| Diabetes
insipidus (DI) is a condition that occurs when there is insufficient
production of antidiuretic hormone (ADH), also known as vasopressin.
ADH is a hormone that helps the kidney and body to conserve the correct
amount of water by controlling the output of urine ADH is secreted by
the hypothalamus to decrease the amount of urine output so that
dehydration does not occur, stored in the pituitary gland and released
into the blood. Diabetes insipidus can be of central and nephrogenic
origin. Central DI occurs after damage to hypothalamus or pituitary due
to head injury, surgery, genetic disorders or brain tumors
(craniopharyngioma), while nephrogenic DI is a lack of response of the
kidney to normal ADH levels due to drugs, chronic disorders, sickle
cell disease or polycystic kidney disease. Most common symptoms of DI
are excessive thirst (polydipsia) and urine production (polyuria),
inability to concentrate the urine along with hypernatremia, seizures
and dehydration. In addition children develop irritability, poor
feeding, failure to thrive and fever. DI is diagnosed with history,
labs (urine /blood tests), water deprivation test DDAVP trial (which
should be done in the hospital) and imaging (MRI/CT Scan), Diabetes
insipidus can lead to further brain damage, impaired mental function,
intellectual disability, hyperactivity and restlessness. Management of
diabetes insipidus depends on the cause of DI. Treatment includes
adequate hydration and antidiuretic hormone medication (oral, injection
or nasal spray), or medications that stimulate the production of ADH
such as Non-steroidal antiinflammatory or chlorpropamide. Depending on
the cause of diabetes insipidus the disease can be temporary or
permanent. Children with central and nephrogenic diabetes insipidus can
lead full healthy lives with proper and monitored
management. References: 1- Hunter JD, Calikoglu AS: Etiological and clinical characteristics of central diabetes insipidus in children: a single center experience.Int J Pediatr Endocrinol. 2016;2016:3. doi: 10.1186/s13633-016-0021-y. Epub 2016 Feb 11. 2- Liu W, Wang L, Liu M, Li G: Pituitary Morphology and Function in 43 Children with Central Diabetes Insipidus. Int J Endocrinol. 2016;2016:6365830. doi: 10.1155/2016/6365830. Epub 2016 Mar 29. 3- Dabrowski E, Kadakia R, Zimmerman D: Diabetes insipidus in infants and children. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):317-28. doi: 10.1016/j.beem.2016.02.006. Epub 2016 Feb 27. 4- Elder CJ, Dimitri PJ: Diabetes insipidus and the use of desmopressin in hospitalised children. Arch Dis Child Educ Pract Ed. 102(2):100-104, 2017 5- Bockenhauer D, Bichet DG: Nephrogenic diabetes insipidus. Curr Opin Pediatr. 29(2):199-205, 2017 6- Zhao C, Tella SH, Del Rivero J et al: Anti-PD-L1 Treatment Induced Central Diabetes Insipidus. J Clin Endocrinol Metab. 103(2):365-369, 2018 |
Childhood obesity has reached global epidemic proportions. Obesity is defined as BMI > 95th percentile for sex and age, with severe obesity within the 99th percentile. Pediatric obesity affects health by causing metabolic syndrome, hypertension, dyslipidemia, diabetes (insulin resistance), obstructive sleep apnea, musculoskeletal complains (fracture, low extremity misalignment), nutritional deficiencies (Vit D and iron deficiency), depression and poor self-esteem. Screening for obesity after age of two years should be standard of care for primary physicians. Breast feeding has a protective effect in childhood obesity and should be encouraged. The basis of management of child obesity remains a goal of energy expenditure that surpasses energy consumption. Daily physical activity of 60 minutes daily should be encouraged between families. If lifestyle modification does not produce significant weight loss bariatric surgery might be needed in the adolescent age. Adolescent considered for bariatric surgery should be severely obese with BMI > 40 and comorbid conditions described above, attained adult stature, failed six months of conventional weight management, demonstrate comprehensive psychological evaluation, avoid pregnancy for at least one year postoperatively, be capable to adhere to nutritional guidelines postoperatively and have decisional capacity. Both Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are effective in achieving significant weight loss. Obesity related comorbidities resolve almost universally with remission of diabetes, hypertension, dyslipidemia and sleep apnea. Metabolic syndrome and concomitant cardiovascular morbidity and mortality is decreased in severely obese adolescent undergoing bariatric surgery. RYGB increases insulin sensitivity by four times in adolescent with and without diabetes after surgery. Perioperative complications seen in 22% and include anastomotic stricture, reoperation, anastomotic leak, dumping syndrome and dehydration. In absence of supplementation inadequate absorption of calcium, Vit D, iron, Vit B1, B12, A and folate can occur resulting in nutritional deficiencies. References: 1- Pujalte GGA, Ahanogbe I, Thurston MJ, White RO, Roche-Green A: Addressing Pediatric Obesity in Clinic. Glob Pediatr Health. 2017 Oct 30;4:2333794X17736971. doi: 10.1177/2333794X17736971. eCollection 2017. 2- Durkin N, Desai AP: What Is the Evidence for Paediatric/Adolescent Bariatric Surgery? Curr Obes Rep. 6(3):278-285, 2017 3- Beamish AJ, Reinehr T: Should bariatric surgery be performed in adolescents? Eur J Endocrinol. 176(4):D1-D15, 2017 4- Xu S, Xue Y: Pediatric obesity: Causes, symptoms, prevention and treatment. Exp Ther Med. 11(1):15-20, 2016 5- Steinbeck KS, Lister NB, Gow ML, Baur LA: Treatment of adolescent obesity. Nat Rev Endocrinol. 14(6):331-344, 2018 6- Dabas A, Seth A: Prevention and Management of Childhood Obesity. Indian J Pediatr. 2018 Feb 19. doi: 10.1007/s12098-018-2636-x. [Epub ahead of print] 7- Inge TH et al: Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 168:47, 2014 |
| The
London sign is a trivial looking circular bruising in the epigastric
area after blunt abdominal trauma. The London sign usually corresponds
to the shape and size of the bicycle handle. The sign means that the
impact was sharp and strong enough to cause some kind of internal
visceral damage to the child. This type of epigastric blunt trauma blow
can cause pancreatic or duodenal injury of sufficient severity since
these two organs get crushed between the blow and the vertebral column.
Presence of the London sign needs hospital admission and further
imaging investigation in most cases as an underlying internal organ
injury might be missed. The shape and size of the bruising depends on
the object transmitting the impacting force. As such the victim can
present bicycle handle, tire marks, shirt buttons, knuckles of hand or
wrist watch marked in the epigastrium all conforming and representing
the London sign. The damage to the internal viscera might include
pancreatic contusion with or without main duct transection, intramural
duodenal hematoma and perforation of the duodenum. A similar sign,
known as the seatbelt sign occurs after high impact blunt injury from
motor vehicle accidents. The seatbelt sign is a linear ecchymosis of
the abdominal wall corresponding to the belt. The seatbelt complex
describes an injury to the intestine (including the rectum), lumbar
spine and other abdominal organs associated with the belt. Chest
injury, fracture of the sternum and ribs along with injury of the major
vessels are also included in this complex. The prevalence of intestinal
injury in patients with the seatbelt sign is almost 15%. Physical
examination is sometimes inaccurate in the diagnosis of blunt abdominal
injury and requires a high index of clinical suspicion. Children with
the London and Seatbelt sign should undergo further abdominal imaging
such as US and CT-Scan in search of missed visceral injury. References: 1- Raveenthiran V: The London sign (patterned bruising of blunt abdominal trauma). J Pediatr Surg. 53(6):1252-1253, 2018 2- Vailas MG, Moris D, Orfanos S, Vergadis C, Papalampros A: Seatbelt sign in a case of blunt abdominal trauma; what lies beneath it? BMC Surg. 30;15:121, 2015 3- Cho HS, Woo JY, Hong HS, Park MH, Ha HI, Yang I, Lee Y, Jung AY, Hwang JY: Multidetector CT findings of bowel transection in blunt abdominal trauma. Korean J Radiol. 14(4):607-15, 2013 4- El Kafsi J, Kraus R, Guy R: A report of three cases and review of the literature on rectal disruption following abdominal seatbelt trauma. Ann R Coll Surg Engl. 98(2):86-90, 2016 5- Streck CJ Jr, Jewett BM, Wahlquist AH, Gutierrez PS, Russell WS: Evaluation for intra-abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model? J Trauma Acute Care Surg. 73(2):371-6, 2012 |
We are inviting all of you to submit contribution of your own to the newsletter. Credit will be given to the authors keeping his or her name, institution and E-mail address on their work.A list of contributors will appear in the internet homepage.All works should be send to Dr. H. Lugo-Vicente to the e-mail: titolugo@coqui.net |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|