Uvular Trauma after Laryngeal Mask Airway Use

5noreservedmixedArigliani, Michele; Dolcemascolo, Valentina; Passone, Eva; Vergine, Michela; Cogo, PaolaArigliani, Michele; Dolcemascolo, Valentina; Passone, Eva; Vergine, Michela; Cogo, Paol

How to recognize and manage psychosomatic pain in the pediatric emergency department

Children and adolescents affected by somatization and somatic symptom disorder commonly refer to emergency services. Due to the absence of specific guidelines for the emergency setting and to a possible lack of knowledge, these patients are at risk of being unrecognized and mismanaged. This study aims at proposing a clinical practice to approach and manage these patients and their families in the emergency setting

Optic Nerve Hypoplasia, Corpus Callosum Agenesis, Cataract, and Lissencephaly in a Neonate with a Novel <b><i>COL4A1</i></b> Mutation

We report the case of a girl with a novel mutation of the &lt;i&gt;COL4A&lt;/i&gt; gene (c.2716+2T&amp;#x3e;C) presenting microcephaly, parenchymal hemorrhages, lissencephaly, and bilateral cataracts, associated with agenesis of the corpus callosum and hypoplasia of the optic nerve. &lt;i&gt;COL4A1&lt;/i&gt;, located on chromosome 13, encodes the α1 chain of type IV collagen, a key component of the basement membrane in various organs, such as eye, brain, kidneys, and muscles. Different mutations have been described and may remain asymptomatic or determine porencephaly, cerebral hemorrhages, renal cysts, hematuria, and dysgenesis of the anterior segment of the eye.</jats:p

Presentation and symptom interval in children with central nervous system tumors. A single-center experience

7noPURPOSE: The aim of this study is to describe the symptoms and signs of central nervous system (CNS) tumors in a pediatric population and to assess the time interval between the onset of the disease and the time of the diagnosis. METHODS: A retrospective observational study was conducted at our Oncology Pediatric Unit between January 2000 and November 2011. We included 75 children between 5 months and 16 years (mean age of 7.8 ± 4.7 years), with male to female ratio of 3:2. The tumor localization was supratentorial in 51% of cases, and the most frequent histological type was low-grade astrocytoma (48%). RESULTS: Presenting symptoms were headache (31%), vomiting (31%), seizures (21%), and behavioral change (11%). The most common symptoms at diagnosis were headache (51%), vomiting (51%), visual difficulties (37%), seizures (24%), and behavioral change (21%). By the time of diagnosis, neurologic examination was altered in 68% of our patients. Vomiting (44%) and behavioral change (44%) were the most frequent symptoms in children under 4 years of age, headache (61%) and vomiting (54%) in children older than 4 years. The median interval between symptoms' onset and diagnosis was 4 weeks (range 0 to 314 weeks). A longer symptom interval was associated with younger age, infratentorial localization and low-grade tumors. The differences in symptom intervals between the different age, location, and grade groups were not statistically significant. Survival probability was influenced by tumor grade but not by diagnostic delay or age of the child. CONCLUSIONS: Headache and vomiting are the earliest and commonest symptoms in children with brain tumors. Visual symptoms and signs and behavioral change are often present. Abnormalities in neurological examination are reported in most of the children. Intracranial hypertension symptoms suggest the need for a neurological clinical examination and an ophthalmological assessment.reservedmixedStocco, Chiara; Pilotto, Chiara; Passone, Eva; Nocerino, Agostino; Tosolini, Raffaello; Pusiol, Anna; Cogo, PaolaStocco, Chiara; Pilotto, Chiara; Passone, Eva; Nocerino, Agostino; Tosolini, Raffaello; Pusiol, Anna; Cogo, Paol

Risk Factors of Persistent Hydrocephalus in Children with Brain Tumor: A Retrospective Analysis

&lt;b&gt;&lt;i&gt;Object:&lt;/i&gt;&lt;/b&gt; Hydrocephalus is one of the main complications of brain tumors in children, being present in about 50% of cases at the time of the tumor diagnosis and persisting up to 10–40% of cases after surgical resection. This is a single-institution retrospective study on the variables that may predict the need for treatment of persistent hydrocephalus in pediatric patients presenting with a brain tumor. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Retrospective case note review of 43 newly diagnosed brain tumors in children referred between April 2012 and January 2018 to our regional pediatric neuro-oncology service was carried out. Diagnosis of hydrocephalus was carried out using both preoperative and postoperative MRI to determine Evans’ index (EI) and the fronto-occipital horn ratio (FOHR) from each scan. Simple logistic regression was used to analyze categorical variables as appropriate. A &lt;i&gt;p&lt;/i&gt; value &amp;#x3c;0.05 was considered significant. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Forty-three children were analyzed, 26 males and 17 females with a median age at diagnosis 10.4 years (IQR: 5.2–13.5). Hydrocephalus was present in 22/43 children (51%) preoperatively; in 8/22 children (36%) with hydrocephalus undergoing tumor resection, hydrocephalus persisted also in the postoperative period. An EI &amp;#x3e;0.34 (&lt;i&gt;p&lt;/i&gt; = 0.028) and an FOHR &amp;#x3e;0.46 (&lt;i&gt;p&lt;/i&gt; = 0.05) before surgery were associated with a higher prevalence of persistent hydrocephalus and therefore to the need for a cerebrospinal fluid drain device in the postoperative phase. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Preoperative identification of children at risk for developing persistent hydrocephalus would avoid delays in planning the permanent cerebrospinal fluid drain devices. This study finds that an EI &amp;#x3e;0.34 and an FOHR &amp;#x3e;0.46 at diagnosis could impact on the therapeutic management of children with hydrocephalus associated with brain tumors. Prospective and larger-scale studies are needed to standardize this approach. </jats:p

Impact of compounded drugs on the caregivers’ burden of home therapy management in pediatric palliative care: A descriptive study

Background: Children with medical complexity need complex assistance, that considerably affects caregivers’ quality of life. They often need multiple medications, with a consequent relevant risk of errors or poor compliance. Galenic (or compounded) drugs are blended in the pharmacy’s laboratory worldwide according to different rules and tailoring the patient’s needs. While their use may sometimes simplify these therapies, little is known about parents’ attitude about this issue. Aim: This study aimed at investigating the complexity of the daily therapy management and exploring the parents’ opinions about galenic compounds. Design: Parents were interviewed by using a structured questionnaire. Setting: Children followed by the Pediatric Palliative Care Network in Friuli Venezia Giulia, Italy, were included from November 2021 to April 2022. Those diagnosed with malignancies were excluded, since therapies are mainly administered through a central venous catheter. Results: Thirty-four parents were interviewed. Fourteen patients took drugs orally, one via nasogastric tube (NGT), 18 via gastrostomy, and one orally + NGT. The mean number of drugs taken every day was six (2–14), in mean 10 (3–18) administrations, that overall required a mean of 44 (8–180) minutes to be delivered. Twenty-eight parents used galenic compounds, and 24 reported relevant advantages, because of a ready-to-use and safe formulation. Conclusions: The therapy management of children with medical complexity relies on parents. Galenic compounds may improve both patients’ and caregivers’ quality of life, either in terms of shorter time of administration or smaller risk of errors. Therefore, their use should be encouraged worldwide, according to the different reference rules. </jats:sec