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INTRODUCTION: The number of patients with congenital disease living to adulthood continues to grow. Often undergoing surgical correction in infancy, they continue to require lifelong care. Their numbers are largely unknown. We sought to evaluate hospital admissions of adult patients with esophageal atresia with tracheoesophageal fistula (EA/TEF), congenital diaphragmatic hernia (CDH), and Hirschsprung disease (HD). METHODS: The Florida Agency for Healthcare Administration inpatient database was merged with the Distressed Communities Index and Centers for Medicare and Medicaid Services Hospital and Physician Compare datasets. The dataset was queried for adult patients (≥18 y, born after 1970) with EA/TEF, CDH, and HD in their problem list from 2010 to 2020. Patient demographics, hospitalization characteristics, and discharge information were obtained. RESULTS: In total, 1140 admissions were identified (266 EA/TEF, 135 CDH, 739 HD). Patients were mostly female (53%), had a mean age of 31.6 y, and often admitted to an adult internist in a general hospital under emergency. Principal diagnoses and procedures (when performed) varied with diagnosis and age at admission. EA patients were admitted with dysphagia and foregut symptoms and often underwent upper endoscopy with dilation. CDH patients were often admitted for diaphragmatic hernias and underwent adult diaphragm repair. Hirschsprung patients were often admitted for intestinal obstructive issues and frequently underwent colonoscopy but trended toward operative intervention with increasing age. CONCLUSIONS: Adults with congenital disease continue to require hospital admission and invasive procedures. As age increases, diagnoses and performed procedures for each diagnoses evolve. These data could guide the formulation of multispecialty disease-specific follow-up programs for these patients.
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Atresia Esofágica , Hernias Diafragmáticas Congénitas , Enfermedad de Hirschsprung , Humanos , Femenino , Masculino , Adulto , Enfermedad de Hirschsprung/cirugía , Enfermedad de Hirschsprung/epidemiología , Hernias Diafragmáticas Congénitas/cirugía , Hernias Diafragmáticas Congénitas/epidemiología , Florida/epidemiología , Atresia Esofágica/cirugía , Adulto Joven , Fístula Traqueoesofágica/cirugía , Fístula Traqueoesofágica/epidemiología , Persona de Mediana Edad , Sobrevivientes/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Adolescente , Estudios Retrospectivos , Lactante , Bases de Datos Factuales/estadística & datos numéricosRESUMEN
INTRODUCTION: Pediatric firearm injury prevention research in younger age groups is limited. This study evaluated a large multicenter cohort of younger children with firearm injuries, focusing on injury patterns and surgical resource utilization. METHODS: Children ≤15 y old sustaining firearm injuries between 2016 and 2021 and treated at 10 pediatric trauma centers in Florida were included. Individual cases were reviewed for demographics, shooting details, injury patterns, resource utilization, and outcomes. Patients were grouped by age into preschool (0-5 y), elementary school (6-10 y), middle school (11-13 y), and early high school (14-15 y). Multivariable logistic regression was used to identify predictors of death and critical resource utilization. RESULTS: A total of 489 children (80 preschool, 76 elementary school, 92 middle school, and 241 early high school) met inclusion criteria. Demographics, injury patterns, and resource utilization were similar across age groups. Assault and self-harm increased with age. Self-harm was implicated in 5% of cases but accounted for 18% of deaths. Hand surgery (i.e., below-elbow) procedures were common at 8%. Overall mortality was 10%, but markedly higher for self-harm injuries (47%). On multivariable regression, age and demographics were not predictive of death or critical resource utilization, but self-harm intent was a strong independent risk factor for both. CONCLUSIONS: This study suggests that given the age distribution and disproportionately high impact of self-harm injuries, behavioral health resources should be available to children at the middle school level or earlier. Hand surgery may represent an overlooked but frequently utilized resource to mitigate injury impact and optimize long-term function.
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BACKGROUND: Relationships between social determinants of health and pediatric trauma mechanisms and outcomes are unclear in context of COVID-19. METHODS: Children <16 years old injured between 2016 and 2021 from ten pediatric trauma centers in Florida were included. Patients were stratified by high vs. low Social Vulnerability Index (SVI). Injury mechanisms studied were child abuse, ATV/golf carts, and firearms. Mechanism incidence trends and mortality were evaluated by interrupted time series and multivariable logistic regression. RESULTS: Of 19,319 children, 68% and 32% had high and low SVI, respectively. Child abuse increased across SVI strata and did not change with COVID. ATV/golf cart injuries increased after COVID among children with low SVI. Firearm injuries increased after COVID among children with high SVI. Mortality was predicted by injury mechanism, but was not independently associated with SVI, race, or COVID. CONCLUSION: Social vulnerability influences pediatric trauma mechanisms and COVID effects. Child abuse and firearm injuries should be targeted for prevention.
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COVID-19 , Armas de Fuego , Heridas por Arma de Fuego , Niño , Humanos , Adolescente , Pandemias , Determinantes Sociales de la Salud , Heridas por Arma de Fuego/epidemiología , COVID-19/epidemiología , Estudios RetrospectivosRESUMEN
Background: Golf carts (GCs) and all-terrain vehicles (ATVs) are popular forms of personal transport. Although ATVs are considered adventurous and dangerous, GCs are perceived to be safer. Anecdotal experience suggests increasing numbers of both GC and ATV injuries, as well as high severity of GC injuries in children. This multicenter study examined GC and ATV injuries and compared their injury patterns, resource utilization, and outcomes. Methods: Pediatric trauma centers in Florida submitted trauma registry patients age <16 years from January 2016 to June 2021. Patients with GC or ATV mechanisms were identified. Temporal trends were evaluated. Injury patterns, resource utilization, and outcomes for GCs and ATVs were compared. Intensive care unit admission and immediate surgery needs were compared using multivariable logistic regression. Results: We identified 179 GC and 496 ATV injuries from 10 trauma centers. GC and ATV injuries both increased during the study period (R2 0.4286, 0.5946, respectively). GC patients were younger (median 11 vs 12 years, p=0.003) and had more intracranial injuries (34% vs 19%, p<0.0001). Overall Injury Severity Score (5 vs 5, p=0.27), intensive care unit (ICU) admission (20% vs 16%, p=0.24), immediate surgery (11% vs 11%, p=0.96), and mortality (1.7% vs 1.4%, p=0.72) were similar for GCs and ATVs, respectively. The risk of ICU admission (OR 1.19, 95% CI 0.74 to 1.93, p=0.47) and immediate surgery (OR 1.04, 95% CI 0.58 to 1.84, p=0.90) remained similar on multivariable logistic regression. Conclusions: During the study period, GC and ATV injuries increased. Despite their innocuous perception, GCs had a similar injury burden to ATVs. Heightened safety measures for GCs should be considered. Level of evidence: III, prognostic/epidemiological.
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BACKGROUND: Significant variation in management strategies for lymphatic malformations (LMs) in children persists. The goal of this systematic review is to summarize outcomes for medical therapy, sclerotherapy, and surgery, and to provide evidence-based recommendations regarding the treatment. METHODS: Three questions regarding LM management were generated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publicly available databases were queried to identify articles published from January 1, 1990, to December 31, 2021. A consensus statement of recommendations was generated in response to each question. RESULTS: The initial search identified 9326 abstracts, each reviewed by two authors. A total of 600 abstracts met selection criteria for full manuscript review with 202 subsequently utilized for extraction of data. Medical therapy, such as sirolimus, can be used as an adjunct with percutaneous treatments or surgery, or for extensive LM. Sclerotherapy can achieve partial or complete response in over 90% of patients and is most effective for macrocystic lesions. Depending on the size, extent, and location of the malformation, surgery can be considered. CONCLUSION: Evidence supporting best practices for the safety and effectiveness of management for LMs is currently of moderate quality. Many patients benefit from multi-modal treatment determined by the extent and type of LM. A multidisciplinary approach is recommended to determine the optimal individualized treatment for each patient.
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OBJECTIVE: The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee conducted a systematic review to describe the epidemiology of venous thromboembolism (VTE) in pediatric surgical and trauma patients and develop recommendations for screening and prophylaxis. METHODS: The Medline (Ovid), Embase, Cochrane, and Web of Science databases were queried from January 2000 through December 2021. Search terms addressed the following topics: incidence, ultrasound screening, and mechanical and pharmacologic prophylaxis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available literature. RESULTS: One hundred twenty-four studies were included. The incidence of VTE in pediatric surgical populations is 0.29% (Range = 0.1%-0.48%) and directly correlates with surgery type, transfusion, prolonged anesthesia, malignancy, congenital heart disease, inflammatory bowel disease, infection, and female sex. The incidence of VTE in pediatric trauma populations is 0.25% (Range = 0.1%-0.8%) and directly correlates with injury severity, major surgery, central line placement, body mass index, spinal cord injury, and length-of-stay. Routine ultrasound screening for VTE is not recommended. Consider sequential compression devices in at-risk nonmobile, pediatric surgical patients when an appropriate sized device is available. Consider mechanical prophylaxis alone or with pharmacologic prophylaxis in adolescents >15 y and post-pubertal children <15 y with injury severity scores >25. When utilizing pharmacologic prophylaxis, low molecular weight heparin is superior to unfractionated heparin. CONCLUSIONS: While VTE remains an infrequent complication in children, consideration of mechanical and pharmacologic prophylaxis is appropriate in certain populations. TYPE OF STUDY: Systematic Review of level 2-4 studies. LEVEL OF EVIDENCE: Level 3-4.
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Cancer stem cells are proposed to be tumor-initiating cells capable of tumorigenesis, recurrence, metastasis, and drug resistance, and, like somatic stem cells, are thought to be capable of unlimited self-renewal and, when stimulated, proliferation and differentiation. Here we select cells by expression of a panel of markers to enrich for a population with stem cell-like characteristics. A panel of eight was initially selected from 95 human cell surface antigens as each was shared among human ovarian primary cancers, ovarian cancer cell lines, and normal fimbria. A total of 150 combinations of markers were reduced to a panel of three--CD44, CD24, and Epcam--which selected, in three ovarian cancer cell lines, those cells which best formed colonies. Cells expressing CD44, CD24, and Epcam exhibited stem cell characteristics of shorter tumor-free intervals in vivo after limiting dilution, and enhanced migration in invasion assays in vitro. Also, doxorubicin, cisplatin, and paclitaxel increased this enriched population which, conversely, was significantly inhibited by Müllerian inhibiting substance (MIS) or the MIS mimetic SP600125. These findings demonstrate that flow cytometry can be used to detect a population which shows differential drug sensitivity, and imply that treatment of patients can be individualized to target both stem/progenitor cell enriched and nonenriched subpopulations. The findings also suggest that this population, amenable to isolation by flow cytometry, can be used to screen for novel treatment paradigms, including biologic agents such as MIS, which will improve outcomes for patients with ovarian cancer.
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Hormona Antimülleriana/farmacología , Antígenos de Neoplasias/metabolismo , Antineoplásicos/farmacología , Biomarcadores de Tumor/metabolismo , Antígeno CD24/metabolismo , Moléculas de Adhesión Celular/metabolismo , Receptores de Hialuranos/metabolismo , Células Madre Neoplásicas/metabolismo , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/metabolismo , Antracenos/farmacología , Hormona Antimülleriana/agonistas , Antineoplásicos/agonistas , Diferenciación Celular/efectos de los fármacos , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Resistencia a Antineoplásicos/efectos de los fármacos , Molécula de Adhesión Celular Epitelial , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , HumanosRESUMEN
OBJECTIVE: This study aims to evaluate if there is any significant linguistic difference in LoR based on applicant's race/ethnicity. DESIGN: Retrospective review of applications to pediatric surgery fellowship at a single institution (2016-2020). Race was self-reported by applicants. LoR were analyzed via the Linguistic Inquiry and Word Count (LIWC) software program. SETTING: Johns Hopkins All Children's Hospital, St. Petersburg, Florida USA. A free-standing tertiary pediatric hospital. PARTICIPANTS: Pediatric surgery fellowship applicants from 2016 to 2020. RESULTS: A total of 1086 LoR from 280 applicants (52% female) were analyzed. Racial distribution was Caucasians 62.1%, Asian 12.1%, Hispanics 7.1%, multiracial 6.4% African Americans 5%, and other/unknown 7.1%. Letter writers were largely male (84%), pediatric surgeons (63%) and professors (57%). There was no difference in LoR word count across races. LoR for female multiracial candidates contained higher use of affiliation and negative emotion terms compared to Hispanic females (pâ¯=â¯0.002 and 0.048, respectively), and past focus terms when compared to Caucasian and Asian female applicants (p < 0.001 and pâ¯=â¯0.003, respectively). Religion terms were more common in LoR for Asian females when compared to Caucasian females (p < 0.001). CONCLUSION: This study demonstrates linguistic differences in LoR for pediatric surgery training programs based on applicant race/ethnicity. While differences are present, these do not suggest overt bias based on applicants race or ethnicity.
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Internado y Residencia , Especialidades Quirúrgicas , Humanos , Masculino , Femenino , Niño , Selección de Personal , Lenguaje , LingüísticaRESUMEN
OBJECTIVE: Given the fact that Mullerian Inhibiting Substance (MIS) causes complex remodeling of the urogenital ridge and regression of the Mullerian ducts during male embryonic development, we examined whether MIS could affect similar cell properties such as migration and invasion that could contribute ultimately to micro-metastasis of cancers arising from Mullerian tissues. MIS receptor expressing cell lines found to be invasive and migratory in vivo are examined in an in vivo assay that is cost-effective. METHODS: We designed in vitro and in vivo experiments to determine if MIS inhibited the movement of cancer lines IGROV-1, HEp3, MDA-MB-231, and HT1080 in cell culture invasion/migration chamber assays and in chick embryo metastasis assays. RESULTS: MIS, at concentrations below those that inhibit cell proliferation, blocked in vitro invasion and in vivo migration of epithelial cancer cells that express the MIS receptor. CONCLUSIONS: While our laboratory has previously established MIS as an inhibitor of cancer cell proliferation using in vitro assays and in vivo xenografts, we now show that MIS can also inhibit in vivo tumor migration.
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Hormona Antimülleriana/farmacología , Movimiento Celular/efectos de los fármacos , Neoplasias/tratamiento farmacológico , Animales , Hormona Antimülleriana/metabolismo , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Línea Celular Tumoral , Embrión de Pollo , Membrana Corioalantoides/citología , Membrana Corioalantoides/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Fibrosarcoma/tratamiento farmacológico , Fibrosarcoma/metabolismo , Fibrosarcoma/patología , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/metabolismo , Neoplasias de Cabeza y Cuello/patología , Humanos , Invasividad Neoplásica , Neoplasias/metabolismo , Neoplasias/patología , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/patología , Paclitaxel/administración & dosificación , Receptores de Péptidos/metabolismo , Receptores de Factores de Crecimiento Transformadores beta/metabolismoRESUMEN
Ovulation induces cyclic rupture and regenerative repair of the ovarian coelomic epithelium. This process of repeated disruption and repair accompanied by complex remodeling typifies a somatic stem/progenitor cell-mediated process. Using BrdU incorporation and doxycycline inducible histone2B-green fluorescent protein pulse-chase techniques, we identify a label-retaining cell population in the coelomic epithelium of the adult mouse ovary as candidate somatic stem/progenitor cells. The identified population exhibits quiescence with asymmetric label retention, functional response to estrous cycling in vivo by proliferation, enhanced growth characteristics by in vitro colony formation, and cytoprotective mechanisms by enrichment for the side population. Together, these characteristics identify the label-retaining cell population as a candidate for the putative somatic stem/progenitor cells of the coelomic epithelium of the mouse ovary.
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Células Epiteliales/citología , Ovario/citología , Regeneración , Células Madre/citología , Animales , Bromodesoxiuridina , Proliferación Celular , Ciclo Estral , Femenino , Proteínas Fluorescentes Verdes , RatonesRESUMEN
OBJECTIVES: Granulosa cell tumors (GCTs) comprise 2-5% of ovarian tumors. Serum Müllerian Inhibiting Substance (MIS, also known as anti-Müllerian hormone, or AMH) levels have been validated as a marker of GCT recurrence and progression. There has been little correlation between serum MIS/AMH levels and several clinical parameters in GCTs, including tumor burden. We have performed a retrospective review correlating aggregate tumor mass as reported by pathologic examination or by radiology with serum MIS/AMH levels drawn on the date of examination. METHODS: We retrospectively identified 32 GCT patients at our institution over the last 15 years who had serum MIS/AMH measurements. Patients who had serum MIS/AMH measurements within three days of surgery or on the same day as abdominal computerized tomography scan (CT) or magnetic resonance imaging (MRI) were further evaluated. RESULTS: We found a significant direct correlation between patient serum MIS/AMH levels and gross aggregate tumor mass determined by pathology (slope=15.4+/-6.06, r=0.65, p<0.04) or by radiographic aggregate tumor mass for all data points identified (slope=0.07+/-0.03, r=0.33, p<0.04) and after correcting for selection bias (slope=1.45+/-0.17, r=0.93, p<0.01). We also identified a significant difference between serum MIS/AMH levels between samples drawn the same day as negative and positive abdominal CT or MRI scans (8.16+/-1.54 vs. 158.7+/-32.2 ng/ml, p<0.0001). CONCLUSIONS: These data indicate a significant direct correlation between serum MIS/AMH levels and both gross and radiographic aggregate tumor mass in GCT patients. Together with the current literature, the present data argue for a more prominent role for serum MIS/AMH in the management of GCTs.
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Hormona Antimülleriana/sangre , Tumor de Células de la Granulosa/sangre , Tumor de Células de la Granulosa/patología , Adulto , Femenino , Tumor de Células de la Granulosa/diagnóstico por imagen , Humanos , Estadificación de Neoplasias , Neoplasias Ováricas/sangre , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/patología , Pronóstico , Radiografía , Recurrencia , Estudios RetrospectivosRESUMEN
Breast hamartomas are uncommon lesions that have not been extensively characterized in the adolescent population. A search of patient records at our institution over a 17-year period identified seven cases of breast hamartomas in patients less than 18 years of age. We examine and report the clinical, radiographic, and pathologic characteristics of these cases. Breast hamartomas present as painless, palpable masses in the adolescent population. Ultrasonography reveals a well-defined, solid, oval mass, similar to the more common fibroadenoma. Two of the patients underwent core needle biopsy for diagnosis as the only intervention with the remainder undergoing surgical excision. None of the patients had any complications from surgery. There was one recurrence 9 months after initial excision. Histologically, the hamartomas consisted of densely packed, enlarged lobules set within a fibrous stroma. Breast hamartomas are rare in the adolescent population. The clinical and radiographic features are similar to the more common fibroadenoma, but the pathologic findings are diagnostic. Recurrence can occur if excision is incomplete. Increased recognition and accurate diagnosis will improve our understanding of the natural history of these lesions.
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Enfermedades de la Mama/cirugía , Hamartoma/cirugía , Adolescente , Biopsia con Aguja , Enfermedades de la Mama/patología , Niño , Colágeno/análisis , Femenino , Hamartoma/patología , Humanos , Recurrencia , Resultado del TratamientoRESUMEN
PURPOSE: The pediatric surgery match is highly competitive with the interview process requiring significant resources. The purpose of this study was to evaluate the efficacy of videoconference interviewing (VI) as a screening tool in the pediatric surgery match process. METHODS: During the 2017 interview season, applicants participated in VI prior to on-site interviews. Applicants and faculty completed 15 and 8-question surveys, respectively, regarding their experiences. RESULTS: Both faculty and applicants agreed VI was easily workable and allowed them to accurately represent themselves. Faculty agreed VI would change how they rank candidates and that it is a helpful screening tool. Most disagreed VI could substitute for on-site interviews. Most applicants reported the cost and time required for on-site interviews was a hardship. Overall, applicants moved an average of 5.5 ± 2.9 (median 3) positions from the pre-VI to post-VI rank list. Thirty-seven percent of applicants moved out of the top ten rank list following VI. Of the lowest 5 applicants on the post-VI rank list, only 20% matched successfully. CONCLUSION: The pediatric surgery match requires a significant investment of time and money that creates a hardship for most applicants. VI may be an effective screening tool that could potentially reduce on-site interviews and alleviate the burden on applicants and general surgery training programs.
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Entrevistas como Asunto/métodos , Pediatría/educación , Selección de Personal/métodos , Especialidades Quirúrgicas/educación , Comunicación por VideoconferenciaRESUMEN
Anatomical variants can pose diagnostic dilemmas for the clinician and may confound critical decision making for traumatic thoracic aortic injuries. With significant morbidity and mortality for both the injury and the therapeutic options in the pediatric population, an accurate diagnosis is essential for a good outcome. Knowledge of both the anatomical variant as well as the potential injury is required for a precise diagnosis. Highlighting these concepts, we present the case of a 13-year-old trauma patient with a possible blunt thoracic aortic injury. A suspected intimal aortic tear on computed tomography angiography proved to be a ductus remnant, which did not require intervention.
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Aorta Torácica/lesiones , Aortografía , Conducto Arterial/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Accidentes de Tránsito , Adolescente , Diagnóstico Diferencial , Conducto Arterial/patología , Disnea/etiología , Fracturas del Fémur/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Humanos , Angiografía por Resonancia Magnética , Masculino , Traumatismo Múltiple , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Costillas/diagnóstico por imagen , Costillas/lesiones , Escápula/diagnóstico por imagen , Escápula/lesiones , Fracturas de la Columna Vertebral/diagnóstico por imagenRESUMEN
Uterine leiomyomas (also known as uterine fibroids) are the most common benign tumors of female reproductive tract and are the single most common indication for hysterectomies. Despite their high prevalence, the exact pathogenesis of these benign tumors is still unknown. One possible mechanism for leiomyoma formation is dysregulation of mesenchymal stem cell activity. Mesenchymal stem cells have been identified in both human and murine uteri and cancer stem cells have been identified in female reproductive malignancies. We compared stem/progenitor cell characteristics in both normal myometrium and the corresponding leiomyoma of patient's undergoing hysterectomies. We found that leiomyoma cells form fewer mesenchymal stem cell colonies and exhibit less Hoechst dye-excluding side population (SP) activity, which is a function associated with progenitor cells in other tissues, than cells isolated from normal myometrium. Whereas in normal myometrium, we observed heterogeneous expression of CD90, a cell surface marker associated the with differentiation potential of uterine fibroblasts, in leiomyomas, we observed homogenous expression of CD90, suggesting leiomyoma cells are more terminally differentiated. Furthermore, we found that while leiomyoma cells could only produce CD90 expressing cells, both CD90+ and CD90- myometrial cells could reestablish their original heterogeneous CD90 profile when expanded in vitro. These results suggest that normal myometrium contains cells with stem/progenitor cell activities that are absent in leiomyomas.
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Leiomiomatosis/patología , Células Madre Mesenquimatosas/patología , Miometrio/citología , Neoplasias Uterinas/patología , Diferenciación Celular/fisiología , División Celular/fisiología , Femenino , Fibroblastos/citología , Fibroblastos/metabolismo , Citometría de Flujo , Humanos , Técnicas In Vitro , Células Madre Mesenquimatosas/metabolismo , Antígenos Thy-1/metabolismoRESUMEN
In the management of pediatric trauma, certain principles that are practiced in children who have sustained injuries more commonly seen in adults are extrapolated from the adult trauma literature. The increased use of computer tomography angiograms in the diagnosis of penetrating vascular trauma and endovascular therapy in treating vascular trauma in the adult population is being extended to the pediatric population. We present a case of a 14-year-old male with an axillary artery injury that was diagnosed by computer tomography angiogram and treated with an endovascular Stent graft with 1-year follow-up.
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Arteria Axilar/lesiones , Stents , Heridas Punzantes/cirugía , Adolescente , Angiografía , Arteria Axilar/diagnóstico por imagen , Arteria Axilar/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos X , Heridas Punzantes/diagnóstico por imagenRESUMEN
While gynecomastia is common in adolescents, male breast cancer in the pediatric population is exceedingly rare. Occasional reports describe malignant and pre-malignant lesions in mastectomy specimens for gynecomastia in young adults. We present a 16-year-old male with unilateral gynecomastia discovered to have ductal carcinoma in situ (DCIS), treated by mastectomy with 4 year follow-up.
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Neoplasias de la Mama Masculina/cirugía , Carcinoma in Situ/cirugía , Carcinoma Ductal de Mama/cirugía , Ginecomastia/cirugía , Adolescente , Neoplasias de la Mama Masculina/complicaciones , Carcinoma in Situ/complicaciones , Carcinoma Ductal de Mama/complicaciones , Ginecomastia/complicaciones , Humanos , Masculino , Mastectomía/métodosRESUMEN
Primary pulmonary rhabdomyosarcoma (RMS) in the pediatric population is a rare entity. A 5-month-old boy initially treated for pneumonia was proven to have a primary pulmonary RMS, which was resected via thoracotomy. After a course of chemotherapy following the Children's Oncology Group low-risk RMS protocol (ARST0331), a restaging chest computerized tomography scan showed local recurrence, which was also resected by open thoracotomy. The patient is currently undergoing local radiotherapy and salvage chemotherapy regimen. This patient is the youngest reported to date with this entity. The prognostic significance of his young age and the morphologic findings of his tumor are unclear.
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Neoplasias Pulmonares/patología , Rabdomiosarcoma Embrionario/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Lactante , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/terapia , Masculino , Recurrencia Local de Neoplasia/patología , Neumonía/patología , Blastoma Pulmonar/patología , Radioterapia , Rabdomiosarcoma Embrionario/metabolismo , Rabdomiosarcoma Embrionario/terapia , Procedimientos Quirúrgicos TorácicosRESUMEN
Conditional deletion of beta-catenin in the Müllerian duct mesenchyme results in a degenerative uterus characterized by replacement of the myometrial smooth muscle with adipose tissue. We hypothesized that the mouse myometrium houses somatic smooth muscle progenitor cells that are hormonally responsive and necessary for remodeling and regeneration during estrous cycling and pregnancy. We surmise that the phenotype observed in beta-catenin conditionally deleted mice is the result of dysregulation of these progenitor cells. The objective of this study was to identify the mouse myometrial smooth muscle progenitor cell and its niche, define the surface marker phenotype, and show a functional response of these cells to normal myometrial cycling. Uteri were labeled with 5-bromo-2'-deoxyuridine (BrdU) and chased for up to 14 weeks. Myometrial label-retaining cells (LRCs) were observed in the myometrium and stroma throughout the chase period. After 12 weeks, phenotypic analysis of the LRCs by immunofluorescence demonstrated that the majority of LRCs colocalized with alpha-smooth muscle actin, estrogen receptor-alpha, and beta-catenin. Flow cytometry of myometrial cells identified a myometrial Hoechst 33342 effluxing "side population" that expresses MISRII-Cre-driven YFP. Functional response of LRCs was investigated by human chorionic gonadotropin stimulation of week 12 chase mice and demonstrated sequential proliferation of LRCs in the endometrial stroma, followed by the myometrium. These results suggest that conventional myometrial regeneration and repair is executed by hormonally responsive stem or progenitor cells derived from the Müllerian duct mesenchyme. Disclosure of potential conflicts of interest is found at the end of this article.