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E/M Medical Decision Making

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8701. Pulmonary Atresia With Ventricular Septal Defect (Diagnosis)

provide all or most pulmonary blood flow with oxygen saturations more than 75%. The native pulmonary arteries must supply at least 10 segments, the equivalent of one lung. If additional major collaterals are identified, test the level of arterial oxygen saturation after occlusion of the collaterals in the catheterization laboratory. If the oxygen saturation remains greater than 75%, then coil occlusion of the collaterals is carried out. The Nakata index is used to guide decision making for surgical (...) C, Pasotti E, Pedrazzini G, et al. Evaluation of pulmonary atresia with 64-slice multidetector computed tomography (MDCT). Echocardiography . 2007 Oct. 24(9):998-9. . Faza N, Kenny D, Kavinsky C, Amin Z, Heitschmidt M, Hijazi ZM. Single-center comparative outcomes of the Edwards SAPIEN and Medtronic Melody transcatheter heart valves in the pulmonary position. Catheter Cardiovasc Interv . 2013 Oct 1. 82(4):E535-41. . Fiane AE, Lindberg HL, Seem E, Geiran OR. Homografts for right ventricular

2014 eMedicine Pediatrics

8702. Small-Bowel Obstruction (Diagnosis)

. Retrospective and prospective studies have reported an incidence of strictures of between 10% and 35% for medically and surgically managed patients. While the exact cause of NEC remains unknown, multiple factors probably lead to ischemic or hypoxemic insult of the intestinal mucosa, followed by bacterial invasion of the denuded mucosa with gram-negative septicemia and intestinal necrosis. Complement activation product C5a (anaphylatoxin) has been reported to be a contributing factor leading to mesenteric (...) antegrade continence enema (MACE) procedure, in which the cecal appendix is used as a tubular conduit between the abdominal wall and the cecum, creating a stoma through which the patient can get an antegrade enema to achieve "social continence." [ ] Duplication cysts See the image below. Surgical photograph of a 3-year-old male patient with an obstructive, noncommunicating ileal duplication. Duplications of the alimentary tract make up a group of rare malformations that vary greatly in appearance, size

2014 eMedicine Pediatrics

8703. Severe Combined Immunodeficiency (Diagnosis)

: , , , , , , , , Disclosure: Nothing to disclose. Acknowledgements David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic David F Butler, MD is a member of the following medical societies: , , , , , , and Disclosure: Nothing to disclose. Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School (...) Center Charles H Kirkpatrick, MD is a member of the following medical societies: , , , American Federation for Clinical Research, , and Disclosure: Lev Pharmaceuticals Consulting fee Consulting James M Oleske MD, MPH, François-Xavier Bagnoud Professor of Pediatrics, Director, Division of Pulmonary Allergy Immunology and Infectious Diseases, Department of Pediatrics, New Jersey Medical School; Professor, Department of Quantitative Methods, University of Medicine and Dentistry of New Jersey James M

2014 eMedicine Pediatrics

8704. Sexuality: Gender Identity (Diagnosis)

interchangeably in the vernacular. However, in a medical and technically scientific sense, these words are not synonymous. Increasingly, the term gender is being accepted to define psychophysiologic processes involved in identity and social role. Therefore, it is not uncommon to hear references to "gender" by professionals from numerous disciplines, including medicine, psychology, anthropology, and social science. Gender comes from the Latin word genus, meaning kind or race. It is defined by one's own (...) congruence either with or without surgical/medical interventions. In each case, a thorough evaluation of gender identity, preferred gender role, and a complete psychosocial history is needed to assess the situation. Standards of care have been outlined and modified by Harry Benjamin, MD, and these continue to be a well-respected management tool in evaluating and managing transsexualism. Decisions regarding hormonal or surgical management are made after a mental health assessment is completed. ICD-10

2014 eMedicine Pediatrics

8705. Surgical Aspects of Cystic Fibrosis and Meconium Ileus (Diagnosis)

. of 2 Tables Contributor Information and Disclosures Author Michael S Irish, MD Adjunct Clinical Assistant Professor, Department of Surgery, University of Iowa, Roy J and Lucille A Carver College of Medicine; Consulting Pediatric Surgeon, Department of Pediatric Surgery, Blank Children's Hospital and Children's Hospital Physicians Group Michael S Irish, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Philip M Bovet, MPH, DO, FACOFP Consulting (...) Physician, Aspirus Clinics, Inc Philip M Bovet, MPH, DO, FACOFP is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Gail E Besner, MD Chief, Department of Pediatric Surgery, Principal Investigator, Center for Perinatal Research, Director, Pediatric Surgery Training

2014 eMedicine Pediatrics

8706. Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity (Diagnosis)

to maintain good cardiovascular fitness and a healthy weight. Effective school-based interventions include support for an active lifestyle, nutritionally appropriate food options at school, and education about healthy decision making around food choices. [ ] Previous Next: Prognosis Untreated obesity-hypoventilation syndrome (OHS) is associated with increased risk for respiratory, metabolic, hormonal, and cardiac impairment. Studies of adult patients have shown decreased quality of life, with higher rates (...) , Halbower AC, Jones J. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics . 2012 Sep. 130(3):e714-55. . Lopata M, Freilich RA, Onal E, Pearle J, Lourenco RV. Ventilatory control and the obesity hypoventilation syndrome. Am Rev Respir Dis . 1979 Feb. 119(2 Pt 2):165-8. . Zwillich CW, Sutton FD, Pierson DJ, Greagh EM, Weil JV. Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med . 1975 Sep. 59(3):343-8. . Mallory GB Jr, Fiser DH, Jackson R

2014 eMedicine Pediatrics

8707. Pancreatitis and Pancreatic Pseudocyst (Diagnosis)

traumatic pancreatitis with ductal injury) is indicated after medical failure. Endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative pancreatic ductography is invaluable in determining the site of ductal disruption and directs surgical decision-making to the most appropriate operative procedure. [ , , , ] Operative management of chronic pancreatitis in children is controversial. Indications for operative intervention include unsuccessful conservative medical therapy, intractable pain (...) DC, Madden J, Leeflang E, Jackson WD, Feola GP, et al. Non-operative treatment versus percutaneous drainage of pancreatic pseudocysts in children. Pediatr Surg Int . 2013 Mar. 29(3):305-10. . Abu-El-Haija M, Palermo JJ, Fei L, Lin TK. Variability in Pancreatitis Care in Pediatrics: A Single Institution's Survey Report. Pancreas . 2015 Oct 22. . Abu-El-Haija M, Wilhelm R, Heinzman C, Siqueira BN, Zou Y, Fei L, et al. Early Enteral Nutrition in Children with Acute Pancreatitis. J Pediatr

2014 eMedicine Pediatrics

8708. Otitis Media (Diagnosis)

at least 6 months with severe signs or symptoms (moderate or severe otalgia, otalgia for 48 hours or longer, or temperature 39°C or higher) and for nonsevere, bilateral AOM in children aged 6 to 23 months On the basis of joint decision-making with the parents, unilateral, nonsevere AOM in children aged 6-23 months or nonsevere AOM in older children may be managed either with antibiotics or with close follow-up and withholding antibiotics unless the child worsens or does not improve within 48-72 hours (...) , Leibovitz E. Acute otitis media caused by Moraxella catarrhalis: epidemiologic and clinical characteristics. Clin Infect Dis . 2009 Dec 1. 49(11):1641-7. . Yilmaz T, Ceylan M, Akyon Y, et al. Helicobacter pylori: a possible association with otitis media with effusion. Otolaryngol Head Neck Surg . 2006 May. 134(5):772-7. . Harimaya A, Takada R, Hendolin PH, et al. High incidence of Alloiococcus otitidis in children with otitis media, despite treatment with antibiotics. J Clin Microbiol . 2006 Mar. 44(3

2014 eMedicine Pediatrics

8709. Neonatal Resuscitation (Diagnosis)

in arterial oxygen related to the onset of spontaneous respirations and on a fall in circulating prostaglandin E 2 (PGE 2 ). Because the placenta is a major site of fetal PGE 2 production, removal of the placenta from the circulation causes circulating fetal PGE 2 concentration to decrease markedly. Further reductions in PGE 2 concentration occur because of increased blood flow to the lungs (the site of PGE 2 metabolism). Functional closure of the ductus arteriosus (PDA) in the normal term infant (...) of the infant, and assessment of the infant's color. These infants should remain with their mothers during and after routine care. Infants who do not meet the criteria for routine care need additional steps in their resuscitation. For such infants, resuscitation may include not only initial stabilization (providing warmth, positioning, clearing the airway, drying, stimulating, and repositioning) but also ventilation, chest compressions, and medications. Anticipation of potential problems The goals

2014 eMedicine Pediatrics

8710. Mood Disorder: Bipolar Disorder (Diagnosis)

imbalances in the brain that may interact with underlying anatomical changes in the brain that adversely impact neural functional connectivity. Smaller subfield hippocampal volumes may reflect underlying pathophysiology of bipolar disorder and impact long term functioning. [ ] Alterations in functional connectivity of areas of the brain involved in executive functioning, decision making – so-called default and salience networks – are other areas being studied. The clinical implications of impaired (...) , Nicoletti M, Hatch JP, Brambilla P, et al. Abnormal corpus callosum myelination in pediatric bipolar patients. J Affect Disord . 2008 Jun. 108(3):297-301. . . Pandey GN, Ren X, Dwivedi Y, Pavuluri MN. Decreased protein kinase C (PKC) in platelets of pediatric bipolar patients: effect of treatment with mood stabilizing drugs. J Psychiatr Res . 2008 Jan. 42(2):106-16. . . Mick E, Kim JW, Biederman J, Wozniak J, Wilens T, Spencer T, et al. Family based association study of pediatric bipolar disorder

2014 eMedicine Pediatrics

8711. Molluscum Contagiosum (Diagnosis)

Dermatology, Department of Dermatology, Northwestern University, The Feinberg School of Medicine; Medical Director for Dermatologic Research, Director of Dermatologic, Laser and Cosmetic Surgery, Oak Dermatology Ashish C Bhatia, MD, FAAD, FACMS is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Chief Editor Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine Dirk M (...) ; Director of Dermatologic Surgery and Dermatology, The Dermatology Institute of DuPage Medical Group Ashish C Bhatia, MD, FAAD is a member of the following medical societies: , , , , , , and Disclosure: Nothing to disclose. David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic David F Butler, MD is a member of the following medical societies

2014 eMedicine Pediatrics

8712. Mitral Valve Insufficiency (Diagnosis)

for management decision-making in patients with left-sided valvular regurgitation. Eur Heart J . 1996 Feb. 17(2):272-80. . Media Gallery Acute stage of mitral regurgitation (MR) (mitral valve insufficiency). Chronic compensated stage of mitral regurgitation (MR) (mitral valve insufficiency). Chronic decompensated stage of mitral regurgitation (MR) (mitral valve insufficiency). Dilated cardiomyopathy with significant mitral regurgitation (MR) (mitral valve insufficiency) by transthoracic echocardiogram (...) of the following medical societies: , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College Julian M Stewart, MD, PhD is a member

2014 eMedicine Pediatrics

8713. Motor Skills Disorder (Diagnosis)

. [ ] Previous Next: Patient Education Children aged 6-7 years can be positively counseled to make modifications in school and in social situations to make the best of their limitations in motor tasks. Acknowledging these limitations and helping the children understand that this problem is not voluntary on their part and not due to lack of effort or intellectual skill is important. As with other chronic medical conditions, the patient can be helped to understand the nature of the condition, to live (...) . [Developmental coordination disorder: relations between deficits in movement and cognition]. Klin Padiatr . 2010 Jan-Feb. 222(1):26-34. . Bax M, Hart H, Jenkins SM. Developmental disorders. Child Development, Child Health . Blackwell Scientific; 1990. 106-48, 229-68. Gillberg C, Kadesjo B. Why bother about clumsiness? The implications of having developmental coordination disorder (DCD). Neural Plast . 2003. 10(1-2):59-68. . . Kopp S, Beckung E, Gillberg C. Developmental coordination disorder and other motor

2014 eMedicine Pediatrics

8714. Mood Disorder: Dysthymic Disorder (Diagnosis)

children or adolescents, when a pervasive depressed or irritable mood is present for at least 1 year. Two additional symptoms of must also be present for most of the day at least half of the time during that year to make the diagnosis. Depressive symptoms typical in persisten depressive disorder include the following [ ] (see Prognosis, Presentation, and Workup): Diminished or increased appetite Insomnia or hypersomnia Low energy or fatigue Poor self-esteem Difficulties with concentration or decision (...) with depressive symptoms. Previous References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . Washington, DC: American Psychiatric Association; 2013. Agnafors S, Svedin CG, Oreland L, Bladh M, Comasco E, Sydsjö G. A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 12. Child Psychiatry Hum Dev . 2016 Sep 15. . Demir T, Karacetin G, Demir DE, Uysal O. Epidemiology of depression in an urban population

2014 eMedicine Pediatrics

8715. Hemothorax (Treatment)

Thorac Cardiovasc Surg . 2014. 20 Suppl:911-4. . Nakayama DK, Ramenofsky ML, Rowe MI. Chest injuries in childhood. Ann Surg . 1989 Dec. 210(6):770-5. . . Sharma OP, Hagler S, Oswanski MF. Prevalence of delayed hemothorax in blunt thoracic trauma. Am Surg . 2005 Jun. 71(6):481-6. . Cottin V, Chinet T, Lavolé A, Corre R, Marchand E, Reynaud-Gaubert M, et al. Pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: a series of 126 patients. Medicine (Baltimore) . 2007 Jan. 86(1):1 (...) : Nothing to disclose. Denise Serebrisky, MD Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center/North Central Bronx Hospital; Director, Jacobi Asthma and Allergy Center for Children, Jacobi Medical Center Denise Serebrisky, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct

2014 eMedicine Pediatrics

8716. Heart Transplantation (Treatment)

of the following medical societies: , , Disclosure: Nothing to disclose. Coauthor(s) Richard E Chinnock, MD, MSc, FAAP, FACHE, CPE Chief Medical Officer, Transplant Pediatrician, Pediatric Heart Transplant Program, Loma Linda University Children's Hospital; Professor and Chair, Department of Pediatrics, Loma Linda University School of Medicine Richard E Chinnock, MD, MSc, FAAP, FACHE, CPE is a member of the following medical societies: , , , , , , , Disclosure: Nothing to disclose. Acknowledgements Richard G (...) contraindications. Many children who are quite ill can make a remarkable recovery once a new heart restores adequate perfusion. However, the following are considered incompatible with successful transplantation: Irreversible elevated pulmonary vascular resistance (>6 Wood units/m 2 or a transpulmonary gradient >15 mm Hg) Diffuse hypoplasia of the central branch pulmonary arteries Total anomalous pulmonary venous connection without pulmonary venous confluence Ectopia cordis Active systemic infection Infection

2014 eMedicine Pediatrics

8717. Hearing Impairment (Treatment)

, Beauchaine KL, Osberger MJ. Management of the child with sensorineural hearing loss. Medical, surgical, hearing aids, cochlear implants. Pediatr Clin North Am . 1999 Feb. 46(1):121-41. . Carter JM, Hoff SR. Endoscopic middle ear exploration in pediatric patients with conductive hearing loss. Int J Pediatr Otorhinolaryngol . 2017 May. 96:21-24. . Cunningham M, Thomson V, McKiever E, Dickinson LM, Furniss A, Allison MA. Infant, Maternal, and Hospital Factors' Role in Loss to Follow-up After Failed Newborn (...) of Medicine and Science Michael Lotke, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. John E McClay, MD Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas

2014 eMedicine Pediatrics

8718. Head Trauma (Treatment)

, , , , , , , Disclosure: Nothing to disclose. Additional Contributors Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin Timothy E Corden, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Acknowledgements G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University (...) of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc G Patricia Cantwell, MD, FCCM is a member of the following medical societies: , , , , , , and Disclosure: Nothing to disclose

2014 eMedicine Pediatrics

8719. Graves Disease (Treatment)

in stressful competitive sports. Previous Next: Consultations The following consultations may be indicated: Endocrinologist - An experienced pediatric endocrinologist can adjust medication and plan medical management, as well as assist the patient and family in decision-making as to appropriate long-term therapy options Nuclear medicine specialist or endocrinologist - Certification in the therapeutic use of RAI is required for this form of therapy; few pediatric endocrinologists are certified in this use (...) , Perrild H, Andersen O, Jacobsen BB. Incidence of juvenile thyrotoxicosis in Denmark, 1982-1988. A nationwide study. Eur J Endocrinol . 1994 Jun. 130(6):565-8. . Klatka M, Grywalska E, Partyka M, Charytanowicz M, Rolinski J. Impact of methimazole treatment on magnesium concentration and lymphocytes activation in adolescents with Graves' disease. Biol Trace Elem Res . 2013 Jun. 153(1-3):155-70. . . Wiersinga WM. Thyroid associated ophthalmopathy: pediatric and endocrine aspects. Pediatr Endocrinol Rev

2014 eMedicine Pediatrics

8720. Fragile X Syndrome (Treatment)

. . Bailey DB Jr, Raspa M, Bishop E, Holiday D. No change in the age of diagnosis for fragile x syndrome: findings from a national parent survey. Pediatrics . 2009 Aug. 124(2):527-33. . de Vries BB, Halley DJ, Oostra BA, Niermeijer MF. The fragile X syndrome. J Med Genet . 1998 Jul. 35(7):579-89. . Hagerman RJ, Berry-Kravis E, Kaufmann WE, Ono MY, Tartaglia N, Lachiewicz A, et al. Advances in the treatment of fragile X syndrome. Pediatrics . 2009 Jan. 123(1):378-90. . Oostra BA, Willemsen R. FMR1: a gene (...) DV, Mu Y, et al. A Randomized Double-Blind, Placebo-Controlled Trial of Minocycline in Children and Adolescents with Fragile X Syndrome. J Dev Behav Pediatr . 2013. 34:147–155. . Media Gallery of 0 Tables Contributor Information and Disclosures Author Jennifer A Jewell, MD, MS Assistant Professor of Pediatrics, Tufts University School of Medicine; Pediatric Hospitalist, The Barbara Bush Children's Hospital at Maine Medical Center Jennifer A Jewell, MD, MS is a member of the following medical

2014 eMedicine Pediatrics

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