Biomedical subjects

V S Nelson

Publications and source records attributed to V S Nelson.

24 records · Page 2Linked to original sources

PubMedDate not supplied

Percutaneous feeding tube placement in pediatric patients: immediate and 30-day results.

PURPOSE: To evaluate fluoroscopically guided percutaneous feeding tube placement in pediatric patients. MATERIALS AND METHODS: Sixty-one procedures were performed. Periprocedural care protocol was changed after patient nine. Forty-eight-hour and 30-day outcomes were assessed. RESULTS: Almost 97% of procedures were successful. The 48-hour major and minor complication rates were 1.9% and 9.6%, respectively, after the initial nine procedures. Risk factors for early complications were the use of the initial care protocol (P < .01) and patient weight below the 50th percentile (P < .05). Major and minor 30-day complication rates were 8.3% and 12.0%, respectively. Risk factors for delayed complications were placement of a gastrojejunostomy tube rather than a gastrostomy tube (P < .05) and immunosuppression (P < .05). CONCLUSION: Percutaneous feeding tubes can be placed in children with a high rate of technical success. Optimal results require attention to periprocedural care. Morbidity is common during the first month of tube use.

Child↗

PubMedDate not supplied

Recurrent and migratory reflex sympathetic dystrophy in children.

Reflex sympathetic dystrophy is a syndrome characterized by superficial pain and tenderness associated with swelling, vasomotor instability, and dystrophic changes of the skin. In children, it is rarely reported and is felt to have a more benign and self-limited course. This case illustrates that, in children, reflex sympathetic dystrophy can occur without any previous history of trauma, and may be recurrent and migratory. A review of the literature is included. An 11-year-old girl, with no history of trauma, presented in 1992 with spontaneous onset of right leg pain. She was diagnosed with reflex sympathetic dystrophy, and she was treated unsuccessfully with oral medications. Her symptoms then resolved in 2 weeks after receiving epidural anaesthesia and aggressive physical therapy. Over the next 5 years, she presented to the paediatric rehabilitation clinic three times with recurrent RSD in her bilateral arms. The first two times were refractory to conservative management and resolved with four stellate ganglion blocks. The third recurrence persisted with three stellate ganglion blocks and resolved with gabapentin.

Acetates↗

PubMedDate not supplied

The quality of life of ventilator-assisted children.

Although an increasing number of ventilator-assisted children are being cared for in the home, few studies in the literature evaluate the resulting quality of life from multiple informant perspectives. A questionnaire was used to gather data on 38 ventilator-assisted children from the children themselves and their caregivers about activities of daily living, measures of independence, and psychological state. The majority (79.4%) of ventilator-assisted children were perceived as either satisfied or very satisfied with how they spent their time, and most (77.1%) were rated as having an excellent or good emotional adjustment to the need for mechanical ventilation. Children older than 12 years were reported to be significantly less satisfied with their daily activities than the younger children, but greater activity levels correlated with greater levels of total satisfaction. A higher total satisfaction did not correlate with the age at onset of assisted ventilation, or the amount of time spent in other activities. Adolescents and primary caregivers had similar responses to most activity and independence parameters on the survey. There were no significant differences in parents' perceptions of the adolescents' emotional status as compared to the adolescents' self- assessment of their emotional status in any parameter.

Activities of Daily Living↗

PubMedDate not supplied

Functional outcome of paediatric stroke survivors.

OBJECTIVE: To examine the medical and functional outcome of paediatric stroke survivors. PATIENTS: Patients aged 1 month to 18 years diagnosed with stroke over a 10 year period. MAIN OUTCOME MEASURES: Discharge functional outcome data were collected by reviewing therapy, nursing, and other chart notes relating to specific functional tasks. Current functional information, living situation, school placement, and medical outcome data were obtained in the telephone survey. RESULTS: Fifty patients responded. The mean age at event was 8.0 years (range: 7 months to 17 years, 7 months). The mean follow-up time was 70 months. Diagnoses included: haemorrhagic (30%), thrombotic/embolic (46%), and undiagnosed (24%). At follow-up, 76% of the patients were independent in all activities of daily living (ADL), compared to 64% at hospital discharge. Younger age at onset, female gender, history of cardiac disease, and presentation with hemiparesis were significant risk factors for dependence in ADL (p < 0.05), while thrombotic/embolic aetiology demonstrated a trend (p = 0.06). Eighty-four per cent were independent in mobility, compared to 74% at discharge. Forty per cent of the patients had speech and language deficits. Of the school age children, only 50% were in a regular classroom. CONCLUSIONS: Children and adolescents who survive stroke have good outcome for mobility and ADL skills, but more difficulty with language and cognitive recovery. Functional recovery is maintained after discharge, and functional gains occur over time with very little evidence of functional regression. Comorbidities are relatively low. All children in the group returned to a home setting.

Activities of Daily Living↗

PubMedDate not supplied

Perinatal spinal cord injury requiring long-term home mechanical ventilation: a report of four cases.

Although perinatal spinal cord injury has been discussed in detail in the literature with respect to aetiology and diagnosis, few studies address long-term outcome, and none address the outcome of long-term home mechanical ventilation in this population. The four patients reported here with perinatal spinal cord injury have used home mechanical ventilation for time periods ranging from 6 to 17 years, with varying results. Their courses with respect to respiratory, neuromuscular, neuropsychological, and nutritional issues are described with reference to the current literature. It is believed that, with the advent of organized home mechanical ventilation programmes and increased acceptance of this technology by the lay public and medical community, the prognosis of the child with perinatal spinal cord injury requiring assisted ventilation is much improved, and may be more positive than the literature currently suggests.

Fatal Outcome↗

PubMedDate not supplied

The use of methylphenidate in paediatric traumatic brain injury.

Methylphenidate (MPH) has been used safely and effectively for many years in children for the treatment of attention deficit disorder with hyperactivity (ADHD). Behavioural and cognitive sequelae to traumatic brain injury (TBI) have features in common with ADHD, and MPH has been reported to be an effective treatment in adults with TBI. There is little literature documenting the efficacy of MPH in children with TBI. A chart review of 10 children who had sustained TBI and were subsequently treated with MPH was performed. Nine of the cases resulted from motor-vehicle accidents, and one from a fall. The severity of TBI ranged from mild to severe. In eight of the cases, MPH was used for cognitive and behavioural problems, and in two cases it was used to stimulate minimally responsive patients. The introduction of MPH improved cognitive function, behaviour and arousal as measured by parental and teacher reports, evaluation by in-/outpatient rehabilitation team, and/or neuropsychometric testing. MPH appears to be an effective treatment for post-TBI cognitive and behavioural sequelae in children, as well as improving arousal in the minimally responsive brain-injured child. Further prospective research is necessary to clarify the role of MPH in children with TBI.

Accidental Falls↗