Ewing Sarcoma Presenting as a Congenital Scalp Mass.

Ewing sarcoma is a locally aggressive, highly malignant tumor most commonly seen in the skeletal system. The "Ewing family of tumors" also includes other tissue types that are not common, such as soft tissue origin classified as extraosseous Ewing sarcoma (EES) or primitive neuroendocrine origin. Age of onset most often occurs within the first 2 decades of life. Congenital presentation of EES is exceedingly rare. We report the first described case to our knowledge of congenital EES originating from the scalp.

Pediatric Digital Necrosis Secondary to Dressing Application: A Case Series.

BACKGROUND: Pediatric digital necrosis resulting in revision amputation is a devastating outcome following digital dressing application. METHODS: We report a series of 4 pediatric patients (age: 21 months-11 years) who presented for surgical consultation related to digital ischemia and irreversible necrosis following the application of Coban digital dressings. A review of the literature demonstrated that such injuries had not previously been described. RESULTS: In our case series, Coban dressing was utilized as a deterrent for thumb sucking, fingertip tuft fractures with nail bed lacerations, and a phalanx fracture secondary to crush injury. All 4 children suffered digital necrosis secondary to Coban dressings and ultimately required revision amputation. CONCLUSIONS: We discuss risks factors, application practices, and strategies to minimize complications with digital dressings in the pediatric population with the intent of creating awareness among hand surgeons to help promote safe practices and improve patient outcomes.

Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly.

BACKGROUND: Published guidelines recommend early cholecystectomy for acute cholecystitis in the elderly. Alternatively, percutaneous cholecystostomy can be used in compromised patients. METHODS: We reviewed 806 elderly patients diagnosed with biliary disease retrospectively identified through billing and diagnosis codes. Two hundred sixty-five patients with histologically documented acute cholecystitis were selected. RESULTS: Initially, 75 patients had percutaneous cholecystostomy (Group 1), 64 (24 % underwent interval cholecystectomy, 74 (28 %) early (Group 2), and 127 (48 %) delayed cholecystectomy (Group 3). Group 1 was more likely to have American Society of Anesthesiologists (ASA) scores of 4 when compared to those in Groups 2 and 3 (p = 0.04). No difference existed among the groups when patients with an ASA of 4 were excluded: conversion rates (11 %), biliary leak, bowel injury, need for reoperation, or 30 days mortality. Patients in Group 1 and in Group 3 were five times (p = 0.04) and four times (p = 0.06) more likely, respectively, than those in Group 2 to have recurrent episodes of pancreatitis, cholecystitis, and cholangitis. CONCLUSION: Patients were more likely to have delayed cholecystectomy after initial antibiotic therapy or cholecystostomy without the benefit of a lower conversion rate when compared to the early group, but they had higher recurrent episodes of cholecystitis/pancreatitis or cholangitis.

Serum concentrations of monocyte chemoattractant protein-1 in healthy and critically ill dogs.

BACKGROUND: The chemokine monocyte chemoattractant protein-1 (MCP-1) is a primary regulator of monocyte mobilization from bone marrow, and increased concentrations of MCP-1 have been associated with sepsis and other inflammatory disorders in critically ill people. The relationship between MCP-1 and disease in dogs has not been evaluated previously. OBJECTIVE: The purpose of this study was to assess serum concentrations of MCP-1 in healthy dogs, dogs in the postoperative period, and critically ill dogs. We hypothesized that MCP-1 concentrations would be significantly increased in critically ill dogs compared with postoperative or healthy dogs. METHODS: Serum concentrations of MCP-1 were measured in 26 healthy control dogs, 35 postoperative dogs, and 26 critically ill dogs. Critically ill dogs were further subgrouped into dogs with sepsis, parvovirus gastroenteritis, immune-mediated hemolytic anemia, and severe trauma (n=26). MCP-1 concentrations were determined using a commercial canine MCP-1 ELISA. Associations between MCP-1 concentrations and disease status were evaluated statistically. RESULTS: MCP-1 concentration was significantly higher in critically ill dogs (median 578 pg/mL, range 144.7-1723 pg/mL) compared with healthy dogs (median 144 pg/mL, range 4.2-266.8 pg/mL) and postoperative dogs (median 160 pg/mL, range 12.6-560.4 pg/mL) (P<.001). All subgroups of critically ill dogs had increased MCP-1 concentrations with the highest concentrations occurring in dogs with sepsis. However, differences among the 4 subgroups were not statistically significant. CONCLUSION: Critically ill dogs had markedly increased serum concentrations of MCP-1 compared with postoperative and healthy dogs. These results indicate that surgery alone is not sufficient to increase MCP-1 concentrations; thus, measurement of MCP-1 may be useful in assessing disease severity in critically ill dogs.