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Manmohan Kamboj1, Vibha Gupta2, Alfonso Torres2, Dilip R Patel21Nationwide Children's Hospital, Columbus, OH, USA; 2Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, MI, USAAbstract: Hypertension has been well recognized as a major contributor of chronic cardiovascular disease, resulting in significant morbidity and mortality not only in adults but also in children and adolescents. Primary or essential hypertension refers to cases where no underlying etiology is apparent for the high blood pressure, and accounts for a majority of the patients. Secondary hypertension refers to a much smaller group of patients in whom the blood pressure elevation may be attributed to an underlying cause. With improved diagnostic techniques, some cases of previously diagnosed essential hypertension may be found to have an underlying etiology. Endocrine causes account for a relatively small proportion of all patients with hypertension. In the following discussion, only secondary hypertension due to endocrine-related causes will be discussed.Keywords: primary hyperalsosteronism, paraganglioma, beta-hydroxy-steroid dehydogenase deficiency, Liddle syndrome, Gordon syndrome

Dedicated bone tumor MRI protocols of the spine are recommended that afford familiarity include T1-weighted sequences that are of most benefit when assessing marrow infiltration. I Purpose or Learning Objective: i (1) To understand the overall frequency of unexpected musculoskeletal (MSK) findings in retrospective reviews; (2) to describe the importance of a correct diagnosis of incidental bone lesion versus marrow infiltration, especially in a setting of known primary malignancy; (3) to introduce and improve characterization of spinal tumor mimics, such as focal marrow hyperplasia (FNMH), Schmorl's node, hemangioma, enostosis, and benign notochordal cell tumors (BNCTs); and (4) to discuss image optimization, novel magnetic resonance imaging (MRI) techniques, and the use of auxiliary imaging modalities. [Extracted from the article]

WHO grading of oral epithelial dysplasia (OED) is employed by pathologists to aid in prognostication and treatment planning. However, considerable inter-observer variability exists. Recently, p53 abnormal OED has been proposed as a unique entity with an increased risk of malignant transformation. Subsequently, a pattern-based approach to p53/p16 immunohistochemistry (IHC) interpretation has been developed to classify OED into Human Papillomavirus (HPV)-associated, p53 wild-type (conventional), and p53 abnormal OED. In this study, the grading (three-tiered and two-tiered) and classification of OED were compared using hematoxylin and eosin-stained sections (H&E) with and without p53/p16 IHC. Formalin-fixed, paraffin-embedded oral biopsy specimens with targeted Next-Generation Sequencing results and/or high-risk HPV in situ hybridization results were collected from 51 patients. Inter-observer variability among 18 pathologists was determined using Fleiss' kappa (κ). 93% of HPV-associated OED and 77% of p53 abnormal OED were successfully identified using p53/p16 IHC. In contrast, 55% of HPV-associated OED and 37% of p53 abnormal OED were identified using H&E. 19% of p53 abnormal OED were initially interpreted as "reactive, no dysplasia" using H&E; this decreased to 10% following reviewing of p53/p16 IHC. There is excellent agreement beyond chance and fair to good agreement beyond chance for the classification of OED using p53/p16 IHC (overall, κ = 0.61, HPV-associated OED, κ = 0.92; p53 abnormal OED, κ = 0.56). Both the three-tiered and two-tiered dysplasia grading systems demonstrate poor agreement beyond chance in H&E (κ = 0.35 and 0.39; p < 0.0001) and p53/p16 IHC (κ = 0.33 and 0.37; p < 0.0001). A panel of p53/p16 IHC can improve both diagnostic accuracy and inter-observer agreement in the diagnosis of OED. p53 abnormal OED cannot be reliably identified on H&E alone, and the histologic spectrum of HPV-associated dysplasia is broader than currently appreciated. [ABSTRACT FROM AUTHOR]

We describe a 53-year-old Caucasian woman with a 19-year history of an evolving amyotrophy confined to her dominant right arm and hand. Although this atypical case of a late-onset monomelic amyotrophy in some respects mimics Hirayama disease or O'Sullivan-McLeod syndrome, it does not conform precisely with either of those disorders. We compare this individual's difficulties and clinical temporal profile to other disorders considered in the differential diagnoses with regard to her evolving clinical setting. [ABSTRACT FROM AUTHOR]

Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy. Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support the use and effectiveness of neuromuscular electrical stimulation in children with cerebral palsy. The effectiveness of many other interventions used in the treatment of cerebral palsy has not been clearly established based on well-controlled trials. These include: sensory integration, body-weight support treadmill training, conductive education, constraint-induced therapy, hyperbaric oxygen therapy, and the Vojta method. This article provides an overview of salient aspects of popular interventions used in the management of children with cerebral palsy. [ABSTRACT FROM AUTHOR]

Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development--from prenatal up to 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions falling within the definition of developmental disabilities. Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything from the common cold to complex and chronic medical conditions. This article reviews the prevalence of different types of CAM used for various developmental disabilities. [ABSTRACT FROM AUTHOR]

Motor function abnormalities are a key feature of cerebral palsy. Spasticity is one of the main motor abnormalities seen in children with cerebral palsy. Spasticity is a velocity dependent increased resistance to movement. While in some children, spasticity may adversely impact the motor abilities, in others, it may help maintain posture and ability to ambulate. Thus, treatment to reduce spasticity requires careful consideration of various factors. Non-pharmacologic interventions used to reduce spasticity include physiotherapy, occupational therapy, use of adaptive equipment, various orthopedic surgical procedures and neurosurgical procedures. Pharmacologic interventions used for reducing spasticity in children with cerebral palsy reviewed in this article include oral administration of baclofen, diazepam, dantrolene and tizanidine, intrathecal baclofen, and local injections of botulinum toxin, phenol, and alcohol. [ABSTRACT FROM AUTHOR]

As more children participate in recreational and competitive sports, primary care physicians must be able to recognize and treat infectious diseases that commonly plague athletes and make sound decisions on when their patients may resume play. [ABSTRACT FROM AUTHOR]