Cardiac tamponade from central venous catheters.

BACKGROUND: This retrospective study was undertaken to determine the mechanism by which cardiac tamponade (CT) occurs after placement of central venous catheters (CVC), and to determine if physicians are aware of this potentially lethal complication. MATERIALS AND METHODS: Twenty-five previously unreported cases of CT from CVC were reviewed. The chest radiographs and postmortem records were reviewed when available. Two hundred physicians were interviewed about their knowledge of CT from CVC. They were specifically asked if they had reviewed the three-volume video, "CVC Complications," that was sent by the Food and Drug Administration to all hospitals where CVC are inserted. RESULTS: All postinsertion chest radiographs showed the tip of the catheter to be within the pericardial silhouette. All patients developed unexplained hypotension from hours to 1 week after CVC placement. Eight patients complained of chest tightness, 12 of shortness of breath, and 15 were noted to have air hunger. The electrocardiogram showed inferior wall injury in 7 patients. None of the physicians surveyed had seen the FDA video. CONCLUSIONS: Cardiac tamponade from central venous catheters is preventable if the tip of the catheter is outside the cardiac silhouette on chest radiograph. Any patient with a CVC in place who develops unexplained hypotension, chest tightness, or shortness of breath should have an emergency echocardiogram to rule out cardiac tamponade.

Torsion of pedunculated hepatocellular carcinoma. Report of a case in a young woman presenting with abdominal pain.

Pedunculated Hepatocellular Carcinoma is an extremely rare neoplasm. There are less than 30 documented cases in the world literature. We present a case which was diagnosed preoperatively using abdominal CT scan and angiography. The fact that the pedunculated tumor had undergone torsion with some necrosis precipitated symptoms of abdominal pain. This is the first reported case of this rare tumor presenting with torsion.

Omphalocele closure: surgical technique with preservation of the amniotic sac.

The ideal surgical closure for large omphaloceles remains controversial. Most techniques described advocate removal of the amniotic sac prior to repair of the abdominal wall defect. Herein, the authors describe a surgical technique preserving the amniotic sac, which has distinct advantages in achieving safe and rapid closure of the omphalocele by primary or secondary means in selected patients.

Multiple granular cell tumors. A familial occurrence in children.

A 23-year-old black woman and her 6-year-old son, both with multiple granular cell tumors, are described herein. The mother and son both presented as children with multiple granular cell tumors. This is the first reported case of multiple lesions arising in childhood in successive generations. Only two other case studies of familial granular cell tumors have been reported, but in neither of these cases did multiple tumors present initially in both family members during childhood. A preponderance of multicentric lesions is reported in blacks. The tumors recurred locally in some of the sites where there were inadequate surgical margins, emphasizing the need for complete excision.

Management of experimental pneumothorax in weanling rabbits with the use of fibrin glue sclerosant.

Fibrin glue pleurodesis successfully sealed surgically created pneumothoraxes in 12 (92.3%) of 13 New Zealand white rabbits, an animal model chosen for its similarity to the thoracic configuration of the human neonate. All chest tubes were removed at 24 hours; there were no recurrences. Two rabbits, in whom human cryoprecipitate was used, died of an immunologically mediated pneumonitis. This reaction would not be expected in the human setting. Four months' follow-up revealed nearly total fibrin glue resorption. This "biodegradability" is well suited to the neonate, since alveolar barotrauma, not congenital emphysematous blebs, is the usual initiator of pneumothorax. Time-limited adhesions created by fibrin glue pleurodesis should be adequate for treatment of the acute event, while avoiding persistent pleural adhesions that could interfere with subsequent thoracic surgery or cause long-term deleterious effects on pulmonary function.

Traumatic liver laceration in the newborn: repair with fibrin glue.

A traumatic liver laceration in a 1,500 g premature infant was successfully treated with temporary hemostatic packing and subsequent fibrin glue repair. Literature review indicates this case to be the smallest survivor.

Use of low intensity roentgen ray imaging for determination of tube and catheter placement in the young primate: implication for use of the Lixiscope in the surgical neonate.

The new technology of low intensity roentgen ray imaging offers promise in rapid bedside location of tube and catheter placement in the surgical neonate. Using the Lixiscope we have been able to accurately detect in an animal model the exact location of various tubes and catheters used routinely in pre and postoperative neonatal care. Minimal training is required to be able to use the device. We think the Lixiscope offers detection of the positions of standard tubes and catheters with increased speed, as well as a reduction in the radiation exposure for patients and staff in the neonatal unit.

Radiographic findings after incomplete pyloromyotomy.

The gastrointestinal series of 10 patients with persistent vomiting following pyloromyotomies for pyloric stenosis were reviewed. Four patients had incomplete pyloromyotomies and required reoperation. Their studies showed persistent obstruction with elongation and narrowing of the pyloric channel similar to preoperative studies, except that the proximal muscle mass was tapered in 3 of the 4 patients. Six patients with similar histories of postpyloromyotomy vomiting but who did not require repeat surgery had irregular but much wider pyloric channels, good gastric emptying, and gastroesophageal reflux.

Focal foveolar hyperplasia presenting as an antral-pyloric mass in a young infant.

A young infant with vomiting associated with a gastric polyp is presented. The polyp proved to be focal foveolar hyperplasia. These non-neoplastic polyps of unknown etiology are usually found in adults.