Diagnosis and management of spinal epidural space extravasation complicating percutaneous central venous line placement in a premature infant: case report and review of literature.

Percutaneous central venous lines are commonly used to establish long-term venous access in the care of premature infants. Misplacement of these catheters can occur and may lead to significant morbidity and mortality. Here we report a very-low-birth-weight premature infant whose percutaneous central venous line was inadvertently placed into the spinal epidural space. The anatomical basis of this complication as well as a comprehensive review of literature are provided.

Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review.

Many lesions that occur in the mandible have a cystlike radiographic appearance. These lesions are often difficult to differentiate on the basis of their radiographic features alone. Mandibular lesions may be odontogenic or nonodontogenic. Among odontogenic lesions without mineralization, ameloblastomas, odontogenic keratocysts, and dentigerous cysts can all appear as well-defined, unilocular, well-corticated, lucent lesions that are often associated with the crowns of impacted or unerupted teeth. Most radicular cysts appear as round or pear-shaped, unilocular, lucent lesions in the periapical region. Among odontogenic lesions with mineralization, complex odontomas contain multiple masses of dental tissue and compound odontomas contain multiple teeth or toothlike structures. Odontogenic myxomas are characterized by lytic osseous changes of varying size, which may be demarcated and expansile or exhibit ill-defined borders. Nonodontogenic lesions that mimic odontogenic lesions include benign fibro-osseous lesions (conventional or juvenile ossifying fibroma, focal or periapical cemento-osseous dysplasia, florid osseous dysplasia), traumatic bone cyst, lingual salivary gland inclusion defect, central giant cell granuloma, brown tumor of hyperparathyroidism, arteriovenous malformation, and mucoepidermoid carcinoma. The clinical and radiographic features of these mandibular lesions help establish a differential diagnosis, although microscopic tissue evaluation is generally necessary to accurately identify the lesion.

The difficult breast.

Mammography is used to screen the population for breast cancer but often is inconclusive. There are several developing techniques to further assess the breast before biopsy that may decrease the number of benign biopsies. These include ultrasound, nuclear medicine, and MR imaging. When a biopsy is deemed necessary, there are several methods used to obtain tissue that are less invasive and less costly than open biopsy. This evolving area of breast evaluation is now filled with great expectation and uncertain future.

Intracranial subependymoma.

Subependymomas most commonly appear as a mass in the fourth ventricle of adults; these tumors are rare but must be considered in the differential diagnosis of a lesion arising in this location. We report a case of a fourth ventricule subependymoma.

Magnetic resonance imaging of a mediastinal ependymoma.

Ependymomas typically occur in the brain and spinal cord, and represent 5% and 16% of primary intracranial and spinal cord tumors respectively. Ependymomas arising outside the central nervous systems are uncommon and when they do occur are usually seen in the sacrococcygeal region. Other reported sites include the pelvis, spinal nerve roots, and lung. An extraspinal mediastinal ependymoma is a rare occurrence, with only two previously reported cases to our knowledge. In both instances, the lesion arose in the posterior mediastinum, and were imaged with either chest radiographs alone or chest radiographs and computed tomography. In our case, plain radiography was followed by magnetic resonance imaging. This report documents the clinical, pathological, and magnetic resonance imaging findings in a case of a posterior mediastinal ependymoma. Primary mediastinal ependymomas are rare lesions that may be considered in the differential diagnosis of a posterior mediastinal mass.

Testicular epidermoid cysts in prepubertal children: case report and review of the world literature.

Epidermoid cysts of the testes are rare, benign lesions that account for approximately 1% of all testicular tumors. They present most often between the second and fourth decade of life, and have been reported in prepubertal children rarely. The authors report the clinical and sonographic findings in a 4 1/2-year-old child with a testicular epidermoid cyst, and they analyze the 22 prepubertal cases found in the world literature. As described below, the clinical and sonographic features of this tumor are not specific for an epidermoid cyst and do not preclude a teratomatous or malignant neoplasm. This case adds to the varied sonographic appearance of prepubertal testicular epidermoid cysts. The lack of either unique clinical or sonographic features would suggest that extreme caution be used if local excision is considered for a patient with presumed epidermoid cyst of the testicle.

Cost effective nursing under prospective reimbursement.

The implications of the prospective payment system are far-reaching and have specific impact on nurses. It is essential that nurses fully understand the ramifications of this system and appreciate their critical role in making health care most cost-effective for both the patient and the institution. This article will compare a retrospective, cost-based reimbursement system with a prospective reimbursement system. The role of the nurse as a Patient Advocate under prospective reimbursement will be examined. A case presentation will demonstrate the types of choices nurses must make to balance technology with cost-containment measures.