Well-differentiated neuroendocrine tumor of the stomach: A rare case at an uncommon site.

INTRODUCTION: A 13-year-old African-American female presented to her primary care physician's office with fatigue, syncope, and hematemesis. After initial evaluation, the patient was referred to pediatric gastroenterology clinic for further evaluation. MAIN CONCERNS, IMPORTANT FINDINGS: An upper gastrointestinal endoscopy was performed to evaluate the source of her bleeding. Endoscopy revealed a 3-cm mass in the lesser curvature of the stomach, and a biopsy of the mass revealed a concern for carcinoid (neuroendocrine) features. DIAGNOSIS: She underwent an open gastrectomy. Post-surgical pathology reports confirmed a well-differentiated neuroendocrine tumor of the stomach. CONCLUSION: Neuroendocrine tumors of the stomach in children are rare and we presently do not have pediatric-specific diagnostic and treatment guidelines. Although adult-based The North American Neuroendocrine Tumor Society (NANETS) guidelines are helpful, they are clearly not geared toward pediatric patients. To establish pediatric guidelines and to assess effectiveness of treatments, multicenter data collection is essential. In the long run, accumulation of clinically useful treatment information and long-term follow-up guidelines should enable clinicians to improve standard of care given to children with neuroendocrine tumors.

A uniform fish consumption advisory protocol for the Ohio River.

ORSANCO and the six Ohio River main stem states have been working to align states' fish consumption advisories (FCAs) to enhance the value of advice issued to the public. To achieve this goal, ORSANCO worked closely with a panel consisting of state and USEPA representatives. The result of this effort is the Ohio River Fish Consumption Advisory Protocol (ORFCAP). The ORFCAP represents a single set of variables agreed upon by the panel that allows for a standardized protocol to create advisory thresholds to which states can defer to issue consumption advice for the Ohio River. The ORFCAP identifies ORSANCO as a clearinghouse for data which will be distributed to the panel for decision making. Other components include identifying primary contaminants of concern (PCBs and mercury) and dividing the river into four reporting units. The protocol was developed to issue FCAs for the protection of sensitive populations using five advisory groupings for PCBs and four for mercury. Specific variables used in the calculation of advisory thresholds such as health protection values, cooking reductions, average meal sizes, etc., were selected by the panel. Lastly, the protocol calls for FCA decisions to be based on analysis of the most recent 10 years of data for each species in each reporting unit to determine size class needs and advisory groupings. Upon pending implementation of the protocol by the main stem states, these decisions will be made annually through a series of discussions involving ORSANCO, the panel, and other appropriate state personnel.

Mycotic osteomyelitis due to Scedosporium Apiospermum: MR imaging-pathologic correlation.

Mycotic osteomyelitis is rare and occurs in immunocompromised patients after inoculation of the pathogen at a penetrating trauma site. Mycotic osteomyelitis due to Scedosporium Apiospermum is extremely rare, with only 13 cases of septic arthritis reported previously. Ours is only the third case of S. apiospermum osteomyelitis in an immunocompromised patient and the only patient with a histopathologic diagnosis from an amputation specimen. Recognition of this pathogen may be delayed due to insidious onset and negative joint fluid cultures, often requiring synovial or bone biopsies to establish the diagnosis. Delay in appropriate treatment may result in disseminating infection or even death.