Chetan C. Shah

Imaging findings in 512 children following all-terrain vehicle injuries.

BackgroundInjuries related to all-terrain vehicle (ATV) use by children have increased in recent years, and the pattern of these injuries is not well known among radiologists.ObjectiveOur purpose was to identify different radiologically diagnosed injuries in children suffering ATV-related trauma and determine associations among various injuries as well as between injuries and outcome.Materials and methodsThe study included 512 consecutive children suffering from ATV injuries treated at a tertiary care pediatric hospital. All imaging studies were reviewed and correlated with injury frequency and outcome using multivariate analysis.ResultsHead injuries occurred in 244 children (48%) and in five of six deaths. Calvarial skull fractures occurred in 104 children and were associated with brain, subdural and epidural injuries. Brain and orbit injuries were associated with long-term disability. A total of 227 extremity fractures were present in 172 children (34%). The femur was the most commonly fractured bone. Nine children had partial foot amputations. Multiorgan injuries occurred in nearly half of the 97 children with torso injuries. Determinants for long-term disability or death were head injuries (odds ratio 3.4) and extremity fractures (odds ratio 3.3).ConclusionHead and extremity injuries are the two most common injuries in children suffering ATV injuries and are associated with long-term disability. ATV use by children is dangerous and is a significant threat to child safety.

Establishment of a Simple and Inexpensive Remote Radiology Conference

t t p q m f P c c r V esidents’andfacultymembers’particpation ineducational conferences is reuired [1], but the delivery of quality onferences is a challenge in today’s acdemic environment. Didactic confernces are time and labor intensive, resients and faculty members are often ocated in multiple sites, and heavy linical workloads can preclude particiation [2,3]. Videoconferencing is a popular ay to transmit information to a disant site, but setup is expensive, and issatisfaction with quality has been eported [4]. A cost-effective alternaive is the Web conference. Real-time udio and video transmissions have ade Web conferencing possible, hile significant improvements in nformation technology and comunication bandwidth have faciliated the rapid development of reote conferencing capabilities [2,5]. Conference attendance in our raiology residency program suffered hen major construction projects ere under way on 2 of our 3 camuses. We sought an alternative that ould eliminate the travel burden. In haring our experience, we hope that ther medical education programs ill be able to implement similar ost-effective options using off-thehelf materials.

Imaging Manifestations and Techniques in Diabetes Insipidus

Etiological classification of diabetes insipidus is as follows. 1. Central Diabetes Insipidus (CDI) A. Idiopathic B. Familial C. Structural Causes i. Congenital: Septo-optic dysplasia Tuber cinereum Hamartoma ii. Traumatic: Iatrogenic, head trauma iii. Inflammatory: Tuberculous Meningitis Sarcoidosis Wegener’s granulomatosis Lymphocytic Hypophysitis iv. Neoplastic: a. Pediatric: Hypothalamic glioma Craniopharyngioma Intracranial Germ Cell Tumors Teratoma Langerhans Histiocytosis b. Adult: Metastasis 2. Psychogenic: Compulsive intake of large amounts of fluid leading to inhibition of normal vasopressin (2).

All-terrain vehicle use by children: a form of child neglect?

The popularity of all-terrain vehicles (ATVs) and injuries from their use have continued to increase in America. Children younger than 16 years of age account for a disproportionately large number of injuries and deaths associated with ATV use [1]. ATVs have a high center of gravity and can travel up to 70 miles per hour. They are designed for single-rider use. Children do not have the strength, size, coordination or judgment to safely operate an ATV [2]. A 37% increase in the number of emergency room visits by adults and children for the treatment of ATV-related injuries occurred between 2001 and 2007 [3]. Children younger than 16 years of age accounted for 40,000 (26%) of the 150,990 emergency room visits for ATV-related injuries in 2007. ATV-related hospitalizations increased by 90% during the 5-year period 2000–2004 [4]. Children younger than 18 years of age accounted for 30% of ATVrelated hospitalizations. The U.S. Consumer Product Safety Commission 2007 Annual Report of ATV-related deaths and injuries recorded 2,497 deaths in children younger than 16 years of age between 1982 and 2007. Children younger than 16 years of age accounted for 28% of all ATV-related deaths. The annual number of deaths in children increased every year from 1997 to 2004. Data are incomplete for subsequent years but will undoubtedly show a continued increase in the annual number of children dying from ATV-related injuries. The highest death rate among all ATV users is in children between the ages 10 and 17 years [5]. Medical professionals have recognized that children should not drive or ride on an ATV. The American Academy of Pediatrics (AAP) has recommended legislation in all states to prohibit the use of ATVs by children younger than 16 years of age [6]. The policy of the AAP was reaffirmed in 2007. The American Academy of Orthopaedic Surgeons (AAOS) concurs with the position of the AAP. The AAOS further states that “Children under the age of 12 generally possess neither the body size and strength, nor the motor skills and coordination necessary for the safe handling of an ATV. Children under age 16 generally have not yet developed the perceptual abilities or the judgment required for the safe use of highly powered vehicles” [7]. The American College of Surgeons has taken a similar position [8]. Safe Kids Worldwide, a global coalition of safety experts, educators, corporations, foundations, governments and volunteers representing 16 countries dedicated to child safety, states: “After extensive review of the data, Safe Kids Worldwide concludes that there is simply no way to make ATV riding a safe activity for children” [9]. Child abuse is defined by separate state statutes. In 36 states, the definition of physical child abuse includes “acts or circumstances that threaten the child with harm or creates a substantial risk of harm to the child’s health or welfare” [10]. Severe neurologic, multiorgan torso and extremity injuries with long-term disability were linked with ATVrelated injuries in our study [11]. Our study showed that ATV use in children creates a substantial risk of harm that threatens the health and welfare of children. The statistics collected by the U.S. Consumer Product Safety Commission indicate an epidemic of ATV-related injuries in children that is out of proportion to ATV use by children. Medical associations and safety experts concerned with child welfare have clearly recognized the danger that ATV use poses to child safety. Permitting children younger than Pediatr Radiol (2009) 39:657–658 DOI 10.1007/s00247-009-1258-x

Follow-up regarding inappropriate and cloned clinical histories on radiology request forms for sick children

Sir, This letter is to follow up with additional information related to our article titled “Inappropriate and cloned clinical histories on radiology request forms for sick children” [1]. The discussion section of the article describes our plans to improve the clinical histories submitted with radiographic requests. Since submission of the paper, we have implemented the changes. Routine daily films have been eliminated from the neonatal intensive care unit. A 3.5-min video titled “Improving clinical ordering of radiographs” was prepared for all NICU staff involved in the ordering process and is available through streaming. The web link is: http:// imediasrv.archildrens.org/mediasite5/Viewer/?peid=d0e1b 1322ab740069af7059f29ef81421d. Laminated cards listing common mistakes and suggestions for appropriate clinical history were distributed to NICU staff. One month following the intervention, the NICU portion of the original study was repeated. Eleven of 63 studies (17%) were inappropriate, which was a better than 50% improvement from the original study. A chi-square test showed that the improvement was significant (chi square=5.69, P=0.017). In the original study 22% of clinical histories were cloned. Cloning was entirely absent in the repeat study. In summary, simple interventions resulted in a reduction of inappropriate histories by greater than 50% and in the elimination of cloning.

Posterior reversible encephalopathy syndrome in a child with Guillian-Barré syndrome

Posterior reversible encephalopathy syndrome (PRES) (synonym: reversible posterior leukoencephalopathy syndrome, reversible posterior cerebral edema syndrome) is a neurotoxic state associated with sudden elevation in blood pres- sure. It presents initially with lethargy and somnolence but can also manifest as headache, confusion, hemianopsia, nausea vomiting, seizures, vision disturbance, paresis, and cortical blindness. Very often these features are short lived and are resolved both clinically and radiologically but occasionally this disease can progress to coma and other devastating permanent complica- tions. Several etiological factors have been described in literature including hypertensive encephalopathy, preeclampsia, eclamp- sia, infection, immunosuppression, autoimmune diseases, cyclosporine toxicity, drug overdose, trauma with aortic dissection, pheochromocytoma and Guillain-Barre syndrome (GBS). Particularly, very few cases have been reported in literature indicating GBS as a precipitating factor for PRES. Therefore, we present here a brief review of literature describing association between GBS and PRES along with detailed diagnostic and therapeutic description. This review suggests necessity for adequate clinical suspicion for PRES in GBS afflicted patient followed by prompt diagnostic and therapeutic intervention. Failure to treat promptly and adequately might lead to the catastrophic consequence both in terms of morbidity and mortality.

Pantothenate Kinase 2 Deficiency: A Neurodegeneration With Brain Iron Accumulation

Pantothenate kinase 2 deficiency (previously known as Hallervorden-Spatz disease) is an unusual metabolic disorder characterized by progressive extrapyramidal dysfunction and dementia. A 27-year-old Caucasian presented with a major depression disorder and social phobia since adolescence. Patient had marked paranoia, auditory hallucinations, extrapyramidal dysfunction, poor memory, and gait abnormality. Laboratory tests including serum copper and ceruloplasmin were all normal. Magnetic resonance imaging (MRI) examination of the brain played an important role in the diagnosis in this patient.