Neonatal asymmetric crying facies: a new look at an old problem.

Neonatal asymmetric crying facies, described 75 years ago, is a clinical phenotype resembling unilateral partial peripheral facial nerve paralysis, with an incidence of approximately 1 per 160 live births. The cause is either facial nerve compression or faulty facial muscle and/or nerve development. Spontaneous resolution is expected with the former, but not necessarily with the latter etiology. Approximately 10% of the developmental cases have associated major malformations. Mandibular asymmetry and maxillary-mandibular asynclitism (non-parallelism of the gums) are frequently overlooked visual clues to nerve compression. Ultrasound imaging of facial muscles and electrodiagnostic testing may be useful for differential diagnosis and management.

Autonomic syncope in pediatrics: a practice-oriented approach to classification, pathophysiology, diagnosis, and management.

This paper presents a practice-oriented approach to the problem of syncope in pediatrics. Autonomic syncope is the major etiologic category in pediatrics and consists of 2 types: reflex and dysautonomic. The latter type is rare in pediatrics. Reflex syncope has 4 subtypes: neurocardiogenic, central, situational, and cerebral. Neurocardiogenic syncope, the most common subtype, is easily diagnosed by taking a careful, detailed history; identifying diagnostic red flags; performing a complete physical examination; and ordering a minimum of laboratory tests. Patient and parent education is essential, and usually, without medication, outcomes are good.

Initial Kaiser Permanente Southern California Experience Embracing the New Technology of Transcatheter Closure of Atrial Septal Defects.

As a result of individual physicians' initiative, transcatheter closure of secundum atrial septal defects-a new procedure-was made available to patients in the Kaiser Permanente (KP) Southern California Region soon after the US Food and Drug Administration (FDA) approved use of the AMPLATZER Septal Occluder. This ingenious device and the procedure for its implantation are described along with results of implantation in our initial 51 pediatric and adult patients. These results are compared with other published results. The clinical implications of using this new procedure are major: Many pediatric and adult patients with atrial septal defects can now benefit from nonoperative closure of these defects. On the basis of these observations, we attest to the commitment of Permanente physicians to incorporate technical advances into medical practice and to assess KP's experience using the new technology.

Chest pain during stenting of a native aortic coarctation: a case for acute intercostal muscle ischemia and rhabdomyolysis.

An adult male experienced severe chest pain during stenting of a native aortic coarctation. He also developed the postcoarctectomy syndrome with paradoxical hypertension and abdominal pain. Our hypothesis suggests that sudden interruption of large collateral blood flow caused acute chest wall muscle ischemia, rhabdomyolysis, and severe chest pain.