Biomedical subjects
Publications and source records attributed to Michael Stephens.
We report on the perioperative management of anesthesia and analgesia in a child with sickle cell disease and a congenital myopathy, presenting for corrective orthopedic surgery. The case illustrates two valuable points of interest: the many benefits of regional anesthesia in complex medical cases and the successful use of tourniquets in children with sickle cell disease.
An assistive technology (AT) device was originally created for a young child who has difficulty communicating. The child is not able to talk and is not old enough to read yet. This rules out conventional communication devices that this child could use to communicate. A device was requested by the child's educator that would talk for the child. Originally it needed to be wristwatch size and able to visually cue the child so that the child would know what was going to be said. The project's first prototype was built by a senior design student. Although the basic features of the prototype functioned properly, it was not practical for day to day use. Originally a rebuild was requested by the educator but after further investigation it was decided that a new design was needed so that it could better cue the child. A new device was built using a high resolution graphic liquid crystal display (LCD), a voice recording chip and a microcontroller. The wristwatch size requirement was changed to meet available technology and the device was packaged to be used on a lanyard.
Two devices were modified and redesigned to further improve on previous designs and to better suit the children they were originally constructed for. The first device is a reacher that needs to be adjustable. The child originally needed a reacher that was small enough to operate. Adult reachers were shortened to fit the child. It became apparent that the reachers would need to be able to grow with the child. For that reason a reacher was developed with interchangeable center sections and control rods. This allows the reacher to grow with child in increments without the need to keep sending the reacher in for modification. The reacher also needs to pinch on a different plane then it is controlled at to simplify use for the child. The second device modified was a chair built for children in wheel chairs to allow for them to sit with their peers at a lunch table at school. The chair was totally redesigned to be more comfortable and stronger. A removable cover was added so that it can be washed. A leg rest with adjustable foot rests was added so the children's feet are well supported and they are comfortable. This chair will allow the children to sit anywhere in the cafeteria so that they may sit with their peers.
BACKGROUND & AIMS: The risk for Crohn's disease (CD) is determined in part by genetic factors. Three recently described mutations in the CARD15(NOD2) gene have been associated with adult-onset CD. We investigated the effect of CARD15 mutations on disease manifestation, disease progression, and the risk for early surgery in childhood-onset CD. METHODS: Genotyping for 3 CARD15 mutations: R702W, G908R, and 3020insC, was performed in 186 children with CD from a prospective cohort. A transmission-disequilibrium test was used to test for association with CD. Genotype with disease location and behavior was tested with logistic regression analysis. The effect of mutations on surgical outcome was evaluated using a Cox proportional hazard analysis. RESULTS: The mean age at CD diagnosis was 12.4 years. The frequency of allelic mutations observed was 6.6% for R702W, 6% for G908R, and 13.1% for 3020insC. Of Caucasian CD children, 42% had at least one CARD15 mutation. None of the non-Caucasian children with CD had any CARD15 mutation. A significant association was detected for 3020insC (P = .0045). Ileal location (odds ratio, 4.3; P = .003) and stricturing disease (odds ratio, 6.6; P = .0001) was more frequent and the risk for surgery was higher (hazard ratio, 5.8; P < .0001) and surgery occurred earlier (hazard ratio, 2.24) in those children with 3020insC mutation compared with those without 3020insC. CONCLUSIONS: In children with pediatric-onset CD, early development of stricturing behavior leading to surgical resection is influenced by ileal location and 3020insC variant of the CARD15 mutation. Genetic testing may identify children with CD who are at risk for early surgery.
Recent evidence suggests that American alligators (Alligator mississippiensis) may be capable of transmitting West Nile virus (WNV) to other alligators. We experimentally exposed 24 juvenile alligators to WNV parenterally or orally. All became infected, and all but three sustained viremia titers >5.0 log10 PFU/mL (a threshold considered infectious for Culex quinquefasciatus mosquitoes) for 1 to 8 days. Noninoculated tankmates also became infected. The viremia profiles and multiple routes of infection suggest alligators may play an important role in WNV transmission in areas with high population densities of juvenile alligators.
Femoral fractures resulting from birth injuries are rare. The authors undertook a study to assess their incidence and outcome. Seven patients from a total of 55,296 live births suffered 8 femoral fractures (incidence 0.13 per 1,000 live births). Twin pregnancies, breech presentations, prematurity, and disuse osteoporosis were associated with the occurrence of a fracture. The typical injury pattern was a spiral fracture of the proximal half of the femur, which was held in an extended position. A variety of treatment modalities were used, including gallows traction, spica cast, and Pavlik harness. All patients in this study, regardless of treatment, had a satisfactory clinical outcome, with no evidence of limb length discrepancy or angular deformity on follow-up.
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Dedicated skate parks have led to an increase in pediatric fractures referred to the authors' unit. The authors performed a prospective analysis of all patients presenting to their unit with fractures sustained while Rollerblading or skateboarding over a 5-month period. Epidemiologic data, user experience, wearing of protective gear, place of injury, and mechanism of injury were collected. Fracture type and its treatment were also recorded. The findings indicated that the use of skate parks is associated with a significant increase in the severity of fracture. This was not related to mean length of experience, age, or sex. The use of skate parks had an increased relative risk of 8.35 for fractures requiring manipulation or invasive orthopedic treatment. Only 5% of children were wearing some form of limb/joint protective gear. The authors believe there should be closer supervision and training of children and more emphasis on limb protective gear. The current high incidence of significant skate park injuries will otherwise continue, with implications for the well-being of these children and the burden on the healthcare system.