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Ledder O, Church P, Cytter-Kuint R, Martínez-León M, Sladek M, Coppenrath E, Weiss B, Yerushalmi B, Martin de Carpi J, Duchano L, Towbin A, Assa A, Shaoul R, Mearin ML, Alex G, Griffiths A, Turner D. A Simple Endoscopic Score Modified for the Upper Gastrointestinal Tract in Crohn's Disease [UGI-SES-CD]: A Report From the ImageKids Study. J Crohns Colitis 2018; 12:1073-1078. [PMID: 29800422 DOI: 10.1093/ecco-jcc/jjy072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/08/2018] [Accepted: 05/24/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is no standardized endoscopic description of upper gastrointestinal [UGI] disease in Crohn's disease [CD]. We prospectively applied the Simple Endoscopic Score for CD [SES-CD] to the UGI tract as a planned sub-study of the multicentre prospective ImageKids study. We aimed to assess the utility of the UGI-SES-CD and its clinical significance in paediatric CD. DESIGN Patients underwent an oesophagogastroduodenoscopy [EGD], ileocolonoscopy, and magnetic resonance enterography [MRE] with explicit clinical data recorded. SES-CD was scored at each region [oesophagus, stomach body, antrum, and duodenum]. Half of the patients were followed for 18 months, when a repeat MRE was performed. RESULTS A total of 202 children were included 56% males, mean age 11.5 ± 3.2 years, median weighted Paediatric Crohn's Disease Activity Index [wPCDAI 25]). UGI-SES-CD score ranged 0-17, with 95 [47%] having a UGI-SES-CD ≥1; no narrowing was detected. UGI-SES-CD ≥1 was associated with higher: wPCDAI [32.5 vs 20; p = 0.03]; Physician's Global Assessment [PGA] of inflammation (45 mm visual analogue score [VAS] vs 30 mm VAS; p = 0.04); ileocolonoscopic SES-CD [10 vs 7; p = 0.004], faecal calprotectin [717 µg/g vs 654 µ/g; p= 0.046]; and radiological global assessment of damage by MRE [7 mm VAS vs 0; p = 0.04]. In all, 81 patients were followed for 18 months and no association was identified between initial UGI SES-CD and markers of disease course such as surgery, MRE assessment, or treatment escalation. CONCLUSION UGI-SES-CD is an easily reported objective scoring system and is associated with a more severe disease phenotype but not with disease course.
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Affiliation(s)
- Oren Ledder
- Instutute of Paediatric Gastroenterology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Church
- Division of GI/Hepatology/Nutrition, SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - Ruth Cytter-Kuint
- Paediatric Radiology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Maria Martínez-León
- Department of Radiology, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | - Malgorzata Sladek
- Department of Pediatric Gastroenterology, Jagiellonian University Medical College, Krakow, Poland
| | - Eva Coppenrath
- Department of Radiology, University of Munich, Munich, Germany
| | - Batia Weiss
- Paediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, Tel Hashomer, Tel Aviv, Israel
| | - Baruch Yerushalmi
- Department of Paediatric Gastroenterology, Soroka University Medical Center and Ben Gurion University of the Negev, Beer Sheba, Israel
| | | | - Larisa Duchano
- Department of Radiology, Soroka University Medical Center and Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Alexander Towbin
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Amit Assa
- Department of Paediatric Gastroenterology, Schneider Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Shaoul
- Department of Paediatric Gastroenterology, Rambam Medical Center, Haifa, Israel
| | - M L Mearin
- Departments of Paediatrics, Leiden University Medical Center and Free University Medical Center, Amsterdam, The Netherlands
| | - George Alex
- Department of Paediatric Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Anne Griffiths
- Division of GI/Hepatology/Nutrition, SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - Dan Turner
- Instutute of Paediatric Gastroenterology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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D'Souza AM, Towbin A, Bondoc A, Gupta A, Nathan J, Alonso M, Tiao G, Geller JI. Heterogeneity of pediatric hepatocellular carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amber M D'Souza
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Anita Gupta
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jaimie Nathan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maria Alonso
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Greg Tiao
- Cincinnati Childrens Medical Center, Cincinnati, OH
| | - James I. Geller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Katzenstein HM, Furman WL, Malogolowkin M, Krailo MD, McCarville MB, Towbin A, Tiao G, Finegold M, Ranganathan S, Dunn S, Langham M, McGahren E, Rodriguez-Galindo C, Meyers R. Vincristine/irinotecan upfront window treatment of high-risk hepatoblastoma: A report from the Children’s Oncology Group (COG) AHEP0731 study committee. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Greg Tiao
- Cincinnati Childrens Medical Center, Cincinnati, OH
| | | | | | - Stephen Dunn
- Alfred Dupont Children's Hospital, Wilmington, DE
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Shaughnessy EE, Towbin A, Prosser J. Neonate with choking. JAMA Pediatr 2015; 169:281-2. [PMID: 25730686 DOI: 10.1001/jamapediatrics.2014.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erin E Shaughnessy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexander Towbin
- Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John Prosser
- Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Walther A, Geller J, Coots A, Towbin A, Nathan J, Alonso M, Sheridan R, Tiao G. Multimodal therapy including liver transplantation for hepatic undifferentiated embryonal sarcoma. Liver Transpl 2014; 20:191-9. [PMID: 24142883 DOI: 10.1002/lt.23773] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/16/2013] [Indexed: 12/14/2022]
Abstract
The outcomes of hepatic undifferentiated embryonal sarcoma (HUES) have historically been limited by persistent, unresectable disease and the subsequent development of disease resistance and dissemination. We present our institutional experience with HUES and assess current treatment trends and outcomes in the era of liver transplantation. We conducted a retrospective chart review of cases presenting with HUES at our institution over the past 10 years. The collected data included age, sex, presenting symptoms, imaging and the associated Pretreatment Extent of Disease (PRETEXT) score, pathology, chemotherapy, surgical interventions, and outcomes. Approval was obtained from the institutional review board of the Cincinnati Children's Hospital Medical Center. HUES was identified in 6 patients (4 males and 2 females) with a median age at diagnosis of 11 years (range = 7-13 years). Initial imaging was available for all but 1 patient. The PRETEXT stage for these patients ranged from II to III. One patient was diagnosed with lung metastases. Two patients underwent upfront resection, and 1 patient received neoadjuvant therapy and then conventional resection. Three patients were treated with orthotopic liver transplantation (OLT) after neoadjuvant chemotherapy (primary OLT in 2 cases and salvage OLT for local recurrence in 1 case). Two patients received posttransplant adjuvant chemotherapy. All 6 patients remained in clinical remission with a mean follow-up of 35 months (range = 12-84 months). In conclusion, OLT has rarely been reported as a treatment option for HUES. The addition of liver transplantation as a surgical option for treating patients with HUES can result in improved survival for patients whose tumors are initially unresectable or recur.
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Affiliation(s)
- Ashley Walther
- Departments of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Esmailpour T, Riazifar H, Liu L, Donkervoort S, Huang VH, Madaan S, Shoucri BM, Busch A, Wu J, Towbin A, Chadwick RB, Sequeira A, Vawter MP, Sun G, Johnston JJ, Biesecker LG, Kawaguchi R, Sun H, Kimonis V, Huang T. A splice donor mutation in NAA10 results in the dysregulation of the retinoic acid signalling pathway and causes Lenz microphthalmia syndrome. J Med Genet 2014; 51:185-96. [PMID: 24431331 DOI: 10.1136/jmedgenet-2013-101660] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Lenz microphthalmia syndrome (LMS) is a genetically heterogeneous X-linked disorder characterised by microphthalmia/anophthalmia, skeletal abnormalities, genitourinary malformations, and anomalies of the digits, ears, and teeth. Intellectual disability and seizure disorders are seen in about 60% of affected males. To date, no gene has been identified for LMS in the microphthalmia syndrome 1 locus (MCOPS1). In this study, we aim to find the disease-causing gene for this condition. METHODS AND RESULTS Using exome sequencing in a family with three affected brothers, we identified a mutation in the intron 7 splice donor site (c.471+2T→A) of the N-acetyltransferase NAA10 gene. NAA10 has been previously shown to be mutated in patients with Ogden syndrome, which is clinically distinct from LMS. Linkage studies for this family mapped the disease locus to Xq27-Xq28, which was consistent with the locus of NAA10. The mutation co-segregated with the phenotype and cDNA analysis showed aberrant transcripts. Patient fibroblasts lacked expression of full length NAA10 protein and displayed cell proliferation defects. Expression array studies showed significant dysregulation of genes associated with genetic forms of anophthalmia such as BMP4, STRA6, and downstream targets of BCOR and the canonical WNT pathway. In particular, STRA6 is a retinol binding protein receptor that mediates cellular uptake of retinol/vitamin A and plays a major role in regulating the retinoic acid signalling pathway. A retinol uptake assay showed that retinol uptake was decreased in patient cells. CONCLUSIONS We conclude that the NAA10 mutation is the cause of LMS in this family, likely through the dysregulation of the retinoic acid signalling pathway.
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Affiliation(s)
- Taraneh Esmailpour
- Department of Pediatrics, Division of Human Genetics, University of California Irvine, Irvine, California, USA
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Cripe TP, Racadio JM, Conner J, Towbin A, Brunner MM, Stockman BA, Currier M, Geller JI. A phase I dose-escalation study of intratumoral herpes simplex virus-1 mutant HSV1716 in pediatric/young adult patients with refractory non-central nervous system solid tumors. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.10047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10047 Background: HSV1716 is a mutant herpes simplex virus type 1 deleted in the RL1 gene which encodes the protein ICP34.5, a specific determinant of virulence. Mutants lacking the RL1 gene are capable of replication in actively dividing cells but not in terminally differentiated cells – a phenotype exploited to selectively kill tumor cells. Studies in adult patients with high grade glioma, melanoma and squamous cell carcinoma report that HSV1716 is safe when administered by intra-tumoral injection. This is the first study of HSV1716 in pediatric/young adult patients. Methods: The primary endpoint of the study is to assess safety of intratumoral HSV1716 in pediatric/young adult patients, and to determine any dose-limiting toxicities (DLT) at the doses given. Patients undergo long-term follow up in accordance with FDA guidelines for viral vectors. The secondary endpoints of the study are to measure: (i) antiviral immune response; (ii) systemic viremia and viral shedding and (iii) the antitumor activity of HSV1716 by radiological response within the confines of a Phase I study. Patients aged 7 to 30 with solid non-CNS tumors refractory to standard therapy (or for which no therapy exists) are eligible for the study provided the target lesion is accessible to image-guided injection. Eligible patients receive a single dose of HSV1716 (Virttu Biologics Limited) at either 105 or 2x106 plaque forming units (pfu) HSV1716 administered directly into the tumor via ultrasound or CT-guided injection by an interventional radiologist. Tumor response between baseline and day 28 is assessed by modified RECIST criteria. Patients showing at least stable disease may receive up to a 3 additional doses of HSV1716. Results: Recruitment of the first cohort of 3 patients has been completed without DLT or procedure related severe adverse events. In the second cohort, 2 patients have been treated without DLT or procedure related SAE. Conclusions: The trial is in progress and the study is open to recruitment. Clinical trial information: NCT00931931.
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Affiliation(s)
| | - John M Racadio
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Joe Conner
- Virttu Biologics, Ltd., Glasgow, United Kingdom
| | | | | | - Beth A Stockman
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - James I. Geller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Matthay KK, Weiss B, Villablanca JG, Maris JM, Yanik GA, Dubois SG, Stubbs J, Groshen S, Tsao-Wei D, Hawkins R, Jackson H, Goodarzian F, Daldrup-Link H, Panigrahy A, Towbin A, Shimada H, Barrett J, Lafrance N, Babich J. Dose escalation study of no-carrier-added 131I-metaiodobenzylguanidine for relapsed or refractory neuroblastoma: new approaches to neuroblastoma therapy consortium trial. J Nucl Med 2012; 53:1155-63. [PMID: 22700000 DOI: 10.2967/jnumed.111.098624] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED (131)I-metaiodobenzylguanidine (MIBG) is specifically taken up in neuroblastoma, with a response rate of 20%-37% in relapsed disease. Nonradioactive carrier MIBG molecules inhibit uptake of (131)I-MIBG, theoretically resulting in less tumor radiation and increased risk of cardiovascular toxicity. Our aim was to establish the maximum tolerated dose of no-carrier-added (NCA) (131)I-MIBG, with secondary aims of assessing tumor and organ dosimetry and overall response. METHODS Eligible patients were 1-30 y old with resistant neuroblastoma, (131)I-MIBG uptake, and cryopreserved hematopoietic stem cells. A diagnostic dose of NCA (131)I-MIBG was followed by 3 dosimetry scans to assess radiation dose to critical organs and soft-tissue tumors. The treatment dose of NCA (131)I-MIBG (specific activity, 165 MBq/μg) was adjusted as necessary on the basis of critical organ tolerance limits. Autologous hematopoietic stem cells were infused 14 d after therapy to abrogate prolonged myelosuppression. Response and toxicity were evaluated on day 60. The NCA (131)I-MIBG was escalated from 444 to 777 MBq/kg (12-21 mCi/kg) using a 3 + 3 design. Dose-limiting toxicity (DLT) was failure to reconstitute neutrophils to greater than 500/μL within 28 d or platelets to greater than 20,000/μL within 56 d, or grade 3 or 4 nonhematologic toxicity by Common Terminology Criteria for Adverse Events (version 3.0) except for predefined exclusions. RESULTS Three patients each were evaluable at 444, 555, and 666 MBq/kg without DLT. The dose of 777 MBq/kg dose was not feasible because of organ dosimetry limits; however, 3 assigned patients were evaluable for a received dose of 666 MBq/kg, providing a total of 6 patients evaluable for toxicity at 666 MBq/kg without DLT. Mean whole-body radiation was 0.23 mGy/MBq, and mean organ doses were 0.92, 0.82, and 1.2 mGy/MBq of MIBG for the liver, lung, and kidney, respectively. Eight patients had 13 soft-tissue lesions with tumor-absorbed doses of 26-378 Gy. Four of 15 patients had a complete (n = 1) or partial (n = 3) response, 1 had a mixed response, 4 had stable disease, and 6 had progressive disease. CONCLUSION NCA (131)I-MIBG with autologous peripheral blood stem cell transplantation is feasible at 666 MBq/kg without significant nonhematologic toxicity and with promising activity.
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Matthay KK, Weiss BD, Villablanca J, Maris JM, Yanik GA, Groshen SG, Jackson H, Hawkins R, Goodarzian F, Panigrahy A, DuBois SG, Stubbs J, Towbin A, Barrett JA, LaFrance ND, Babich JW. Dosimetry, toxicity, and response in a phase IIa trial of no-carrier added iobenguane I-131 (nca-MIBG): A New Approach to Neuroblastoma Therapy (NANT) study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yin H, Dorris KMO, Wagner LM, Collins MH, Towbin A, Nagarajan R. INI1 and mib-1 expression in childhood chordomas. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hummel T, Anyane-Yeboa A, Mo J, Towbin A, Weiss B. Response of NF1-related plexiform neurofibroma to high-dose carboplatin. Pediatr Blood Cancer 2011; 56:488-90. [PMID: 21225936 DOI: 10.1002/pbc.22827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 08/17/2010] [Indexed: 11/09/2022]
Abstract
Plexiform neurofibromas (PN) are a hallmark of neurofibromatosis type 1 (NF1). These large nerve tumors can be disfiguring and surgery is the only known standard therapy. Surgical intervention may be suboptimal due to the diffuse nature of PN. Here, we present a case in which we describe the use of high-dose carboplatin to treat the patient's testicular seminoma which resulted in the decrease in size of a PN in a patient with NF1.
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Affiliation(s)
- Trent Hummel
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Rayburg M, Towbin A, Yin H, Maugans T, Maurer B, Nagarajan R, Weiss B. Langerhans cell histiocytosis in a patient with stage 4 neuroblastoma receiving oral fenretinide. Pediatr Blood Cancer 2009; 53:1111-3. [PMID: 19621427 DOI: 10.1002/pbc.22200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Langerhans cell histiocytosis (LCH) has previously been reported in association with other malignancies. The pathogenesis of LCH and its relationship to other malignancies is poorly understood. We present a novel case of a child who developed an LCH bone lesion while receiving a Phase I protocol therapy with oral fenretinide/Lym-X-Sorb (4-HPR/LXS) powder for neuroblastoma.
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Affiliation(s)
- Melissa Rayburg
- Division of Hematology/Oncology, Cincinnati Children's Hospital, Cincinnati, Ohio 45249, USA
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Towbin A, Towbin R, Di Lorenzo C, Grifka R. Interventional Radiology in the Treatment of the Complications of Organ Transplant in the Pediatric Population-Part 1: The Kidneys, Heart, Lungs, and Intestines. Semin Intervent Radiol 2005; 21:309-20. [DOI: 10.1055/s-2004-861565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
We report three cases of dry beriberi in adolescents who underwent gastric bypass surgery for clinically severe obesity. The key to successful treatment of this problem lies in prompt recognition and thiamine supplementation.
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Affiliation(s)
- Alexander Towbin
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Abstract
OBJECTIVE The purpose of this study is to determine the risk of CNS and/or peritoneal infection in children with ventriculoperitoneal shunts in whom a percutaneous gastrostomy tube is placed. MATERIALS AND METHODS We placed 205 gastrostomy or gastrojejunostomy tubes from January of 1991 to December 1996. Twenty-three patients (10 boys, 13 girls) had ventriculoperitoneal shunts at the time of placement. All shunts were placed at least 1 month prior to placement of the gastrostomy tube. The patients ranged in age from 8 months to 16 years with a mean age of 6 years, 9 months. Patient weight ranged from 2 kg to 60 kg. All 23 children required long-term nutritional support due to severe neurologic impairment. No prophylactic antibiotics were given prior to the procedure. Of the patients, 21/23 had a 14-F Sacks-Vine gastrostomy tube with a fixed terminal retention device inserted, using percutaneous fluoroscopic antegrade technique. Two of the 23 patients had a Ross 14-F Flexi-flo gastrostomy tube which required a retrograde technique due to a small caliber esophagus in these children. RESULTS All 23 children had technically successful placements of percutaneous gastrostomy (7) or gastrojejunostomy (16) tubes. Of the children, 21/23 (91%) had no complications from the procedure. Two of 23 (9%) patients demonstrated signs of peritonitis after placement of their gastrostomy tubes and subsequently had shunt infections. In both, children CSF culture grew gram-positive cocci. The antegrade technique was used in both children who developed peritonitis. CONCLUSION Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora.
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Affiliation(s)
- S S Sane
- Department of Radiology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
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Mooney MP, Burrows AM, Wigginton W, Singhal VK, Losken HW, Smith TD, Dechant J, Towbin A, Cooper GM, Towbin R, Siegel MI. Intracranial volume in craniosynostotic rabbits. J Craniofac Surg 1998; 9:234-9. [PMID: 9693554 DOI: 10.1097/00001665-199805000-00010] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Although craniosynostosis alters brain growth direction resulting in compensatory changes in the neurocranium, it has been suggested that such compensations occur with little reduction in intracranial volume (ICV). This hypothesis was tested in a rabbit model with nonsyndromic, familial coronal suture synostosis. Cross-sectional three-dimensional computed tomographic head scans were obtained from 79 rabbits (25 normal, 28 with delayed-onset synostosis, and 26 with early-onset synostosis) at 25, 42, and 126 days of age. Intracranial contents were reconstructed and indirect ICV was calculated. Results revealed that by 25 days of age the intracranial contents from early-onset synostosed rabbit skulls showed rostral (anterior) constrictions and a "beaten copper" morphology in the parietal and temporal regions compared with the other two groups. These deformities increased in severity with age. Quantitatively, ICV was significantly reduced (P < 0.05) by 7% in rabbits with early-onset synostosis compared with both control rabbits and rabbits with delayed-onset synostosis at 25 days of age. By 126 days of age, ICV in rabbits with synostosis was significantly reduced (p < 0.05) by 11% in early-onset synostosis and by 8% in delayed-onset synostosis compared with normal rabbits. Results suggest that in rabbits with uncorrected craniosynostosis, compensatory changes in the neurocranium were not adequate to allow normal expansion of the neurocapsular matrix. Further research is needed to determine if ICV reduction is correlated with cerebral atrophy or cerebral spinal fluid (i.e., ventricular or subarachnoid) space compression in this model.
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Affiliation(s)
- M P Mooney
- Department of Anatomy, University of Pittsburgh, PA 15261, USA
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Abstract
The present report considers organic factors of pathogenesis, in addition to environmental factors, as causal processes in cases of dual disability of mental retardation and behavior disorders. Relevant to organic pathogenesis, in cases of dual diagnosis, basic biological processes are presented, mechanisms concerned with gestational and birth complications that led to fetal-neonatal hypoxic cerebral cortical damage. In such cases, dual diagnosis manifestations of mental retardation and behavior disorders, together with other chronic cerebral disabilities, may be attributed to residues of fetal-neonatal cerebral damage.
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Affiliation(s)
- A Towbin
- Mental Retardation Research Institute, Danvers, Massachusetts
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Abstract
In obstetric malpractice litigation, there are two main bases of defense: the clinical basis and the pathogenesis basis. The malpractice suit in most cases involves an infant delivered at term that later develops cerebral palsy. Despite the fact that much information has been elucidated about the pathogenesis of cerebral palsy, the defense is often jeopardized by an inadequate presentation of relevant causal mechanisms, pathogenesis. Studies in recent years with correlated clinical and pathologic investigations have provided evidence that the occurrence of cerebral palsy is a time marker, reflecting cerebral damage incurred during the premature period, and does not result from the events of labor and delivery at term. There is broad need generally and in legal situations for clinicians and pathologists to become knowledgeable in comprehensively correlating obstetric factors with fetal-neonatal systemic pathologic conditions and with neuropathologic effects.
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Towbin A. Cerebral dysfunction related to perinatal organic damage: clinical--neuropathologic correlations. J Abnorm Psychol 1978. [PMID: 739085 DOI: 10.1037//0021-843x.87.6.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Towbin A, Turner GL. Obstetric factors in fetal-neonatal visceral injury. Obstet Gynecol 1978; 52:113-24. [PMID: 683621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Towbin A. Cerebral dysfunctions related to perinatal organic damage: Clinical–neuropathologic correlations. Journal of Abnormal Psychology 1978; 87:617-35. [PMID: 739085 DOI: 10.1037/0021-843x.87.6.617] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The present investigation indicates the high incidence of intracranial venous thrombosis in adults in the older age groups, especially in the female. Commonly overlooked clinically and pathologically, cerebral venous thrombosis is usually preceded congestive circulatory failure and other related systemic disturbances. Most patients with venous thrombosis intracranially also develop thromboembolic complications at other sites in the body. Although often latent clinically, concurrent pulmonary embolism (as revealed in postmortem studies) occurs in a majority of patients with cerebral venous thrombosis. With clinical and pathological aspects of the process correlated, cerebral venous thrombosis in the aged presents a characteristic pattern. In some cases, in patients with enigmatic progressive coma and neurological deterioration, cerebral venous thrombosis occurs as the primary cause of death. In other instances, in patients with cardiac disease or other major systemic disorders, intracranial venous thrombosis develops as a terminal complication leading to death. Cerebral venous thrombosis is of increasing incidence. There is an expressed need that this form of stroke be more widely recognized clinically.
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Towbin A. Organic causes of minimal brain dysfunction. Perinatal origin of minimal cerebral lesions. JAMA 1971; 217:1207-14. [PMID: 5109459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Towbin A. Central nervous system damage in the human fetus and newborn infant. Mechanical and hypoxic injury incurred in the fetal-neonatal period. Am J Dis Child 1970; 119:529-42. [PMID: 4910173 DOI: 10.1001/archpedi.1970.02100050531015] [Citation(s) in RCA: 125] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
MESH Headings
- Brain Damage, Chronic/embryology
- Brain Damage, Chronic/pathology
- Brain Stem/embryology
- Central Nervous System Diseases/embryology
- Central Nervous System Diseases/pathology
- Cerebral Cortex/pathology
- Cerebral Ventricles/pathology
- Cerebrovascular Disorders/embryology
- Female
- Fetal Diseases
- Hematoma, Epidural, Cranial/embryology
- Hematoma, Subdural/pathology
- Humans
- Hypoxia/embryology
- Infant, Newborn
- Infant, Newborn, Diseases/embryology
- Infant, Premature, Diseases/embryology
- Infarction
- Intracranial Embolism and Thrombosis/embryology
- Pregnancy
- Spinal Cord Injuries/embryology
- Spinal Cord Injuries/pathology
- Veins
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Towbin A. Nervous-system damage related to hyaline-membrane disease. Lancet 1969; 1:890. [PMID: 4180552 DOI: 10.1016/s0140-6736(69)91936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Towbin A. Cerebral intraventricular hemorrhage and subependymal matrix infarction in the fetus and premature newborn. Am J Pathol 1968; 52:121-40. [PMID: 5634505 PMCID: PMC2013311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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