Functional adrenal cortical tumors in pediatric patients: a clinicopathologic and immunohistochemical study of a long term follow-up series.

BACKGROUND: Controversy exists as to which variable is a reliable predictor of clinical outcome of adrenal cortical tumors in children. METHODS: Twenty patients with adrenal cortical tumors were studied. Tumor weight, histologic features, and percentage of proliferating cell nuclear antigen (PCNA/cyclin) in tumor cells were analyzed to determine the best predictor of clinical outcome. RESULTS: Eleven patients had Cushing's syndrome with virilization and 9 had virilization without Cushing's syndrome. The mean age at diagnosis was 7.1 +/- 5.2 years (range, 0.4-15.6 years). Sixteen patients, with good outcomes have been followed for 10.7 +/- 7.8 years (range, 3-23 years). All but two patients had a tumor weight of less than 100 g (185 g and 800 g, respectively) (mean 47.7 g +/- 46.4 g). Two patients with large tumors (weighing 1000 g and 780 g, respectively) had poor outcomes; 1 died 3 months after surgery with metastasis and the other presented with lung metastasis 18 months after surgery. Histologic features did not correlate with clinical outcome. Overall, PCNA stained cells were 6.96 +/- 8.2% (range, 0-32.5%). PCNA values were significantly lower in tumors of patients with good outcomes (P < 0.002). Within all tumors, we found a weak correlation between tumor weight and PCNA (r = 0.51; P < 0.02), but a better correlation was found between tumor weight and PCNA in patients with Cushing's syndrome (r = 0.70; P < 0.01). Patients with Cushing's syndrome had higher PCNA values than those with virilization syndrome (10.3 +/- 9.6% vs. 2.8 +/- 3.3%; P < 0.03). CONCLUSIONS: Our data show that small tumors (less than 100 g) are associated with good outcome; the two patients with the poorest prognosis had Cushing's syndrome and large tumors (more than 100 g). Histologic features are not adequate predictors of outcome and PCNA may be useful in tumors of patients with Cushing's syndrome, but this parameter should not be used alone. Two patients had virilization syndrome, large tumors (185 g and 800 g, respectively), and good outcomes, which contradicts with the concept that these tumors are usually associated with poor prognosis.

Quistes pilares vellosos eruptivos: localización axilar / Eruptive vellous pilar cysts: axiliary localization

Presentamos a una niña de 10 años de edad en la que observamos numerosas pápilas de 2 a 5 mm de diámetro, de color piel, asintomáticas, algunas lisas y otras umbilicadas, localizadas en ambas axilas. El diagnóstico histopatológico confirmó el diagnóstico clínico de quistes pilares vellosos eruptivos. Realizamos una revisión de la bibliografía, la que sugiere que no constituyen una afección rara, sino que son subdiagnosticados por ser asintomáticos y no motivar la consulta. Se discuten los diagnósticos diferenciales clínicos e histopatológicos

Quistes pilares vellosos eruptivos: localización axilar / Eruptive vellous pilar cysts: axiliary localization

Presentamos a una niña de 10 años de edad en la que observamos numerosas pápilas de 2 a 5 mm de diámetro, de color piel, asintomáticas, algunas lisas y otras umbilicadas, localizadas en ambas axilas. El diagnóstico histopatológico confirmó el diagnóstico clínico de quistes pilares vellosos eruptivos. Realizamos una revisión de la bibliografía, la que sugiere que no constituyen una afección rara, sino que son subdiagnosticados por ser asintomáticos y no motivar la consulta. Se discuten los diagnósticos diferenciales clínicos e histopatológicos (AU)

Postcholecystectomy wound infection. The impact of prophylactic antibiotics on the epidemiology of infections.

The clinical courses of 347 patients undergoing gallbladder surgeries were monitored to study the epidemiology of postcholecystectomy wound infection in a hospital in which high-risk patients received prophylactic antibiotics. Overall, 3.8% of patients had wound infections. Patients who had positive bile cultures taken during surgery or positive intraoperative wound cultures had higher rates of infection than patients with negative cultures. However, there was a poor correlation among the bacterial isolates that were recovered from the bile or the wound surface during surgery and from postoperative infections. Antibiotic-sensitive enteric bacteria were recovered from bile samples at surgery, gram-positive organisms and enteric gram-negative bacteria were isolated from intraoperative cultures of the wound surface, and antibiotic-resistant gram-negative bacteria or enterococci were recovered from wounds that developed postoperative infections. There was a strong association between the prior receipt of prophylactic antibiotics and infections with antibiotic-resistant bacteria. Data suggest that bactibilia is still an important epidemiologic marker that identifies patients at high risk for subsequent wound infection. However, in patients who have received prophylactic antibiotics, intraoperative cultures cannot be relied on to guide the choice of empiric therapeutic antibiotics for postoperative infections. Bacteria responsible for these infections are not identified by cultures taken at the time of surgery and are often resistant to the class of antibiotics used for prophylaxis.

Comparison of nonwoven and woven gown and drape fabric to prevent intraoperative wound contamination and postoperative infection.

In a prospective, controlled clinical trial, nonwoven, disposable gown and drape fabrics were no better barriers to intraoperative wound contamination or postoperative wound infection than reusable cotton poplin. We observed no difference between the two study groups in either the frequency or level of intraoperative wound contamination as judged by cultures of specimens collected at the time of wound closure. Of procedures in which reusable fabrics were used, 13.1 percent had positive cultures compared with 15.5 percent of those in which disposable fabrics were used (difference not statistically significant). We recovered coagulase-negative Staphylococci from more than 95 percent of contaminated wounds. Rates of postoperative wound infection were virtually identical in the two groups. Our data suggest that either both fabrics were similar in their ability to block bacteria that were shed from skin surfaces from entering the wound, or that bacteria which contaminate the wound in clean surgical procedures are derived from sources other than skin.