Pediatric Palliative Care of a Transgender Adolescent.

A 15-year-old patient with metastatic synovial sarcoma conveyed to his palliative care physician that his dying wish was to start gender-affirming hormone therapy. His medical team was able to identify resources to support both him and his family as they navigated the immense difficulty of a cancer diagnosis and began to understand their child's gender identity. Literature on the care of gender diverse pediatric patients with terminal illness is minimal, but applications from adult literature, and research on supporting gender diverse adolescents more broadly, provided guidance for palliative care, oncology, and gender-affirming care teams.

Code status orders in hospitalized patients with COVID-19.

Background: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19.

Methods: A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest.

Hypertension in Pregnancy: What We Now Know.

Purpose Of Review: Hypertensive disorders of pregnancy remain a highly morbid condition that affects both the mother and fetus, complicate approximately 10% of pregnancies worldwide, and contribute to immediate and long-term cardiovascular outcomes. There is still much to learn regarding pathogenesis and treatment goals.

Recent Findings: There is updated information on the pathogenesis of preeclampsia and treatment thresholds for HTN in pregnancy.

Cancer disparities among non-Hispanic urban American Indian and Alaska Native populations in the United States, 1999-2017.

Background: Disparities in cancer incidence have not been described for urban American Indian/Alaska Native (AI/AN) populations. The purpose of the present study was to examine incidence rates (2008-2017) and trends (1999-2017) for leading cancers in urban non-Hispanic AI/AN (NH AI/AN) compared to non-Hispanic White (NHW) populations living in the same urban areas.

Methods: Incident cases from population-based cancer registries were linked with the Indian Health Service patient registration database for improved racial classification of NH AI/AN populations.

Informed Care for the Gynecologic Day Surgical Patient with a History of Sexual Trauma.

The field of Obstetrics and Gynecology is one that provides intersections between one's most private and intimate moments with scenarios that could potentially trigger significant emotional trauma. As providers, one must balance providing appropriate care with the respect and autonomy of the patient. The perioperative and operative space presents many ethical dilemmas in navigating these boundaries, particularly among individuals with a history of sexual trauma.

[Breast angiosarcoma induced by radiotherapy - surgical treatment options and review of literature].

Introduction: Radiation-induced angiosarcoma is a rare but very aggressive tumour. The highest risk of sarcoma development is in patients after breast-conserving surgery.Case 1: The 66 years old patient underwent radical mastectomy with axillary dissection because of ductal carcinoma with consequent radiotherapy, chemotherapy and hormonal therapy.

[The use of acellular biological xenografts in local treatment of Lyells syndrome].

Lyells syndrome, also known as toxic epidermal necrolysis (TEN), is a rare skin disease characterized by a high mortality rate, systemic toxicity and extensive epidermal necrolysis with mucosal erosions. TEN is caused by an allergic autoimmune response, most commonly occurring as a result of an allergic reaction to medication. Our case report describes a nine-year-old boy suffering from Lyells syndrome, with 95% of the body surface area affected.

Medical student-mothers.

Medical training is challenging and parenting is a full-time responsibility. Balancing a family with the significant demands of medical school is a daunting endeavor. Yet there is little research available to guide students, faculty, or administrators.

Body water in children during recovery from severe burn injury using a combined tracer dilution method.

Useful information about hydration and the size of the body cell mass (BCM) can be obtained by monitoring changes in the amount of total body water (TBW) and its components, extracellular water (ECW) and intracellular water (ICW). A combined tracer dilution method with deuterium to measure TBW and bromide to measure ECW was used to assess changes in ICW (as a proxy for the BCM) and in the ECW/ICW ratio (an indicator of water distribution) over the course of recovery in nine severely burned children. During the acute phase of recovery, ICW losses averaged (mean +/- SD) 2.

Short-term enteral glutamine does not enhance protein accretion in burned children: a stable isotope study.

Objective: Glutamine is a nonessential amino acid that, in recent years, has been found to play important roles in several metabolic and immunologic processes. It has been theorized that, in a stressed state, it may become "conditionally essential" because the patient's ability to manufacture glutamine may not be adequate to meet their needs under this condition. We chose to evaluate the ability of 48 hours of enteral glutamine to enhance immediate nitrogen accretion in stressed pediatric burn patients.

Sodium bromide by instrumental neutron activation analysis quantifies change in extracellular water space with wound closure in severely burned children.

Background: The ability to measure extracellular water (ECW) in critically ill patients can significantly enhance current methods of assessing fluid homeostasis, body composition, and response to nutritional therapy. We measured corrected bromide space to determine change in ECW with wound closure among acutely burned children.

Methods: Fifteen children with burns over 30% of their total body surface area had their ECW determined following hemodynamic stabilization and when wound closure was complete.

Radical D2 surgery for patients with gastric cancer.

Unlabelled: The authors analyzed and prepared a report concerning 18 radical surgeries for gastric cancer that were performed between 1999-2001. Overall, 55 operation were performed, 32 radical, 18 palliative and 5 explorative laparatomies. D2 resections were performed 18 times, while D1 type 14 times.

Initial experience with a composite autologous skin substitute.

Patients with large burns are surviving in increasing numbers, but there remains no durable and reliable permanent skin replacement. After initial favorable small animal experiments, a pilot trial of a composite skin replacement was performed in patients with massive burns. A composite skin replacement (CSR) was developed by culturing autologous keratinocytes on acellular allogenic dermis.

Initial experience with a prototype staple detector.

Stainless steel staples can be overgrown by granulation tissue or skin grafts and become buried in tissue. Although they are generally asymptomatic, they can on rare occasion erode to the surface or complicate the radiographic evaluation of pain not related to the staples. A device to facilitate detection of retained staples would be desirable, but it has been difficult to develop because stainless steel staples have poor magnetic and conductive properties.

Early burn center transfer shortens the length of hospitalization and reduces complications in children with serious burn injuries.

Prompt transfer of the child with acute burns can be difficult from distant or inaccessible locations, and it is believed that the outcomes of children with serious burns whose transfer to a specialized burn care facility is delayed may be compromised. A 4-year experience with 16 consecutive children with serious burns (> or =20% of the body surface area) whose transfer to a burn care facility was delayed for 5 or more days was reviewed to document the difficulties that can follow such delays. These 16 children had an average age of 8.

Infradiaphragmatic central venous pressures reflect supradiaphragmatic pressures in stable burn patients.

Objective: Because the skin of the groin is often spared, femoral central venous catheters are sometimes used in patients with extensive burns. The accuracy of central venous pressures obtained from the infradiaphragmatic location relative to the traditional supradiaphragmatic value is not known in this population.

Methods: Seventeen seriously injured but hemodynamically stable burn patients were enrolled in a protocol approved by the human studies committee in which, during scheduled central venous line rotations, supradiaphragmatic and infradiaphragmatic central venous pressures were determined simultaneously.

Laser ablation of burns: initial clinical trial.

Background: Scanning, high-powered carbon dioxide laser ablation of eschar may facilitate blood conservation in patients with burns.

Methods: Twenty-one children with full-thickness burns that required serial excisions were enrolled in a Human Studies Committee approved protocol in which a full-thickness wound was ablated with a rapidly scanned continuous wave carbon dioxide laser system. A control wound was sharply excised, and both wounds were immediately autografted.

Acellular allodermis in burns surgery: 1-year results of a pilot trial.

We grafted 10 sites on 6 children with limited (< 25%) areas of body surface available for donor harvest with an acellular allogenic dermis and a thin autograft. Matched control sites were grafted with autograft alone. Study site autografts (0.

Treatment of the seriously burned infant.

Infants (younger than 12 months) with large (more than 30%) burns are reported to have poorer chances for survival than older children with similar injuries. However, recent experience with such infants has been positive, prompting a 5-year review of management techniques. The injuries were approached in an organized fashion that included precise fluid support, excision, and biologic closure of full-thickness wounds within 5 days, limited exposure to high inflating pressures (more than 40 cm H2O), weekly replacement of central venous catheters, and intensive nutritional support via the enteral route whenever possible.

Tunable dye laser neovessel ablation as an adjunct to the management of hypertrophic scarring in burned children: pilot trial to establish safety.

Hypertrophic scarring is a major source of morbidity in patients with burns. The physiologic characteristics are poorly understood, but increased neovascularity is typically seen in those wounds destined to become hypertrophic. We theorize that ablation of the developing neovasculature may favorably influence the development of the hypertrophic scar.

Ultrasonic imaging as an adjunct to femoral venous catheterization in children.

Central venous catheterization is critically important to the management of burned children, but major morbidity is associated with the technical misadventures that can occur when inserting these devices. We used a bedside ultrasound device to facilitate placement of femoral venous catheters in eight edematous children with an average age of 7.0 years, weight of 23 kg, and burn size of 54%.

Once-daily wound cleansing and dressing change: efficacy and cost.

Children requiring inpatient burn care generally undergo wound cleansing and dressing change twice daily. Each dressing change is associated with significant pain and expense. We explored the efficacy of once- versus twice-daily dressing changes in children with burns of 30% or less of the body surface in a Human Studies Committee approved, prospective, open-label protocol.

Planimetry study of the percent of body surface represented by the hand and palm: sizing irregular burns is more accurately done with the palm.

Sizing irregular burns is commonly done with use of the patient's hand as a template representing 1% of the body surface. To verify that this is accurate over a broad range of ages or to see if the surface of the palm is a more consistent template, a planimetry study was done. This revealed that the surface area of the palm averaged 0.

Clinical experience with the use of biodegradable tacks in pediatric patients with burns.

Stainless steel staples are very popular for securing grafts and dressings on patients with burns because of the speed and security with which they can be applied and the fact that stainless steel is nonreactive. In patients with large burns hundreds of staples are used and can be difficult to visualize and remove; they are therefore retained. Although stainless steel does not cause local tissue reaction, its presence can confuse the later evaluation of local pain.