Monroe Carell Jr. Children's Hospital at Vanderbilt

About: Monroe Carell Jr. Children's Hospital at Vanderbilt is a based out in . It is known for research contribution in the topics: Population & Medicine. The organization has 1046 authors who have published 1262 publications receiving 28063 citations. The organization is also known as: Vanderbilt Children's Hospital.

Right-Sided Pulmonary Venous Obstruction Between a Right Aortic Arch and an Amplatzer Septal Occlusion Device Following Closure of a Secundum Atrial Septal Defect

Abstract: Right-sided pulmonary venous obstruction between a right aortic arch and an Amplatzer Septal Occluder device developed following closure of a large secundum atrial septal defect. The obstruction was not apparent on postprocedure transesophageal echocardiogram but developed over time. The patient recovered completely following surgical removal of the device.

A 21-Month-Old Male With Refusal to Walk, Rash, and Weight Loss.

Abstract: History of the present illness The patient was in good health until 4 months prior to presentation. During this time, he progressively stopped walking, became more irritable, and had decreased appetite. He developed bilateral diffuse swelling of his feet and refusal to bear weight. His feet were tender to light touch. He had a purple-colored, mildly pruritic rash that initially began on his legs and progressed to his trunk and face over several days. His symptoms persisted and he presented to his primary care physician 3 months into his illness. He was noted to have a distended abdomen and failure to thrive. His weight and height decreased from the 90th and 75th percentiles, respectively, to the 25th percentile. An abdominal ultrasound was unremarkable. Laboratory results at that time demonstrated a white blood cell count of 5,900 cells/ml, a hemoglobin of 11.1 gm/dl, and a platelet count of 266,000/ml. Absolute neutrophil count was 3,300 cells/ ml, and absolute lymphocyte count was 2,000 cells/ml. Electrolytes were normal with creatinine of 0.5 mg/dl. Albumin was low at 2.7 gm/dl. Liver enzymes, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were normal. Antinuclear antibody and rheumatoid factor were negative. He began to have daily fevers of 101–1038F 2 weeks prior to presentation. Ibuprofen mildly alleviated his symptoms; however, he continued to have fever once to twice daily. He was referred to the pediatric rheumatology clinic and admitted to the hospital for an expedited evaluation.

Increased Intracranial Pressure

Abstract: The infant or child with increasing pressure within the cranial cavity must be identified early and treated promptly in order to prevent serious complications or death. When the pressure elevation is gradual it is frequently well tolerated, and the patient may seem deceptively well. There is a critical point, however, beyond which any further increase in pressure leads to a catastrophic deterioration in the patient9s condition.1 When this occurs, the outlook for quality survival is poor despite the best therapy. Unfortunately, this can occur when the underlying process is benign and would have been reversible if recognized and treated promptly. For prompt recognition and treatment, the physician must be familiar with the pathophysiology of raised intracranial pressure. PATHOPHYSIOLOGY The intracranial compartment contains blood vessels, cerebrospinal fluid (CSF), brain, and leptomeninges which include the rigid dural membranes forming the falx and tentorium. Whenever there is an increase in the volume of any one of these intracranial components (brain, CSF, blood) there must be a corresponding reduction in the size of the others in order for the intracranial pressure to remain normal. This type of compensation or buffering capacity is particularly important in the early stages of intracranial disease. As the pressure mounts from any type of mass lesion, the CSF is displaced caudally into the spinal subarachnoid space and there is a corresponding increase in the rate of absorption of CSF.2