Hartford Hospital, Inc.

Pediatric vascular injuries pose a unique set of challenges for surgeons given their rarity. When indicated, vascular reconstruction requires careful consideration of the patient's age and continued growth. This influences the choice of conduit and operative technique. Here we present a case report of an 11-year-old boy with an internal avulsion injury and thrombosis of the right common femoral artery after a blunt handlebar injury from a bicycle crash. Reconstruction was performed using contralateral great saphenous vein in a panel graft fashion.

Sebaceoma is a benign sebaceous neoplasm with broad architectural variability, and outside of mismatch repair (MMR)-deficient tumors, its molecular features have remained poorly defined. Recent work identified recurrent GRHL1/GRHL2 rearrangements in a subset of sebaceomas, suggesting the presence of a molecularly distinct group. We report three additional sebaceomas harboring RCOR1::GRHL2 fusions identified by RNA-based next-generation sequencing and integrate the clinical, morphologic, and molecular features of all 11 currently known GRHL-rearranged sebaceomas. Patients ranged from 40 to 84 years; two tumors arose on the head and neck, and one represented the first documented extracranial example (axilla). All tumors were macronodular to multinodular basaloid proliferations with variably complex corded ("organoid") architecture; infundibulocystic structures were present in one case. One tumor demonstrated partially cystic growth and rounded basaloid nests, expanding the recognized morphologic spectrum. All three tumors were microsatellite stable without pathogenic MMR gene alterations. Across the combined cohort, no recurrences have been reported. These findings broaden the clinicopathologic spectrum of GRHL-rearranged sebaceoma and support this group as a sporadic, MMR-proficient subset characterized by distinctive organoid-patterned architecture. Further studies are needed to determine whether GRHL rearrangements represent a unifying driver of organoid morphology in sebaceoma.

Gastrointestinal pathogen multiplex panels (GPPs) can test a single stool specimen for multiple pathogen targets in less than 5 h with some as little as 1 h. Although GPPs have demonstrated rapid and sensitive detection, their increased cost and unclear reimbursement structures have put into question their value and role in the cost-effective management of patients with gastrointestinal infections. We performed a scoping review to identify and systematically map the existing literature regarding the impact of GPPs on immediate, proximal, and distal clinical and healthcare utilization outcomes across healthcare settings.

Databases were searched from inception until November 22, 2022. Full research articles in English were eligible for inclusion if they included a multiplexed (≥3 targets) nucleic acid amplification testing method and conventional microbiology comparator method performed on clinical samples.

A total of 6027 potential studies were identified. Following title and abstract screening and full article review, 175 studies were included. The most frequently studied GPPs were laboratory-developed tests (LDTs) (34.9%) and the Biofire® FilmArray® Gastrointestinal Panel (22.3%). The majority of these studies were conducted in the inpatient (37.1%), outpatient (28.0%), and emergency department (ED) (14.0%) settings. The most frequently reported outcomes included diagnostic accuracy (69.7%), organism detection (59%), time to diagnosis (12.6%), and antibiotic changes (8.6%).

We identified a paucity of research reporting on proximal and distal outcomes associated with GPP use. Our review highlights the critical need for well-designed studies focusing on downstream clinical and healthcare utilization outcomes to guide meaningful and cost-effective incorporation of GPPs into diagnostic work flows.