Pediatric incidental brain tumors: a growing treatment dilemma

Object Rising numbers of MRI studies performed during evaluations for pediatric disorders have contributed to a significant increase in the number of incidentally found brain tumors. Currently, there is very little literature on the nature of and the preferred treatment for these incidental brain tumors. In this paper the authors review their experience diagnosing and treating these lesions in children as well as the current literature on this topic. Methods Records from 2 centers were reviewed for incidentally found brain tumors, treatment approaches, and outcomes for both surgical and nonsurgical cohorts. Results Forty-seven children (30 males and 17 females) with a mean age of 8.6 years were found to have incidental brain lesions suspected to be neoplasms. Twenty-five underwent surgery and 22 were observed. Two children in the observation group required surgery at a later stage. Tumor pathology in 24 patients was benign. Only 3 patients had high-grade tumors. All nonsurgically treated lesions were presumed to be low-grade tumors and were followed up for 25 ± 20 months. Conclusions The discovery of incidental brain tumors on MRI in children poses an increasing challenge. Additional studies are needed to determine the significance as well as the optimal management strategies in this situation.     

Pediatric seizures and their management in the emergency department

Seizures result from paroxysmal involuntary disturbance of brain function. The history and physical examination guide to management, and will help to differentiate seizures from non-epileptic disorders. The studies needed depend on the child’s age, presence or absence of fever, the duration of seizure activity, and clinical examination. Afebrile seizures in children older than 6 months of age require minimal investigation, while younger children are more likely to have an electrolyte abnormality or hypoglycemia that requires treatment in the emergency department. Children with febrile seizures are not at high risk for serious bacterial illness and routine diagnostic evaluation of simple febrile seizures is not indicated. Anti-epileptic drugs should not be routinely initiated in the emergency department in children whose seizures have resolved. We review the management of status epilepticus in this paper.     

Biological consequences of cancer and its treatment and their relationship to current treatment planning

Advances in the treatment of childhood cancer have produced dramatic changes in survival. Unfortunately, many of the advances associated with this improvement have been accompanied by delayed sequelae induced by treatments such as surgery, radiotherapy, and chemotherapy. This article reviews published reports of treatment sequelae and examines their impact on the design of current forms of treatment. Recognition of the delayed effects of these treatment modalities has resulted in alterations in established therapies. This alteration is an ongoing process and demonstrates the concern of physicians with improving quality of life for long-term survivors of childhood cancer.     

Pediatric obesity: etiology and treatment

This article reviews factors that contribute to excessive weight gain in children and outlines current knowledge regarding approaches for treating pediatric obesity. Most of the known genetic causes of obesity primarily increase energy intake. Genes regulating the leptin signaling pathway are particularly important for human energy homeostasis. Obesity is a chronic disorder that requires long-term strategies for management. The foundation for all treatments for pediatric obesity remains restriction of energy intake with lifestyle modification. There are few long-term studies of pharmacotherapeutic interventions for pediatric obesity. Bariatric surgical approaches are the most efficacious treatment but, because of their potential risks, are reserved for those with the most significant complications of obesity.     

Pediatric choledochal cysts: diagnosis and current management

Choledochal cysts are rare congenital disorders first described by Vater and Ezler in 1723. Their exact etiology remains incompletely understood; however, an anomalous pancreaticobiliary union (APBDU) and subsequent reflux of biliary contents into the biliary tree are thought to play a role. Accordingly, APBDU-associated choledochal cyst patients are significantly more likely to have evidence of hepatitis, cholangitis or pancreatitis and pathologically confirmed inflammation. In 1977, Todani and colleagues modified the original Alonso-Lej classification to include five types of CC. Type I and IV are the most common and most likely to be associated with malignancy. The majority of choledochal cysts are diagnosed in childhood. Clinical presentation varies and most often consists of nonspecific abdominal pain. Diagnosis is typically accomplished using multimodality imaging techniques including computed tomography, magnetic resonance imaging, ultrasound and MRCP. The use of diagnostic PTC and ERCP in CC has been largely replaced by MRCP. Appropriate management consists of prompt, complete cyst excision followed by restoration of biliary enteric continuity when necessary. Minimally invasive CC resection in the pediatric population has demonstrated acceptable outcomes. Prognosis is generally excellent; however, malignancy risk remains higher than the general population even after complete surgical excision.     

Pediatric Graves' disease: outcome and treatment

Graves' disease treatment in children and adolescents includes antithyroid drugs (ATD), 131I (RI) or subtotal thyroidectomy (CX), all of which present beneficial effects and disadvantages. OBJECTIVE: To review our experience in the management of pediatric patients with Graves' disease considering the therapeutic strategies used. PATIENTS AND METHODS: Clinical and biochemical data of 116 children (23 boys) aged 11.2 +/- 3.7 years at diagnosis were reviewed. Outcome and remission were evaluated and persistency at 10 years calculated with Kaplan Meier analysis. RESULTS: Initially 113/116 patients received ATD, two RI and one CX. After 10 years of follow up, 38 remitted with ATD, 23 were persistently hyperthyroid with ATD, 38 received RI, one underwent CX, and 13 were lost to follow up. The cumulative proportion with persistent hyperthyroidism at 10 years was 31%. CONCLUSIONS: ATD, although the first choice of treatment, was long-lasting and achieved a low remission rate at 10 years of follow up. Conversely, RI was shown to be a safe, low cost, efficient and definitive alternative for Graves' disease treatment in children and adolescents.     

Pediatric obesity prevention and management

Obesity has reached epidemic proportions worldwide in turn redirecting the goals of the Pediatric well care visit. There is no effective pharmacological or surgical treatment available for this entity but if left unaddressed it can lead to detrimental medical complications. Several known contributors to obesity exist which allow the development of successful prevention programs. Prior to initiating such a program, a pediatric practitioner should be equipped with the skills of identification of overweight and its risk factors as well as strong knowledge of treatment options. We attempt to provide the appropriate guidelines for childhood obesity prevention in this review.     

Pediatric orthopedic trauma: principles of management

Musculoskeletal injuries in the pediatric population are unique and require a thorough evaluation by a trained specialist. Unlike adults, many of the injuries may be treated closed due to the amazing growth and remodeling potential of children. Special consideration should be taken in treating certain fracture patterns to prevent the long-term consequences of growth deformities and protect children from child abuse. It is the goal of this article to outline common orthopedic injuries in the pediatric population to facilitate proper care in the multidisciplinary evaluation and treatment of children.     

Pediatric brain MRI part 1: basic techniques

Pediatric neuroimaging is a complex and specialized field that uses magnetic resonance (MR) imaging as the workhorse for diagnosis. Standard MR techniques used in adult neuroimaging are suboptimal for imaging in pediatrics because there are significant differences in the child’s developing brain. These differences include size, myelination and sulcation. MR protocols need to be tailored to the specific indication and reviewed by the supervising radiologist in real time, and the specialized needs of this population require careful consideration of issues such as scan timing, sequence order, sedation, anesthesia and gadolinium administration. In part 1 of this review, we focus on basic protocol development and anatomical characterization. We provide multiple imaging examples optimized for evaluation of supratentorial and infratentorial brain, midline structures, head and neck, and intracranial vasculature.     

The growth of Pediatric Rheumatology: Pediatric Rheumatology European Society and the impact factor

ABSTRACT: We are pleased to announce that Pediatric Rheumatology (PR) has its first impact factor. The journal has just been given an impact factor of 1.44 this June after 5 years of association with the online publisher BioMed Central. This ranks our journal 59th out of 113 pediatric journals and 22nd out of 29 rheumatology journals and we are just 5 years old (based on Impact Factor in the 2011 Journal Citation Reports) [1]. We have been listed on PubMed since 2007 and have applied for inclusion in MedLine. These are important steps in the growth and maturation of our journal. Pediatric Rheumatology is the only journal entirely devoted to our specialty with an impact factor and is an open access journal and can therefore be reached by medical students, residents, and primary care physicians and specialists, as well as non-physicians and the general public all over the world.     

Pediatric pulmonary lymphatic flow Disorders: Diagnosis and management

Pulmonary lymphatic flow disorders involve the abnormal lymphatic flow via lymphatic channels to the lungs and pleural space. Plastic bronchitis and chylothorax are the main complications of this abnormal lymphatic perfusion, which has been termed pulmonary lymphatic perfusion syndrome (PLPS). Following lymphatic access, dynamic contrast MR lymphangiography is the imaging modality of choice to diagnose these disorders. Management includes medical therapy, percutaneous interventions under fluoroscopy, and surgical interventions.