Retroperitoneal, paraspinal migration of distal ventriculoperitoneal shunt catheter: a peculiar complication of cerebrospinal fluid shunt.

We describe a case of a ventriculoperitoneal shunt malfunction in which the tip of the peritoneal catheter found its way to the paraspinal subcutaneous tissues. The specific findings on physical examination and the results of the imaging made to make the diagnosis are presented. No prior report of migrating shunt tubing into this anatomic area was found in the literature. This curiosity is added to the list of organs or spaces shunts are capable of wandering into.

Virilizing para-adrenocortical adenoma associated with idiopathic-acquired generalized anhidrosis in an adolescent girl.

Adrenocortical tumors are rare in childhood and adolescence. Virilization, alone or in combination with signs of overproduction of other adrenal hormones, is the most common clinical presentation. Here we report an unusual case of an African-American female adolescent presenting with idiopathic acquired generalized anhidrosis, dysregulation of body temperature, absence of adult body odor and dry skin in the face of a virilizing para-adrenocortical adenoma. Virilization signs regressed soon after removal of the tumor, but normalization of the 3alpha-androstenediol glucuronide (3alpha-AG) took longer compared to other measurable androgens; accompanied by anhidrosis. The association of remitting anhidrosis with normalized levels of 3alpha-AG suggests it might be a possible mechanism for anhidrosis. High 3alpha-AG levels might implicate the increased peripheral conversion of weak pro-androgens with different biochemical structure. We recommend obtaining 3alpha-AG beside other androgens in virilized patients with atypical dermatological symptoms in the face of hyperandrogenism.

The relation of obesity to cardiovascular risk factors among children: the CARDIAC project.

West Virginia's prevalence of obesity is among the highest in the nation, contributing to an excess mortality rate from heart disease. Individuals who are overweight and obese have a greater risk for coronary artery disease. To gain insight into the impact of obesity on other modifiable cardiovascular disease (CVD) risk factors among children, 5,887 students from 27 rural West Virginia counties participated in the school-based Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project during the 1999-2002 school years. Results confirmed a very high prevalence of overweight and obese children in this rural, pre-adolescent population. Almost 43 percent of the children screened were considered to be overweight (BMI > or = 85th percentile), and over one-fourth of them were obese (BMI > or = 95th percentile). This high rate of obesity among schoolchildren in West Virginia is associated with increased prevalence of other CVD risk factors such as hypertension, dyslipidemia, and insulin resistance. Interventions for prevention of excess weight and obesity should be implemented through schools and community-based programs.

Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project.

BACKGROUND: A number of cardiovascular disease (CVD) risk factors have been linked to obesity and associated negative health outcomes in children. However, no consistent definition of metabolic syndrome exists for children. In addition, research is needed to systematically examine the prevalence of metabolic syndrome in high-risk children, including those with insulin resistance. This study explores several definitions of metabolic syndrome and determines the prevalence of metabolic syndrome in a large sample of children with acanthosis nigricans (AN). METHODS: The study used results from a large-scale screening of fifth-grade students in West Virginia to explore the prevalence of metabolic syndrome among 676 male and female participants who had mild to severe AN. RESULTS: In this high-risk sample of students who had AN, 49% met the criteria, i.e., three risk factors including insulin resistance, high body-mass index, and elevated blood pressure or dyslipidemia, when tested for metabolic syndrome. Children with AN who were classified as obese or morbidly obese were at significantly increased odds of having metabolic syndrome. CONCLUSIONS: Results are discussed in terms of systematically defining metabolic syndrome for high-risk children, as well as public health and clinical interventions targeting children who are overweight or obese. The presence of AN and morbid obesity might be easily observed markers for metabolic syndrome.

A decade of using intraluminal tracheal/bronchial stents in the management of tracheomalacia and/or bronchomalacia: is it better than aortopexy?

BACKGROUND: We compared the efficacy and clinical outcomes of aortopexy versus tracheal stents in the management of tracheomalacia. METHODS: A retrospective analysis of 25 consecutive patients undergoing aortopexy (n = 11; 8 boys, 3 girls) or tracheal stents (n = 14; 9 boys, 5 girls) between 1993 and 2003 was performed. RESULTS: Both treatment groups, aortopexy versus stents, were comparable in their mean age of diagnosis, timing of intervention, surgical indications ("dying spell" or failed extubation), and previous underlying conditions. The operative time (190 vs 72 minutes) and blood loss (26 vs 0 mL) were significantly greater in aortopexy group (P < .01). There were no perioperative deaths in either group. Interestingly, 4 of 11 patients in the aortopexy group developed pericardial effusion (P < .01). With stents in place for a mean of 15 (range 2-41) months, 3 of 8 patients with stent removal had significant granulation tissue requiring further dilatation. No death was observed in aortopexy group, whereas 1 stent-related death and 1 cardiac arrest requiring median sternotomy occurred during stent removal in 44 and 32 months' follow-up, respectively. CONCLUSION: Both aortopexy and tracheal stents are effective treatment modalities in the management of tracheomalacia. However, although aortopexy is associated with early perioperative complications, tracheal stents are associated with higher failure rate and more severe stent-related morbidity and mortality.

School-based obesity screening in rural Appalachia.

BACKGROUND: Although identification of obesity during childhood is strongly recommended for the prevention of adult disease, access to obesity screening for children is almost exclusively through physicians' office visits. We examined the feasibility and utility of conducting a school-based obesity and cardiovascular disease (CVD) risk factor screening program in a rural Appalachian population. METHODS: Height, weight, blood pressure, total cholesterol (TC), and high-density lipoprotein (HDL) cholesterol were measured in 1338 fifth-grade children (631 boys and 707 girls) in 14 rural West Virginia counties in 2000-2001. RESULTS: We found a high prevalence of overweight (17.5%) and obesity (27.0%). Compared with non-overweight children, obese children had greater risk of high TC (OR 2.4), low HDL cholesterol (OR 5.3), high systolic blood pressure (OR 3.3), and high diastolic blood pressure (OR 2.4) (all OR >1.0, P < 0.05). Only 63% of obese and 26% of overweight children were identified by their physician as having a weight above recommended values. CONCLUSIONS: The high prevalence of obesity, the associated clustering of CVD risk factors, and the low obesity identification rate by physicians suggest that alternative approaches to obesity screening, such as universal school-based programs, may be warranted in high-risk communities.