John carlo Campo - Academia.edu (original) (raw)

Papers by John carlo Campo

Primary Psychiatry, 2007

Functional abdominal pain (FAP) is impairing recurrent abdominal pain in the absence of explanato... more Functional abdominal pain (FAP) is impairing recurrent abdominal pain in the absence of explanatory physical disease. Pediatric FAP is common and associated with high rates of comorbid anxiety, depression, and non-gastrointestinal somatic symptoms and disorders, such as migraine. This article reviews the relationship between childhood FAP and functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), anxiety, depression, and other somatic symptoms and disorders in adulthood as well as the familial associations of FAR Though longitudinal studies are limited, childhood FAP is associated with higher-than-expected rates of IBS, other somatic symptoms, and anxiety and depressive disorders later in life. Family members of affected youths appear to be at higher risk of FAP, other somatic symptoms, and anxiety and depressive symptoms and disorders than those of unaffected control groups. Childhood FAP may be a better predictor of anxiety and depressive disorders than of IBS in adulthood and in family members. FAP defies simplistic classification as a gastrointestinal disorder given the various physical and emotional symptoms that are commonly associated across development and in the families of affected youths.

Handbook of Behavior Therapy in the Psychiatric Setting, 1993

It surprises very few mental health workers that emotional and behavioral disorders in children a... more It surprises very few mental health workers that emotional and behavioral disorders in children and adolescents are often underdiagnosed and undertreated or inappropriately treated in traditional medical and pediatric settings, where the focus of patient, family, and physician is generally on physical symptoms or complaints (Costello, Edelbrock, Costello, Dulcan, Burns, & Brent, 1988). Conversely, in the mental health setting, where the focus is generally on “psychological” suffering, the presence of a predisposing, precipitating, or coexisting medical illness may be overlooked or undervalued, or it may be treated with a great deal of uneasiness. The mind-body problem that has plagued Western medicine and philosophy does not appear likely to go away any time soon. Although some have derided the “false boundary between mind and brain” (Detre, 1987, p. 621), our real limitations in examining, identifying, and studying the somatic underpinnings of psychological states are all too evident from a practical perspective. In our day-to-day dealings with patients, we are confronted with a “practical dualism” (McHugh & Slavney, 1983; Schiffer, Klein, & Sider, 1988). In order to ensure adequate care, we must view our patients as both subjective agents (who experience and do things) and objective organisms (who are diagnosed, studied, and “have” things, like diseases) (Schiffer et al., 1988). Nevertheless, an integrated understanding of our patients is desirable, and in many instances, the relationship between the “psychological” and the “organic,” the subjective and the objective, can be sorted out, at least in part. In some instances, there appears to be evidence that a biological lesion or vulnerability may require a subsequent Stressor in order to become manifest (Kruesi, 1990). In addition, although our impressions about the direction of causality (i. e., whether psychological distress precedes physical illness or vice versa) are often of clinical relevance, and words like psychosomatic or somatopsychic slip easily off the tongue, it is difficult to imagine a truly “nonpsychosomatic” disorder (Lask & Fosson, 1989).

Background and Purpose: Research has documented substantially higher rates of psychotropic medica... more Background and Purpose: Research has documented substantially higher rates of psychotropic medication use for children in foster care compared to other low-income groups; however, little is known about patterns of polypharmacy over time and variations across Medicaid enrollment groups. This is especially critical, given a growing body of research documenting disparities in mental health service use and quality of care across Medicaid eligibility groups, with lower quality of care for children in foster care. The objective of this study was to examine polypharmacy patterns and rates over time among Medicaid enrolled youth, comparing three enrollment groups (foster care (FC), disabled (ABD), and low-income (CFC) youth). Methods: A serial cross-sectional analysis of Medicaid claims data was conducted to examine trends in polypharmacy for children and adolescents between 2002 and 2008 stratified by the 3 Medicaid program eligibility categories: children in foster care (FC), disabled chi...

Psychiatric Services, 2014

Skeletal Radiology, 1986

Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering unde... more Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering underwent thin slice (1.5 mm) axial high resolution computed tomography (CT), or direct coronal CT. The normal epiphyseal plate was readily visualised as a low density layer of soft tissue density between adjacent sclerotic margins of epiphysis and metaphysis. Two growth plates had greater than 50% obliteration and ten had partial obliteration. Our preliminary results show excellent correlation between the CT findings and surgical pathology. We expect that CT will replace polytomography in the operative evaluation of partial growth plate arrest, as it has in our institution.

Psychosomatics, 2000

This article characterizes the academic, administrative, clinical service, and fiscal characteris... more This article characterizes the academic, administrative, clinical service, and fiscal characteristics of departments of psychiatry in traditional children's hospitals to determine the characteristics of fiscally successful programs. A survey of chairs of psychiatry from short-term general children's hospitals was conducted based on 38 questions addressing the descriptive characteristics of their respective departments. The characteristics of psychiatry programs identified as fiscally successful were compared to those of programs that required subsidy. Nine of 45 eligible children's hospitals (20%) did not have a department or section of psychiatry, and surveys were returned by 35 of 36 department chairs (97% response). Considerable variation exists in the academic, administrative, clinical services, and fiscal characteristics of programs, although over half are operating at a deficit. Fiscal success was associated with availability of inpatient and intermediate levels of psychiatric care, better integration of the psychiatry program within the children's hospital, and adequate fiscal information being provided to the psychiatry chair. Additional research regarding the potential of psychiatric services to generate clinical success and cost savings is warranted. Pediatric health care professionals and third-party payers should be educated regarding the relevance of psychiatric services within children's hospitals and in physically ill children.

Postgraduate Medical Journal, 1997

Summary Patients infected by the human immunodeficiency virus are predisposed to many infectious ... more Summary Patients infected by the human immunodeficiency virus are predisposed to many infectious and noninfectious complications and often receive a variety of drugs. Furthermore, they seem to have a particular susceptibility to idiosyncratic adverse drug reactions. It is therefore surprising that only a few cases of the neuroleptic malignant syndrome have been described in patients with the acquired immunodeficiency syndrome. A high index of suspicion is required to diagnose the neuroleptic malignant syndrome in these patients, as its usual manifestations, including fever and altered consciousness, are frequently attributed to an underlying infection.

Pediatrics, 2001

Objective.To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood ... more Objective.To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood predicts abdominal pain, irritable bowel syndrome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood.Methods.A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood participants in a study of tonsillectomy and adenoidectomy. RAP caseness was established by structured retrospective chart review requiring agreement by 2 independent reviewers. Standardized assessments of abdominal pain, IBS, other somatic symptoms, psychopathology, perceived health, and history of maltreatment were performed an average of 11.1 years after the index visit.Results.Former RAP patients were significantly more likely than controls to endorse anxiety symptoms and disorders, hypochondriacal beliefs, greater perceived susceptibility to physical impairment, poorer social functioning, current t...

Pediatric Surgery International, 1988

Primary liver tumours account for 6% of all paediatric neoplasms. In a child with a clinical abdo... more Primary liver tumours account for 6% of all paediatric neoplasms. In a child with a clinical abdominal mass, imaging (in consultation with a paediatric surgeon) aims to confirm the intrahepatic site, determine its likely resectability, exclude metastatic abdominal disease, and characterise the mass. The imaging in 44 patients with primary liver tumour over a 33-year period was reviewed and correlated with surgical/pathological findings. Characterising hepatic masses with ultrasound, computed tomography, nuclear medicine, and angiography is less important than determining its resectability and alerting the surgeon to vascular anomalies and the presence of metastatic disease. We conclude that a chest X-ray and ultrasound study are the primary methods for evaluation of a child with suspected hepatic mass. With careful attention to technique, the mass can be evaluated and an assessment made of tumour resectability preoperatively. Based on this review, we propose a schema for the initial evaluation of suspected hepatic masses in children.

Pediatric Radiology, 1988

Ultrasound scans of 18 children with primary hepatic tumours were reviewed to assess the accuracy... more Ultrasound scans of 18 children with primary hepatic tumours were reviewed to assess the accuracy of ultrasound in determining hepatic origin, extent, resectability, and histology. Using basic landmarks, ultrasound correctly predicted extent and resectability in 72% of patients. Accuracy would be increased by more detailed scanning to determine segmental and lobar landmarks. Hepatoblastoma demonstrated a characteristic appearance of a well-defined hyperechoic mass. Other tumour types showed some overlap in ultrasound appearances. Ultrasound examination overestimated the incidence of obliteration of the IVC lumen, and such patients require inferior venacavography to assess the true status of the cava preoperatively.

Pediatric Radiology, 1989

Efforts to improve the non-surgical management of childhood intussusception centre around (a) rea... more Efforts to improve the non-surgical management of childhood intussusception centre around (a) reassessment of selection criteria used to ensure as many children as possible have the advantage of hydrostatic reduction, and (b) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the authors to evaluate this technique over an 18 month period using our previously reported technique of oxygen at 2 litres/minute and a pressure of 80 mmHg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks for gas reduction using our current selection criteria and had primary surgery. The overall success rate considering all cases of intussusception managed at our institution over this period was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of complications and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction has replaced traditional barium reduction at our institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts that results will improve further.

Pediatric Radiology, 1986

The grey scale ultrasound features of 30 cases of Wilms' tumour examined using a water de... more The grey scale ultrasound features of 30 cases of Wilms' tumour examined using a water delay scanner are presented. Eighty-seven percent of masses were of uniform texture, with echogenicity equal to or slightly greater than that of liver with small hypo-echoic areas. There were no totally cystic tumours in the series. In 21 cases the mass was clearly arising from the ipsilateral kidney, but in 9 cases the ipsilateral kidney could not be distinguished from the tumour. The state of the intrahepatic inferior vena cava (IVC) was correctly diagnosed in 27 cases and further evaluation was needed in two patients in whom this segment could not be demonstrated. If this segment is sonographically normal, then the IVC need not be evaluated further. Differential diagnosis is discussed, with particular reference to neuroblastoma. In the majority of patients ultrasound is the only modality needed to diagnose Wilms' tumour pre-operatively.

Pediatric Radiology, 1988

Pediatric Radiology, 1984

The radiological findings in 13patients with total aganglionosis colt were reviewed. There was a ... more The radiological findings in 13patients with total aganglionosis colt were reviewed. There was a male to female ratio of 7: 6. Fifty-four percent of patients presented in the first week of life, but a significant number (31%) did not present until after 1 month of age. All patients had plain film evidence of bowel obstruction when referred for a barium enema. There were no pathognomonic barium enema findings, and barium enema results covered the entire spectrum of findings which can be encountered in the neonate and young infant with bowel obstruction. Seventy-seven percent had normal calibre colon, 23% had micro colon, 23% had a shortened colon, 46% had colonic wall irregularity, 33% had significant ileal reflux. Delayed evacuation of barium from colon occurred in the two patients who had delayed films. Total colonic aganglionosis should be considered in any infant or young child with plain film evidence of bowel obstruction, whatever the barium enema findings. Hirschsprung's disease and the level of transition can only be definitively diagnosed by biopsy. Archives Franc.aises de Prdiatrie (Paris) Porencrphalies ischrmiques de la p&iode n~onatale. Saliba, E. et al. (Hrp.

Journal of the American Academy of Child & Adolescent Psychiatry, 2012

Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unc... more Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unclear whether impaired decision making plays a role in the etiopathogenesis of youth suicidal behavior. The purpose of this study was to examine decision-making processes in adolescent suicide attempters and never-suicidal comparison subjects. Method: Using the Iowa Gambling Task, the authors examined decision making in 40 adolescent suicide attempters, 13 to 18 years old, and 40 never-suicidal, demographically matched psychiatric comparison subjects. Results: Overall, suicide attempters performed significantly worse on the Iowa Gambling Task than comparison subjects. This difference in overall task performance between the groups persisted in an exact conditional logistic regression analysis that controlled for affective disorder, current psychotropic medication use, impulsivity, and hostility (adjusted odds ratio ϭ 0.96, 95% confidence interval ϭ 0.90-0.99, p Ͻ 0.05). A two-way repeated-measures analysis of variance revealed a significant group-by-block interaction, demonstrating that attempters failed to learn during the task, picking approximately the same proportion of disadvantageous cards in the first and final blocks of the task. In contrast, comparison subjects picked proportionately fewer cards from the disadvantageous decks as the task progressed. Within the attempter group, overall task performance did not correlate with any characteristic of the index attempt or with the personality dimensions of impulsivity, hostility, and emotional lability. Conclusions: Similar to findings in adults, impaired decision making is associated with suicidal behavior in adolescents. Longitudinal studies are needed to elucidate the temporal relationship between decision-making processes and suicidal behavior and to help frame potential targets for early identification and preventive interventions to reduce youth suicide and suicidal behavior.

Journal of the American Academy of Child & Adolescent Psychiatry, 1994

To review the empirical literature on somatization in the pediatric age group, emphasizing preval... more To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment. One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization. Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R-defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services. Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.

Journal of the American Academy of Child & Adolescent Psychiatry, 2007

Objective: To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a scree... more Objective: To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a screen for common pediatric mental disorders in primary care. Method: Patients were 269 children and adolescents (8Y15 years old) whose parents completed the PSC-17 in primary care waiting rooms. Children were later assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). The PSC-17's subscales were compared with K-SADS-PL diagnoses and measures of anxiety, depression, general psychopathology, functioning, and impairment. Results: In receiver operating characteristics analyses, the PSC-17 subscales performed as well as competing screens (Child Depression Inventory, the parent and child Screens for Child Anxiety-Related Disorders) and Child Behavior Checklist subscales (Aggressive, Anxious-Depressed, Attention, Externalizing, Internalizing, and Total) in predicting diagnoses of attention-deficit/hyperactivity disorder, externalizing disorders, and depression (area under the curve Q0.80). The instrument was less successful with anxiety (area under the curve = 0.68). None of the screens were highly sensitive, many were insensitive, and all would have low positive predictive value in low-risk primary care populations. Conclusions: The PSC-17 and its subscales are briefer than alternative questionnaires, but performed as well as those instruments in detecting common mental disorders in primary care. Continued research is needed to develop brief yet sensitive assessment instruments appropriate for primary care.

Journal of the American Academy of Child & Adolescent Psychiatry, 2002

Primary Psychiatry, 2007

Functional abdominal pain (FAP) is impairing recurrent abdominal pain in the absence of explanato... more Functional abdominal pain (FAP) is impairing recurrent abdominal pain in the absence of explanatory physical disease. Pediatric FAP is common and associated with high rates of comorbid anxiety, depression, and non-gastrointestinal somatic symptoms and disorders, such as migraine. This article reviews the relationship between childhood FAP and functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), anxiety, depression, and other somatic symptoms and disorders in adulthood as well as the familial associations of FAR Though longitudinal studies are limited, childhood FAP is associated with higher-than-expected rates of IBS, other somatic symptoms, and anxiety and depressive disorders later in life. Family members of affected youths appear to be at higher risk of FAP, other somatic symptoms, and anxiety and depressive symptoms and disorders than those of unaffected control groups. Childhood FAP may be a better predictor of anxiety and depressive disorders than of IBS in adulthood and in family members. FAP defies simplistic classification as a gastrointestinal disorder given the various physical and emotional symptoms that are commonly associated across development and in the families of affected youths.

Handbook of Behavior Therapy in the Psychiatric Setting, 1993

It surprises very few mental health workers that emotional and behavioral disorders in children a... more It surprises very few mental health workers that emotional and behavioral disorders in children and adolescents are often underdiagnosed and undertreated or inappropriately treated in traditional medical and pediatric settings, where the focus of patient, family, and physician is generally on physical symptoms or complaints (Costello, Edelbrock, Costello, Dulcan, Burns, & Brent, 1988). Conversely, in the mental health setting, where the focus is generally on “psychological” suffering, the presence of a predisposing, precipitating, or coexisting medical illness may be overlooked or undervalued, or it may be treated with a great deal of uneasiness. The mind-body problem that has plagued Western medicine and philosophy does not appear likely to go away any time soon. Although some have derided the “false boundary between mind and brain” (Detre, 1987, p. 621), our real limitations in examining, identifying, and studying the somatic underpinnings of psychological states are all too evident from a practical perspective. In our day-to-day dealings with patients, we are confronted with a “practical dualism” (McHugh & Slavney, 1983; Schiffer, Klein, & Sider, 1988). In order to ensure adequate care, we must view our patients as both subjective agents (who experience and do things) and objective organisms (who are diagnosed, studied, and “have” things, like diseases) (Schiffer et al., 1988). Nevertheless, an integrated understanding of our patients is desirable, and in many instances, the relationship between the “psychological” and the “organic,” the subjective and the objective, can be sorted out, at least in part. In some instances, there appears to be evidence that a biological lesion or vulnerability may require a subsequent Stressor in order to become manifest (Kruesi, 1990). In addition, although our impressions about the direction of causality (i. e., whether psychological distress precedes physical illness or vice versa) are often of clinical relevance, and words like psychosomatic or somatopsychic slip easily off the tongue, it is difficult to imagine a truly “nonpsychosomatic” disorder (Lask & Fosson, 1989).

Background and Purpose: Research has documented substantially higher rates of psychotropic medica... more Background and Purpose: Research has documented substantially higher rates of psychotropic medication use for children in foster care compared to other low-income groups; however, little is known about patterns of polypharmacy over time and variations across Medicaid enrollment groups. This is especially critical, given a growing body of research documenting disparities in mental health service use and quality of care across Medicaid eligibility groups, with lower quality of care for children in foster care. The objective of this study was to examine polypharmacy patterns and rates over time among Medicaid enrolled youth, comparing three enrollment groups (foster care (FC), disabled (ABD), and low-income (CFC) youth). Methods: A serial cross-sectional analysis of Medicaid claims data was conducted to examine trends in polypharmacy for children and adolescents between 2002 and 2008 stratified by the 3 Medicaid program eligibility categories: children in foster care (FC), disabled chi...

Psychiatric Services, 2014

Skeletal Radiology, 1986

Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering unde... more Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering underwent thin slice (1.5 mm) axial high resolution computed tomography (CT), or direct coronal CT. The normal epiphyseal plate was readily visualised as a low density layer of soft tissue density between adjacent sclerotic margins of epiphysis and metaphysis. Two growth plates had greater than 50% obliteration and ten had partial obliteration. Our preliminary results show excellent correlation between the CT findings and surgical pathology. We expect that CT will replace polytomography in the operative evaluation of partial growth plate arrest, as it has in our institution.

Psychosomatics, 2000

This article characterizes the academic, administrative, clinical service, and fiscal characteris... more This article characterizes the academic, administrative, clinical service, and fiscal characteristics of departments of psychiatry in traditional children's hospitals to determine the characteristics of fiscally successful programs. A survey of chairs of psychiatry from short-term general children's hospitals was conducted based on 38 questions addressing the descriptive characteristics of their respective departments. The characteristics of psychiatry programs identified as fiscally successful were compared to those of programs that required subsidy. Nine of 45 eligible children's hospitals (20%) did not have a department or section of psychiatry, and surveys were returned by 35 of 36 department chairs (97% response). Considerable variation exists in the academic, administrative, clinical services, and fiscal characteristics of programs, although over half are operating at a deficit. Fiscal success was associated with availability of inpatient and intermediate levels of psychiatric care, better integration of the psychiatry program within the children's hospital, and adequate fiscal information being provided to the psychiatry chair. Additional research regarding the potential of psychiatric services to generate clinical success and cost savings is warranted. Pediatric health care professionals and third-party payers should be educated regarding the relevance of psychiatric services within children's hospitals and in physically ill children.

Postgraduate Medical Journal, 1997

Summary Patients infected by the human immunodeficiency virus are predisposed to many infectious ... more Summary Patients infected by the human immunodeficiency virus are predisposed to many infectious and noninfectious complications and often receive a variety of drugs. Furthermore, they seem to have a particular susceptibility to idiosyncratic adverse drug reactions. It is therefore surprising that only a few cases of the neuroleptic malignant syndrome have been described in patients with the acquired immunodeficiency syndrome. A high index of suspicion is required to diagnose the neuroleptic malignant syndrome in these patients, as its usual manifestations, including fever and altered consciousness, are frequently attributed to an underlying infection.

Pediatrics, 2001

Objective.To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood ... more Objective.To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood predicts abdominal pain, irritable bowel syndrome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood.Methods.A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood participants in a study of tonsillectomy and adenoidectomy. RAP caseness was established by structured retrospective chart review requiring agreement by 2 independent reviewers. Standardized assessments of abdominal pain, IBS, other somatic symptoms, psychopathology, perceived health, and history of maltreatment were performed an average of 11.1 years after the index visit.Results.Former RAP patients were significantly more likely than controls to endorse anxiety symptoms and disorders, hypochondriacal beliefs, greater perceived susceptibility to physical impairment, poorer social functioning, current t...

Pediatric Surgery International, 1988

Primary liver tumours account for 6% of all paediatric neoplasms. In a child with a clinical abdo... more Primary liver tumours account for 6% of all paediatric neoplasms. In a child with a clinical abdominal mass, imaging (in consultation with a paediatric surgeon) aims to confirm the intrahepatic site, determine its likely resectability, exclude metastatic abdominal disease, and characterise the mass. The imaging in 44 patients with primary liver tumour over a 33-year period was reviewed and correlated with surgical/pathological findings. Characterising hepatic masses with ultrasound, computed tomography, nuclear medicine, and angiography is less important than determining its resectability and alerting the surgeon to vascular anomalies and the presence of metastatic disease. We conclude that a chest X-ray and ultrasound study are the primary methods for evaluation of a child with suspected hepatic mass. With careful attention to technique, the mass can be evaluated and an assessment made of tumour resectability preoperatively. Based on this review, we propose a schema for the initial evaluation of suspected hepatic masses in children.

Pediatric Radiology, 1988

Ultrasound scans of 18 children with primary hepatic tumours were reviewed to assess the accuracy... more Ultrasound scans of 18 children with primary hepatic tumours were reviewed to assess the accuracy of ultrasound in determining hepatic origin, extent, resectability, and histology. Using basic landmarks, ultrasound correctly predicted extent and resectability in 72% of patients. Accuracy would be increased by more detailed scanning to determine segmental and lobar landmarks. Hepatoblastoma demonstrated a characteristic appearance of a well-defined hyperechoic mass. Other tumour types showed some overlap in ultrasound appearances. Ultrasound examination overestimated the incidence of obliteration of the IVC lumen, and such patients require inferior venacavography to assess the true status of the cava preoperatively.

Pediatric Radiology, 1989

Efforts to improve the non-surgical management of childhood intussusception centre around (a) rea... more Efforts to improve the non-surgical management of childhood intussusception centre around (a) reassessment of selection criteria used to ensure as many children as possible have the advantage of hydrostatic reduction, and (b) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the authors to evaluate this technique over an 18 month period using our previously reported technique of oxygen at 2 litres/minute and a pressure of 80 mmHg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks for gas reduction using our current selection criteria and had primary surgery. The overall success rate considering all cases of intussusception managed at our institution over this period was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of complications and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction has replaced traditional barium reduction at our institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts that results will improve further.

Pediatric Radiology, 1986

The grey scale ultrasound features of 30 cases of Wilms' tumour examined using a water de... more The grey scale ultrasound features of 30 cases of Wilms' tumour examined using a water delay scanner are presented. Eighty-seven percent of masses were of uniform texture, with echogenicity equal to or slightly greater than that of liver with small hypo-echoic areas. There were no totally cystic tumours in the series. In 21 cases the mass was clearly arising from the ipsilateral kidney, but in 9 cases the ipsilateral kidney could not be distinguished from the tumour. The state of the intrahepatic inferior vena cava (IVC) was correctly diagnosed in 27 cases and further evaluation was needed in two patients in whom this segment could not be demonstrated. If this segment is sonographically normal, then the IVC need not be evaluated further. Differential diagnosis is discussed, with particular reference to neuroblastoma. In the majority of patients ultrasound is the only modality needed to diagnose Wilms' tumour pre-operatively.

Pediatric Radiology, 1988

Pediatric Radiology, 1984

The radiological findings in 13patients with total aganglionosis colt were reviewed. There was a ... more The radiological findings in 13patients with total aganglionosis colt were reviewed. There was a male to female ratio of 7: 6. Fifty-four percent of patients presented in the first week of life, but a significant number (31%) did not present until after 1 month of age. All patients had plain film evidence of bowel obstruction when referred for a barium enema. There were no pathognomonic barium enema findings, and barium enema results covered the entire spectrum of findings which can be encountered in the neonate and young infant with bowel obstruction. Seventy-seven percent had normal calibre colon, 23% had micro colon, 23% had a shortened colon, 46% had colonic wall irregularity, 33% had significant ileal reflux. Delayed evacuation of barium from colon occurred in the two patients who had delayed films. Total colonic aganglionosis should be considered in any infant or young child with plain film evidence of bowel obstruction, whatever the barium enema findings. Hirschsprung's disease and the level of transition can only be definitively diagnosed by biopsy. Archives Franc.aises de Prdiatrie (Paris) Porencrphalies ischrmiques de la p&iode n~onatale. Saliba, E. et al. (Hrp.

Journal of the American Academy of Child & Adolescent Psychiatry, 2012

Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unc... more Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unclear whether impaired decision making plays a role in the etiopathogenesis of youth suicidal behavior. The purpose of this study was to examine decision-making processes in adolescent suicide attempters and never-suicidal comparison subjects. Method: Using the Iowa Gambling Task, the authors examined decision making in 40 adolescent suicide attempters, 13 to 18 years old, and 40 never-suicidal, demographically matched psychiatric comparison subjects. Results: Overall, suicide attempters performed significantly worse on the Iowa Gambling Task than comparison subjects. This difference in overall task performance between the groups persisted in an exact conditional logistic regression analysis that controlled for affective disorder, current psychotropic medication use, impulsivity, and hostility (adjusted odds ratio ϭ 0.96, 95% confidence interval ϭ 0.90-0.99, p Ͻ 0.05). A two-way repeated-measures analysis of variance revealed a significant group-by-block interaction, demonstrating that attempters failed to learn during the task, picking approximately the same proportion of disadvantageous cards in the first and final blocks of the task. In contrast, comparison subjects picked proportionately fewer cards from the disadvantageous decks as the task progressed. Within the attempter group, overall task performance did not correlate with any characteristic of the index attempt or with the personality dimensions of impulsivity, hostility, and emotional lability. Conclusions: Similar to findings in adults, impaired decision making is associated with suicidal behavior in adolescents. Longitudinal studies are needed to elucidate the temporal relationship between decision-making processes and suicidal behavior and to help frame potential targets for early identification and preventive interventions to reduce youth suicide and suicidal behavior.

Journal of the American Academy of Child & Adolescent Psychiatry, 1994

To review the empirical literature on somatization in the pediatric age group, emphasizing preval... more To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment. One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization. Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R-defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services. Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.

Journal of the American Academy of Child & Adolescent Psychiatry, 2007

Objective: To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a scree... more Objective: To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a screen for common pediatric mental disorders in primary care. Method: Patients were 269 children and adolescents (8Y15 years old) whose parents completed the PSC-17 in primary care waiting rooms. Children were later assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). The PSC-17's subscales were compared with K-SADS-PL diagnoses and measures of anxiety, depression, general psychopathology, functioning, and impairment. Results: In receiver operating characteristics analyses, the PSC-17 subscales performed as well as competing screens (Child Depression Inventory, the parent and child Screens for Child Anxiety-Related Disorders) and Child Behavior Checklist subscales (Aggressive, Anxious-Depressed, Attention, Externalizing, Internalizing, and Total) in predicting diagnoses of attention-deficit/hyperactivity disorder, externalizing disorders, and depression (area under the curve Q0.80). The instrument was less successful with anxiety (area under the curve = 0.68). None of the screens were highly sensitive, many were insensitive, and all would have low positive predictive value in low-risk primary care populations. Conclusions: The PSC-17 and its subscales are briefer than alternative questionnaires, but performed as well as those instruments in detecting common mental disorders in primary care. Continued research is needed to develop brief yet sensitive assessment instruments appropriate for primary care.

Journal of the American Academy of Child & Adolescent Psychiatry, 2002