Prognostic significance of normal dobutamine-atropine stress sestamibi scintigraphy in women with chest pain

The high risk of vaso-occlusive events in children younger than 4 years with cyanotic congenital heart disease and polycythaemia has been attributed to increased thromboxane (Tx) A2 formation. In older children with cyanotic congenital heart disease, however, the risk of vaso-occlusive events is much lower. We therefore hypothesized that the formation of TxA2 and prostacyclin is not disturbed in this age group. We measured urinary excretion of stable index metabolites of in vivo TxA2 and prostacyclin formation by gas chromatography-mass spectrometry in nine children (age 5.9-14.4, median 8.7 years) with cyanotic congenital heart disease, and in nine healthy, age-matched control subjects. The patients excreted less 2,3-dinor-TxB2 (systemic TxA2 formation, P = 0.03), 2,3-dinor-6-keto-PGF1 alpha (systemic prostacyclin formation. P = 0.03) and TxB2 (renal TxA2 formation, P = 0.01) than the control subjects. We conclude that in children older than 5 years with cyanotic congenital heart disease, endogenous synthesis of TxA2 and prostacyclin is not stimulated. This result may explain the lower risk of vaso-occlusive events in this age group as compared with younger children. In addition, our results suggest that chronic hypoxaemia may affect the in vivo formation of TxA2 and prostacyclin and the metabolic disposition of TxB2.     

Granular cell tumor of the pituitary stalk

Erythropoietin is a hormone responsible for regulation of red blood cell production. Circulating erythropoietin values are regulated by renal oxygen supply, which is determined by hemoglobin concentration, hemoglobin oxygen saturation, and renal blood flow. Previous animal and human studies regarding erythropoietin regulation have assumed pulsatile renal blood flow. During cardiopulmonary bypass, non-pulsatile renal perfusion has been shown to result in decreased glomerular filtration rate and decreased renal blood flow in comparison to pulsatile perfusion. Repair of congenital heart disease during cardiopulmonary bypass is an attractive circumstance in which to study the effect of non-pulsatile blood flow on erythropoietin production. The hypothesis in this study was that non-pulsatile perfusion would result in increased erythropoietin production because of decreased renal oxygen supply. Fourteen children with congenital heart disease and without preoperative renal insufficiency or anemia were enrolled in the study. All patients underwent cardiopulmonary bypass with non-pulsatile flow. In addition, 10 control patients without congenital heart disease were enrolled. Six cardiopulmonary bypass patients had 1.5- to 6-fold increases in plasma erythropoietin concentrations from baseline. These patients had longer cardiopulmonary bypass times, more commonly performed under low flow deep hypothermic conditions. The remaining 8 patients with congenital heart disease, and all control patients, did not develop increased postoperative erythropoietin concentrations. The conditions under which cardiopulmonary bypass are performed appear to influence postoperative circulating erythropoietin concentrations.     

Cerebral emboli during cardiac surgery in children

BACKGROUND: Microemboli occur commonly during cardiac surgery in adults, and, when present, increase the risk of neuropsychological deficits. Their incidence and significance during correction of congenital heart disease is unknown. The authors hypothesized that microemboli would occur before bypass with right-to-left cardiac shunts and would also occur in large numbers when the aortic crossclamp was released in children during repair of congenital heart defects. METHODS: In 25 children studied with carotid artery Doppler, embolic signals were counted and timed in relation to 13 intraoperative events. Patients were classified as either at high risk (obligate right-to-left shunt or uncorrected transposition of the great arteries) or at low risk (net left-to-right shunt or simple obstructive lesions) for paradoxical (venous to arterial) emboli. RESULTS: The median number of emboli detected was 122 (range, 2-2,664). Forty-two percent of all emboli were detected within 3 min of release of the aortic crossclamp. The high-risk group had significantly more emboli (median, 66; range, 0-116) during the time interval before cardiopulmonary bypass than did the low-risk group (median, 8; range, 0-73), with P < 0.01. There was no significant difference between the high- and low-risk groups in the total number of emboli detected. There was no apparent association between number of emboli and gross neurologic deficits. CONCLUSIONS: Microemboli can be detected in the carotid arteries of children undergoing repair of congenital heart disease and are especially prevalent immediately after release of the aortic crossclamp. The role of emboli in causing neurologic injury in children undergoing repair of congenital heart disease remains to be determined.     

Cardiovascular abnormalities in children with autosomal dominant polycystic kidney disease

It is known that adults with autosomal dominant polycystic kidney disease (ADPKD) have an increased incidence of cardiovascular abnormalities, including mitral valve prolapse. The cardiac manifestations of ADPKD in the pediatric population have not been well established. To determine the cardiac manifestations of children with ADPKD, echocardiography was performed in 154 children of 66 families in which one parent has ADPKD. Eighty-six affected children and 68 unaffected children were evaluated in a prospective, single-blinded manner by echocardiography. Affected children were defined as those with any cysts on a concurrent renal ultrasound or those predicted to be gene carriers by gene linkage analysis. A 12% incidence of mitral valve prolapse was found in the affected children compared with only 3% of the unaffected children (P < 0.05). ADPKD children, but not their unaffected siblings, demonstrate a significant correlation between left ventricular mass index and systolic blood pressure. Moreover, hypertensive ADPKD children have significantly larger left ventricular mass index than do normotensive ADPKD children. A 3.5% incidence of congenital heart disease was found in the affected group, whereas 2.9% of the unaffected children had congenital heart disease. It was concluded that systemic manifestations of ADPKD, particularly cardiovascular abnormalities, are present even in childhood and these warrant the clinician's attention.     

Problem-solving skills training and relationship therapy in the treatment of antisocial child behavior.

The present investigation evaluated the effects of cognitive-behavioral problem-solving skills training (PSST) and nondirective relationship therapy (RT) for the treatment of antisocial child behavior. Psychiatric inpatient children (N?=?56, ages 7–13) were assigned randomly either to PSST, RT, or to a treatment-contact control condition (in which children met individually with a therapist but did not engage in specific activities designed to alter antisocial behavior). Children were hospitalized during the period in which treatment was administered and discharged thereafter. The PSST condition led to significantly greater decreases in externalizing and aggressive behaviors and in overall behavioral problems at home and at school and to increases in prosocial behaviors and in overall adjustment than the RT and contact-control conditions. These effects were evident immediately after treatment and at a 1-year follow-up. The RT and control children did not consistently improve over the treatment and follow-up periods. Comparisons with nonclinical (normative) levels of functioning revealed that a significantly higher proportion of PSST children, compared with those in other conditions, fell within the normative range for prosocial behavior at posttreatment and at follow-up. Even so, the majority of PSST children and almost all RT and control children remained outside the normative range of deviant behavior. The implications of the results for further research for antisocial youth are highlighted. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early intervention for parents at risk of child abuse and neglect: A preliminary investigation.

An early intervention program for young parents and children who have been identified as being at risk of child maltreatment was evaluated. Thirty mother–child dyads were randomly assigned to one of two conditions: (a) an information group offered by the child protection agency (which served as a control condition) or (b) a special program of behavioral parent training in addition to the agency group. Self-report measures indicated that significant improvements in parenting risk and child behavior problems at posttest and at 3-month follow-up were evident only for mothers who received parent training in addition to information groups. Home observation data were inconclusive, possibly due to the limited opportunities to observe behaviors of interest. Both groups showed improvements in their child-rearing environments and in their children's adaptive behaviors at follow-up. Caseworker ratings of clients' risks of maltreatment and abilities to manage their families at 1-year follow-up significantly favored the families who received parent training in addition to information. Methodological and treatment issues arising from this preliminary investigation of early intervention with diverse population of high-risk parents and children are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safety and efficacy of chloral hydrate sedation in children undergoing echocardiography

The purpose of this prospective study was to determine the safety and efficacy of chloral hydrate sedation in children with known or suspected congenital heart disease. The study population included 405 children with a median age of 13 months (3 weeks to 14 years). Cyanotic heart disease was present in 64 of the children. The median dosage of chloral hydrate given was 77 mg/kg, with a range of 25 to 125 mg/kg. Sedation was achieved in 397 (98%) of the children. The complete study time averaged 2.2 hours (range, 1.6 to 5.2 hours). The time to achieve sedation was 30 minutes or less in 82%, more than 30 but less than 60 minutes in 12%, and more than 60 minutes in 4%; 2% failed to achieve sedation. Children aged 3 years or younger were more likely to be successfully sedated with chloral hydrate (p = 0.003). The type of heart disease did not affect the success of sedation. No child had a clinically significant change in heart rate or blood pressure during sedation; however, oxygen saturation decreased in 24 (6%) of 397 children successfully sedated. Decreases in oxygen saturation occurred more commonly in children with trisomy 21 (7/13) than in children without genetic syndromes (17/384). Vomiting occurred in 23 (6%) of the 405 study subjects, usually immediately after drug administration. Chloral hydrate is a safe and effective agent for sedation of children with known or suspected congenital heart disease who are undergoing echocardiography in the outpatient cardiology clinic.     

Echocardiographic diagnosis alone for the complete repair of major congenital heart defects

OBJECTIVES: The study was done to determine the diagnostic accuracy of echocardiography alone in the preoperative diagnosis of children with major congenital heart defects undergoing primary complete repair. BACKGROUND: Although echocardiography is well established as the first-line imaging technique for the diagnosis of all forms of congenital heart disease, most institutions continue to perform cardiac catheterization prior to complete repair of more complex defects. METHODS: To determine the diagnostic accuracy of echocardiography alone and echocardiography plus catheterization, we reviewed the records of 503 children with major congenital heart defects who underwent primary complete repair at our institution between July 1992 and June 1997. We included children with transposition of the great arteries, tetralogy of Fallot, double-chamber right ventricle, interrupted aortic arch, aortic coarctation, atrioventricular septal defect, truncus arteriosus, aortopulmonary septal defect, and totally anomalous pulmonary venous return. We excluded children with less complex defects such as isolated shunt lesions, as well as those with the most complex defects that would require surgical palliation (e.g., functional univentricular heart). We defined major errors as those that increased the surgical risk and minor errors as those that did not. Errors in diagnosis were determined at surgery. RESULTS: Eighty-two percent of children (412 of 503) underwent surgery after preoperative diagnosis by echocardiography alone. There were 9 major (2%) and 10 minor errors in the echocardiography alone group and 7 major and 5 minor errors in the echocardiography plus catheterization group. The most common type of error was misidentification of coronary artery anatomy in patients with transposition of the great arteries. No error in either group resulted in surgical morbidity or mortality. CONCLUSIONS: This study suggests that echocardiography alone is an accurate tool for the preoperative diagnosis of major congenital heart defects in most children undergoing primary complete repair, and may obviate the need for routine diagnostic catheterization.     

A comparative survey of beliefs about "normal" childhood sexual behaviors

OBJECTIVE: This study sought to collect data on what adults believe constitutes normal childhood sexual behaviors, and how variables, such as role, gender, and life experience might contribute to the formation of one's beliefs. METHODS: A survey describing 20 different scenarios of children under the age of 13 interacting with themselves or other children in a sexual manner was administered to four groups of adults: sexual abuse experts; therapists involved in a sexual abuse training program; medical students attending a human sexuality program; and group facilitators of the human sexuality program. RESULTS: Behaviors that involved oral, vaginal, or anal penetration were judged by a majority of adults to be abnormal sexual behaviors in children under 13 years of age. Professionals working with sexually abused children rated certain sexual behaviors as more abnormal than adults participating in a human sexuality course. Both sexual abuse trainees and facilitators of the human sexuality course showed more directional biases than other groups, with trainees always rating behaviors in the direction of abnormal and facilitators always rating behaviors in the direction of normal. Females also judged many of the sexual behaviors to be more abnormal than males. CONCLUSIONS: Role and gender significantly influence what adults believe constitutes normal and abnormal childhood sexual behavior.     

Adjustment of children with invisible and visible handicaps: Congenital heart disease and facial burns.

26 11-15 yr old children with congenital heart disease and 22 with facial burns were compared on 10 measures of adjustment to test the effects of invisible and visible disability upon social and psychological development. Interview data were coded and submitted to analysis of covariance, using sex, grade, and age as covariates. The invisible disability group (the heart group) was higher in adjustment in all 10 measures. Significant differences (p     

Platelet hyporeactivity in young infants during cardiopulmonary bypass

Platelet dysfunction is one of the most important factors contributing to a postoperative hemorrhagic diathesis in children with congenital heart disease undergoing operations requiring cardiopulmonary bypass (CPB). However, very little is known about the influence of CPB on platelets in neonates and young infants. We studied 16 patients--8 young infants (<2 mo old) and 8 children (>12 mo old)--with congenital heart disease undergoing CPB. Surface density of an important platelet adhesive receptor, glycoprotein Ib, and degree of platelet activation, indicated by p-selectin positivity, were measured by whole blood flow cytometry in samples obtained at seven time points during the operations. We found that the percentage of p-selectin-positive platelets increased significantly in children, but not in young infants, during CPB. The young infant group exhibited a significantly smaller reduction of glycoprotein Ib than the child group during CPB (21.0% +/- 12.0% vs 32.7% +/- 18.1%; P < 0.05). Lack of CPB-induced increase of p-selectin and a smaller decrease of glycoprotein Ib in young infants in the current study suggest reduced platelet reactivity in young infants and neonates during CPB. The clinical significance of the reduced platelet reactivity in young infants and neonates remains to be determined. Implications: Platelets of young infants are less reactive than those of children during cardiopulmonary bypass, as determined by the cardiopulmonary bypass-induced alterations in platelet membrane adhesive receptors.     

A comparison of epidemiologic, histologic, and virologic studies on Hodgkin''s disease in western Kenya and Nagasaki, Japan

AIMS: The aim of the present study was to determine which medical variables were predictors of long-term behavioural/emotional outcome after surgical correction for congenital heart disease in infancy and childhood. METHODS: The Child Behavior Checklist (CBCL) was used to predict parent-reported behavioural/emotional problems in 125 10-15 year-old congenital heart disease children from: (1) biographical status (2) medical history (3) heart surgery (4) short-term post-operative course and (5) number of heart operations and (6) extra cardiac concomitant anomalies. RESULTS: Higher CBCL total problem scores at follow-up were associated with a greater number of heart operations and deep hypothermic circulatory arrest (< 22 degrees). 'Internalizing problems' were associated with a greater number of heart operations, deep hypothermic circulatory arrest, a short gestational age, low systemic oxygen saturation, and older age at surgical repair. 'Externalizing problems' were associated with a greater number of heart operations only. CONCLUSION: Several medical variables were significant predictors and can be used to identify those congenital heart disease children who are at risk of long-term behavioural/emotional maladjustment.     

A cognitive-social learning approach to social skill training with low-status preschool children.

Changes in the behavior and peer acceptance of low-status preschool children as a result of social skill training were examined. Children who had low sociometric status and were also low in classroom use of social skills were randomly assigned to a skill training group (n?=?18) or to an attention control group (n?=?15). Children in the training group were coached in 4 skills: leading peers, asking questions of peers, making comments to peers, and supporting peers. Trained children showed a significant increase in their use of the trained skills comments and leads from pretest to posttest, whereas control-group children showed no change. Neither control nor skill-trained children changed significantly on sociometric measures from pretest to posttest. Increases in skill use in the classroom with peers was correlated with improvements in children's knowledge of friendly social strategies from pre- to posttest. Results are interpreted as evidence of a social skill basis for peer acceptance and of the need to develop procedures to assess the mechanisms of change during social skills training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glucose metabolism in children undergoing extracorporeal circulation: its correlation with weight and the degree of hypothermia

INTRODUCTION: A prospective study has been carried out in 33 children with congenital heart disease, aged 5 days to 16 years, operated on with the aid of cardiopulmonary bypass (CPB), in order to evaluate intra and postoperative glycemia in relation to children's weight and intra-CPB perfusion temperature. MATERIAL AND METHODS: Plasmatic levels of glucose, lactate, insulin, C-peptide, growth hormone (GH) and cortisol were measured at five different times, from pre-CPB up to 18 hours post-CPB. Thirteen children weighing less than 10 kilograms (group I) were compared to 20 children weighing more than 10 kilograms (group II), and 15 children operated on with perfusion temperature below 27 degrees C (group A) were compared to 18 with perfusion temperature above 27 degrees C. RESULTS: All the cases showed intraoperative hyperglycemia. In relation to weight, evolution of glycemia was similar in both groups but anaerobic glycolysis was significantly higher in group I. In relation to temperature, glycemia, lactic acidemia intra- and post-CPB and serum C-peptide post-CPB were significantly higher in group A. Intraoperative insulin was decreased and GH serum levels were also higher in group I and A, but fell drastically post-CPB in all groups. CONCLUSIONS: Perioperative control of glycemia is important in children operated on with the aid of CPB. Control of lactic acidemia is also expedient. Carbohydrates metabolism and its hormonal regulation are more disturbed in infants and in children operated on with low perfusion temperature.     

High school students as therapeutic agents with young children experiencing school adjustment difficulties: The effectiveness of a filial therapy training model.

Filial therapy has been used since the early 1960s to train parents as therapeutic agents for children experiencing a broad range of social, emotional and behavioral difficulties. Using a pretest-posttest control group design, this study examined the efficacy of a filial therapy model in training high school students to be effective helpers with young children experiencing school adjustment difficulties. 32 high school students enrolled in a Peer Assistance and Leadership course titled PALs were trained to become therapeutic change agents for identified prekindergarten and kindergarten students. The PALs students received training and supervision in child-centered play therapy skills that they practiced in weekly play sessions with their assigned child. Results from the statistical analyses reveal that the experimental group of high school students receiving filial therapy training demonstrated a significant increase in their empathic interactions with children and that the experimental group of children receiving the play therapy intervention experienced a significant reduction in problem behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Filial therapy with parents of children experiencing learning difficulties.

The purpose of this study was to determine the effectiveness of a 10 week filial therapy training model as an intervention method for parents of children with learning difficulties. Results of the analysis of covariance revealed that the parents in the experimental group scored significantly higher after training than the parents in the control group on their attitude of acceptance of the child. The experimental group parents attained a significantly lower mean total score on level of stress related to parenting than the control group parents. There was no significant difference between the experimental and control groups' posttest mean scores on the total behavior problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skill training in an integrated preschool program.

This study examined the effectiveness of a commercially available social skills training program plus classroom reinforcement for use with preschoolers with developmental delays. Two groups of 19 participants (mean age 49.73–52.9 mo old) each received either the combined treatment package or classroom reinforcement of target behaviors only. An additional 20 participants served as a control group. The combination of social skills training plus classroom reinforcement of target behaviors resulted in statistically significant increases in sharing behavior over those obtained by both control participants and participants receiving reinforcement of classroom behavior alone. Group behavior was increased over that shown by control participants through the use of either the social skills plus classroom reinforcement treatment package or classroom reinforcement alone. Social skills interventions were viewed favorably by both classroom teachers and preschool participants. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Role of endothelium in the maintenance of low pulmonary vascular tone in normal children

BACKGROUND: Resting vascular tone is low in the normal pulmonary circulation, and experimental studies have suggested that this may be due to the continuous release of endothelium-derived nitric oxide (NO), a locally acting vasodilator. We have investigated whether NO contributes to the normal control of pulmonary vascular tone and resistance in children. METHODS AND RESULTS: We studied the hemodynamic effects of NG-monomethyl-L-arginine (L-NMMA), a specific inhibitor of NO synthesis, on the pulmonary circulation of six children 2 to 17 years old (mean, 9 years) with congenital heart disease but normal pulmonary blood flow, pressure, and resistance (all had isolated left heart obstructive lesions). The diameter of a segmental pulmonary artery and pulmonary blood flow velocity were measured by quantitative angiography and intra-arterial Doppler catheters. There was a consistent, dose-dependent fall in pulmonary blood flow velocity in response to three increasing doses of L-NMMA (compared with baseline, flow velocity fell to 75 +/- 7%, 62 +/- 8%, and 40 +/- 10%, P < .01). Flow velocity returned to control values with subsequent infusion of L-arginine, the substrate for NO. Thereafter, acetylcholine, an endothelium-dependent dilator, produced an increase in flow velocity (56 +/- 10% greater than baseline, P < .01). Arterial diameter was unchanged during L-NMMA and L-arginine infusions, indicating that the major effect of each agent is to alter vascular tone distal to the segmental pulmonary arteries. CONCLUSIONS: The dilator action of endothelium-derived NO contributes to the maintenance of low resting pulmonary tone in normal children. Impairment of NO production may contribute to the elevated pulmonary vascular resistance that complicates some cases of congenital heart disease.