Medicine and Health Sciences Commons^™

Wire Guided Cannulation Facilitates Endoscopic Management Of Buried Bumper Syndrome: A Novel Technique, Jacquelin Peck, Kaitlin Sapp, Alexander Wilsey, Michael Wilsey

Pediatrics Faculty Publications

Buried bumper syndrome is a rare but potentially severe complication of percutaneous endoscopic gastrostomy tube insertion. Though this complication is uncommon, it may lead to pressure necrosis, bleeding, perforation, peritonitis, sepsis, or death. Each case of buried bumper syndrome is unique in terms of patient comorbidities and anatomic positioning of the buried bumper. For this reason, many approaches have been described in the management of buried bumper syndrome. In this case report, we describe the case of an adolescent Caucasian female who developed buried bumper syndrome three years after undergoing percutaneous endoscopic gastrostomy insertion. We review diagnosis and management of …

Down The Rabbit Hole-Considerations For Ingested Foreign Bodies, Jerry Brown, Molly Kidder, Abigail Fabbrini, Jonathan Devries, Jason Robertson, Nicole Chandler, Michael Wilsey

Pediatrics Faculty Publications

We report the case of a seven-year-old boy with an ingested foreign body, which was retained within the appendix for a known duration of ten months, ultimately requiring appendectomy. The ingested foreign body was incidentally discovered by abdominal x-ray at an emergency room visit for constipation. Despite four bowel cleanouts, subsequent x-rays showed persistence of the foreign body in the right lower quadrant. While the patient did not have signs or symptoms of acute appendicitis, laparoscopic appendectomy was performed due to the risk of this foreign body causing appendicitis in the future. A small metallic object was found within the …

Lamotrigine Odt-Induced Seizure In A 3-Year-Old Child After Accidental Ingestion, Ashley Griswold, Briana Tully, Kenneth Katz, Gillian Beauchamp, Matthew Cook, Robert Cannon

Pediatrics Faculty Publications

Lamotrigine is a new generation antiepileptic which blocks sodium channels and can cause significant toxicity in overdose. A case of a three-year-old child who suffered a seizure and required endotracheal intubation after accidental lamotrigine ingestion is presented. The lamotrigine concentration measured 23.2 mcg/mL which is the highest reported after accidental pediatric exposure. A review of the literature regarding pediatric lamotrigine poisoning is also included.

D-Cycloserine-Augmented One-Session Treatment Of Specific Phobias In Children And Adolescents, Lara J. Farrell, Allison M. Waters, Ella L. Oar, Evelin Tiralongo, Vinay Garbharran, Clair Alston-Knox, Harry Mcconnell, Nigel Collings, Melanie Zimmer-Gembeck, Caroline L. Donovan, Chris Testa, Eric A. Storch, Thomas H. Ollendick

Pediatrics Faculty Publications

Background: D-Cycloserine has potential to enhance exposure therapy outcomes. The current study presents a preliminary randomized, placebo-controlled double-blind pilot trial of DCS-augmented one-session treatment (OST) for youth (7–14 years) with specific phobia. A secondary aim of this pilot study was to explore the effects of youth age and within-session fear reduction as potential moderators of DCS outcomes in order to generate hypotheses for a larger trial. It was hypothesized that DCS would be associated with greater improvements than placebo, that children (7–10 years) would have greater benefits than adolescents (11–14 years), and that DCS effects would be stronger for participants …

Two Unrelated Patients With Autosomal Dominant Omodysplasia And Frizzled2 Mutations, Hannah E. Warren, Raymond J. Louie, Michael J. Friez, Jaime L. Frías, Jules G. Leroy, Jürgen W. Spranger, Steven A. Skinner, Neena L. Champaigne

Pediatrics Faculty Publications

No abstract provided.

Necrotizing Fasciitis Secondary To Aeromonas Infection Presenting With Septic Shock, Nikhil Bhatia, Manuel Castro-Borobio, John N. Greene, Sowmya Nanjappa

Pediatrics Faculty Publications

This report describes a case of necrotizing fasciitis presenting with septic shock due to an Aeromonas infection. The patient cut his foot while mowing the lawn and then spent time in a pool with black mold. He began feeling ill and developed swelling and a quarter-sized black area on his right lower extremity. Despite being hemodynamically unstable with systolic blood pressure in the low 70s, the patient was transferred to our facility from outside hospital 100 miles away. Upon arriving to facility, the patient appeared to be septic and the infected area of skin had grown. Irrigation and debridement were …

Three Year Old Male With Multiple Dieulafoy Lesions Treated With Epinephrine Injections Via Therapeutic Endoscopy, Christina L. Baldwin, Michael Wilsey

Pediatrics Faculty Publications

Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the …

Four-Month-Old Infant With Intussusception Presenting As Altered Mental Status, Luis Maldonado, Jennifer Takagishi

Pediatrics Faculty Publications

Objective: To remind pediatric care providers that an altered mental status can be the only presenting symptom for intussusception, a life-threatening diagnosis.

Method: A case report that presents a unique presentation of intussusception: a 4-month old boy with neurological findings after a reported head injury.

Conclusion: Diagnosis of intussusception in the pediatric population is highly dependent on its classical presenting signs and symptoms: sudden severe colicky abdominal pain, vomiting, and an abdominal mass in children between 3 months and 6 years of age. Consider that an altered mental status can be the only presenting symptom.

Hyperparathyroidism Two Years After Radioactive Iodine Therapy In An Adolescent Male, Danielle L. Gomez, Dorothy I. Shulman

Pediatrics Faculty Publications

Primary hyperparathyroidism is a very rare complication following radioactive iodine therapy. There is typically a latency period of more than a decade following radiation exposure and, therefore, it is observed almost exclusively in adults. Consequently, pediatricians are not aware of the association. We present a case of primary hyperparathyroidism due to a solitary parathyroid adenoma occurring in an adolescent male two years following radioactive iodine treatment for papillary thyroid carcinoma. Periodic screening of serum calcium following ablative doses of radioactive iodine for thyroid cancer may be justified even in adolescents.

Plac1 Expression Decreases In Chorionic Villi In Response To Labor, Yahdira M. Rodriguez-Prado, Xiaoyuan Kong, Michael E. Fant

Pediatrics Faculty Publications

PLAC1 (Placenta-Specific 1) is a recently described, trophoblast-expressed gene essential for normal placental development. The protein localizes to the microvillus membrane surface of the syncytiotrophoblast in direct proximity to the maternal compartment. Although its role has not been defined, increased circulating levels of human PLAC1 mRNA in maternal blood are associated with preeclampsia. Furthermore, PLAC1-null mice exhibit decreased viability in the peripartum period suggesting a role in pregnancy maintenance late in gestation. We examined PLAC1 gene expression in the human placenta during normal pregnancy and pregnancies associated with maternal diabetes and preeclampsia using quantitative, real time PCR (q-RT-PCR). Although …

Neuromyelitis Optica In Child: Diagnostic And Therapeutic Challenges, Karolina Dembinski, Maria Gieron-Korthals, Carlos R. Martinez, Lisa Rodriguez

Pediatrics Faculty Publications

Neuromyelitis optica (NMO) is a rare syndrome of severe inflammatory demyelination of the central nervous system, causing attacks of optic neuritis and transverse myelitis. Although uncommon, attention should be given to the proper identification and management of the affected patients. We present a case of a 13-year-old girl with severe neuromyelitis optica. The patient’s initial presentation consisted of encephalopathy and optic neuritis. Approximately 2 months later, coinciding with the weaning of steroid treatment, she presented with ascending paralysis and respiratory failure. She was seropositive for NMO-IgG. Treatment included intravenous immune globulin, steroids, plasmapheresis, and rituximab and was complemented with proper …

Complex Cytogenetic Rearrangements At The Durs1 Locus In Syndromic Duane Retraction Syndrome, Hagit N. Baris, Wai-Man Chan, Caroline Andrews, Doron M. Behar, Diana J. Donovan, Cynthia C. Morton, Judith Ranells, Tuya Pal, Azra H. Ligon, Elizabeth C. Engle

Pediatrics Faculty Publications

No abstract provided.

Methicillin-Resistant Staphylococcus Aureus Infections In Human Immunodeficiency Virus-Infected Children And Adolescents, George K. Siberry, Toni Frederick, Patricia Emmanuel, Mary E. Paul, Beverly Bohannon, Travis Wheeling, Theresa Barton, Mobeen H. Rathore, Kenneth L. Dominguez

Pediatrics Faculty Publications

Background. Methicillin-resistant Staphylococcus aureus (MRSA) infection incidence has increased in healthy US children. Our objective was to evaluate MRSA incidence and correlates in HIV-infected youth. Methods. The CDC-sponsored LEGACY study is a US multicenter chart abstraction study of HIV-infected youth. We identified MRSA infections among participants with ≥1 visit during 2006. We used bivariate and multivariable analyses to compare sociodemographic and HIV clinical factors between MRSA cases and noncases. Results. Fourteen MRSA infections (1 invasive, 12 soft tissue, 1 indeterminate) occurred among 1,813 subjects (11.1 infections/1,000 patient-years (PY), 95% CI: 11.06–11.14). Most (86%) isolates were clindamycin susceptible. …

Development And Characterization Of Anti-Nitr9 Antibodies, Radhika N. Shah, Ivan Rodriguez-Nunez, Donna D. Eason, Robert N. Haire, Julien Y. Bertrand, Valērie Wittamer, David Traver, Shila K. Nordone

Pediatrics Faculty Publications

The novel immune-type receptors (NITRs), which have been described in numerous bony fish species, are encoded by multigene families of inhibitory and activating receptors and are predicted to be functional orthologs to the mammalian natural killer cell receptors (NKRs). Within the zebrafish NITR family, nitr9 is the only gene predicted to encode an activating receptor. However, alternative RNA splicing generates three distinct nitr9 transcripts, each of which encodes a different isoform. Although nitr9 transcripts have been detected in zebrafish lymphocytes, the specific hematopoietic lineage(s) that expresses Nitr9 remains to be determined. In an effort to better understand the role of …

Mentorship Programs For Faculty Development In Academic General Pediatric Divisions, Jennifer Takagishi, Sharon Dabrow

Pediatrics Faculty Publications

Introduction. Mentoring relationships have been shown to support academicians in areas of research, work/life balance, and promotion. Methods. General pediatric division chiefs accessed an electronic survey asking about mentorship relationships, their ability to create a mentorship program, and resources needed. Results. Dyadic mentorship programs were available at 53% of divisions. Peer mentorship programs were available at 27% of divisions. Overall, 84% of chiefs believed that dyadic mentorship would benefit their faculty. 91% of chiefs believed that peer mentorship would benefit their faculty. Chiefs were interested in starting peer (57%) or dyadic (55%) mentorship programs. Few divisions had …

Isoniazid-Induced Severe Hepatotoxicity: An Infrequent But Preventable Cause Of Liver Failure In Children Treated For Latent Tuberculosis Infection, Dan Desrochers, Regino P. González-Peralta, Daniel T. Mcclenathan, Michael J. Wilsey Jr, Allah Haafiz

Pediatrics Faculty Publications

Isoniazid (INH) monotherapy has gained widespread acceptance as an efficacious therapy for latent tuberculosis infection (LTBI) especially in low-prevalence settings. Although INH related hepatotoxicity is well recognized, progression to severe liver dysfunction requiring care at a transplant center remains unpredictable. We report the management of a five year-old girl who developed progressive liver failure due to INH prophylaxis. This highlights the potential severity of INH related hepatic injury and underscores the significance of vigilant clinical monitoring throughout the duration of the therapy in children.

Late-Presenting Left-Sided Morgagni Congenital Diaphragmatic Hernia In A 9-Year-Old Male, Jennifer M. Kim, Marisa Couluris, Bruce M. Schnapf

Pediatrics Faculty Publications

Congenital diaphragmatic hernias are common, primarily occurring through the foramen of Bochdalek. However, in contrast, defects through the foramen of Morgagni are much more rare. When late presentations occur, patients may be asymptomatic or may be critically ill with respiratory and gastrointestinal symptoms. In this paper, we present a 9-year-old male who presented with recurrent, vague abdominal pain, and a previously normal abdominal CT scan. Initial investigation via an abdominal radiograph demonstrated an unexpected left lower lobe abnormality. Further evaluation and management revealed this abnormality to be an unusual left-sided congenital diaphragmatic hernia that appeared through the retrosternal foramen of …

Mesalamine-Induced Myocarditis And Coronary Vasculitis In A Pediatric Ulcerative Colitis Patient: A Case Report, Elimarys Perez-Colon, Gul H. Dadlani, Ivan Wilmot, Michelle Miller

Pediatrics Faculty Publications

Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function …

Circulating Anti-Plac1 Antibodies During Pregnancy And In Women With Reproductive Failure: A Preliminary Analysis, Anne C. Kotto-Kome, Celso Silva, Valerie Whiteman, Xiaoyuan Kong, Michael E. Fant

Pediatrics Faculty Publications

The aims of this study were to determine the prevalence of anti-PLAC1 antibodies in normal pregnant women and in women with infertility or recurrent pregnancy loss (RPL). Secondary outcomes were the development of complications associated with anti-PLAC1 seropositivity and the rate of seroconversion during pregnancy. Sera from 103 healthy pregnant women and 45 women with unexplained infertility or RPL were analyzed by ELISA. The prevalence of anti-PLAC1 antibodies was 2% in healthy pregnant women and 4.5% in women with unexplained infertility or RPL (𝑃 = 0 . 3 5 5). There was no detectable association of seropositivity with increased risk …