Sasia J. V. Pedersen

Introduction: Mohs Micrographic Surgery (MMS) is a treatment option for high-risk facial nonmelanoma skin cancer with high cure rates. Especially on the nasal tip, the tissue sparing properties of MMS are appealing. The nasal tip is a common location of nonmelanoma skin cancer and can be a challenging anatomical structure for reconstructive surgery due to its prominent location in the face, the shortage of spare tissue, as well as the stiffness and composition of different skin types, cartilage and bone. Objectives: The aim of the present paper is to review and demonstrate how reconstruction of the nasal tip can be done successfully to improve the care for patients undergoing MMS in this area. Methods: Using selected literature on the area and the surgeons experience, each method of repair are described including their individual advantages and challenges. Pictures and consent were selected from one patient who underwent each repair method and three photos are presented in this paper: one after tumor resection, one immediately after repair, and one minimum 6 months post-surgery. Results: We present eight surgical methods as well as pictures from previous surgeries. Conclusions: The results demonstrate obtainable results using very different surgical methods and the importance of an individualized approach to repairing cutaneous defects of the nasal tip.

The present retrospective cohort study examines whether there is an association between circulating nucleated red blood cells (nRBCs) and mortality in critically ill children. nRBCs are erythropoietic progenitor cells not found in peripheral blood of healthy adults and children beyond the neonatal period. The presence of circulating nRBCs is associated with poor prognosis in adults and neonates, though little is known about their significance in children. Admissions to both the general and cardiac pediatric intensive care unit at the Stollery Children’s Hospital in Edmonton, Alberta between January 1, 2015 and December 31, 2017 were examined, and logistic regression was performed to ascertain the association between the peak absolute nRBC counts and in-hospital mortality in critically ill children. A total of 2065 admissions were included. The number of admissions with detectable nRBCs was 386 (prevalence: 13.9%), and the number of deaths was 93 (mortality: 4.5%). A statistically significant association was found between the absolute value of nRBC peak and intensive care unit mortality (odds ratio=1.37; 95% confidence interval: 1.13-1.67; P=0.002) as well as hospital mortality (odds ratio=1.38; 95% confidence interval: 1.12-1.70; P=0.003) independent of the Pediatric Index of Mortality 3 score (PIM3). This result warrants more attention to nRBC values and their potential clinical use.

Background: Sickle cell disease (SCD) is associated with renal complications starting as early as infancy. Allogeneic hematopoietic stem cell transplant (HSCT) treatments using newer nonmyeloablative (NMA) conditioning regimens show promising results in treating SCD in the pediatric population, but renal outcome parameters after transplantation have not been described.Aim: To describe baseline renal parameters as well as short‐ and long‐term renal outcomes in pediatric patients with SCD who underwent NMA‐HSCT.Methods: A retrospective chart review of pediatric patients who received NMA‐HSCT in Alberta, Canada. Short‐term renal outcomes evaluated were: (1) acute kidney injury (AKI), (2) fluid overload (FO), and (3) hypertension. Long‐term outcomes evaluated were: (1) estimated glomerular filtration rate (eGFR) development and at last follow‐up with hyperfiltration defined as eGFR ≥ 150 mL/min/1.73 m², (2) proteinuria, and (3) hypertension.Results: The mean follow‐up time was 128.6 weeks (standard deviations, 69.3). No posttransplant AKI events or FO were observed. eGFR remained > 90 mL/min/1.73 m² at last follow‐up in all patients, whereas hyperfiltration was present in eight (44.4%) and four (22.2%) patients pre‐ and post‐HSCT, respectively, which are significantly different (P < 0.0001). Consequently, median GFR was significantly higher pre‐HSCT compared with 24 months HSCT (P < 0.009). Long‐term hypertension post‐HSCT was present in six patients (33.3%).Conclusion: This study describes stable kidney function in children with SCD after NMA‐HSCT without evidence of AKI or FO episodes. Rates of hyperfiltration decreased post‐HSCT, which signifies that NMA‐HSCT could potentially preserve long‐term renal function in this population at risk of progressive chronic kidney disease. Further prospective studies are needed to confirm these novel findings.