest tumor size was 5.5 cm in one of the resections. The incisional/fragmented tissues were all less than 5 cm in aggregate. Most cases showed predominance of nodular growth and a minor component of spindle cell population along with lymphangiomatosis like vascular channels, with evidence of microthrombi in 2 cases. Few multinucleated giant cells were observed in 2 cases. None of the cases exhibited significant nuclear atypia or mitotic activity. One of the cases arising in dermis showed underlying bone involvement. HHV8 was negative in 7/7 cases. Conclusions KHE can also involve adult population and it should always be considered in the differential diagnoses of a vascular lesion. Presence of multinucleated giant cells is a rare finding. Knowledge about histological features and potential mimics is helpful in avoiding misdiagnosis.

Pediatric Lung Transplantation: Perspectives for the Pathologist

2008 ◽  
Vol 11 (2) ◽  
pp. 85-105 ◽  
Author(s):  
Megan K. Dishop ◽  
George B. Mallory ◽  
Frances V. White
Keyword(s):  
Lung Transplantation ◽  
Pediatric Population ◽  
Adult Population ◽  
Bronchiolitis Obliterans Syndrome ◽  
Pulmonary Vascular Disease ◽  
Pathologic Evaluation ◽  
Routine Surveillance ◽  
Pediatric Pathologist ◽  
Future Challenges ◽  
Cellular Rejection

Lung transplantation offers life-saving and life-extending treatment for children and adolescents with congenital and acquired forms of pulmonary and pulmonary vascular disease, for whom medical therapy is ineffective or insufficient for sustained response. This review summarizes the pathology related to lung transplantation for the practicing pediatric pathologist and also highlights aspects of lung transplantation unique to the pediatric population. Clinical issues related to availability of organs, candidate eligibility, surgical technique, and postoperative monitoring are discussed. Pathologic evaluation of routine surveillance transbronchial biopsies requires attention to acute cellular rejection, opportunistic infection, and other forms of acute and resolving lung injury. These findings are correlated in some cases with endobronchial biopsies and bronchoalveolar lavage as adjunctive tools in surveillance. Open or thoracoscopic biopsies also have diagnostic utility in cases with acute or chronic graft deterioration of uncertain etiology. Future challenges in pediatric lung transplantation are similar to those in the adult population, with continued efforts focused on prolonging graft survival, prevention of bronchiolitis obliterans syndrome due to chronic cellular rejection, and evaluation of humoral rejection.

scholarly journals MR-Proadrenomedullin as biomarker of renal damage in urinary tract infection in children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rafael Peñalver Penedo ◽  
Marta Rupérez Lucas ◽  
Luis Antonio Álvarez-Sala Walther ◽  
Alicia Torregrosa Benavent ◽  
María Luisa Casas Losada ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Roc Curves ◽  
Renal Scintigraphy ◽  
Reactive Protein ◽  
Sensitivity Specificity

Abstract Background Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. Methods A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. Results 62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66–1.59), while in patients without RS were 0.48 nmol/L (0.43–0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77–0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. Conclusion MR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction.

High frequency of otolaryngology/ENT encounters in Canadian primary care despite low medical undergraduate

2021 ◽  
Author(s):  
Brendan Sorichetti ◽  
Julie Pauwels ◽  
Thomas Jacobs ◽  
Neil Chadha ◽  
Emelie Kozak ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Primary Care Physicians ◽  
Pediatric Population ◽  
Adult Population ◽  
Care Facility ◽  
Symptom Presentation ◽  
Undergraduate Medical Students ◽  
Related Symptom ◽  
Medical Undergraduate

Otolaryngology involves the treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. Many medical students in Canada have limited experiences in ENT and a vast majority of these students go on to pursue a career as primary care physicians. Physicians at a primary care facility classified patient’s visits as either being “ENT” related or not, to assess the amount of ENT related concerns they typically encounter. The data was collected separately in the summer and winter months to assess any seasonal variability. One in eight patient encounters presented with an ENT related concern. The percentage of ENT related symptom presentation visits in the pediatric population for both data collection periods (29%) was more than three times that of the adult population (9%). The rate of ENT symptom presentation in both adult and pediatric populations was not affected by seasonality. Primary care physicians will encounter new patients presenting with ENT related concerns quite frequently. This is especially true in the pediatric patient population. Increased ENT medical education is both necessary and essential for undergraduate medical students, residents, and primary care physicians.

Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population

2021 ◽  
Vol 25 (01) ◽  
pp. 068-081
Author(s):  
Grzegorz Pracoń ◽  
Maria Pilar Aparisi Gómez ◽  
Paolo Simoni ◽  
Piotr Gietka ◽  
Iwona Sudoł-Szopińska
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Juvenile Dermatomyositis ◽  
Pediatric Population ◽  
Connective Tissue Diseases ◽  
Young Patients ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Disease Monitoring ◽  
Juvenile Scleroderma

AbstractJuvenile idiopathic arthritis is the most frequent rheumatic disease in the pediatric population, followed by systemic lupus erythematosus, juvenile scleroderma syndromes, juvenile dermatomyositis, chronic recurrent multifocal osteomyelitis, and juvenile vasculopathies. The imaging approach to inflammatory connective tissue diseases in childhood has not changed dramatically over the last decade, with radiographs still the leading method for bony pathology assessment, disease monitoring, and evaluation of growth disturbances. Ultrasonography is commonly used for early detection of alterations within the intra- and periarticular soft tissues, assessing their advancement and also disease monitoring. It offers several advantages in young patients including nonionizing radiation exposure, short examination time, and high resolution, allowing a detailed evaluation of the musculoskeletal system for the features of arthritis, tenosynovitis, enthesitis, bursitis, myositis, as well as pathologies of the skin, subdermis, vessels, and fasciae. In this pictorial essay we discuss radiographic and ultrasound inflammatory features of autoimmune pediatric inflammatory arthropathies: juvenile idiopathic arthritis, lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis and polymyositis.

scholarly journals Primary Cardiac Fibroma in an Adult

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Samuel H. Cho ◽  
Timothy Fritz ◽  
Lynn J. Cronin ◽  
Stephen D. Cohle
Keyword(s):  
Connective Tissue ◽  
Left Ventricle ◽  
Pediatric Population ◽  
Adult Population ◽  
Surgical Excision ◽  
Imaging Modalities ◽  
Cardiac Fibroma ◽  
Primary Tumors ◽  
Immunohistological Analysis ◽  
Unusual Finding

Cardiac fibromas are benign primary tumors composed of connective tissue and fibroblasts. These uncommon tumors are primarily found in the pediatric population, and their prevalence among the adult population is exceedingly rare. We report a case of an adult with nonspecific symptoms, who was subsequently found to have a solitary mass located in the left ventricle. This case highlights an unusual finding in an adult who through various imaging modalities, surgical excision, and immunohistological analysis was found to have a cardiac fibroma.

Anterior Chamber Tube Shunt to an Encircling Band in the Treatment of Neovascular Glaucoma and other Refractory Glaucomas

Ophthalmology ◽  
1985 ◽  
Vol 92 (4) ◽  
pp. 553-562 ◽  
Author(s):  
Stanley S. Schocket ◽  
Verinder S. Nirankari ◽  
Vinod Lakhanpal ◽  
Richard D. Richards ◽  
Brian C. Lerner
Keyword(s):  
Anterior Chamber ◽  
Neovascular Glaucoma ◽  
Encircling Band ◽  
Tube Shunt

scholarly journals Epidemiological and Clinical-Pathological Aspects of Helicobacter pylori Infection in Brazilian Children and Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Evelyn Pedroso Toscano ◽  
Fernanda Fernandes Madeira ◽  
Mayra Pinheiro Dutra-Rulli ◽  
Luiz Otavio Maia Gonçalves ◽  
Marcela Alcântara Proença ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Population ◽  
Adult Population ◽  
Developed Countries ◽  
Upper Gastrointestinal Endoscopy ◽  
Only Children ◽  
Screening Programs ◽  
Adolescents And Adults ◽  
H Pylori ◽  
Over 40 Years

Aim. To evaluate the prevalence and risk factors of H. pylori infection in the pediatric and adult population seen at a public hospital in São José do Rio Preto, SP, Brazil. Methods. This is a retrospective study that evaluated 2406 medical records of children, adolescents, and adults with dyspeptic symptoms who underwent upper gastrointestinal endoscopy. H. pylori diagnosis and demographic and clinical-pathological features were recorded. Results. A total of 852 subjects were H. pylori positive, with an overall prevalence of infection of 35.4%, occurring mainly in adults over 40 years of age, and a 24.7% prevalence considering only children and adolescents. No association was observed between H. pylori infection and risk factors. However, the H. pylori positive individuals showed a higher frequency of pangastritis (p<0.01), severe lesions (p=<0.001), and erosive lesions (p=0.04). The bacterium was eradicated in 83.5% (127) of the patients who received the standard therapy. Conclusions. The prevalence of H. pylori detected in a public service in São José do Rio Preto, SP, Brazil, is as expected for developed countries, showing growing rates with increasing age. As H. pylori infection occurs during childhood, screening programs for detection and prevention in the pediatric population are important to reduce the prevalence of this infection in adults.

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