AngiosarcomaH istopathological examination of the tissue re- vealed it to be a high-grade, poorly differentiated sarcoma positive for vimentin and CD31.It was 9 cm in greatest dimension, spanning the full thickness of the jejunal wall, with mucosal ulceration and no angiolymphatic invasion.There were some features of gastrointestinal stromal tumors and Ewing sarcoma; however, owing to the strong CD31 positivity, these diagnoses were excluded.Genetic studies for gastrointestinal stromal tumors like KIT tyrosine kinase and plateletderived growth factor ␣ were negative.Diagnosis of posttransplant lymphoproliferative disorder was excluded, as in situ hybridization for the Epstein-Barr virus was negative.Angiosarcomas represent 1% to 2% of all sarcomas and most frequently occur in the skin and subcutaneous tissue.The most frequently affected intra-abdominal organs are the spleen and the liver.Primary gastrointestinal manifestation is quite rare and usually occurs in the stomach or small bowel. 1 Exposure to vinyl chloride, Thorotrast, arsenic chemotherapy, trauma, long-standing lymphedema, and radiotherapy have been implicated in its pathogenesis. 2,3Clinical presentation usually is a combination of nausea, vomiting, abdominal pain, constipation, and gastrointestinal bleeding. 4Immunosuppression is responsible for increasing the relative risk of malignancies in transplant recipients. 5he histological features of angiosarcoma are similar to Ewing sarcoma, lymphoma, and gastrointestinal stromal tumors, among others.Immunohistochemical staining with expression of endothelial markers such as CD31, CD34, and factor VIII-related antigen is necessary to allow definite diagnosis of angiosarcoma. 6Sarcomas are rare neoplasms with a 1.7% incidence among all transplant recipients presenting with de novo malignancies. 4Sarcomas in solid organ transplantation appear to have an aggressive pattern, with 62% being high grade and 40% being metastatic at the time of primary diagnosis. 7ransplant recipients with newly diagnosed sarcomas should be treated with multimodal therapy owing to increased incidence of high-grade tumors and a higher rate of recurrence.The mainstay of treatment is complete surgical excision, as in our case.Adriamycin-based chemotherapy can be used as an adjunct.There is also a role of switching to rapamycin-based immunosuppression. 7
Bladder RhabdomyosarcomaT he patient had a 15ϫ13-cm, lobulated mass aris- ing from the dome of the bladder.A partial cystectomy with removal of the tumor, iliac node dissection, and primary repair of the bladder was carried out.The patient had an uncomplicated course and was discharged on the third postoperative day with a urinary catheter.The pathological finding on the resected specimen was embryonal, botryoid rhabdomyosarcoma involving the right iliac nodes with negative margins (pT2, pN1, pMX).Childhood rhabdomyosarcoma, a malignant tumor of skeletal muscle origin, accounts for approximately 3.5% of cancer cases among children aged 0 to 14 years. 1 The most common primary sites are the genitourinary tract, extremities, and head and neck.Although most cases are sporadic, some are associated with Li-Fraumeni, Costello, Beckwith-Wiedemann, and Noonan syndromes.Rhabdomyosarcoma has been histologically classified into embryonal (60%-70%), alveolar (20%), and pleomorphic (anaplastic) subtypes.The treatment of rhabdomyosarcoma requires multimodality therapy including surgery for local tumor control, systemic chemotherapy, and radiation.The Soft Tissue Sarcoma Committee of the Children's Oncology Group develops treatment protocols incorporating surgicopathological group, primary tumor site, regional lymph node status, and presence or absence of metastases.The surgical treatment involves complete resection of the primary tumor with a surrounding margin of normal tissue and lymph node sampling of the draining nodal basin provided there is no major functional or cosmetic impairment. 2 The prognosis depends on the age of the patient, stage, group, location of the primary tumor, and histological findings. 3Patients aged between 1 and 9 years have the best overall prognosis. 4Rhabdomyosarcoma involving the nonparameningeal head and neck, paratestis, vagina, and biliary tract carry a better prognosis, whereas tumors larger than 5 cm and metastatic disease at diagnosis are associated with poor long-term survival.Overall, it is a curable disease with greater than 70% 5-year survival in children with localized disease receiving multimodal therapy. 5
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Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
HYPOTHESIS:Minimizing time to definitive care in an effort to optimize outcomes is the goal of trauma systems. Toward this end, some systems have imposed standards on time to interfacility transfer. This study evaluates compliance and outcome in a system with a 2-hour transfer rule.DESIGN:Retrospective review.SETTING:State trauma registry data from 1999 to 2003.PATIENTS:Trauma patients who underwent interfacility transfer and those who did not.MAIN OUTCOME MEASURES:Time to transfer; Injury Severity Score; mortality; and time to operating room at second facility. These variables were then stratified by time to transfer.RESULTS:During the study period, there were 22 447 interfacility transfers. Overall transfer rate was 10.4%. Of the transfers, 4502 (20%) occurred within 2 hours. Median transfer time was 2 hours 21 minutes. Injury Severity Score, mortality, and number of patients with operation performed on same day of transfer were all higher for the group transferred within 2 hours in comparison with patients transferred on the same day of injury at greater than 2 hours.CONCLUSIONS:While the majority of transfers occur at greater than the mandated 2-hour interval, the most seriously injured patients are reaching definitive care within 2 hours. Markers of acuity for patients transferred at greater than 2 hours parallel those of the general trauma patient population. These data suggest that, in this system, provider-determined transfer time that exceeds 2 hours has no adverse effect on patient outcome. It appears to accomplish recognition and rapid transport of the most seriously ill. This may obviate the need for onerous system mandates that are not feasible or have poor compliance.
A 42-YEAR-OLD MAN PRESENTED TO THE emergency department with diffuse abdominal pain, confusion, and a history of fever and chills for the preceding 2 days. He was hypotensive and tachycardic. Abdominal examination revealed a soft, distended abdomen with moderate, diffuse tenderness to palpation, without rebound or guarding. Laboratory studies showed leukocytosis with a white blood cell count of 29 700/μL (reference range, 4500-10 500/μL; to convert to 10/L, multiply by 0.001) and neutrophilia with a neutrophil count of 89.6%. Upright chest radiography revealed pneumomediastinum, pneumopericardium, and a markedly distended stomach with air in the gastric wall (Figure 1). Abdominal computed tomography with intravenous and oral contrast revealed pneumoperitoneum, retroperitoneal gas, thickened gastric mucosa, and gas in the wall of the stomach (Figure 2).
PRESENTED TO THE EMERgency department after experiencing a near syncopal episode and diaphoresis while riding the train home from work.He was seen by his primary care physician in an outpatient setting and was found to be orthostatic and sent immediately to the emergency department.On arrival at the emergency department, he was found to have a blood pressure of 92/62 mm Hg and heart rate of 112 beats per minute.His respiratory rate was 16 breaths per minute; pulse oximetry, 100% with room air; and temperature, 97.9°F.He was immediately given 2 liters of crystalloid intravenous fluids, and repeated blood pressure was 110/78 mm Hg.He had abdominal pain, primarily in the left upper quadrant, and felt light-headed and fatigued.He described that the pain had started the night before.He specifically denied chest pain, shortness of breath, cough, fevers, weight loss, diarrhea, or any other recent illness.He was otherwise in good health and reported no current medications or previous surgeries.He denied smoking, alcohol, or illicit drug use.He had no allergies.He did note a recent injury about 3 months prior in which he was involved in a sledding accident and was admitted to our institution for a grade 3 splenic injury noted on a computed
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
