Epstein-Barr virus (EBV) antibody in patients treated by radical radiotherapy for head and neck cancer.

Antibody against Epstein Barr Viral capsid (EBV-VCA) was measured in 65 patients with primary head and neck cancer referred for radical radiotherapy. Sixty-three percent had locally advanced cancer and 37% had early disease. Forty-eight percent had detectable antibody in their sera. Thirty-three percent had elevated titers (above 1:20 dilution). Only 19% of cases with early cancer had increased titers. Almost 50% of those with locally advanced cancer or recurrence following treatment had titers above 1:20. A rise in titer within six months following radiotherapy was associated with a significant incidence of recurrence. There was no correlation between delayed hypersensitivity skin reaction to 2--4 dinitrochlorobenzene (DNCB) and titer values. EBV-VCA may be an additional parameter which can be used to determine host defenses in patients with malignancies.     

Surgical outcome of necrotizing enterocolitis

Forty-six neonates were treated for necrotizing enterocolitis (NEC) between 1982 and 1987. The mean gestational age was 33.6 weeks and the mean birth weight was 1865 g. Birth weight less than 1500 g and gestational age less than 32 weeks had an adverse effect on survival. Neonates less than or equal to 30 week's gestation developed symptoms at a mean age of 10.8 days while those greater than 30 weeks developed symptoms at a mean age of 1.7 days. All infants who never had enteral feedings survived; 20 were cured with medical treatment only. Three patients underwent peritoneal lavage (2 of these survived). Twenty-two patients required surgery; the operative mortality was 9%. Four patients underwent elective surgery for primary strictures. The remaining 18 presented with acute perforation (11), obstruction (5), deterioration with medical therapy (1), or peritonitis (1). The most frequent site of perforation was the terminal ileum, while the most common site of stricture was the left colon. Seven patients were found to have strictures after prior emergency surgery. In 6 of the patients who underwent primary enterostomy, the strictures were located in the defunctionalized bowel segment. Evidence of progression of the disease, which most frequently involved the right and transverse colon, necessitated extensive resection. When performing a proximal ileostomy for acute NEC, the surgeon must be aware that the chances of conservation of the defunctionalized distal bowel segment are minimal because of progression of the disease. Complications related to resection of the ileocecal valve have been negligible. Our results with peritoneal lavage are encouraging, and our overall mortality of 13% in contrast with higher rates in earlier series reflects improvement in the management of these neonates. Offprint requests to: S. Yazbeck     

Kaposi's sarcoma in homosexual men. A seroepidemiologic case-control study

The cases of 20 male homosexuals with Kaposi's sarcoma and the acquired immunodeficiency syndrome were compared with those of 40 age- and race-matched male homosexual controls. Patients with Kaposi's sarcoma had lower OKT4/OKT8 (T-helper/T-suppressor) ratios than controls, due to smaller numbers of OKT4 cells. Serum IgG concentrations and antibody titers to cytomegalovirus in patients exceeded those in controls, but patients had lower antibody titers to Epstein-Barr virus. Logistic regression analysis comparing patients with controls showed significant relative risks for Kaposi's sarcoma associated with the number of partners per month in receptive anal-genital intercourse, occasions per month of " fisting ," and cytomegalovirus antibody titers. Cytomegalovirus titers also were inversely correlated with OKT4 cell concentrations in the control group. Significantly greater OKT4 cell concentrations were found at diagnosis in HLA-DR5-positive patients than in HLA-DR5-negative patients. Patients who have HLA-DR5 may express disease at lesser degrees of immunodeficiency than HLA-DR5-negative patients.     

Delayed presentation and sub-optimal outcomes of pediatric patients with acute appendicitis during the COVID-19 pandemic

ObjectiveEarly presentation and prompt diagnosis of acute appendicitis are necessary to prevent progression of disease leading to complicated appendicitis. We hypothesize that patients had a delayed presentation of acute appendicitis during the COVID-19 pandemic, which affected severity of disease on presentation and outcomes.Patients and methodsWe conducted a retrospective review of all patients who were treated for acute appendicitis at Morgan Stanley Children's Hospital (MSCH) between March 1, 2020 and May 31, 2020 when the COVID-19 pandemic was at its peak in New York City (NYC). For comparison, we reviewed patients treated from March 1, 2019 to May 31, 2019, prior to the pandemic. Demographics and baseline patient characteristics were analyzed for potential confounding variables. Outcomes were collected and grouped into those quantifying severity of illness on presentation to our ED, type of treatment, and associated post-treatment outcomes. Fisher's Exact Test and Kruskal-Wallis Test were used for univariate analysis while cox regression with calculation of hazard ratios was used for multivariate analysis.ResultsA total of 89 patients were included in this study, 41 patients were treated for appendicitis from March 1 to May 31 of 2019 (non-pandemic) and 48 were treated during the same time period in 2020 (pandemic). Duration of symptoms prior to presentation to the ED was significantly longer in patients treated in 2020, with a median of 2 days compared to 1 day (p = 0.003). Additionally, these patients were more likely to present with reported fever (52.1% vs 24.4%, p = 0.009) and had a higher heart rate on presentation with a median of 101 beats per minute (bpm) compared to 91 bpm (p = 0.040). Findings of complicated appendicitis on radiographic imaging including suspicion of perforation (41.7% vs 9.8%, p < 0.001) and intra-abdominal abscess (27.1% vs 7.3%, p = 0.025) were higher in patients presenting in 2020. Patients treated during the pandemic had higher rates of non-operative treatment (25.0% vs 7.3%, p = 0.044) requiring increased antibiotic use and image-guided percutaneous drain placement. They also had longer hospital length of stay by a median of 1 day (p = 0.001) and longer duration until symptom resolution by a median of 1 day (p = 0.004). Type of treatment was not a predictor of LOS (HR = 0.565, 95% CI = 0.357–0.894, p = 0.015) or duration until symptom resolution (HR = 0.630, 95% CI = 0.405–0.979, p = 0.040).ConclusionPatients treated for acute appendicitis at our children's hospital during the peak of the COVID-19 pandemic presented with more severe disease and experienced suboptimal outcomes compared to those who presented during the same time period in 2019.Level of EvidenceIII     

Lupus-associated vasculitis manifesting as acute appendicitis in a 16 year old girl

A 16 year old female with systemic lupus erythematosus presents with acute appendicitis. Final pathologic analysis of the appendix describes a lupus-associated vasculitis.     

Aberrant cervical thymus in children: three case reports and review of the literature

Aberrant migration of thymic tissue occurs with ectopic thymus in the mediastinum, base of the skull, tracheal bifurcation, and cervical region. A recent review of the literature showed a total of 76 reported cases of aberrant thymus or thymic cysts in patients who presented with primary neck masses. We report three additional cases of ectopic cervical thymus. All three patients presented with asymptomatic cervical masses, and preoperative diagnosis included branchial cleft cyst, cervical lymphangioma, and cervical teratoma. All patients underwent complete surgical resection of the masses. Aberrant cervical thymus rarely produces symptoms because it does not invade contiguous strictures. Despite its rarity, it should be considered in the differential diagnosis of asymptomatic neck masses in children.