Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report.

Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention.

Age-adjusted diabetes mortality rates vary in local communities in a metropolitan area: racial and spatial disparities and correlates.

OBJECTIVE: Diabetes has held steady as the seventh leading cause of death in the U.S. since 2006. While aggregated data provide insights into how the country as a whole, or even as states, is faring with respect to diabetes mortality, disaggregation provides data that may facilitate targeted interventions and community engagement. RESEARCH DESIGN AND METHODS: We analyzed deaths from diabetes for residents of Chicago to calculate age-adjusted diabetes mortality rates (AADMRs). We calculated AADMRs for Chicago by race/ethnicity and community area. We also examined the correlation between AADMR and 1) racial/ethnic composition of a community area and 2) median household income. RESULTS: The AADMR for Chicago (27.5 per 100,000 population) was significantly higher than the national rate (22.5). Within both the U.S. and Chicago, the highest AADMRs were found among non-Hispanic blacks, followed by Hispanics, and then non-Hispanic whites. Within Chicago, Puerto Ricans displayed the highest AADMR at 45.7, compared with 35.0 at the national level. There was a strong positive correlation between the proportion of black residents in a community area and the AADMR (0.64). There was a strong negative relationship between household income and the AADMR for the entire city (-0.63) and for the predominantly black community areas (-0.52). CONCLUSIONS: These data provide insight into where the worst diabetes mortality problems reside in Chicago. Our hope is that these data can be used to work toward the development of solutions to the very high diabetes mortality rates observed in several communities in Chicago and in similar communities throughout the U.S.

Exploring nonoffending caregiver satisfaction with a Children's Advocacy Center.

This study is a case evaluation research report on one Children's Advocacy Center that provides a coordinated response to allegations of child maltreatment, particularly sexual abuse. The data come from a mailed survey of nonoffending caregivers measuring their satisfaction with services provided through the Children's Advocacy Center. The results indicate overall satisfaction with the Children's Advocacy Center; however, they also suggest that the forensic interview may be perceived or experienced as distinct from the ongoing investigative and legal processes. Recommendations are made to better assess nonoffending caregiver satisfaction with Children's Advocacy Center services and to encourage consumer driven service improvement.