Jim Ski's List: Med

• prevalence of scoliosis was highest (1.2%) in patients aged 12-14 years
• point prevalence of idiopathic scoliosis (Cobb angle >10°) to be 0.5% (76 of 15,799 patients)
• Other studies using the 10° definition of scoliosis have placed the overall prevalence in the 1.9-3.0% range.
• • Observation for curves less than 25° with follow-up radiographs at regular intervals
  • Bracing for curves that range from 25-40° and at least consideration of bracing (based on curve flexibility) for curves from 40-50°
  • Bracing for smaller curves that demonstrate rapid progression to the 20-25° range
  • Surgical intervention for inflexible curves that exceed 40° or virtually any curve that exceeds 50°.
• observation for curves less than 30°
• The first widely used scoliosis brace with proven effectiveness was the Milwaukee brace
• • Observation, 49%
  • Electrical stimulation, 39%
  • Bracing 8 hours per day, 60%
  • Bracing 16 hours per day, 62%
  • Bracing 23 hours per day, 93%
• Some authors have not been able to identify a major difference between full-time bracing (23 h/d) and part-time bracing (12-16 h/d

• Even in the setting of adequate correction and solid fusion, up to 38% of patients still have occasional back pain.^{76, 105}

  The primary goal of scoliosis surgery is to achieve a solid bony fusion.

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• Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.
• Pancreatic calcification can often be seen on X-rays, as well as CT scans.
• biliruin and alkaline phosphatase can be elevated, indicating possible compression of the intrapancreatic bile duct due to edema, fibrosis, or cancer
• 
   While the outcome of trials regarding pain reduction with pancreatic enzyme replacement is inconclusive, some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis

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• Ischemic pancreatitis also may occur and is associated with epigastric pain. Laboratory studies reveal mildly elevated amylase and lipase. Steatorrhea may be observed.

• Abdominal Angina
• Relieved by defecation
• Patients who are affected describe widened dermatomal distributions of referred pain
• Both colonic inflammation and small bowel inflammation
• This has led to proposed treatments with probiotics and antibiotics
• The development of symptoms in people older than 40 years does not exclude IBS but should prompt a closer search for an underlying organic etiology
• Symptoms not consistent with IBS include the following:
• Onset in middle age or older
• Nocturnal symptoms
• Anorexia or weight loss
• Steatorrhea
• sigmoid tenderness
• Lubiprostone (Amitiza)

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• Apnea of Prematurity
• • Other conditions associated with Apnea:
    
    Infection, anemia, reflux,
• Apnea is defined as the cessation of breathing for more than 20 seconds or apnea or the cessation of breathing for less than 20 seconds if it is accompanied by bradycardia or oxygen (O₂) desaturation
• Bradycardia in a premature neonate is considered clinically significant when the heart rate slows by least 30 bpm from the resting heart rate
• Periodic breathing is defined as periods of regular respiration for as long as 20 seconds followed by apneic periods of 10 seconds or less that occur at least 3 times in succession
• Periodic breathing may be observed for 2-6% of the breathing time in healthy term neonates and as much as 25% of the breathing time in preterm neonates. The occurrence of periodic breathing is directly proportional to the degree of prematurity
• Kelly and coworkers (1979) observed periodic breathing in 78% of neonates examined at 0-2 weeks of age
• Immaturity and/or depression of the central respiratory drive to the muscles of respiration have been accepted as key factors in the pathogenesis of AOP
• Approximately 70% of babies born before 34 weeks of gestation have clinically significant apnea, bradycardia, or O₂ desaturation during their hospital stay
• Mixed apnea accounts for about 50% of all cases of apnea in premature neonates; about 40% are central apneas, and 10% are obstructive apneas.⁵² These percentages vary in different reports. In 50% of all apneic episodes, an obstructive component precedes or follows central apnea, which leads to mixed apnea
• • Reflex effects of apnea include characteristic changes in heart rate, blood pressure, and pulse pressure.
  • • Bradycardia may begin within 1.5-2 seconds of the onset of apnea.
    • Apneic episodes associated with bradycardia are characterized by decreases in heart rate of more than 30% below baseline rates.
• the abnormal control of breathing seen in AOP represents neuronal immaturity of the brain.

• Apnea-free interval before discharge

  Most neonatologists agree that babies should be apnea-free for 2-10 days before discharge. However, the interval between the last apneic event and a safe time for discharge is not clearly established. The minimum apnea-free period is debated among clinicians. Darnall et al (1997) concluded that otherwise healthy preterm neonates continue to have periods of apnea separated by as many as 8 days before the last episode of apnea before discharge.¹²² Infants with long intervals between apneic event often have risk factors other than apnea of prematurity (AOP).
• However, in some infants, apnea may persist until the age of 44 weeks after conception.

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• • Good Review Art on TS 21
• The frequency is 1 case in 800 live births
• intelligence quotient (IQ) of 20-85 (mean, approximately 50)
• Hypotonia
• Seizure disorder (5-10%)
• Chronic otitis media and hearing loss are common
• Congenital heart defects are common (40-50%)
• most common lesions are patent ductus arteriosus (16%) and pulmonic stenosis (9%).
• About 30% of patients have several cardiac defects.
• (12%): Duodenal atresia or stenosis
• Immunodeficiency: Patients have about a 12-fold increased risk of infectious diseases, especially pneumonia, because of impaired cellular immunity
• Echocardiography: This test should be performed on all infants with Down syndrome to identify congenital heart disease, regardless of findings on physical examination.
• Congenital heart disease is the major cause of death.

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• A child has a shorter neck, smaller and anterior larynx, floppy epiglottis, short trachea, and large tongue
• Airway control is the first priority. Unlike in adults, the cause of childhood cardiac arrest is an initial respiratory arrest
• Avoid accidental hypothermia during the initial phase of resuscitation

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