Doctor`s Digest - St. Louis Children`s Hospital

Doctor’s Digest
november 2010
A monthly newsletter for St. Louis Children’s Hospital attending and referring medical staffs
In this issue
3 Kids with Sports Concussions
Need Time Out
4 Mental Maturity Scan Tracks
Brain Development
6 Surgical Case Study:
Complex Cholodochal
Cyst in 15-Year-Old
Clinical Focus |Adolescent Bariatric Clinic Helps Obese Teens
at High-Risk for Medical Problems
St. Louis Children’s Hospital (SLCH) has teamed
with the Washington University Surgical Weight
Loss Program and Barnes-Jewish Hospital to establish
the first adolescent bariatric clinic in the St. Louis
area. The clinic focuses on teens whose weight is
causing them to have significant medical problems
that likely will result in serious complications as they
mature into adulthood.
“We are seeing an
increased incidence
of really severe
complications from
obesity in adolescents,
including high blood
pressure, type 2 diabetes,
metabolic syndrome and
Blount’s disease,” says
Abby Hollander, MD,
interim division director
of endocrinology and
diabetes at SLCH.
“While diet and exercise
remain the gold standard
for weight loss, teens
who are severely obese
often have extreme
difficulty reducing their
BMIs into a normal
range. Although it’s
not known why this is
true—both hereditary
and environmental
factors probably play a
role—the fact remains
that many of these teens benefit greatly
from undergoing bariatric surgery.”
SLC6990 10/2010
Criteria for teens seen at the
adolescent bariatric clinic include:
•15 to 19 years of age with a
BMI of 40 or greater
•diagnosis of a serious medical condition
•maturity level needed to undergo major
surgery and commit to a new lifestyle
All patients undergo an evaluation by an SLCH
pediatric endocrinologist; Esteban Varela, MD, FACS,
Washington University bariatric surgeon and clinic
co-director; a psychologist and a registered dietitian.
Families also are evaluated to gauge their commitment
to providing emotional support and helping to change
the teen’s living environment.
In addition, before undergoing surgery all patients
must first complete a six-month weight management
program during which they either lose or maintain
their weight. This requirement shows patients’
commitment to adhering to healthy eating, and it
helps them learn the lifestyle and diet changes they’ll
need to make following surgery. Those changes include
eating only three small meals a day, eating only healthy
foods, not snacking, giving up soda and exercising at
least 30 minutes a day.
Dr. Varela notes that bariatric surgery is becoming more
common in obese teens, and new research suggests it
may be more effective than behavioral programs alone.
Dr. Varela was the lead author in a study that showed
bariatric surgery in adolescents has proven to be as safe
as in the adult population.1
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Share Your Ideas
Should you have ideas or
suggestions you would like
brought before the Children’s
Medical Executive Committee
(CMEC), contact one of your
CMEC private physician
representatives:
Jean E. Birmingham, MD
314.918.8827
Peter Putnam, MD
314.965.5437
Isabel L. Rosenbloom, MD
314.291.7766
Kathie Wuellner, MD
618.474.1711
Let Us Hear From You
If you have comments or
suggestions regarding Doctor’s
Digest, or if you would like
to share information about
your activities as a physician,
contact:
Amy Connelly
Marketing and
Communications
St. Louis Children’s Hospital
600 South Taylor Ave.
Suite 202
St. Louis, MO 63110
Mailstop 90.94.210
314.286.0324
fax: 314.286.0420
[email protected]
Doctor’s Digest
Published for the attending
and referring medical staffs of
St. Louis Children’s Hospital.
Lee F. Fetter
President
Alison Nash, MD
Medical Staff President
Perry Schoenecker, MD
Medical Staff President-Elect
2|
“Performing bariatric surgery when
patients are adolescents means we can
have a significant impact on their lives
early on,” says Dr. Varela. “Their overall
health and quality of life is drastically
improved, and that means avoiding the
irreversible health issues that adults deal
with even after they’ve undergone bariatric
surgery.”
Dr. Varela performs three types of bariatric
surgeries: adjustable gastric band, Roux-enY
gastric bypass and vertical sleeve gastrectomy.
Three types of
bariatric surgeries
• Adjustable gastric band, which decreases
food intake by placing a small braceletlike band around the top of the stomach
to produce a small pouch about the size of
a thumb. The outlet size is controlled by a
circular balloon inside the band that may be
inflated or deflated with saline solution to
meet the needs of the patient.
• Roux-enY gastric bypass, which restricts
food intake and decreases food absorption.
Food intake is limited by a small pouch
similar in size to the adjustable gastric
band. In addition, food absorption in the
digestive tract is reduced by excluding
most of the stomach, duodenum and
upper intestine from contact with food by
routing food directly from the pouch into
the small intestine.
• Vertical sleeve gastrectomy, which
restricts food intake but does not
lead to decreased food absorption.
Approximately 60 percent of the
stomach is removed, reshaping it
into a tube or “sleeve.”
“All of these surgeries are done laparoscopically, which
means patients’ hospital stays are only a day or two,”
he says. “They are followed closely for the first year
and then have annual check-ups.”
He adds, “Of course, surgery is always the last resort
for adolescents who are obese. But when they are
at high risk for developing severe health problems
as adults and they have been unable to reduce their
weight any other way, this intervention is the best
course for them.”
For more information about the adolescent bariatric
clinic, call Children’s Direct at 800.678.HELP (4357).
1 Varela JE, Hinojosa MW, Nguyen NT. Perioperative outcomes of
bariatric surgery in adolescents compared with adults at academic
medical centers. Surgery for Obesity and Related Diseases, September
2007;3(5):537-40.
Children’s Direct Line 800.678.4357
StLouisChildrens.org
Medical Update | Kids with Sports Concussions Need Time Out – By Jim Dryden
Between 1997-2007, the number of
emergency room visits for concussions
doubled in children ages 8 to 13 who
play organized sports.
Mark E. Halstead, MD
Part of the reason is greater awareness,
according to Mark E. Halstead, MD,
pediatric orthopedic surgeon at
St. Louis Children’s Hospital and
assistant professor of orthopedic
surgery and of pediatrics at Washington
University School of Medicine.
“I think, overall, there probably aren’t many more concussions,”
Dr. Halstead says. “What we’re really seeing is more attention.
People are seeking more medical attention because that’s what we’re
recommending.”
Dr. Halstead, who is director of Washington University in
St. Louis’ Sports Concussion Program, is first author on a report
with new guidelines for managing sports-related concussions. The
recommendations give advice to both parents and physicians and
appear in the September issue of Pediatrics.
Young athletes are especially vulnerable because their brains are still
developing and may be more susceptible to the effects of a concussion,
according to Dr. Halstead. As recently as 10 years ago, a child with a
low-grade concussion may have been allowed to return to action as
soon as 15 minutes after symptoms had subsided, he says.
Now, Dr. Halstead’s team recommends that no athlete be allowed back
into competition the same day. In some cases, he says, it may be weeks
or even months before it’s safe to go back on the playing field. At the
very least, he recommends — and now laws in many states require
— that young athletes be evaluated and cleared by a physician before
returning to competition.
dramatic swelling in the brain and even die following that second injury.
That syndrome is unique to the pediatric population. We’ve never seen
it happen in a professional athlete.”
To avoid those devastating consequences, Dr. Halstead says it’s never
appropriate to allow young athletes to return to action the same day an
injury is sustained. In fact, he says athletes should not return to physical
activity of any kind until they are symptom-free. And in some cases, in
addition to resting from physical activity, young athletes may need what
he calls “brain rest,” including temporarily refraining from school work,
video games, television and reading.
“All of those activities can aggravate symptoms, so we want them to
refrain from those things in order to heal better,” he says. “Once they are
okay when at rest, we can allow them to slowly begin physical activity,
while paying close attention to ensure that symptoms don’t return.”
These are the first concussion guidelines published for athletes
younger than high-school age. Previous guidelines used in older athletes
defined concussions in stages, as either grade 1, 2 or 3. The length of
rehabilitation was determined by the grade of the concussion.
These new recommendations, Dr. Halstead says, urge doctors to avoid
that kind of “cookie cutter” approach and to allow individuals back into
competition only after they feel better and symptoms have subsided.
Verifying that, however, requires cooperation from the patient.
“That’s the trouble with a concussion as opposed to a knee injury,”
Dr. Halstead says. “When a kid hurts a knee, he or she goes limping
off the field and can’t put weight on the leg. With a head injury, a lot
of times we’re relying on the athlete to tell us that he or she is having
problems. We want kids and coaches to know the signs and symptoms.
That way, if there’s any question, they can be evaluated. Especially in
children, concussions aren’t something to ‘monkey around’ with.”
For more information about the Sports Concussion Program or to speak
with Dr. Halstead, contact Children’s Direct at 800.678.HELP (4357).
Common signs and symptoms of a concussion include headache (by
far the most common symptom), dizziness or memory or concentration
problems, in which many athletes will describe feeling “foggy.” Some
also may feel sick to their stomachs or have issues with balance.
“If someone has taken a blow to the head and they’re feeling some of
those symptoms, parents and coaches need to assume that the player
has suffered a concussion,” Dr. Halstead says. “We always tell people
to err on the side of caution.”
That’s particularly important in younger children. Although concussions
are more common among older athletes due to more violent collisions
involving bigger bodies at higher speeds, concussions have the potential
to be much more dangerous in younger athletes whose brains are still
growing and developing.
“There is a problem called ‘second impact syndrome’ that affects children
but is not seen in older athletes,” Dr. Halstead says. “If a child returns to
competition too soon and suffers another head injury, they can develop
|3
Research Update | Mental Maturity Scan Tracks Brain Development
Five minutes in a scanner can reveal how
far a child’s brain has come along the path
from childhood to maturity and potentially
shed light on a range of psychological
and developmental disorders, scientists at
Washington University School of Medicine
have shown.
Researchers assert in the September 10
issue of Science that their study proves brain
imaging data can offer more extensive help
in tracking aberrant brain development.
“Pediatricians regularly plot where their
patients are in terms of height, weight and
Bradley Schlagger, MD other measures, and then match these up to
standardized curves that track typical developmental pathways,”
says senior author Bradley Schlaggar, MD, PhD, a pediatric
neurologist at St. Louis Children’s Hospital. “When the patient
deviates too strongly from the standardized ranges or veers
suddenly from one developmental path to another, the physician
knows there’s a need to start asking why.”
Dr. Schlaggar and his colleagues say a new way of looking at
brain scanning data may be able to provide similar guidance
for monitoring and treating of patients with psychiatric and
developmental disorders.
Dr. Schlaggar, the A. Ernest and Jane G. Stein Associate Professor
of Neurology and associate professor of radiology, anatomy and
neurobiology, and pediatrics at Washington University School
of Medicine, says he has sent children with obvious, profound
psychiatric conditions for MRI scans and received results
marked “no abnormalities noted.”
“That’s typically looking at the data from a structural point
of view—what’s different about the shapes of various brain
regions,” he says. “But MRI also offers ways to analyze how
different parts of the brain work together functionally.”
Compare functional data to standardized models of how brain
function or disease normally develops, Dr. Schlaggar says,
and a range of new clinical insights becomes available.
Dr. Schlaggar and his colleagues use an approach to brain
scanning called resting state functional connectivity. By
correlating increases and decreases in blood flow to the
various brain regions as subjects rest in the scanner,
scientists determine which of these regions work
together in brain networks.
4|
In a study published in 2009, Washington University
scientists showed that as the brain matures, these brain
networks change (visit StLouisChildrens.org/dd for a
link to the article). The overall organization switches
from networks involving regions physically close
to each other — which is the dominant motif in a child’s brain — to
networks that connect distant regions — the primary organizational
principal in adult brains.
For the new study, lead author Nico Dosenbach, MD, PhD, a pediatric
neurology resident at St. Louis Children’s Hospital, took this and other
distinctions that mark the transition from child to adult brain and
adapted them for use in a technique for mathematical analysis called a
support vector machine. The technique is employed in many contexts
in science and economics and on the Internet.
“It’s a way that mathematicians have developed for predicting something
with high specificity and sensitivity when you have huge amounts of
data instead of one really good measurement,” Dr. Dosenbach explains.
“Any one of these measurements alone doesn’t tell you much, but if you
put them together and use the right math to sift through and restructure
them, you can get good predictive results.”
Researchers charted the results of 238 brain maturity analyses,
with age on the horizontal axis and maturity on the vertical axis.
Dr. Dosenbach used data from five-minute MRI scans of 238 normal
subjects ranging in age from 7 to 30. The support vector machine
analyzed approximately 13,000 functional brain connections and
selected the best 200 to produce a single index of the maturity of each
subject. The data allowed scientists to predict whether subjects were
children or adults, and roughly formed a curving line that tracks the
path of normal functional brain development.
The researchers suspect patients with brain disorders will appear out
of alignment with this normal developmental curve.
“The beauty of this approach is that it lets you ask what’s different in
the way that children with autism, for example, are off the normal
development curve versus the way children with attention-deficit
disorder are off that curve,” Dr. Schlaggar says.
Dr. Schlaggar suggests that functional brain scans might be
conducted on a group of children at risk but not yet suffering
from a developmental disorder.
Children’s Direct Line 800.678.4357
StLouisChildrens.org
“When a fraction of them later develop that disorder, you can go
back and construct an analysis like this one that will help predict
the characteristics of the next child at highest risk of developing the
disorder,” he says. “That’s very powerful both clinically and from the
perspective of understanding the causes of these disorders.”
This approach might enable treatment prior to onset of symptoms,
Dr. Schlaggar says, and should help physicians more quickly and
closely track the results of clinical trials of new therapies.
“MRI scans are expensive, so this may not be what we use for everyone
right now,” Dr. Dosenbach says. “But many children with these types
of disorders already receive regular structural MRI scans, and five more
minutes in the scanner won’t add that much to the cost.”
Dosenbach NUF, Nardos B, Cohen AL, Fair DA, Power JD, Church JA, Nelson SM, Wig GS,
Vogel AC, Lessov-Schlaggar CN, Barnes KA, Dubis JW, Feczko E, Coalson RS, Pruett JR JR,
Barch DM, Petersen SE, Schlaggar BL. Prediction of individual brain maturity using fMRI.
Science, Sept. 10, 2010.
Funding from the National Institutes of Health, the John Merck Scholars Fund, the BurroughsWellcome Fund, the Dana Foundation, the Ogle Family Fund, the McDonnell Center, the
Simons Foundation, the American Hearing Research Foundation, and the Diabetes Research
Center at Washington University supported this research.
Research Multi-Year Study Investigates Effect of Environment and Genetics
Update on Children’s Health
The National Children’s Study (NCS) is the largest study of child
health ever conducted in the United States, and it began last month
in the St. Louis area. The overall goal of the NCS is to study how the
environment and gene-environment interactions influence children’s
health, development and quality of life. A total of 79 metropolitan
areas and 26 rural communities were chosen randomly to recruit
100,000 children to represent the diversity found across the country.
Locally, the following schools are partnering to assess children in
St. Louis City and Jefferson County in Missouri, and Macoupin
County and Johnson/Williamson/Union Counties in Illinois:
• Washington University School of Medicine
• Saint Louis University Schools of Public Health and Medicine
• Southern Illinois University Edwardsville School of Nursing
• Southern Illinois University School of Medicine
• Southern Illinois University Carbondale
• Battelle St. Louis Operations
Together, these institutions and communities form the Gateway Study
Center.
In September 2010, the Gateway Study Center began recruiting
pregnant women (or women who are planning on becoming pregnant
in the near future) from randomly chosen segments of St. Louis City.
The children will be followed from before birth until age 21 years.
Interval assessments of the environment and of the children will be
completed to determine the impact of the environment on child health
and development. Environment is defined broadly to include physical,
chemical, biological, and psychosocial factors. Findings from the NCS
will be made available as the research progresses, making potential
benefits known to the public as soon as possible.
The Gateway Study Center has been working with a Community
Advisory Board and determining the needs of local communities
in preparation for this study. The majority of participants will join
through door-to-door, census-type recruitment efforts. Others will
join through physicians’ offices and health clinics. A local media
campaign will emerge in the fall as well.
“The NCS will succeed only with the collaboration of researchers,
community organizations, healthcare providers, social service agencies,
and other local groups,” says Allison King, MD, MPH, co-principal
investigator and hematology and oncology physician at St. Louis
Children’s Hospital. “The data gathered from this study will serve as
the foundation for child health guidelines and interventions for years
to come.”
Oversight of the NCS is provided by a consortium of federal partners
that includes the Eunice Kennedy Shriver National Institute of Child
Health and Human Development (NICHD), the National Institute of
Environmental Health Sciences, the Centers for Disease Control and
Prevention, and the U.S. Environmental Protection Agency. Funding
for the NCS is appropriated annually by Congress, separate from the
NIH budget, and then administered by NICHD. To learn more about
the study, visit nationalchildrensstudy.gov.
|5
Surgical Case Study | Complex Cholodochal
Cyst in 15-Year-Old
Physicians: Brad Warner, MD, surgeon-in-chief,
St. Louis Children’s Hospital (SLCH)
William Hawkins, MD, hepatobiliary pancreatic and
gastroenterology surgeon, Barnes-Jewish Hospital (BJH)
Shawn Larson, MD, pediatric surgery fellow, SLCH
Background The patient, 15-year-old Amanda, had been
experiencing severe abdominal pain, to the point of twice visiting a
hospital emergency room in her hometown of Springfield, Illinois.
According to her mother, Lisa, Amanda had frequent stomach
problems throughout her life; even as an infant, Lisa described her
daughter as being a “puker.”
“Amanda’s stomach pain began getting out of control. We didn’t know
that she’d already been diagnosed as having a cholodochal cyst,”
says Lisa. “It was identified on CT scans done when Amanda had her
appendix removed at age 14. Unfortunately, we weren’t told about
that discovery.”
Amanda was seen by a local surgeon, who performed an endoscopic
retrograde cholangiopancreatography (ERCP). The study showed
Amanda had a large cyst located within the head of her pancreas.
In an attempt to alleviate Amanda’s pain, the surgeon placed a stent
within the pancreas as a drain. When another study showed the cyst
hadn’t changed, Lisa contacted Dr. Warner at St. Louis Children’s
Hospital.
The surgical challenge: “Usually cholodochal cysts are diagnosed
in infants and young children when they present with jaundice,”
says Dr. Warner. “However, most of these cysts involve the bile
duct above the pancreas. In Amanda’s case, her cyst was actually
within the pancreas, which is probably the reason her symptom was
stomach pain rather than jaundice. No matter the position of these
cysts, however, we remove them because these patients are at risk for
developing pancreatitis and, over time, cancer in the bile duct.”
The location of Amanda’s cyst meant she needed a more complex
surgery than usual to remove it. Dr. Warner first considered a
Whipple procedure, which most often is the treatment for pancreatic
cancer. It involves removing the head of the pancreas, the duodenum
and part of the bile duct.
“The Whipple is associated with a significant complication rate
and long-term consequences in young teenagers,” says Dr. Warner.
“Early on there’s a risk of leakage from the point where the intestine
and what remains of the pancreas are sewn together. Long term,
there’s the risk of malnutrition because patients are unable to gain
weight and grow well. In addition, the blood supply to the stomach
and pylorus is sometimes disturbed, resulting in problems with the
stomach emptying.”
He adds, “It was obvious a Whipple procedure was not the ideal
surgery for Amanda, which led me to consult with my surgical
colleagues at Barnes-Jewish Hospital. I found they had experience
with these more-complex cholodochal cysts in the adult population.
6|
Fortunately, our mutual affiliation with Washington University
School of Medicine makes this type of collaboration possible.”
The surgical approach: Drs. Warner and Hawkins’ alternative surgical
approach was to identify the bile duct above the pancreas, cut across
it, and then, with traction on the lower bile duct, dissect close to the
bile duct wall and ultimately identify the cyst. They removed the cyst
within the pancreas gland without cutting across any pancreas tissue
but rather with traction on the cyst and gentle dissection.
“We left open the upper part of the bile duct coming from the liver
and removed the lower part all the way down to where it joined
the pancreas duct. We oversewed it there,” explains Dr. Warner.
“To replace the missing segment of bile duct within the pancreas,
we brought up a loop of intestine and sewed it to the bile duct
coming out of the liver. Now instead of the bile going through the
bile duct and pancreas, into the cyst and then into the duodenum,
the bile goes out of the liver into the upper bile duct and then
drains directly into a piece of small intestine.”
The outcome: Approximately six months after the surgery,
Amanda is doing well, with testing showing normal pancreas
and liver enzymes. Other than periodic check-ups, she does
not require medications or any other ongoing treatment.
“Amanda was a great patient—really upbeat, and she worked hard
at getting better after the surgery,” says Dr. Warner. “The outcome
was significantly better than may have been possible following a
Whipple procedure. It was gratifying to offer her and her family
a more effective, less invasive surgical solution thanks to the
combined expertise of pediatric and adult surgeons.”
Children’s Direct Line 800.678.4357
StLouisChildrens.org
Faculty Scoliosis Research Society (SRS)
Update Installs Lenke as President
Lawrence G. Lenke, MD, a pediatric
orthopedic spinal surgeon at St. Louis
Children’s Hospital, has been installed
as the 40th president of the Scoliosis
Research Society (SRS) at its annual
meeting in Kyoto, Japan. The SRS is an
international organization, the oldest
spinal society in the world, with a
singular mission to foster the optimal
care of all spinal deformity patients.
“The SRS has always been associated
with excellence, encompassing
members from around the world who
provide the highest level of care to their patients with various
spinal problems,” says Dr. Lenke. “It’s an honor to work with
the board of directors, committee chairs and members in
helping to lead and shape the organization’s future.”
Dr. Lenke, the Jerome J. Gilden Endowed Professor of
Orthopaedic Surgery and Professor of Neurological Surgery
at Washington University School of Medicine, specializes in
spinal surgery with an emphasis on complex reconstructive
surgery and treatment of various spinal deformities such as
scoliosis and kyphosis. He is known for treating the most
challenging cases of pediatric spinal deformity throughout
this country and beyond.
After receiving his medical degree at Northwestern
University Medical School, Dr. Lenke completed his
internship and residency as well as fellowship training in
pediatric and adult spinal surgery at Washington University
School of Medicine in the Department of Orthopaedic
Surgery. Since 1992, he has maintained an active clinical
and research practice here at the medical center. Together
with his partner, Keith H. Bridwell, MD, the ASA A. Jones
Professor of Orthopaedic Surgery, and 2003 SRS president,
they have contributed more presentations on spinal
deformity surgery topics at the annual SRS meeting than
any other program in the world over the past 20 years.
The SRS is a professional organization of physicians and
allied health personnel. Their primary focus is on providing
continuing medical education for health care professionals
and on funding/supporting research in spinal deformities.
Founded in 1966, the SRS has gained recognition as one
of the world’s premier spine societies. Strict membership
criteria ensure that the individual Fellows support that
commitment. Current membership includes over 1,100 of
the world’s leading spine surgeons and researchers involved
in the treatment of spinal deformities.
New Physicians at SLCH
Jaime P. Hook, MD
Instructor in Psychiatry (Child), WUSM
Specialty: Child Psychiatry
Education/Training:
• Child & adolescent psychiatry fellowship,
St. Louis Children’s Hospital
• Psychiatry residency, Saint Louis University
Hospital, St. Louis
• Medical degree, Saint Louis University School of Medicine
Departing Medical Staff Members
Susan Foerster, MD, Pediatric Interventional Cardiology
Children’s Holiday
Festival December 3 - 5
The Children’s Holiday Festival,
presented by Peabody Energy, is
quickly becoming a local holiday
tradition. Stroll through 6,000
square feet of winter wonderland
at the St. Louis Science Center featuring more than 65 trees which have
been lavishly decorated for the holidays by top local designers, artists,
businesses and families. Designer trees and wreaths will be available for
immediate purchase or auction and all proceeds will benefit St. Louis
Children’s Hospital. Special honorary trees that have been specifically
decorated for a patient at Children’s Hospital will also be on display.
Following the event, these trees will be donated and delivered to the
child’s home to brighten their holiday season. Admission to the festival is
free and open to the public.
The Children’s Holiday Festival Preview Party and Tree Auction, Dec. 1,
offer a special preview of the trees and opportunity to bid on auction items.
Tickets for the preview party are available for $75 per guest.
For more information, call the St. Louis Children’s Hospital Foundation at
314.286.0987 or visit StLouisChildrens.org/dd for a link to the Web site.
Chief Resident Award |
Whitney Bour, MD
Each month, St. Louis Children’s Hospital’s
chief residents honor a resident who
shows exceptional dedication to his or
her patients, colleagues or profession.
In September, the SLCH Chief Resident
Award was presented to Whitney Bour, MD,
first-year pediatrics resident, in recognition
of her extraordinary empathy and work
ethic. Her performance was outstanding
while caring for medically complex infants
in the neonatal intensive care.
|7
One Children’s Place
St. Louis, MO 63110
Marketing and Communications
314.286.0324
Fax: 314.286.0420
In this issue
1
5
7
Adolescent Bariatric Clinic Helps Obese Teens at
High-Risk for Medical Problems
Multi-Year Study Investigates Effect of Environment and
Genetics on Children’s Health
Scoliosis Research Society (SRS) Installs Lenke
as President
Upcoming Events | Plan Now for 2011
Plan now to attend St. Louis Children’s Hospital’s continuing education
programs in 2011. Join us to learn more about important issues
related to pediatric and newborn health care.
April 15: Current Concepts in Pediatric Trauma Care
Eric P. Newman Education Center, St. Louis, Missouri.
April 16: 18th Annual Emergency Medicine Conference
Eric P. Newman Education Center, St. Louis, Missouri.
April 27: Telephone Triage Conference
Sheraton Clayton Plaza Hotel, Clayton, Missouri.
May 6: Spring Clinical Pediatric Update: Pediatric Mental Health
Symposium
The Westin St. Louis, St. Louis, Missouri.
Topics include eating disorders, psychopharmacology 201, disruptive
behavior, adolescent substance abuse, depression screening,
motivational interviewing and preschool psychotherapy
June 3 – 4: Midwest Pediatric Hospital Medicine Conference
Renaissance Grand Hotel, St. Louis, Missouri.
Visit StLouisChildrens.org/Med_Ed to learn more about these and
other educational programs.
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