New-onset psychosis in the pediatric population poses many diagnostic challenges. Given the diversity of underlying causes, which fall under the purview of multiple medical specialties, a timely, targeted, yet thorough workup requires a systematic and coordinated approach. A committee of expert pediatric physicians from the divisions of emergency medicine, psychiatry, neurology, hospitalist medicine, and radiology convened to create and implement a novel clinical pathway and approach to the pediatric patient presenting with new-onset psychosis. Here we provide background and review the evidence supporting the investigations recommended in our pathway to screen for a comprehensive range of etiologies of pediatric psychosis.
Giant inguinoscrotal hernias are uncommon in the practice of a general surgeon. Patients typically present with marked disruption in their quality of life and operative management of these hernias can be quite challenging, especially when accompanied by loss of domain. Various approaches to the management of giant inguinoscrotal hernias associated with loss of domain have been described in the literature. This case report describes the use of FlexHD ® allograft and component separation with small bowel resection in the repair of a large left inguinoscrotal hernia in an elderly African American male.
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