Acute gastric volvulus mimicking features of gastroenteritis in a 5-year-old girl.

Acute gastric volvulus is a life-threatening condition. Especially, a history of adjacent organ deformities in children with intermittent vomiting and abdominal pain should suggest gastric volvulus, even if the symptoms resemble gastroenteritis.

Mediastinal emphysema around the left carotid arteries from a toothbrush impalement injury.

This report describes a case of a pediatric patient with a fever after an oral cavity injury caused by a toothbrush. On physical examination, no bleeds or injuries in his mouth were evident, but diagnostic imaging revealed wide mediastinal emphysema including the left carotid arteries. It shows the importance of carefully examining patients not to miss life-threating conditions.

A Case of Pediatric Breast Abscess Caused by Rarely Observed Bacteria in a Three-Year-Old Boy With an Inverted Nipple: Peptoniphilus harei, Actinotignum sanguinis, and Porphyromonas somerae.

Mastitis and breast abscesses are most common in lactating women but can also be observed in non-lactating women, adolescent girls, and neonates. However, breast abscesses are extremely rare in young boys. Herein, we report the case of a three-year-old boy with a swollen and painful right nipple, later diagnosed with a breast abscess. In this case, we suspected that the patient's inverted nipple was the possible site of the infection. To our best knowledge, this is the first case report of breast abscess in a young boy after the neonatal period. Although Staphylococcus aureus is the most common pathogen, our patient showed three rare bacteria, namely, Peptoniphilus harei, Actinotignum sanguinis, and Porphyromonas somerae, in the culture of the aspirated pus. Furthermore, this case study is the first report of a breast abscess caused by Porphyromonas somerae.

Legg-Calvé-Perthes Disease Following Nephrotic Syndrome With Long-Term Steroid Use in a Three-Year-Old Boy: A Case Report.

Nephrotic syndrome (NS) is one of the common pediatric diseases that require glucocorticoid treatment. Patients with NS might receive steroids for a long time if remission is not achieved. Evidence shows that long-term steroid use may induce osteoporosis in adults and children, and steroid use is well known to be related to avascular necrosis of the femoral head (ANFH) in adults. However, no pediatric case of AFNH caused by long-term steroid use due to NS has been reported. In this report, we describe the case of a three-year-old boy with a chief complaint of gait difficulty, who had been treated with glucocorticoid orally for a year because of NS. His body temperature was within the normal limit. His legs did not show trauma, redness, or swelling; however, he did not want his left thigh touched. A pelvic X-ray scan showed asymmetrical femoral heads due to the thinning of the left femoral head. Pelvic magnetic resonance imaging showed a low intensity of the left femoral head on the T2-weighted image and high and low mixed intensities on the fat-suppressed T2-weighted image. Deformation of the left femoral head was suspected. The epiphysial nucleus of the right femoral head was also small for his age. He was diagnosed with Legg-Calvé-Perthes disease and referred to an orthopedic clinic to begin rehabilitation with equipment to support his joints. Thus, we cannot completely conclude that glucocorticoid use and NS are not related to AFNH in children. Physicians must consider early diagnosis.

The International Transfer of Patients With Positive SARS-CoV-2 Test Using a Framework.

The Japanese Fellowship Program at the U.S. Naval Hospital Yokosuka has served as a liaison with Japanese hospitals during the transfer of acutely ill U.S. Navy patients since 1952. The SARS-CoV-2 pandemic has complicated this process and prompted the creation of a new framework that involves the Public Health Center. We present two international transfer cases of patients with positive SARS-CoV-2. The creation of a framework enabled a safe and smooth transfer process of patients with a favorable outcome. This report can help guide future cases of international transfer, especially for patients who need infectious disease surveillance. To our knowledge, we describe the first report of an international transfer of patients with positive SARS-CoV-2 test using a framework.