LESSONS FROM A LARGE NATIONWIDE STUDY OF 350 CHILDREN WITH OVARIAN MATURE TERATOMA: A PLEA FOR OVARIAN-SPARING SURGERY

Objective Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10% to 20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed. This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. Design A retrospective review of all girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, follow-up second events and their management were retrieved. Results Overall, 350 children were identified. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: 8 cases including one malignant tumor, contralateral: 18 cases, both ovaries: 3 cases). A large palpable mass, bilateral forms at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas type of surgery or approach did not. Conclusion This study is a plea in favor of OSS as the first choice of treatment of OMT when possible. Close follow-up during the first five years is mandatory considering the risk of 8.3% of second events especially in cases with risk factors.

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Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02336-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yu Liu ◽

Chunjie Liu ◽

Dongmei Guo ◽

Ning Wang ◽

Ying Zhao ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Conservative Treatment ◽

Closed Reduction ◽

Pediatric Population ◽

Normal Weight ◽

Medical Community ◽

Overweight Children ◽

Radius Fractures

Abstract Background The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. Methods We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. Results In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320–3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169–3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975–5.421). Conclusions Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

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Treatment of Intramedullary Arteriovenous Malformations of the Spinal Cord

Interventional Neuroradiology ◽

10.1177/15910199000060s133 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 203-207 ◽

Cited By ~ 5

Author(s):

S. Ushikoshi ◽

K. Hida ◽

Y. Kikuchi ◽

Y. Iwasaki ◽

K. Miyasaka ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Malformations ◽

Radical Excision ◽

Arteriovenous Fistulas ◽

First Choice ◽

Choice Of Treatment ◽

Technical Complication ◽

Surgical Manipulation ◽

Residual Lesions

We retrospectively reviewed our treatment results for spinal intramedullary arteriovenous malformations (AVMs). Fifteen consecutive patients were included in this syudy. Five patient underwent particulate embolization. Surgery was performed in ten patients (including two patient who were treated embolization initially). Five patients, at the beginning of our experience, underwent radical excision of the nidus via the posterior myelotomy. Recent five patients underwent interruption of the feeding pedicles on the surface of the spinal cord. Especially when arteriovenous fistulas (AVFs) or aneurysms were demonstrated, accurate obliteration of them were performed. Four patients, including two with residual AVM after the surgery, underwent irradiation therapy. Anatomically, four AVMs disappeared completely and the other 11 patients have a residual lesions after the treatment. Clinically, three patients improved, six remained unchanged, and six worsened. The causes of neurological deterioration after the treatment were technical complication of embolization in one patient and surgical manipulation in five. There was no patient who experienced hemorrhage during the follow-up period ranged from 6 months to 17 years, with a mean of 7.5 years. In conclusion, particulate embolization should be considered as the first choice of treatment if feasible. Surgical treatment is indicated for the dangerous anatomical features such as AVFs or aneurysms.

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Management of Traumatized Permanent Maxillary Immature Incisor with Oblique Subgingival Crownroot Fracture

Mustansiria Dental Journal ◽

10.32828/mdj.v14i1.760 ◽

2018 ◽

Vol 14 (1) ◽

pp. 58

Author(s):

Dr. Muna S. Khalaf ◽

Dr. Bayan S. Khalaf ◽

Dr. Shorouq M. Abass

Keyword(s):

Treatment Approach ◽

Resin Cement ◽

Permanent Teeth ◽

Treatment Level ◽

Fiber Post ◽

Anterior Teeth ◽

First Choice ◽

Choice Of Treatment ◽

Root Fractures

Background: Trauma to the anterior teeth is a common injury in young children. Themaxillary incisors being the most affected. Although root fractures are rare, theydo occur and were previously and often considered hopeless and were extracted.The time between the injury and the initiation of treatment, level of the fractureline, and stage of root development are some criteria to be considered whenchoosing a treatment approach for a complicated tooth fracture. This case reportdescribes the management of a traumatized immature maxillary central incisorwith Elise class IV fracture with vertical oblique subgingival fracture of the root.Materials and method: Apexification was carried out using biodentine followed byremoval of the fractured segment. A fiber post was cemented in the root canalwith resin cement. The coronal portion of the tooth was restored using anteriorlight cured composite material. The tooth was examined and evaluated after 1week and after 2 months by clinical examination and radiographical evaluation ofroot development.Results: The follow up evaluation revealed clinical and radiographical success.Radiographic view showed continued development in the apex of the root andshowed normal periodontal ligament space and dense lamina dura.Conclusion: Extraction should not be the first choice of treatment for extensivelydamaged young permanent teeth in the anterior region; instead, alternativetreatment modalities must be considered. The traumatized immature tooth wassaved and restored.

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A multicenter Spanish study of atropine 0.01% in childhood myopia progression

Scientific Reports ◽

10.1038/s41598-021-00923-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Inés Pérez-Flores ◽

Beatríz Macías-Murelaga ◽

Jesús Barrio-Barrio ◽

Inés Pérez Flores ◽

Marta Valcárcel Vizcaíno ◽

...

Keyword(s):

Risk Factors ◽

Adverse Effects ◽

Pupil Diameter ◽

Pediatric Population ◽

Anterior Chamber Depth ◽

Eye Drops ◽

Myopia Progression ◽

Telephone Consultation ◽

Progression Risk

AbstractTo evaluate the efficacy and safety of atropine 0.01% eye drops for myopia control in a multicentric pediatric Spanish cohort. An interventional, prospective, multicenter study was designed. Children aged between 6 and 14 years, with myopia between − 2.00 D to − 6.00 D, astigmatism < 1.50 D and documented previous annual progression greater than − 0.5 D (cycloplegic spherical equivalent, SE) were included. Once nightly atropine 0.01% eye drops in each eye were prescribed to all participants for 12 months. Age, gender, ethnicity and iris color were registered. All patients underwent the same follow-up protocol in every center: baseline visit, telephone consultation 2 weeks later and office controls at 4, 8 and 12 months. At each visit, best-corrected visual acuity, and cycloplegic autorefraction were assessed. Axial length (AL), anterior chamber depth and pupil diameter were measured on an IOL Master (Carl Zeiss Meditec, Inc, Dublin, CA). Adverse effects were registered in a specific questionnaire. Mean changes in cycloplegic SE and AL in the 12 months follow-up were analyzed. SE progression during treatment was compared with the SE progression in the year before enrollment for each patient. Correlation between SE and AL, and annual progression distribution were evaluated. Progression risk factors were analyzed by multivariate logistic regression analyses. Of the 105 recruited children, 92 completed the treatment. Mean SE and AL changes were − 0.44 ± 0.41 D and 0.27 ± 0.20 mm respectively. Mean SE progression was lower than the year before treatment (− 0.44 ± 0.41 D versus − 1.01 ± 0.38 D; p < 0.0001). An inverse correlation between SE progression and AL progression (r: − 0.42; p < 0.0001) was found. Fifty-seven patients (62%) had a SE progression less than − 0.50 D. No risk factors associated with progression could be identified in multivariate analyses. Mean pupil diameter increment at 12-months visit was 0.74 ± 1.76 mm. The adverse effects were mild and infrequent, and decreased over the time. Atropine 0.01% is effective and safe for myopia progression control in a multicentric Spanish children cohort. We believe this efficacy might be extensible to the myopic pediatric population from Western countries with similar social and demographic features. More studies about myopia progression risk factors among atropine treated patients are needed.

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Evolution of treatment for children with esthesioneuroblastoma (1969–2019)

Head and neck tumors (HNT) ◽

10.17650/2222-1468-2021-11-3-56-71 ◽

2021 ◽

Vol 11 (3) ◽

pp. 56-71

Author(s):

A. D. Rodina ◽

A. S. Krylov ◽

T. V. Gorbunova ◽

V. A. Korolyov ◽

O. A. Merkulov ◽

...

Keyword(s):

Risk Factors ◽

Primary Tumor ◽

Pediatric Population ◽

Disease Onset ◽

Specific Treatment ◽

Special Treatment ◽

Cervical Lymph Nodes ◽

Tumor Dissemination ◽

Long Term Treatment

Introduction. Esthesioneuroblastoma is a rare neuroectodermal malignant tumor. The incidence of this tumor in children under 15 years of age is 0.1 per 100,000 pediatric population. The information on incidence, disease course, and treatment of esthesioneuroblastoma in children vary significantly and depend on the follow-up period and statistical methods.Objective – to assess risk factors for esthesioneuroblastoma and evaluate treatment strategies used in children and their prospects.Materials and methods. This study included 29 patients aged 2 to 17 years diagnosed with esthesioneuroblastoma and treated at the Research Institute of Oncology and Hematology, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russia between 1969 and 2019. The median age upon diagnosis was 10 years. Six patients (20 %) developed the disease early in their life (being under 3 years of age). Esthesioneuroblastoma was equally common in boys and girls. More than half of the patients (n = 15; 51 %) had stage IV disease. The primary tumor invaded the maxillary sinus (n = 25; 86 %), orbit (n = 10; 34 %), ethmoid sinus (n = 18; 62 %), and cranial cavity (n = 12; 41 %). The majority of children (n = 28; 96 %) received pharmacotherapy and radiotherapy (n = 27; 93 %); the total focal dose was 50 Gy in case of primary tumor. The affected cervical lymph nodes were irradiated in 10 (35 %) patients (total focal dose 40 Gy). Ten (35 %) patients have undergone surgery.Results. The follow-up period varied between 3 months and 50 years. Nine (34 %) patients are still alive. Fourteen patients (48 %) died due to tumor progression; 1 (3 %) patient died due to complications from special treatment. Five (17 %) patients were lost to follow-up at different stages.Conclusion. The following risk factors were associated with poor prognosis in children with esthesioneuroblastoma: disease onset in early childhood, no adequate diagnosis of distant metastases prior to specific treatment initiation, disseminated disease, and high Ki-67 index. In patients with advanced cancer, surgeries were effective only in combination with chemoradiotherapy. Long-term treatment outcomes in children with esthesioneuroblastoma are poor due to high risk of recurrence and tumor dissemination.

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Assessing the Risk Factors for Refractory Eosinophilic Esophagitis in Children and Adults

Gastroenterology Research and Practice ◽

10.1155/2019/1654543 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Erminia Ridolo ◽

Irene Martignago ◽

Irene Pellicelli ◽

Cristoforo Incorvaia

Keyword(s):

Risk Factors ◽

Food Allergy ◽

Eosinophilic Esophagitis ◽

Pediatric Population ◽

Statistical Significance ◽

Diagnostic Delay ◽

First Line ◽

Female Sex ◽

First Line Therapy

Background. Up to one-third of the patients suffering from eosinophilic esophagitis (EoE) present a refractory form, as defined by nonresponsiveness in clinical, endoscopic, or histological assessment after first-line therapy. Several studies recently investigated which factors can influence the development of this disease, but very few analyzed the factors underlying refractory EoE. Methods. Medical charts of patients affected by EoE were retrospectively evaluated. Phenotyping of patients was conducted according to demographic, clinical, histological, and treatment variables. Then, patients were divided into responder and nonresponder to therapy and distinguished among children and adults. Results. Forty-five children and 35 adult EoE patients were included. In the pediatric population, female sex (p<0.05) and a higher score of visual analogue scale (VAS) at the follow-up visit (p=0.02) were significantly associated to the risk of refractory EoE. Among adults, statistical significance was reached for years of follow-up (p=0.001), diagnostic delay (p=0.03), use of antibiotics during infancy (p=0.01), and food allergy (p=0.04). Conclusions. Our study highlighted female sex and a higher VAS score at the time of follow-up visits as risk factors for refractory EoE in children, while the risk factors in adults were identified as fewer years of follow-up, greater diagnostic delay, use of antibiotics during infancy, and food allergy.

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Symptoms, Vascular Anatomy and Endovascular Treatment of Spinal Cord Arteriovenous Malformations

Interventional Neuroradiology ◽

10.1177/15910199000060s132 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 199-202 ◽

Cited By ~ 5

Author(s):

Y. Niimi ◽

A. Berenstein ◽

A. Setton ◽

J. Pryor

Keyword(s):

Spinal Cord ◽

Endovascular Treatment ◽

Retrospective Analysis ◽

Arteriovenous Malformations ◽

Vascular Anatomy ◽

Provocative Test ◽

First Choice ◽

Complete Obliteration ◽

Choice Of Treatment

The purpose of this study is to evaluate the symptoms, anatomy and efficacy of embolization of spinal cord AVMs (SCAVMs). We performed retrospective analysis of 108 SCAVMs consisting of 38 pediatric and 70 adult cases. They included 81 nidus (26 pediatric) and 27 fistulous (12 pediatric) AVMs. Hemorrhage occurred in 74% of pediatric and 62% of adult cases with multiple hemorrhages in 54% of pediatric and 42% of adult cases. Fistulous AVMs hemorrhaged more frequently in children than adults (75% vs. 13%). 75 cases were treated with embolization alone, 10 with surgery and embolization, 2 with embolization following radiation and 12 with surgery alone. 9 patients received no treatment. In 79 of 87 embolized patients, acrylic was utilized either alone (49) or in combination (30) with other materials. Embolization was attempted 156 times in 93 patients. Complete obliteration by embolization was obtained in 17 cases. If complete obliteration was not possible, partial targeted embolization was performed, aiming at dangerous anatomic structures such as aneurysms. During the follow-up period (mean: 34 months), hemorrhage was observed in only 2 cases. Although technical complications such as dissection or vasospasm occurred on 19 occasions, only 4 resulted in aggravation of neurological symptoms. Of the 21 sessions in which worsening of symptoms occurred after embolization, 10 resulted in permanent deficits and eight of these occurred prior to 1990. SCAVMs have a poor functional prognosis due to frequent hemorrhage if untreated. Embolization with acrylic is feasible as the first choice of treatment. Provocative test and electrophysiological monitoring have improved safety. Partial targeted embolization is effective in preventing hemorrhage.

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ACUTE MYOCARDITIS IN THE MAGNETIC RESONANCE IMAGING ERA: PATIENT’S CHARACTERISTICS AND MID-TERM FOLLOW-UP.

Brazilian Journal of Medicine and Human Health ◽

10.17267/2317-3386bjmhh.v1i2.175 ◽

2013 ◽

Vol 1 (2) ◽

Author(s):

Carma Karam ◽

Ali Alghamdi ◽

Nicolas Mansencal ◽

Stephen Binsse ◽

Pascal Lacombe ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Magnetic Resonance ◽

Cardiac Troponin ◽

Acute Myocarditis ◽

Myocardial Inflammation ◽

Coronary Angiogram ◽

First Choice ◽

Wide Range

Background: Myocarditis is an inflammation of myocardial tissue that presents with a wide range of symptoms. Cardiovascular magnetic resonance (CMR) has become the first choice of non-invasive assessment of myocardial inflammation in suspected pts. Aims: The aim of this study was to report clinical, paraclinical and follow up data observed in pts with acute myocarditis confirmed by CMR in a single center. Methods: We retrospectively studied27 pts admitted for acute myocarditis between November 2010 and November 2012. All pts had ECG, echocardiography and CMR. Ultrasensitive cardiac troponin and CRP were measured. Coronary angiogram was performed in case of acute myocardial infarction-like syndrome or in the presence of CV risk factors. We reviewed the files of the hospital out-patient clinic and contacted the pts or their cardiologists by phone for those followed outside the hospital. Results: There were 23 males (85.2%) and 4 females, aged 36 ± 19 yrs. ST elevation was found in17 pts (62.9%). All had elevated cardiac troponin. Echocardiography showed abnormalities of wall motion in16 pts (59.2%). Mean LVEF on CMR was 53.96 ± 9.9% and late gadolinium enhancement was in lateral in 80%, in inferior in 10% and anterior or apical wall in 10%. Coronary angiogram was normal, performed in14 pts (51.8%). Complications included VT in4 pts (14.8 %), AF in 2, and cardiac tamponade in 1. Follow-up was obtained for23 pts (85%).One died for pulmonary embolism on lung cancer. All others had a favorable evolution. Conclusion: Our study showed that myocarditis affects in majority young and male patients. CMR appears as the main modality of diagnosis. Coronary angiogram is mandatory in case of CV risk factors and/or myocardial infarction-like presentation. Evolution is often favorable. Optimal medical therapy is still to be defined. Pts can be considered as cured in the absence of chest pain and in case of normalization of echocardiography and/or CMR at follow-up.

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Immediate Therapeutic Outcomes and Medium Term Follow up Results of Percutaneous Balloon Pulmonary Valvuloplasty in Pulmonary Valve Stenosis in the Pediatric Population

10.22541/au.162250252.22271375/v1 ◽

2021 ◽

Author(s):

Dan Yin ◽

Xiaoyun Wu ◽

Ping Xiang ◽

Yu Zhang ◽

Jie Tian ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Valve ◽

Pediatric Population ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Stenosis ◽

Medium Term ◽

Residual Stenosis ◽

Percutaneous Balloon ◽

Therapeutic Outcomes

Percutaneous balloon pulmonary valvuloplasty is a preferred treatment in pulmonary valve stenosis children with higher success rate. It is important to study the risk factors of postoperative severe pulmonary regurgitation, residual stenosis, and re-stenosis.

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Complementary Effects of Multivitamin and Omega-3 Fatty Acid Supplementation on Indices of Cardiovascular Health in Individuals with Elevated Homocysteine

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000093 ◽

2012 ◽

Vol 82 (1) ◽

pp. 41-52 ◽

Cited By ~ 5

Author(s):

P. Earnest ◽

S. Kupper ◽

M. Thompson ◽

Guo ◽

S. Church

Keyword(s):

Risk Factors ◽

Cardiovascular Health ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

C Reactive Protein ◽

Fatty Acid Supplementation ◽

Omega 3 Fatty Acid ◽

Reactive Protein ◽

Daily Ingestion

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.

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