Valley Children's Hospital (VCH), formerly Children's Hospital Central California is a stand-alone, pediatric acute care children's teaching hospital located in Madera County, California. The hospital has 358 pediatric beds and is affiliated the Stanford University School of Medicine. The hospital is a member of Valley Children's Healthcare and is one of only two children's hospitals in the network, servicing approximately 1.3 million children and adolescents in their coverage area. The hospital provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21 throughout Madera County, Fresno, and California. Valley Children's also sometimes treats adults that require pediatric care.Valley Children's also features the largest ACS verified Level 2 Pediatric Trauma Center in the region, the only Level IV NICU in the Central Valley, and the only provider of pediatric extracorporeal life support (ECLS) for their service area. Valley Children's is one of the largest providers of pediatric health services in California and in the country. The hospital is adjacent to the Ronald McDonald House of the Central Valley.
Juvenile idiopathic arthritis (JIA) is among the most prevalent chronic inflammatory rheumatic diseases in children. Over the past two decades, the treatment landscape has evolved significantly with the introduction of biologic disease-modifying antirheumatic drugs and the adoption of treat-to-target strategies aimed at achieving clinically inactive disease. Early initiation of biologic therapies can facilitate rapid disease control and improve long-term outcomes. However, the implementation and integration of newer treatments within the current healthcare system are often hindered by insurance authorization requirements, high costs, and variability in clinical practice. This review evaluates current evidence-based approaches supporting the treat-to-target strategy and early biologic intervention in polyarticular JIA. Additionally, it discusses the practical challenges of translating evidence into routine clinical care and proposes sustainable strategies to optimize treatment outcomes while addressing existing knowledge and practice gaps.
PURPOSE:Malignant rhabdoid tumor of the kidney (MRTK) is a rare, aggressive tumor seen in young children. The optimal timing of resection for locally advanced tumors is not well-defined. The purpose of this study is to evaluate modern oncologic outcomes and the impact of surgical timing. METHODS:A multicenter retrospective review was performed by institutions participating in the Pediatric Surgical Oncology Research Collaborative. Children younger than 21 years old with MRTK diagnosed between 2000 and 2022 were included. RESULTS:Sixty-nine patients were identified with MRTK and met the inclusion criteria. Median age of diagnosis was 10.1 months. Overall survival (OS) at 1, 5, and 10 years was 49%, 32%, and 19%, respectively. Patients with local Stage III disease who underwent upfront resection (n = 18) compared to those who had delayed resection after NAT (n = 15) had a similar OS, median OS greater than 60 months versus 14.6 months, respectively; p = 0.396. The surgical timing groups were balanced in terms of the presence of metastasis, length of follow-up, and tumor characteristics. There was one occurrence of primary intraoperative tumor spill and two occurrences of organ injury in the upfront resection group compared to none in the delayed resection group. CONCLUSION:MRTK carries a poor prognosis despite multimodal treatment. Histologic diagnosis may not be confirmed at presentation, and MRTK cannot be reliably distinguished from Wilms tumor on imaging alone. As overall survival is similar, the decision regarding surgical timing in locally advanced tumors should be individualized based on perceived resectability, balancing the risk of intraoperative complications against the possibility of tumor progression during neoadjuvant therapy.
Pediatric hand surgery frequently requires precise surgical reconstruction of the upper limb to prevent worsening deformity. However, there is a balance of achieving a perfect radiologic film of the planned surgery and causing inadvertent harm from performing overly aggressive surgery. Precise K-wire placement and immobilization are important for optimal results; however, surgery that is too invasive results in several downsides, including loss of reduction, poor bony healing, loss of blood supply, growth plate failure, and scar contractures from poor wound healing. Here, we review this important concept of "Good Enough" to accept completely adequate results over unattainable perfection in pediatric hand surgery.
