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A salute to Noah’s heroes
Noah Hamm has escaped death more times than his mother Danielle can count. And he’s only 3. Since Noah was born there have been three constants in his life: Noah’s knack for near misses, his family and a neonatologist/pulmonologist who’s always there with the right care for Noah … and the right words for his family. “I tell Larry [Dr. Larry Rhein] he’s our George Bailey,” says Noah’s mom Danielle DiBenedetto. Larry gave me hope. Even when things were bad, I always felt better when Larry was there. Noah was a 29-week twin when Danielle’s water broke prematurely. “The only condition I thought I had to wor...
Source: Thrive, Children's Hospital Boston - May 25, 2016 Category: Pediatrics Authors: Lisa Fratt Tags: Diseases & Conditions Our Patients’ Stories Dr. Anne Hansen Dr. Larry Rhein Dr. Reza Rahbar Dr. Terry Buchmiller esophageal atresia laryngeal cleft patent ductus arteriosus tracheoesophageal fistula Source Type: news

What Causes Vomiting?
Discussion Regurgitation is a passive expulsion of ingested material out of the mouth. It is a normal part of digestion for ruminants such as cows and camels. Nausea is an unpleasant abdominal perception that the person may describe as feeling ill to the stomach, or feeling like he/she is going to vomit. Anorexia is frequently observed. Nausea is usually associated with decreased stomach activity and motility in the small intestine. Parasympathetic activity may be increased causing pale skin, sweating, hypersalivation and possible vasovagal syndrome (hypotension and bradycardia). Retching or dry heaves is when there are sp...
Source: PediatricEducation.org - May 2, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Minimally Invasive Surgery in Neonatal Patients: A Review
Laparoscopic and thoracoscopic surgery have gradually become accepted diagnostic and therapeutic modalities in the management of neonatal surgical conditions. In the hands of experienced surgeons, minimally invasive surgery (MIS) has reduced the need for open procedures. In children younger than 1 year, the advantages of MIS are evident in avoiding the sequelae of open surgery. MIS has shown outcomes comparable to those with open surgery. The recent literature in the PubMed database was reviewed, using the keywords "minimally invasive surgery," "neonatology," "pediatric surgery," "laparoscopy," and "thoracoscopy." The revi...
Source: NeoReviews recent issues - May 2, 2016 Category: Pediatrics Authors: Lopez, J., Stringel, G. Tags: Pediatric Drug Labeling Update Articles Source Type: news

What Are Risk Factors for Latex Allergy?
Discussion Latex comes from the Hevea brasiliensis plants. There are multiple potentially allergenic polypeptides within the plant’s fluid called Heb b 1-13. True sensitizers are Heb b 1, 5 and 6. Heb b 8 and 12 are cross-reacting proteins. The type of the latex product and how it is prepared makes a difference in exposure to the latex allergens. Certain extruded latex products such as catheters and rubber stoppers have higher concentrations of true sensitizer allergens. Products made from molds such as gloves have higher concentrations of potential allergens than latex made in sheets such as such as dental dams. Use...
Source: PediatricEducation.org - February 1, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

The Importance of Patient Advocacy and Family Care
By Kerry Sheeran, author of The Marathon, a novel based on the true, emotional journey of a mother and father forced to face their daughter’s life-threatening medical crisis.  Having held my daughter Emma’s hand through eight major surgeries, I consider myself well-versed in what it means to be a patient advocate. All parents are advocates for their children to a degree. From trying to feed them the right foods to connecting with their teachers, helping kids find their way in the world requires a lot of guidance and support from mom and dad. But when your child has a medical crisis, advocacy takes on a whole new ...
Source: Thrive, Children's Hospital Boston - August 7, 2014 Category: Pediatrics Authors: Guest Blogger Tags: All posts our patients' stories patient advocacy Source Type: news

What Causes Abdominal Distention?
Discussion Constipation generally is defined as infrequent or painful defecation. It often is due to passing large hard stool infrequently which causes painful defecation and then withholding behaviors. As stool withholding continues, the rectum dilates and gradually accommodates with the normal defecation urge disappearing. Chronic rectal distension results in both loss of rectal sensitivity, and loss of urge to defecate, which can lead to encopresis. Abdominal distention because of stool retention occurs frequently. Treatment includes colonic evacuation, establishing regular bowel habits, eating a balanced diet with diet...
Source: PediatricEducation.org - July 21, 2014 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Causing These Spells?
Discussion Spells, episodic or paroxysmal events can be very difficult to evaluate. They seem to occur randomly, often inconsistently, and are described by independent observers differently. These descriptions also make it difficult to tell if the problem falls into one area versus another, such as a seizure versus apnea. Not surprisingly the clinical signs and symptoms and the differential diagnoses of these events markedly overlap. Many times it is necessary to start evaluating a patient for a potentially more life-threatening problem or several problems at once, while at the concurrently, gathering new information and r...
Source: PediatricEducation.org - November 26, 2012 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: news

Genetics Home Reference: esophageal atresia/tracheoesophageal fistula
(Source: NLM General Announcements)
Source: NLM General Announcements - September 4, 2012 Category: Databases & Libraries Source Type: news

What Causes Wheezing?
Discussion Wheezing is an adventitial breath sound caused by narrowing of the airway causing a musical, high-pitched, continuous sound. It occurs with expiration but as severity increases, it also occurs in inspiration. If caused by secretions then wheezing may disappear after a cough, and change in different parts of the lung fields. It is usually associated with intrathoracic processes (usually mid-trachea and below). Stridor is sometimes confused with wheezing but it occurs during inspiration and is usually caused by extrathoracic processes such as croup or vocal cord paralysis. An explanation of other adventitial breat...
Source: PediatricEducation.org - July 9, 2012 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: news

What Causes Coughs?
Discussion “A cough is a voluntary or involuntary explosive expiration. After a deep inspiration, the glottis is closed and the expiratory muscles contract, compressing the lung and raising intrapulmonary pressure above the atmospheric pressure. The glottis then opens, and gas is expelled at a rapid rate.” Acute coughs are commonly due to upper respiratory tract diseases in children of all ages – often because of post-nasal rhinorrhea. Chronic coughs may be more difficult to determine the cause of and may require more investigation, consultation, and/or empiric trials of medication including radiographic...
Source: PediatricEducation.org - September 5, 2011 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: news

Prevention and management of hemorrhage after pediatric button battery ingestion
4.5 out of 5 stars Management of Button Battery-induced Hemorrhage in Children. Brumbaugh DE et al. J Pediatr Gastroenterol Nutr 2011 May;52:585-589. Abstract Ingestion of a button battery can cause fatal injury in a child.  Potential complications include tracheoesophageal fistula, esophageal stricture and stenosis, vocal cord paralysis, and aspiration pneumonia.  However, the most devastating sequela is exsanguination from erosion into the aorta or other major artery.  A significant injury can be caused by a battery in place as little as 2 hours.  Life-threatening hemorrhage has occurred as long as 18 days after batt...
Source: The Poison Review - April 25, 2011 Category: Toxicology Authors: Leon Tags: Medical button battery ingestion esophageal damage esophagealaortic fistula fatality gastrointestinal hemorrhage pediatrics Source Type: news

Tracheoesophageal fistula: a serious complication of infectious esophagitis
Obrecht WF Jr, Richter JE, Olympio GA, Gelfand DW (Source: The Aspergillus Website - articles)
Source: The Aspergillus Website - articles - April 22, 2011 Category: Respiratory Medicine Source Type: news

Tracheoesophageal fistula induced by aspergillus infection following bone marrow transplantation
Kapelushnik J, Springer C, Naparstek E, Drakos P, Peled N, Picard E, Delukina M, Avital A (Source: The Aspergillus Website - articles)
Source: The Aspergillus Website - articles - April 22, 2011 Category: Respiratory Medicine Source Type: news

Tracheoesophageal fistula and sinusitis from invasive aspergillosis
Stack BC Jr, Ridley MB, Greene JN, Hubbell DS (Source: The Aspergillus Website - articles)
Source: The Aspergillus Website - articles - April 22, 2011 Category: Respiratory Medicine Source Type: news

Teaming up for EA/TEF
Dr. Jennings (center) and the McGahans at one of their many fundraisers Like Lewis and Clark, Holmes and Watson or even Batman and Robin, Russell Jennings, MD, and Lori McGahan are an amazing team. Working together as doctor and parent advocate, Jennings and McGahan have done tremendous work raising awareness and funds for esophageal atresia/tracheo-esophageal fistula (EA/TEF), a rare congenital birth defect affecting one in every 4,00 births that, without correction, makes swallowing impossible, complicates breathing and makes gastric reflux and aspiration even more hazardous. It’s a collaboration that epitomizes the c...
Source: Thrive, Children's Hospital Boston - January 31, 2011 Category: Pediatrics Authors: Tripp Underwood Tags: All posts Diseases & conditions Media & marketing Parenting esophageal atresia/tracheo-esophageal fistula; (EA/TEF); Rusty Jennings; Bridging the Gap; treatment for EA/TEF; Social media in medicine; Source Type: news

This week on Thrive, October 11- 15
Are audio books a good idea for your child? Dr. Rich explores whether or not audio books are more stimulating for children than TV or reading? More than meds: a multifaceted approach to ADHD Attention Deficit Hyperactivity Disorder is one of the most common neurobehavioral disorders in children. Recent numbers show 4.5 million students age 5 to 17 have been diagnosed with some form of ADHD, where impulsivity, hyperactivity, inattentive behavior or a combination of all three, interferes with relationships at school or home. While medication is an important part of treatment, there are many behavioral approaches adults can u...
Source: Thrive, Children's Hospital Boston - October 17, 2010 Category: Pediatrics Authors: Childrens Hospital Boston staff Tags: All posts Source Type: news

One patient’s story: our baby’s Esophageal Atresia and Tracheoesophageal Fistula
Brandon at Children's My husband Brain and I are about to celebrate our 14 year anniversary. A big milestone for any relationship, but after the hardships we’ve lived through in the past few years, it seems extra special. For the first 10 years of our marriage we tried for kids, but it never happened. Eventually we sort of accepted that it wasn’t meant to be and resigned ourselves to a life of sleeping through the night and ample free time. Then, almost out of the blue, I became pregnant. It was such a blessing; we were beside ourselves with joy. But 31 weeks into my pregnancy I became seriously ill. After sev...
Source: Thrive, Children's Hospital Boston - October 11, 2010 Category: Pediatrics Authors: Tripp Underwood Tags: All posts One patient's story EA/TEF esophageal atresia and tracheoesophageal fistula John Foker Manali Amin Russell Jennings Source Type: news

Button battery ingestions causing increased fatalities
5 out of 5 stars Emerging Battery-Ingestion Hazard: Clinical Implications.  Litovitz T et al.  Pediatrics June 2010;125:1168-1177. Abstract This must-read article points out that with the growing popularity of 20-mm lithium batteries, the percentage of button battery ingestions involving major outcomes or fatalities is increasing.  The authors, from the National Capital Poison Center in Washington, DC, analyzed data from 3 major sources concerning these ingestions.  They make the following important points: • A button battery stuck in the esophagus can cause significant injury if not removed within 2 hours. • Compl...
Source: The Poison Review - June 7, 2010 Category: Toxicology Authors: Leon Tags: Best of TPR Medical button battery ingestion esophageal damage lithium cell Source Type: news

Which Esophageal Stent Is More Effective, Ultraflex Or Choostent?
Less than 50% of patients with esophageal carcinoma are suitable for surgery at the time of diagnosis. Most of these patients present with locally advanced or metastatic disease and/or significant comorbidities. In such circumstances, the only therapeutic option is palliative care to treat dysphagia and prevent respiratory complications secondary to aspiration. Self-expanding metal stents have been proven effective for palliation of dysphagia in patients with esophageal carcinoma, tracheo-esophageal fistulas or anastomotic leaks... (Source: Health News from Medical News Today)
Source: Health News from Medical News Today - May 12, 2010 Category: Consumer Health News Tags: Cancer / Oncology Source Type: news

An unusual cause of dysphagia
This was a 30 year-old Caucasian-American male who had a past medical history that was significant for community acquired pneumonia and migraines. He presented to the clinic with a chief complaint of dysphagia for solids and weight loss. Chest x-rays both of the PA and lateral view were negative and without lymphadenopathy. A CT scan of the thorax was performed and was significant for the presence of a 2.8 x 2.9 cm mass in the sub carinal region causing external compression of the esophagus. An upper endoscopy was performed which revealed intraluminal bulging as seen here. Linear endoscopic ultrasound was performed and ...
Source: The Digital Atlas of Video Education - Gastroenterology - May 3, 2010 Category: Gastroenterology Authors: Mankawal S. Sachdev, MD,, Source Type: news

One family’s story: esophageal atresia
Bradley Linden, MD, (far left) and Russell Jennings, MD, (far right) with patient Elliot Cleckler and parents Heather and Jay. For expecting parents, learning that their soon to be born baby will enter the world with a birth defect can be very difficult news.  Five weeks before Heather and Jay Cleckler’s son’s due date, he was diagnosed with esophageal atresia and tracheoesophageal fistula (TEF), an abnormal connection between the esophagus and the trachea that can cause food traveling down the esophagus or acid refluxing up from the stomach to pass into the lungs. Although Jay and Heather were upset, they we...
Source: Thrive, Children's Hospital Boston - April 16, 2010 Category: Pediatrics Authors: Steve Coldwell Tags: All posts esophageal atresia and tracheoesophageal fistula Source Type: news

Esophageal Stent for Treatment of a Tracheo-Gastric Fistula
A 49 year-old man underwent a recent esophagectomy for esophageal cancer. His postoperative course was complicated by a fistula between the trachea and the intra-thoracic stomach. A previously placed tracheal stent was unsuccessful at sealing the fistula. Using argon plasma coagulation, the perimeter of the opening is ablated in order to de-epithelialize the tissue and promote complete sealing of the fistula after approximating its edges. Endoscopic hemoclips are placed around the border of the fistula, and a detachable snare--or endoscopic polyloop--is used to approximate the edges of the defect. Following this, a flexi...
Source: The Digital Atlas of Video Education - Gastroenterology - March 13, 2010 Category: Gastroenterology Authors: Jonathan Buscaglia, MD,, Stony Brook University Medical Center Source Type: news

Role of esophageal stents in benign and malignant diseases
Aims: This review considers the role of esophageal stents in benign and malignant disease. Self-expanding metal stents (SEMS) are currently the most common means of palliation of malignant dysphagia - difficulty in swallowing due to cancer. Recently, self-expandable plastic stents (SEPS) have been used for the management of benign esophageal conditions, such as tracheoesophageal fistulas, benign esophageal strictures, esophageal perforations, and leaks. Intended audience: Healthcare professionals. Publication history information: Published February 2010.  Access: Available to the general public. (Source: Gastroen...
Source: Gastroenterology and Liver Diseases Specialist Library - Oesophagus - March 12, 2010 Category: Gastroenterology Source Type: news

Doctors warned that use of medical abbreviations presents risk to patients
According to a BBC report, the UK's Medical Defence Union has warned doctors that the use of abbreviations in medical notes is putting patients’ lives at risk. A recent US study of 30,000 medication errors, found that 5% were linked to abbreviations in notes; common errors include those associated with the abbreviation of drug names and doses. One fatal example involved a patient on haemodialysis who was given an inappropriately high dose of aciclovir – the notes had the abbreviation HD (for haemodialysis) written next to aciclovir, which was misread as TID (three times daily). The report also discusses the findin...
Source: NeLM Headline News - January 7, 2008 Category: Drugs & Pharmacology Source Type: news

DES exposure may possibly increase risk of having a child with a malformation
A complex observational study from the Netherlands suggests that a mother's in utero exposure to diethylstiboestrol (DES) might possibly result in an increased risk of malformations in her children - i.e. a second generation effect. The authors noted a possible association between children born with oesophageal atresia and tracheoesophageal fistula (EA/TEF) and maternal exposure to DES, and carried out this study to investigate it further. They sent questionnaires to members of a support association for parents of affected children, and obtained data from a hospital register for EA/TEF and from a Dutch birth defects regist...
Source: NeLM Headline News - July 31, 2007 Category: Drugs & Pharmacology Tags: 8.3.1 Oestrogens, Drugs in pregnancy Source Type: news

Recalls and Safety Alerts: Warning about Tracheoesophageal Fistula with Avastin
Genentech recently alerted healthcare professionals about patients with limited-stage small cell lung cancer who developed tracheoesophageal (TE) fistulae after receiving a treatment regimen that included Avastin. Avastin (bevacizumab) is approved t... (Source: Food and Drug Adminstration (FDA): Patient Safety News)
Source: Food and Drug Adminstration (FDA): Patient Safety News - July 1, 2007 Category: American Health Source Type: news

AVASTIN® (bevacizumab) and tracheo-esophageal fistulas
Health Canada and Hoffmann-La Roche Limited have issued a letter to health care professionals warning of the risk of tracheo-esophageal fistula associated with bevacizumab: Serious adverse events, including fatal events, of tracheo-esophageal (TE) fistula have been reported in association with use of AVASTIN clinical trials of small cell lung cancer (SCLC), non small cell lung cancer (NSCLC) and esophageal cancer. AVASTIN should be permanently discontinued in patients with tracheo-esophageal (TE) fistula or any gastrointestinal fistula. There is limited information on the continued use of AVASTIN in patients with other ...
Source: West Midlands Centre for Adverse Drug Reactions - June 29, 2007 Category: Drugs & Pharmacology Authors: admin Tags: Health Canada Source Type: news

Colon Cancer Drug Avastin Linked To Potentially Deadly Abnormality In Esophagus
TORONTO -- The drug Avastin, used as part of a chemotherapy regimen to treat advanced colorectal cancer, has been linked to the development of a potentially fatal malformation in the esophagus in a small number of patients. In an advisory Tuesday, Health Canada said a few patients taking Avastin along with other cancer treatments developed tracheo-esophageal fistulas - abnormal connections between the esophagus (the tube from the throat to stomach) and the trachea (the windpipe). Normally, the two structures are separate. Health Canada said two patients with small cell lung cancer being treated with Avastin, other cancer d...
Source: Cancercompass News: Colorectal Cancer - June 14, 2007 Category: Cancer & Oncology Source Type: news

FDA warns Avastin (bevacizumab) linked to tracheoesophageal fistula in small-cell lung cancer patients
The FDA and Genentech have notified healthcare professionals in the US of important new safety information regarding Avastin (bevacizumab) and a possible risk of tracheoesophageal (TE) fistula formation. This has come to light following case reports from a phase II study, which is assessing four cycles of concurrent irinotecan, carboplatin, radiation therapy, and bevacizumab, followed by maintenance bevacizumab for up to 6 months in patients with limited-stage small cell lung cancer (SCLC) (unlicensed indication). There have been two confirmed cases of tracheoesophageal (TE) fistula reported in the first 29 patients enro...
Source: NeLM Headline News - April 24, 2007 Category: Drugs & Pharmacology Tags: 8.1.5 Other antineoplastic drugs, Adverse Drug Reactions, Food & amp; Drug Administration (FDA), Cancer: lung Source Type: news

FDA Warns of Possible Bevacizumab Fistula Complication
ROCKVILLE, Md. -- The FDA and Genentech have issued a warning about the possible formation of tracheoesophageal fistulas as a complication of an off-label use of bevacizumab (Avastin). (Source: MedPage Today Pulmonary)
Source: MedPage Today Pulmonary - April 23, 2007 Category: Respiratory Medicine Source Type: news

Avastin Linked to Tracheoesophageal Fistula Formation in Lung Cancer Study
Enrollment in a study of bevacizumab in limited-stage small-cell lung cancer patients receiving concomitant chemotherapy and radiation was closed due to 2 cases of tracheoesophageal fistula formation.Medscape Medical NewsYael Waknine (Source: Medscape Hematology-Oncology Headlines)
Source: Medscape Hematology-Oncology Headlines - April 23, 2007 Category: Cancer & Oncology Tags: Hematology-Oncology Source Type: news

Avastin (bevacizumab)
Formation of tracheoesophageal fistula exceeds the background rate in a study of patients receiving chemotherapy and radiation plus Avastin for the treatment of limited-stage small cell lung cancer. (Source: FDA MedWatch)
Source: FDA MedWatch - April 21, 2007 Category: American Health Tags: Oncological and other healthcare professionals Source Type: news