Bilateral Mesenchymal Hamartoma of the Chest Wall in a 3-Month-Old Boy: A Case Report and Review of the Literature.

Mesenchymal hamartoma of the chest wall is a well-recognized but extremely rare entity. This entity is believed to be benign with no propensity for invasion or metastasis. Although the lesion manifests with alarming aggressive clinical, radiological, and histological features, it is considered benign and carries an excellent outcome. Therefore it is important to recognize this benign entity to avoid the possible misdiagnosis of malignancy and the unnecessary use of chemotherapy. We present a case of bilateral multifocal mesenchymal hamartomas of the chest wall in a male infant and a literature review of this entity. Our aim is to improve the awareness of this condition and highlight its benign behavior and satisfactory outcome following complete surgical resection.

Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery.

BACKGROUND: Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis. It has been shown that during general anesthesia, obese patients have a greater risk of atelectasis than nonobese patients. Preventing atelectasis is important for all patients but is especially important when caring for obese patients. METHODS: We randomly allocated 66 adult obese patients with a body mass index between 30 and 50 kg/m(2) scheduled to undergo laparoscopic bariatric surgery into 3 groups. According to the recruitment maneuver used, the zero end-expiratory pressure (ZEEP) group (n = 22) received the vital capacity maneuver (VCM) maintained for 7-8 s applied immediately after intubation plus ZEEP; the positive end-expiratory pressure (PEEP) 5 group (n = 22) received the VCM maintained for 7-8 s applied immediately after intubation plus 5 cm H(2)O of PEEP; and the PEEP 10 group (n = 22) received the VCM maintained for 7-8 s applied immediately after intubation plus 10 cm H(2)O of PEEP. All other variables (e.g., anesthetic and surgical techniques) were the same for all patients. Heart rate, noninvasive mean arterial blood pressure, arterial oxygen saturation, and alveolar-arterial Pao(2) gradient (A-a Pao(2)) were measured intraoperatively and postoperatively in the postanesthesia care unit (PACU). Length of stay in the PACU and the use of a nonrebreathing O(2) mask (100% Fio(2)) or reintubation were also recorded. A computed tomographic scan of the chest was performed preoperatively and postoperatively after discharge from the PACU to evaluate lung atelectasis. RESULTS: Patients in the PEEP 10 group had better oxygenation both intraoperatively and postoperatively in the PACU, lower atelectasis score on chest computed tomographic scan, and less postoperative pulmonary complications than the ZEEP and PEEP 5 groups. There was no evidence of barotrauma in any patient in the 3 study groups. CONCLUSIONS: Intraoperative alveolar recruitment with a VCM followed by PEEP 10 cm H(2)O is effective at preventing lung atelectasis and is associated with better oxygenation, shorter PACU stay, and fewer pulmonary complications in the postoperative period in obese patients undergoing laparoscopic bariatric surgery.

Multi-drug-resistant tuberculosis in a patient presenting with bilateral gluteal abscesses and right leg swelling with end-stage renal disease.

This is a 40-year-old woman with end-stage renal disease (ESRD). She received empirical treatment for presumed TB of the right knee joint. The arthritis and the constitutional symptoms resolved despite the patient's poor compliance. One year later, she presented with TB abscesses involving the upper end of right tibia and bilateral gluteus muscles, which proved to be resistant to isoniazid, rifampicin and ethambutol. The patient was successfully treated with pyrazinamide, ofloxacin and amikacin.

Resternotomy for a retrosternal cardiac pseudoaneurysm in a 1.5-year- old child: a case report.

Cardiac pseudoaneurysm is a contained rupture of the myocardium that can occur after cardiac surgery, chest trauma, and endocarditis. The wall of the pseudoaneurysm consists of fibrous tissue and lacks the structural elements found in a normal cardiac wall, and it is contained by the pericardial adhesions or the epicardial wall. Early surgery is recommended even for asymptomatic patients due to the propensity for rupture and fatal outcome. We report our experience with the surgical approach of a child with a cardiac pseudoaneurysm who had undergone a biventricular repair of a double outlet right ventricle with non-committed ventricular septal defect in the form of intraventricular tunneling.

Bilateral universal nephroblastomatosis in an 8-month-old infant treated with chemotherapy.

We report the case of an 8-month-old female infant presenting with bilateral, diffusely enlarged kidneys. A diagnosis of bilateral, universal nephroblastomatosis was made on tissue biopsies from both kidneys after correlation with the radiological findings. As far as we know, this is the oldest patient reported with this diagnosis in the English literature (they are usually younger than 4 months). The patient was treated with chemotherapy with very good response and almost 1 year later she is showing no signs of recurrence of her disease.

Ascites as first presentation of ventriculo-peritoneal shunt infection in a neonate.

Infection is a common complication of ventriculoperitoneal shunts, and ascites is one of the rare manifestations of shunt infection. We report a neonate in whom shunt infection is presented only by ascites. The causative organism, coagulase negative staphylococci, was detected only in the cerebrospinal fluid although peritoneal fluid analysis was consistent with infection. Our patient shows the importance of considering shunt infection when unexplained ascites is the first and only manifestation in neonates with ventriculoperitoneal shunts.

Central fever due to hypothalamic lesion in a patient with tuberculous meningitis.

Abnormalities of body temperature are perhaps the most common features in many systemic pathologic processes. Such pathologic alterations are nearly always the result of extrinsic factors (for example, systemic pyrogens) which affect the hypothalamic thermoregulatory center by way of circulatory system. Much less common is alterations in temperature regulation resulting from intrinsic lesions of the thermoregulatory center in the hypothalamus. We report a patient with tuberculous meningitis who continued to have persistent fever despite the satisfactory treatment of her tuberculosis. A central thermoregulatory defect was documented and was attributed to a small structural lesion in the anterior hypothalamus.