Management of Acute Surgical Pain in Plastic and Reconstructive Surgery.

Fewer than half of all patients undergoing surgery report adequate postoperative pain relief. Poorly managed postoperative pain can lead to complications, increased hospital stays, prolonged rehabilitation, and a decreased quality of life. Pain rating scales are commonly used to identify, manage, and track the perceived intensity of pain.

Enhanced Recovery After Surgery: A Quality Improvement Approach.

Enhanced recovery after surgery (ERAS) protocols exist to optimize perioperative care for patients of all ages. The efficacy of ERAS protocols has been studied in various surgical specialties, including pediatric surgery and otolaryngology, but its role in pediatric otolaryngology has not been widely demonstrated in the literature. This review article attempts to assess the current state of ERAS within otolaryngology, pediatric surgery, and more specifically, pediatric otolaryngology to identify opportunities for future development and utilization.

Button battery taping and disposal: Risk reduction strategies for the household setting.

Objectives: Pediatric esophageal button battery (BB) injury occurs rapidly and continues to be a significant source of morbidity and mortality. Unfortunately, a BB that no longer supplies power to a device can still have enough residual voltage to cause injury within the body. Development of additional prevention strategies for consumers may reduce esophageal injury risk.

Passing the Scalpel: Lessons on retirement planning from retired academic surgeons.

Background: Almost half of practicing surgeons in the United States are currently older than 55, but guidelines on how to prepare for retirement are limited. We sought to identify possible facilitators for, and obstacles to, surgeons' preparations for retirement.

Methods: A qualitative study was conducted using semi-structured interviews with clinically inactive academic surgeons.

Current management of aerodigestive foreign bodies in children.

Foreign bodies ingestion or aspiration events in children can be a source of morbidity and mortality. In most cases, removal by a coordinated endoscopy can be performed when there is the availability of equipment and support staff for pediatric care. Close communication with the anesthesia, surgeon and operating room support staff is essential and rehearsing with a facsimile of the foreign body is useful.

The Effect of Implementing Teledermatology in Patients Presenting with Cellulitis Versus Pseudocellulitis in an Academic Emergency Department Setting: A Pilot Study.

There is a shortage of dermatologists available to see hospitalized patients, especially for urgent evaluations such as in the emergency department setting. The use of teledermatology in the emergency setting was studied for patients presenting to the emergency department with symptoms of or a diagnosis of cellulitis. Thirty patients were enrolled and randomized to a teledermatology note being placed in their chart versus control patients undergoing standard care.

Benign adenoidal hypertrophy caused by adenovirus presenting as a nasopharyngeal mass concerning for malignancy.

Benign adenoidal hypertrophy is the most common cause of nasopharyngeal obstruction. However, depending on size and location, masses may cause nasopharyngeal obstruction. We present our experiences with a ten-year-old female who presented with what appeared to be a large nasopharyngeal mass that was initially favored to be malignant and was ultimately found to be adenoid hypertrophy related to acute infection with adenovirus.

Pediatric facial kaposiform hemangioendothelioma: a case report and review of the literature.

Cutaneous kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are vascular tumors that are often misdiagnosed. Treatment urgency and type varies depending on which tumor-type is diagnosed, because of the differing rates of progression to Kasabach-Merritt phenomenon. An 11-month-old male presented with a facial mass and biopsy results favoring a diagnosis of TA.

Myeloid sarcoma presenting as bilateral acute otitis externa in newly diagnosed acute myeloid leukemia.

Myeloid sarcoma (MS) is an extramedullary collection of immature myeloid cells that can commonly occur with acute myeloid leukemia (AML). While head and neck presentations are not unheard of, there have been few published pediatric cases of external auditory canal MS. Here, we report a case of a 14-year-old male who presented with MS masquerading as bilateral acute otitis externa.

Systemic cervical cytology training and quality control programs can improve the interpretation of Papanicolaou tests.

Introduction: There is no national cervical screening program or national standards for cervical cytology quality control in China. Since 2013, systematic training and quality control programs were implemented in the Papanicolaou testing process at Jinan KingMed Diagnostics. Pathologists were required to complete 1 year of cytology study in the KingMed Diagnostics Cytology School, including 6 months of a diagnostic course and 6 months of practical training in the clinical laboratory.

Initial clinical application of tissue pH neutralization after esophageal button battery removal in children.

Objectives/hypothesis: Pediatric esophageal button battery (BB) injuries can progress even after removal and continue to be a significant source of morbidity and mortality. The objective in this case series is to present initial safety data for the human application of intraoperative tissue pH neutralization using 0.25% acetic acid irrigation after BB removal.

Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children.

Button battery ingestions result in significant morbidity and mortality in children-before, during, and even after removal. The injuries created by a button battery lodged in the esophagus develop rapidly and can be severe. The current of the button battery, conducted through saliva and the tissue drives a highly alkaline caustic injury, leading to liquefactive tissue necrosis.

Atypical Squamous Cells of Undetermined Significance Cervical Cytology Report Rate and Histologic Follow-up Findings From the Largest College of American Pathologists-Certified Laboratory in China.

Context.—: Reports for atypical squamous cells of undetermined significance (ASC-US) and histologic findings are rare in China.

Objective.

Comparison of the Fitbit® charge and polysomnography for measuring sleep quality in children with sleep disordered breathing.

Background: Due to the cost and inconvenience of polysomnography (PSG), wrist-worn accelerometers have been explored as an alternative method to measure sleep efficacy in children with obstructive sleep apnea (OSA) or sleep-disordered breathing (SDB). We compared the measurement of sleep quality with the Fitbit charge (Fitbit Inc., San Francisco, CA, USA) compared to PSG in children presenting for sleep studies.

Clinical Indices to Drive Quality Improvement in Otolaryngology.

A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed.

Button Battery Safety: Industry and Academic Partnerships to Drive Change.

The pediatric button battery (BB) hazard has been recognized for several decades. In 2012, the National Button Battery Task Force was established, and most manufacturers have improved warning labels, more secure packaging, and made BB compartments in products are more secure. Tissue neutralization before BB removal (ie, honey or sucralfate/Carafate®) is an effective way to reduce the rate of BB injury.

Utilization of a handheld metal detector protocol to reduce radiation exposure in pediatric patients with esophageal coins.

Objective: The primary objective of this study is to assess the utility of a handheld metal detector for identification and surveillance of patients with known esophageal coin ingestion to reduce repeat x-rays and associated radiation exposure.

Methods: Prospective study of children presented to the emergency department with esophageal coins confirmed by an initial x-ray were enrolled. The otolaryngology team used the handheld metal detector to detect and localize the coin on patient.

pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury.

Objectives/hypothesis: Ingestion of button batteries (BB) can rapidly lead to caustic esophageal injury in infants and children, resulting in significant morbidity and mortality. To identify novel mitigation strategies, we tested common weakly acidic household beverages, viscous liquids, and Carafate® for their ability to act as protective esophageal irrigations until endoscopic removal of the BB.

Study Design: Cadaveric and live animal model.

A Multidisciplinary Approach to a Pediatric Difficult Airway Simulation Course.

Objective To design and assess an advanced pediatric airway management course, through simulation-based team training and with multiple disciplines, to emphasize communication and cooperation across subspecialties and to provide a common skill set and knowledge base. Methods Trainees from anesthesiology, emergency medicine, critical care, pediatric surgery, and otolaryngology at a tertiary children's hospital participated in a 1-day workshop emphasizing airway skills and complex airway simulations. Small groups were multidisciplinary to promote teamwork.

Potential for severe airway obstruction from pediatric retropharyngeal abscess.

Retropharyngeal abscesses in the pediatric population can cause severe respiratory distress. We report a rare case of significant airway obstruction in a 14-month-old patient requiring rapid, emergent tracheotomy after attempts at endotracheal intubation by an experienced airway surgeon were unsuccessful. The patient was diagnosed with streptococcal pharyngitis 9 days prior to presentation to our facility and was being treated with amoxicillin.

Characterization of CD38 in the major cell types of the heart: endothelial cells highly express CD38 with activation by hypoxia-reoxygenation triggering NAD(P)H depletion.

The NAD(P)-hydrolyzing enzyme CD38 is activated in the heart during the process of ischemia and reperfusion, triggering NAD(P)(H) depletion. However, the presence and role of CD38 in the major cell types of the heart are unknown. Therefore, we characterize the presence and function of CD38 in cardiac myocytes, endothelial cells, and fibroblasts.