Severe Coronavirus Disease-2019 in Children and Young Adults in the Washington, DC, Metropolitan Region.

Despite worldwide spread of severe acute respiratory syndrome coronavirus-2, few publications have reported the potential for severe disease in the pediatric population. We report 177 infected children and young adults, including 44 hospitalized and 9 critically ill patients, with a comparison of patient characteristics between infected hospitalized and nonhospitalized cohorts, as well as critically ill and noncritically ill cohorts. Children <1 year and adolescents and young adults >15 years of age were over-represented among hospitalized patients (P = .

Surgical correction of an arteriovenous fistula in a ring-tailed lemur (Lemur catta).

A 10-y-old ovariohysterectomized ring-tailed lemur (Lemur catta) was presented for exacerbation of respiratory signs. The lemur had a history of multiple examinations for various problems, including traumatic lacerations and recurrent perivulvar dermatitis. Examination revealed abnormal lung sounds and a femoral arteriovenous fistula with a palpable thrill and auscultable bruit in the right inguinal area.

A mosaic activating mutation in AKT1 associated with the Proteus syndrome.

Background: The Proteus syndrome is characterized by the overgrowth of skin, connective tissue, brain, and other tissues. It has been hypothesized that the syndrome is caused by somatic mosaicism for a mutation that is lethal in the nonmosaic state.

Methods: We performed exome sequencing of DNA from biopsy samples obtained from patients with the Proteus syndrome and compared the resultant DNA sequences with those of unaffected tissues obtained from the same patients.

Embryonal rhabdomyosarcoma in a Rothschild's giraffe (Giraffa camelopardalis rothschildi).

Abstract: A 3-yr-old male Rothschild's giraffe (Giraffa camelopardalis rothschildi) presented for acute swelling caudomedial to the left parietal horn. Following initial diagnostics and supportive treatment, the mass was surgically resected and intralesional chemotherapy was administered. Despite treatment, the giraffe's condition worsened and euthanasia was performed.

Interobserver variation in the assessment of appendiceal perforation.

Background: Following an appendectomy, surgeons define appendicitis, for treatment and billing purposes, into one of four categories: normal appendix, acute appendicitis, gangrenous appendicitis, and perforated appendicitis. Treatment of appendicitis is predicated upon classification at the time of visual inspection. Further, this classification often plays a role in the assessment of hospital outcomes.

Pediatric surgery workforce: supply and demand.

Introduction: Recent studies report a shortage of pediatric surgeons in the United States. We surveyed members of the American Pediatric Surgical Association (APSA) to estimate current workforce and demand and to provide data for workforce planning.

Methods: We conducted a survey of 849 APSA members to provide workforce data on their communities as follows: the number of active, retired, or inactive APSA surgeons; non-APSA fellowship graduates; surgeons without accredited fellowship training; and the estimated demand for additional pediatric surgeons.

Clinical and financial characteristics of pediatric surgery practices.

Unlabelled: Pediatric surgical practices face many challenges. We wanted to define the clinical practice and financial support among different types of practices as follows: academic, private practice, and employed.

Methods: This study involved an Internet survey of members of the American Pediatric Surgical Association (APSA), comparisons using chi(2) and paired t test analyses.

Pediatric surgery workforce: population and economic issues.

Background: Whether a shortage of pediatric surgeons exists in the United States, such as those observed in the total physician and general surgical workforces, is an important issue that will affect decisions regarding training, credentialing, and reimbursement. Our goal was to update information regarding the demand and supply of pediatric surgeons.

Methods: Online American Pediatric Surgical Association (APSA) membership directory gave numbers of pediatric surgeons and their residence by metropolitan statistical areas (MSA), defined by the US census.

Incidence of postoperative hyponatremia and complications in critically-ill children treated with hypotonic and normotonic solutions.

Objective: To determine the incidence and clinical consequences of postoperative hyponatremia in children.

Study Design: We performed a retrospective analysis of postoperative admissions to the pediatric intensive care unit (excluding cardiac, neurosurgical, and renal). The incidence of severe (serum sodium < 125 mmol/L or symptoms) and moderate (serum sodium < 130 mmol/L) hyponatremia in children receiving hypotonic (HT) and normotonic (NT) fluids was calculated.

Transforming a payer-provider relationship from conflict to collaboration.

The current relationship between payers and providers is often adversarial. The growth of managed care has fostered very little cooperation between the payer and provider, even though both are working toward improved patient outcomes. This article describes the process by which a payer and provider were able to transform a contentious relationship into a collaborative patient-centered program.

Current management of appendicitis.

Appendicitis is the most common surgical disease of the abdomen in children. Pediatric appendicitis varies considerably in its clinical presentation, contributing to delay in diagnosis and increased morbidity. The methods of diagnosis and treatment of appendicitis also vary significantly among clinicians and medical centers according to the patient's clinical status, the medical center's capabilities, and the physician's experience and technical expertise.

Seminars: controversies in the management of pediatric thyroid malignancy.

Thyroid cancer in children is a rare malignancy with unusual biological behavior. It often presents at advanced stages, yet behaves in a benign manner, when compared to its adult counterpart. Surgeons have debated the risks and benefits of aggressive surgical procedures for over a decade.

Intensified platinum therapy is an ineffective strategy for improving outcome in pediatric patients with advanced hepatoblastoma.

Purpose: The INT-0098 Intergroup Liver Tumor Study demonstrated no statistically significant differences in event-free and overall survival between patients randomized to treatment with either cisplatin + fluorouracil + vincristine (C5V) or cisplatin + doxorubicin. Results from this and other therapeutic trials suggested that cisplatin was the most active agent against hepatoblastoma. To increase the platinum dose-intensity, a novel regimen was developed alternating carboplatin and cisplatin (CC) every 2 weeks.

Analysis of head injury admission trends in an urban American pediatric trauma center.

Background: Head injury is the leading cause of death in children. Child safety legislation and risk-specific intervention programs have flourished to mitigate the incidence of injury to children. This analysis documents the trend in head injury to children in a specific institution.

Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children.

Context: The rates of appendiceal rupture and negative appendectomy in children remain high despite efforts to reduce them. Both outcomes are used as measures of hospital quality. Little is known about the factors that influence these rates.

Fibrolamellar hepatocellular carcinoma in children and adolescents.

Background: Children with hepatocellular carcinoma (HCC) were treated on a prospective, randomized trial and were then analyzed to determine whether children with the fibrolamellar (FL) histologic variant of HCC have a more favorable presentation, increased surgical resectability, greater response to therapy, and improved outcome compared with children who have typical HCC.

Methods: Forty-six patients were enrolled on Pediatric Intergroup Hepatoma Protocol INT-0098 (Pediatric Oncology Group Study 8945/Children's Cancer Group Study 8881) between August 1989 and December 1992. After undergoing initial surgery or biopsy, children with Stage I HCC (n = 8 patients), Stage III HCC (n = 25 patients), and Stage IV HCC (n = 13 patients) were assigned randomly, regardless of histology, to receive treatment either with cisplatin, vincristine, and fluorouracil (n = 20 patients) or with cisplatin and continuous-infusion doxorubicin (n = 26 patients).

Spectrum of intrapartum management strategies for giant fetal cervical teratoma.

Background/purpose: The management of the fetus with a large neck mass that obstructs the airway remains a clinical challenge. The authors review their experience with giant fetal cervical teratoma and discuss options for management.

Methods: A retrospective review of all patients referred since 1994 for prenatal management of a fetal neck mass was performed.

Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals.

Background/purpose: To improve clinical results and resource utilization in the care of appendicitis in children, the authors examined the current practice and outcomes of 30 pediatric hospitals.

Methods: The Pediatric Health Information System (PHIS) database consists of comparative data from 30 free-standing Children's hospitals. The study population of 3,393 children was derived from the database by selecting the "Diagnosis Related Group Code" for appendicitis (APRDRGv12 164), ages 0 to 17 years, using discharges between October 1, 1999 and September 30, 2000.

Laparoscopy is useful in the diagnosis and management of foramen of Morgagni hernia in children.

Foramen of Morgagni hernia is a rare form of congenital diaphragmatic hernia. We report the use of laparoscopy to diagnose and manage suspected foramen of Morgagni hernias in children. Cardiophrenic masses were seen on chest radiography in two asymptomatic children aged 1 and 3 years.

The diagnosis and management of endocrine tumors causing hypertension in children.

In contrast to that in adults, hypertension in children is frequently amenable to surgical therapy. With advancing techniques in imaging, surgery, and anesthesia, the outcomes of surgery are excellent for children with endocrine tumors causing hypertension.

Classical positioning decreases subclavian vein cross-sectional area in children.

Background: Recommendations for subclavian vein catheter placement in children are extrapolated from adult experience. The purpose of this study was to determine the ideal body position to optimize the size of the subclavian vein in children for percutaneous catheter placement.

Methods: Children underwent ultrasound imaging of the subclavian vein in four supine body positions: head in a neutral position with the chin midline (NL) and no shoulder roll (SR); head turned 90 degrees away (TA) and no SR; head NL with an SR; and head TA with an SR.

Principles for the surgical management of patients with Proteus syndrome and patients with overgrowth not meeting Proteus criteria.

Background: Proteus syndrome is a rare, sporadic disorder consisting of disproportionate overgrowth of multiple tissues, vascular malformations, and connective tissue or epidermal nevi. Patients with Proteus syndrome present with diverse and variable phenotypes because of the syndrome's mosaic pattern of distribution.

Methods: Eighty patients with Proteus syndrome, satisfying published diagnostic criteria, and 51 patients with overgrowth not meeting Proteus criteria were identified from the literature.