Just sinus bradycardia or something more serious?

An asymptomatic 5-year-old girl presented with bradycardia during a routine well-child visit. Further evaluation revealed profound sinus bradycardia, exercise-induced bidirectional ventricular tachycardia, and supraventricular tachycardia. An echocardiogram showed heavy trabeculations in the left ventricular myocardium. This patient's presentation suggested catecholaminergic polymorphic ventricular tachycardia and left ventricular noncompaction. Genetic testing revealed mutations in the cardiac ryanodine receptor (RyR2), calsequestron (CASQ2), and titin (TTN). She was effectively treated with beta-blockade to suppress tachyarrhythmias and pacemaker implantation to treat her bradycardia.

Theoretical breast cancer induction risk from thoracic spine CT in female pediatric trauma patients.

OBJECTIVES: To quantify the radiation dose received during thoracic spine computed tomography (CT) versus plain radiographs as well as the theoretical risk of breast cancer induction in a pediatric trauma population. METHODS: A retrospective evaluation of 179 female pediatric trauma patients who received CT or plain radiographs for clearance of the thoracic spine was performed. Subjects were secondarily grouped as children (0-<12 years) or adolescents (≥12-17.9 years). Radiation doses were calculated by using the ImPACT Patient Dosimetry Calculator. Excess absolute risk (EAR) of induction of breast cancer was determined by multiplying the radiation dose by breast cancer induction rates taken from the National Academy's Biological Effects of Ionizing Radiation Committee's seventh report. RESULTS: The average radiation dose to the breast from a thoracic spine CT was 41.1 (SD 11.4) mSv and 1.8 (SD 0.9) mSv for plain radiographs. The EAR for plain radiographs was 2.7 (95% confidence interval [CI] 2.48-2.85) excess cases of breast cancer per 10 000 studies for female children and 1.4 (95% CI 1.14-1.55) for female adolescents. The breast cancer EAR for thoracic spine CT was significantly higher -79.6 (95% CI 58.6-100.5) and 45.8 (95% CI 42.0-49.6) excess cases per 10 000 scans for female children and adolescents, respectively. There was a substantially higher risk of breast cancer induction for children receiving thoracic spine CT compared with adolescents. CONCLUSIONS: CT clearance of the thoracic spine in the pediatric trauma patient results in a high dose of radiation and an age-dependent increase in theoretical breast cancer induction.

Longer duration of hormonal contraceptive use predicts better cognitive outcomes later in life.

BACKGROUND: The cognitive effects of postmenopausal hormone therapy (HT) have been studied extensively, but little is known about the relationship between premenopausal hormone use and cognition. Hormonal contraceptive use vs. nonuse may be a potential factor influencing cognitive processes in midlife. The aim of this study is to explore the effect of modification of hormone milieu through use of hormonal contraception in premenopausal women and midlife cognitive function. METHODS: Subjects were 261 cognitively normal women, aged 40-65 (mean µ=52), enrolled in the Wisconsin Registry for Alzheimer's Prevention. All women completed the Women's Health History Questionnaire and a self-report health history questionnaire and were administered a battery of neuropsychologic tests. Cognitive results were analyzed using summary scores for the domains of Verbal Ability, Visuo-spatial Ability, Working Memory, Verbal Learning & Memory, and Speed & Flexibility derived using a confirmatory factor analysis. RESULTS: Hormonal contraceptive ever users performed significantly better than never users in the domains of Visuo-spatial Ability (µ=0.75, 95% confidence interval [CI] 0.23-1.28, p=0.005) and Speed & Flexibility (µ=0.52, 95% CI -0.16-1.04, p=0.007), with duration-dependent increases in performance, especially in ever users with ≥ 15 years of use. CONCLUSIONS: These data provide preliminary evidence that hormonal contraceptive use may influence cognitive outcomes, even years after use is discontinued. Hormonal contraceptive users scored better in domains of Visuo-spatial Ability and Speed & Flexibility than never users, with a duration-dependent trend. Further research is needed to explore the use of hormonal contraceptives to prevent or delay cognitive decline and to clarify the physiologic basis of this phenomenon.

Theoretical increase of thyroid cancer induction from cervical spine multidetector computed tomography in pediatric trauma patients.

BACKGROUND: The trend of increasing cervical spine multidirectional computed tomography (MDCT) imaging of pediatric trauma patients is characteristic of the overall dramatic increase in computed tomography utilization in the United States. The purpose of this study is to compare the amount of radiation a pediatric trauma patient absorbs to the thyroid from plain radiographs and MDCT of the cervical spine and to express risk by calculation of theoretical thyroid cancer induction. METHODS: A retrospective evaluation of pediatric trauma patients admitted from October 1, 2004, to October 31, 2009, was performed at an academic, Level I trauma center. Inclusion criteria were Level I/II trauma patients, cervical spine imaging performed at our institution, and age <18 years. Absorbed thyroid radiation was calculated for patients receiving plain radiographs or MDCT. Thyroid cancer risk was calculated using the 2006 Biological Effects on Ionizing Radiation VII report. RESULTS: Six hundred seventeen patients met inclusion criteria: 224 received cervical spine radiographs and 393 received cervical spine MDCT. The mean thyroid radiation absorbed from radiographs was 0.90 mGy for males and 0.96 mGy for females compared with 63.6 mGy (males) and 64.2 mGy (females) receiving MDCT (p < 0.001). The median excess relative risk of thyroid cancer induction from one cervical spine MDCT in males was 13.0% and females was 25.0%, compared with 0.24% (males) and 0.51% (females) for radiographs (p < 0.001). CONCLUSIONS: The significant difference in radiation that MDCT delivers to the pediatric trauma patient when compared with plain radiographs should temper routine use of computed tomography in pediatric cervical spine clearance algorithms.

Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a risk-benefit analysis.

BACKGROUND: The only cure for primary hyperparathyroidism (1 degrees HPT) is parathyroidectomy. However, many elderly patients are not referred for surgery due to medical comorbidities and/or advanced age. The purpose of this study was to evaluate benefits against risks of parathyroidectomy in this patient population. MATERIALS AND METHODS: From March 2001 to June 2006, 50 patients aged 80 years or older with 1 degrees HPT underwent parathyroidectomy by a single surgeon. Clinical presentation and surgical outcomes of all patients were evaluated. The standard form of the SF-36 Health Survey, designed to measure patient quality of life (QOL), was completed by a subset of patients. RESULTS: There were 45 females and 5 males with a mean age of 83 +/- 2 y. Patient comorbidities included hypertension (72%), coronary artery disease (22%), diabetes mellitus (16%), chronic obstructive pulmonary disease (10%), and congestive heart failure (10%). Bone pain was the most common primary presenting symptom (44%), followed by fatigue (12%), confusion (6%), and joint pain (6%). Eleven patients (22%) had ectopic glands. The cure rate postsurgery was 98% (49/50). There were 2 postoperative complications (4%): one patient with transient hypocalcemia and another with cellulitus at an i.v. site. Of patients who completed QOL surveys, greater than 60% reported improved physical functioning, social functioning, and/or mental health, and reduction of bodily pain. CONCLUSION: Parathyroidectomy is safe and curative for octogenarians and nonagenarians with 1 degrees HPT, and maintains or improves quality of life. The surgical benefits outweigh operative risks, making parathyroid surgery an excellent option for patients over 80 years of age.