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Falls are the leading cause of nonfatal injury in U.S. children (Centers for Disease Control and Prevention [CDC], 2023). More than 1.3 million children younger than 18 visit an emergency [...], Falling from windows as a mechanism of traumatic injury has been a priority for public health interventions since the 1970s, yet window falls remain a cause of injury and death in children. The complexity of the issue requires a multilayered approach well represented by the socioecological model (SEM). This analysis of local window fall events, prevention efforts, and existing legislation promotes an opportunity to ensure child safety and family well-being in California and other communities by providing recommendations for cost-effective and trauma-informed policy to prevent unintentional pediatric window falls.

BACKGROUND Teratoma, a tumor containing a variety of tissues, is a broad diagnosis containing mature teratoma, immature teratoma, and teratomas with malignant transformation. The tumor forms during embryological development secondary to unsuccessful migration of primordial germ cells. A specific type of mature teratoma, containing human-like features, is called a fetiform teratoma. The fetiform teratoma is often compared and confused with fetus in fetu, a reabsorbed twin. While these tumors have commonly been described in the gonads, the retroperitoneal location finding on antenatal imaging is rare. The distinction between the aforementioned subtypes is not well established, proving a challenging diagnosis prior to resection. CASE REPORT We present a case of a newborn male with a prenatal diagnosis of retroperitoneal cystic mass. Although prenatal imaging was obtained, the diagnosis remained unclear. After birth, planned surgical excision on day of life 7 showed the suprarenal mass contained contiguous intestinal elements. Histopathology examination revealed a mature cystic teratoma with multiple tissue types, including colonic, brain, respiratory, lymphatics, and nerves, reminiscent of fetiform teratoma. This case report presents an interesting example of differentiating elements straddling the diagnoses mentioned above. CONCLUSIONS This is the first reported case of fetiform teratoma diagnosed in a newborn and is especially unique for having the element of intestinal duplication within the retroperitoneal mass. The differentiating features of fetus in fetu and fetiform teratoma depend on subjective distinctions. The case provides an opportunity to discuss the differentials and management strategies.

BACKGROUND:Over one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic. METHODS:Demographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016. Data were de-identified and analyzed using Stata version 14.0. RESULTS:Two-thousand-seven-hundred and fifty-three individual patients were seen in the clinic. Of these, 2232 (81.1%) were insured by the state indicating arrival within the last 3 months. The median age was 25, interquartile range 16-34. Only 786 (28.6%) were female, while 1967 (71.5%) were male. The most frequent diagnoses were respiratory (17.4%), followed by miscellaneous symptoms and otherwise not classified ailments (R series, 14.1%), infection (10.8%), musculoskeletal or connective tissue (9.3%), gastrointestinal (6.8%), injury (5.9%), and mental or behavioral (5.1%) categories. CONCLUSIONS:This study illustrates the diverse medical conditions that affect the asylum seeker population. Asylum seekers in our study group did not have a high burden of communicable diseases, however several warranted additional screening and treatment, including for tuberculosis and scabies. Respiratory illnesses were more common amongst newly arrived refugees. Trauma-related mental health disorders comprised half of mental health diagnoses.

Complications from lost gallstones after cholecystectomy are rare but varied from simple perihepatic abscess to empyema and expectoration of gallstones. Gallstone complications have been reported in nearly every organ system, although reports of malignant masquerade of retained gallstones are few. We present the case of an 87-year-old woman with a flank soft tissue tumor 4 years after laparoscopic cholecystectomy. The initial clinical, radiographic and biopsy findings were consistent with soft tissue sarcoma (STS), but careful review of her case in multidisciplinary conference raised the suspicion for retained gallstones rather than STS. The patient was treated with incisional biopsy/drainage of the mass, and gallstones were retrieved. The patient recovered completely without an extensive resectional procedure, emphasizing the importance of multidisciplinary sarcoma care to optimize outcomes for potential sarcoma patients.

BACKGROUND: Legal intervention trauma (LIT) is defined as injury due to any encounter with law enforcement. This study investigates associations between demographics, violent status, and law enforcement tactics among youth decedents of LIT. STUDY DESIGN: Decedents of LIT age 26 years or younger were identified using the CDC's National Violent Death Reporting System from 2003 to 2018. Decedents were classified as "violent" if they possessed a weapon, were committing a violent crime, or if law enforcement reported justified use of force. All others were classified as "nonviolent." Law enforcement tactics were stratified into "lethal" (firearm with standard ammunition) or "less lethal" (any other) force. Differences in the racial distribution across these classifications were assessed using chi-square tests of proportions. RESULTS: We identified 1,281 youth decedents of LIT; of which, 92.5% met violent criteria. Black youths were less likely than White youths to possess a weapon (71.6% vs 77.4%, p = 0.02) and were not more likely to be committing a violent crime (63.6% vs 60.4%, p = 0.27). They were, however, more likely than White youths to experience force reported as justified by law enforcement (89.9% vs 82.4%, p = 0.002) and to experience exclusively lethal force not preceded by less-lethal tactics (94.0% vs 88.7%, p = 0.001). Among the subset of 85 cases where law enforcement reported justified use of force despite the decedent not possessing a weapon or committing a violent crime, the precipitating event was more often a traffic stop for Black youths than for White youths (28.5% vs 6.66%, p = 0.02). CONCLUSIONS: These findings indicate a racial disparity among youth decedents of LIT. [ABSTRACT FROM AUTHOR]

Multiseptate gallbladder (MSG) is a rare congenital anomaly characterized by abnormal partial internal divisions of the gallbladder. Clinical presentation spans from asymptomatic to biliary symptoms such as nausea, vomiting, and right upper quadrant abdominal pain. The literature regarding this anomaly is limited, with only a few reported cases in the pediatric population. Here we present the case of a full-term, otherwise healthy girl who has had recurrent episodes of diarrhea, since two months of age, and on a hospital admission at 11 weeks, was found, on a right upper quadrant ultrasound, to have MSG, with otherwise normal extrahepatic duct anatomy. She has been followed since discharge with repeated ultrasounds and liver function tests and has remained asymptomatic. As long as she remains asymptomatic with stable ultrasound and normal liver function tests, and has no associated symptoms, we will continue to manage her nonoperatively. [ABSTRACT FROM AUTHOR]

Background: Adult trauma centers, including combined pediatric/adult centers (CPACs), see high volumes of penetrating trauma. Few studies have compared outcomes of adolescents presenting with gunshot wounds (GSWSs) at CPACs vs. pediatric only hospitals (POHs). This study aimed to compare injury patterns, complications, and mortality for adolescents sustaining GSWs presenting to CPACs vs POHs, hypothesizing decreased associated risk of complications and mortality at CPACs., Study Design: The 2017-2021 Trauma Quality Improvement Program database was queried for adolescents (aged 12-17) with isolated GSWs. Patients transferred or with brain injury were excluded. CPACs included centers with adult and pediatric ACS-verification while POHs only had pediatric ACS-verification. Multivariable logistic regression analysis was performed to identify risk factors associated with in-hospital complications and mortality, controlling for age, injury severity score (ISS), vitals, surgery, and blood transfusions., Results: Of 3,064 adolescents presenting with GSWs, 1,512 (49.3%) presented to CPACs. When compared to POH, CPAC patients were slightly older (median, 16 vs. 15 years old, p<0.001) had increased ISS (median: 9 vs. 4, p<0.001), and injuries to the spine (9.3% vs. 5.7%, p<0.001), heart (2.3% vs. 0.7%, p<0.001), lung (19.1% vs. 10.6%, p<0.001), liver (8.5% vs. 4.8%, p<0.001), and spleen (3.2% vs. 1.5%, p=0.002). CPAC adolescents also had increased rates of emergent operations (31.9% vs. 23.5%, p<0.001). However, on multivariable analysis, CPAC adolescents had a similar associated risk of in-hospital complications (OR 0.91, CI 0.59-1.41, p=0.68) and mortality (OR 0.76, CI 0.40-1.48, p=0.42)., Conclusions: Adolescent GSW patients had similar associated risk of mortality and complications when comparing POHs to CPACs. This suggests that adolescents with GSWs receive similar care at both CPACs and POHs. Additional research is warranted to corroborate these findings., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)