In late March and early April, New York City was an epicenter of the COVID-19 pandemic. Citizens were ordered to stay at home to flatten the curve. The adult population was affected with a severe respiratory illness as well as acute kidney injury, cardiomyopathy, arrhythmia, and thromboembolism. Although children were not affected in the same manner, weeks after the peak, reports from other countries emerged about cases of pediatric patients presenting with a novel inflammatory syndrome. We present 4 patients along with their emergency department course, so providers will have a better understanding of the identification and workup of these patients. Currently, it is unclear when this inflammatory syndrome develops in respect to a COVID-19 infection. The clinical features of this syndrome seem to overlap between Kawasaki disease, toxic shock syndrome, and myocarditis. All patients presenting to our emergency department had fever, variable rash, abdominal pain, vomiting, and/or diarrhea. Patients remained persistently tachycardic and febrile despite being given proper doses of antipyretics. Severity of presentations varied among the 4 cases. All 4 patients were found to have antibodies to COVID-19. All patients required admission, but 2 required the pediatric intensive care unit for cardiac and/or respiratory support or closer monitoring. Upon follow-up on our patients, it seems that most patients are recovering with treatment, and overall, there is a low reported mortality rate.
SUMMARY [1,2-3H]Progesterone (5–50 pg) injected intraluminally into the uterus of spayed mice was retained only to a small extent; producing a 'half-life' of about 30 min compared with > 240 min for [6,7-3H]oestradiol-17β (50 pg). Retention of progesterone by the uterus was not significantly different from that by the plantaris muscle, a non-target tissue. Paper chromatography of extracts indicated that metabolism of [1,2-3H]progesterone occurred in both the uterus and the vagina within 5 min of local injection. There was more metabolism in the vagina and it was qualitatively different. No selective retention of progesterone or its metabolites occurred in either organ. The proportion of the radioactivity present as progesterone over 120 min after injection remained constant.
Lymphoblastoma involving the ovaries, either primarily or secondarily, appears to be a very unusual condition. Less than a dozen instances of metastatic lymphoblastonla have been described. In a review of lymphosarcoma of the female genitalia, published in 1934, Walther ' records only two primary ovarian lymphosarcomas, one from the literature and one from his own material. Since that time no cases reported by name have appeared. The disease, however, is probably not quite so rare as is suggested by such a survey of the literature. Scattered in text-books, usually under the name of small round-cell sarcoma, can be found a few descriptions and illustrations of tumors which are a t least consistent with a diagnosis of lymphosarcoma. However, there does not now seem to be anything to be gained from an attempt to trace and reclassify such obscure cases.The patient, a white female aged twenty-three, mother of three healthy children, entered the Mary Fletcher Hospital complaining of rapid enlargement of the abdomen, gradual loss of strength for the past three months, and gas pains for the past four days.The family history and the patient's own past history were irrelevant. She had last menstruated five and a half months before admission. She knew herself to be pregnant, and for the past three months and a half had been able to feel in the left side of her abdomen a growing mass which she observed to be increasing in size more rapidly than in her previous pregnancies. During this period she had noticeably lost strength.Two months before admission a small, soft, painless mass appeared at the introitus. Two weeks later, following a bump, the patient observed a small non-tender mass in the upper outer quadrant of the right breast. Simultaneously she noticed that her gums bled readily after she brushed her teeth, and discovered a small pedunculated mass attached to the gum near the left upper canine tooth. These tangible lesions and the abdominal mass continued to grow, and two weeks before admission the patient first noticed several nodules in the left breast.On admission to the hospital, the patient appeared as a rather pale but fairly well developed and nourished woman in no obvious discomfort. Her abdomen was markedly distended, and on palpation presented two distinct, firm, ovoid masses. The larger, on the left side, appeared to arise from the pelvis and extended to the costal border. It did not move with respiration. On the right, a similar smaller mass rose to the level of the umbilicus. Fetal heart sounds could be heard in this mass.On pelvic examination, the vaginal mucosa was found studded with many sessile, moderately firm nodules 1 to 2 cm. in diameter. All were covered with smooth mucous membrane, but the centers of the larger nodules were hemorrhagic. From the anterior vaginal wall a mass 3 by 2 cm. projected through the introitus. The cervix seemed to be continuous 1 iiber die Lymphosarcomatose dcr ueib!ichen Genitalorgane, Arch. f. Gynah. 157: 44, 1934. 567
Summary1. Plasma, peripheral and thoracic lymph concentrations of penicillin V, phenethicillin, carbenicillin, ampicillin, cloxacillin, penicillin G, chloramphenicol and sulphadiazine were determined at various time intervals up to 6 h following intramuscular administration of 50 mg/kg to dogs. 2. Peak plasma concentrations of the penicillins occurred within half an hour after administration with the peak lymphatic concentrations occurring 15 to 3 h afterwards. For the remaining period of the test the concentration in the lymph exceeded the corresponding concentra-tion in the plasma. Sulphadiazine gave concentrations in thoracic lymph equal to the plasma concentration, but the peripheral lymph concentrations were lower while the concentrations of chloramphenicol in both peripheral and thoracic lymph were always lower than the plasma concentrations. 3. After the peak concentrations were reached, the concentration curves for penicillins in lymph followed the same pattern as found in plasma, the penicillin concentrations declining exponentially. Sulphadiazine produced more persistent levels both in lymph and in plasma while the concentrations of chloramphenicol were still rising 6 h after administration. 4. The free concentrations of penicillin in lymph were equal to the free concentrations in plasma, whereas the concentrations of free sulphadiazine and chloramphenicol in lymph were less than those in the plasma.
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