[Pancreatoblastoma: report of one case].

Pancreatoblastoma is an extremely rare pancreatic tumor in childhood, comprising 0.5% of pancreatic non-endocrine tumors. It mostly affects children of under 8 years old without special sexual predilection. Abdominal mass is the dominant clinical feature and abdominal X-ray, sonography, UGI series, CT scan are of assistance in establishing diagnosis. The presence of acinar cells with zymogen granules, squamous metaplasia and endocrine components makes the diagnosis. We report a case of 4-year-old girl, who suffered from abdominal pain for two months. Abdominal mass was found at our OPD and abdominal sonography, UGI series, CT scan all indicated a parapancreatic tumor. AFP was 4700 ng/ml. Laparotomy confirmed a pancreatic tumor and only partial excision was performed due to tumor invasion and adhesion to major vessels. Diagnosis of pancreatoblastoma was made by pathohistology, cytochemical special stains and electronic microscopic examination of the tumor. Neither chemotherapy nor radiotherapy was performed due to family refusal. Then patient followed up at NTUH OPD regularly. Unfortunately patient expired because of the regrowth of residual tumor eight months later.

Congenital rubella infection: escape of one monozygotic twin with two amnions, one chorion, and single placenta.

We report a 2 amnions, 1 chorion, single placenta, monozygotic identical twins, who were born by a mother with a subclinical rubella infection during the gestation; one twin had a congenital rubella infection, the other escaped from it. Both twins were premature and small for their gestational age at birth. They both had an intraventricular hemorrhage ascribed to prematurity. One had a strong positive rubella IgM antibody for more than 3 months and a persistent IgG antibody for more than 1 year. The other had a fading rubella IgG antibody within 3 months, and a negative IgM. The baby with the congenital infection of rubella did not have a defective appearance, but the auditory brain stem evoked potential test showed abnormal findings. In monozygotic identical twins, vessel communication usually exist and the escape of a twin from rubella is a rare condition; there have been only two such events reported in the English literature.

[Staphylococcus aureus endocarditis with large vegetation and emboli: report of a case].

A 12-year-old boy with infective endocarditis caused by staphylococcus aureus is reported. The patient suffered from intermittent high fever for 10 days. Physical examination revealed a grade II/VI systolic murmur at apex, conjunctival petechiae, and Janeway lesions over palms and soles. Three sets of blood culture were done immediately, and staphylococcus aureus was grown from all. Echocardiograms showed an increased thickness of anterior mitral leaflet, and a vegetation with 2.2 cm in diameter was found in left atrium. Aortograms revealed total occlusion of abdominal aorta and superior mesenteric artery. Emergent operation of abdominal aorta was done, a bacterial embolus was taken out, measuring 5-6 cm in length. Seven days after operation, cerebral hemorrhage occurred, and the patient expired 8 more days later.