RESUMO
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.
Assuntos
Artérias/anormalidades , Artérias/diagnóstico por imagem , Ultrassonografia/métodos , Extremidade Superior/irrigação sanguínea , Extremidade Superior/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Prevalência , Fatores de Risco , Adulto JovemRESUMO
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.
Assuntos
Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Veículos Off-Road , Valva Tricúspide/lesões , Adolescente , Biomarcadores/sangue , Ponte Cardiopulmonar , Criança , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Valva Mitral/lesões , Valva Mitral/cirurgia , Marca-Passo Artificial , Valva Tricúspide/cirurgiaRESUMO
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.
Assuntos
Coartação Aórtica/complicações , Doenças da Aorta/etiologia , Fístula Esofágica/etiologia , Fístula Vascular/etiologia , Adolescente , Aneurisma Aórtico/complicações , Aneurisma Aórtico/etiologia , Coartação Aórtica/diagnóstico , Doenças da Aorta/diagnóstico , Doenças da Aorta/patologia , Fístula Esofágica/diagnóstico , Fístula Esofágica/patologia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Fatores de Tempo , Fístula Vascular/diagnóstico , Fístula Vascular/patologiaRESUMO
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.