RESUMEN
OBJECTIVES: To use real-time ultrasonography to estimate the prevalence of persistent median arteries in a cohort of pediatric orthopedic patients. METHODS: With Institutional Review Board approval, patients between the ages of 3 months and 19 years were recruited for this cross-sectional study. Variables of interest included demographics, underlying diagnoses, and the presence of a Doppler-confirmed median artery. Ultrasonographic examinations were performed on both upper extremities by a single investigator. Patient- and limb-level analyses were performed. A multivariable generalized logistic regression analysis was used to test the association between the prevalence of limb-specific persistent median arteries and age. A generalized estimating equation was used to adjust for the inclusion of multiple limbs from the same patient. RESULTS: A total of 135 patients (270 limbs) were evaluated. The patient-specific prevalence rate (persistent median arteries present in 1 or both limbs) was 26.7%. Among these patients (n = 36), a persistent median artery was present bilaterally in 55.6% (n = 20). The limb-specific prevalence rate (proportion of limbs with a persistent median artery) was 20.7%. After adjusting for race, for every 1-year increase in age, the odds of a persistent median artery decreased by 4.4%. After adjusting for age, African Americans were significantly more likely to present with a persistent median artery (odds ratio, 3.78; 95% confidence interval, 1.25-11.48). CONCLUSIONS: Ultrasonography can effectively visualize anatomic variants, such as persistent median arteries, in the pediatric population. The prevalence of persistent median arteries was higher than anticipated, especially among African American patients.
Asunto(s)
Arterias/anomalías , Arterias/diagnóstico por imagen , Ultrasonografía/métodos , Extremidad Superior/irrigación sanguínea , Extremidad Superior/diagnóstico por imagen , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
All-terrain vehicle (ATV) accidents leading to severe morbidity and mortality are common. At our institution, 2 children presented within weeks of each other after ATV accidents. Both children required cardiac valve surgery. The surgical management of these 2 children is discussed, and the literature is reviewed. On initial patient presentation, the diagnosis of a ruptured cardiac valve or ventricular septal defect (VSD) associated with these types of accidents is often delayed. We propose that patients presenting with evidence of high-energy blunt thoracic trauma after an ATV accident should undergo an electrocardiogram, cardiac enzyme assessment, and cardiac echocardiogram as part of the initial work-up to rule out significant myocardial injury.
Asunto(s)
Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/etiología , Vehículos a Motor Todoterreno , Válvula Tricúspide/lesiones , Adolescente , Biomarcadores/sangre , Puente Cardiopulmonar , Niño , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Lesiones Cardíacas/cirugía , Humanos , Masculino , Válvula Mitral/lesiones , Válvula Mitral/cirugía , Marcapaso Artificial , Válvula Tricúspide/cirugíaRESUMEN
Delayed presentation of coarctation of the aorta can be associated with severe complications. A challenging case of aortoenteric fistula secondary to an aneurysm from coartation of the aorta presented with massive gastrointestinal hemorrhage. The clinical management of this patient and a review of the literature are presented.
Asunto(s)
Coartación Aórtica/complicaciones , Enfermedades de la Aorta/etiología , Fístula Esofágica/etiología , Fístula Vascular/etiología , Adolescente , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/etiología , Coartación Aórtica/diagnóstico , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/patología , Fístula Esofágica/diagnóstico , Fístula Esofágica/patología , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Factores de Tiempo , Fístula Vascular/diagnóstico , Fístula Vascular/patologíaRESUMEN
Methylene blue is a useful therapy for catecholamine-resistant vasoplegic shock. Three cases of methylene blue administration for the treatment of catecholamine-resistant hypotension during orthotopic liver transplantation are presented.