Prevalence and risk factors for post thrombotic syndrome after deep vein thrombosis in children: a cohort study.

BACKGROUND: While post thrombotic syndrome (PTS) is increasingly recognized as a frequent and potentially serious complication of deep vein thrombosis (DVT) in children, limited information is available regarding predictors of PTS. METHODS: Using the Mayo Clinic Master Diagnostic Index, all pediatric patients (age 0 to 18 years) with a potential DVT based on ICD-8 codes over the 15-year period, 1995 to 2009 were identified. A validated PTS survey instrument was mailed to eligible patients followed by a second mailing and three reminder phone calls for non-responders. Baseline clinical and radiographic characteristics were abstracted from patient medical records and tested as potential predictors of PTS using logistic regression. Associations were summarized by calculating odds ratios (OR) and corresponding 95% confidence intervals. RESULTS: Ninety patients agreed to participate. The mean age (±SD) at DVT diagnosis and survey completion were 12.8 (±6.1) and 19.3 (±7.7) years, respectively. Fifty three respondents (59%) reported mild PTS whereas 12 (13%) reported moderate-to-severe PTS. Pain (34%) and dilated blood vessels (40%) were the most frequent PTS symptom and sign, respectively. On multivariate analysis, predictors of PTS included duration between incident DVT and survey completion (OR 1.75; 95% CI: 1.08-2.84) and number of thrombosed vein segments (OR 1.40; 95% CI: 1.05-1.86). CONCLUSION: Over 70% of children with DVT report subsequent symptoms or signs of PTS, though only 13% report clinically significant, moderate-to-severe PTS. Number of thrombosed vein segments at diagnosis and time duration between incident DVT and survey completion were independent predictors of PTS.

Health-related quality of life in children and young adults with post-thrombotic syndrome: results from a cross-sectional study.

OBJECTIVE: While post-thrombotic syndrome (PTS) is increasingly recognized in children with a history of deep vein thrombosis (DVT), its impact on the health-related quality of life (HRQoL) is unknown. Our objective was to evaluate the association between the PTS and HRQoL by surveying a cohort of patients treated at our institution for DVT. MATERIALS/METHODS: All unique pediatric patients (0-18 years) treated for a DVT at the Mayo Clinic during the 15-year period, 1995-2009 were identified. A previously validated PTS survey instrument and age appropriate Pediatric Quality of Life inventory, version 4 (PedsQL 4.0) were mailed to eligible patients. Linear regression models were fit to compare the HRQoL scores between PTS groups (none, mild, moderate/severe), after adjusting for the presence of potential covariates. RESULTS: Of the 90 respondents, 65 (72%) reported signs and/or symptoms of PTS. Mean age (± SD) at DVT diagnosis and survey completion were 12.8 (± 6.1) and 19.3 (± 7.7) years, respectively. Self-report PedsQL 4.0 module was completed by 79 patients, and 34 guardians completed the parent-proxy module. Patients with moderate to severe PTS reported significantly worse total HRQoL score (mean ± SD, 71.3 ± 13.4) as compared to patients with mild PTS (84.8 ± 14.2) and no PTS (83.4 ± 14) (P = 0.001). CONCLUSION: Moderate to severe PTS has a significant impact on self-reported HRQoL as measured using the generic PedsQL 4.0. Further research is warranted to develop a venous disease-specific quality of life measure for children with a history of DVT.

Cystic changes in the ovaries of a pre-pubertal girl with Henoch-Schönlein purpura.

Henoch Schönlein Purpura is an IgA mediated vasculitis that is known to be associated with scrotal pathology. However, an association between Henoch Schönlein purpura and ovarian pathology has not been described. We present the case of a girl who developed cystic changes in her ovaries during her course of Henoch Schönlein purpura.

Infraclavicular brachial plexopathy secondary to coracoid osteoid osteoma.

Coracoid osteoid osteomas are rare. This case report presents two patients with coracoid osteoid osteomas who developed neurologic sequelae of the infraclavicular brachial plexus (namely, musculocutaneous neuropathy in one patient with an anterior lesion, and suprascapular neuropathy in the other patient with a more posterior lesion). The neuropathy was due to soft tissue edema, which surrounded the bony lesion and was apparent on MRI. Surgical resection of the bony lesion in both cases produced excellent outcomes at long-term follow-up.

Anatomy of successfully separated thoracopagus-omphalopagus conjoined twins.

The birth of conjoined twins occurs in approximately 1 in 50,000 to 1 in 100,000 deliveries, and the majority are either stillborn or die early in life. Approximately 184 successful separations have been described. The authors describe the preoperative radiologic evaluation of a set of thoracopagus-omphalopagus twins and their successful surgical separation. Preoperative radiologic imaging demonstrated that the twins did not share myocardium, but an ectopic cordis was present. The inferior vena cavae entered the right atria at more acute angles than normal. The liver was fused, two gallbladders were present, and there was a large bridging portal vein that crossed the hepatic isthmus of one twin to the conjoined twin's portal venous system. Replaced hepatic arteries originated from the superior mesenteric arteries. Each twin had separate kidneys, colons, and rectums. Preoperative tissue expansion was necessary, and the twins were separated at 5 1/2 months of life. Successful separation of twins conjoined by several organ systems requires a multispecialty approach. Preoperative knowledge of shared anatomy is necessary for adequate preparation and planning. Despite meticulous preoperative investigations, certain anatomy can only be discovered at the time of surgery, and the ability to adjust to these findings is imperative.