Michel S. Slim

Intravascular missile embolization in childhood: Report of a case, literature review, and recommendations for management

A collective review of 20 cases of missile embolization among children (1961 to 1988) is analyzed, one case added, and guidelines for diagnosis and management are outlined. Causative agents were bullets (14 patients), pellets (5), and fragments (2). Their trajectory was arterioarterial (11), venovenous (5), paradoxical (4), and mixed (1). Diagnosis was suspected when an exit wound was absent and the foreign body was traced on regional x-ray. Embolization was predominantly to the legs, with a tendency for the left (5 of 8 cases). Upper extremity emboli were exclusively to the right. Only one of five cardiac entries required closure to control bleeding compared with four of six aortic. Embolectomy was performed in 16 patients. The overall mortality rate was 9.5%. Factors predicting a favorable outcome are early presentation, diagnosis, and intervention; location of cardiovascular entry and embolus site; and presence of soft tissue tamponade at entry wound. Although embolectomy for cerebral, asymptomatic pulmonary arterial, and silent venous emboli is controversial, universal agreement prevails regarding removal of systemic arterial as well as venous emboli that are potentially problematic.

Ehlers‐Danlos syndrome type IV D: an autosomal recessive disorder

Two siblings born to consanguineous parents are reported with typical clinical features of the Ehlers‐Danlos syndrome type IV. However, their cultured skin fibroblasts synthesize and secrete procollagen type III in normal amounts and proportions. This is probably a new form of the Ehlers‐Danlos syndrome with autosomal recessive inheritance classified as Ehlers‐Danlos syndrome type IV D.

Circular Myotomy of the Esophagus: Clinical Application in Esophageal Atresia

Three infants born with esophageal atresia that was repaired by end-to-end anastomosis combined with a circular myotomy on the upper segment are reported. The distance between the free surgical margins of the esophagus ranged between 1.5 and 4.5 cm. The esophageal myotomy was used to reduce the tension on the anastomosis. The suture line healed in each patient without clinical or roentgenographic evidence of breakdown. Follow-up of these patients ranged between 10 months and 3 years. Roentgenographic evaluation of their esophageal motility showed efficient peristaltic activity in the distal esophageal segment. Two of the patients had a subsequent history of impaction of solid particles in the upper esophageal segment at the age of 13 months and 2 years. The possibility that the circular myotomy contributed to this increased incidence of impaction is raised.

Spinal cord compression in neuroblastoma

Twelve of 80 patients suffering from neuroblastoma who were treated during a 21-year period had intraspinal involvement. Mediastinal tumors have a greater tendency to extend to the spinal canal; however, distant spread of the tumor is rare in patients presenting with intraspinal extension. Patients with intraspinal extension also survive longer than those without. Other factors affecting survival are age, stage of disease, duration of neurological symptoms, degree of histologic differentiation, and mode of therapy. In the absence of osseous metastasis, total excision of the primary lesion and its intraspinal components is usually followed by a favorable outcome; residual neurological deficits among survivors, however, are relatively common.

Familial imperforate anus: Report of a family.

SummaryA family with three female siblings affected with imperforate anus and rectovaginal fistula is reported. This is the twelfth family in the literature with more than one member born with imperforate anus. A multifactorial genetic etiology of this condition is suggested.

Pulmonary inflammatory pseudotumor with esophageal obstruction - Report of a case and review of the literature

A 6-year-old boy with an unusually agressive pulmonary inflammatory pseudotumor is presented. The tumor invaded the mediastinum and resulted in an esophageal obstruction, initially necessitating a pneumonectomy, then radiation therapy, and eventually colonic substitution of the esophagus. The previously reported 8 cases of pulmonary inflammatory pseudotumors with involvement of the mediastinum are reviewed.

Bronchial mucoepidermoid tumor in childhood

The histopathological and clinical management of two children, 7 and 14 years of age, with bronchial mucoepidermoid tumor are reported. One had regional lymphatic involvement. Pneumonectomy was carried out for both because of local spread of the disease in one and extensive pneumonia in the other, which was followed by a smooth postoperative course. Both are asymptomatic and free of disease after a follow-up of 1.5 and 5 years, respectively. A review of the English literature revealed 17 other cases, the youngest being 4 years old. The low-grade malignant potential of this tumor in children is stressed.

Primary angiosarcoma of the heart. A case report and review of the english literature

Primary angiosarcoma of the heart is a rare tumor. In view of its variable clinical picture, the diagnosis is delayed and often difficult to establish without an open biopsy. In the majority of cases the tumor originates from the right atrium, metasta sizes early to distant sites, and carries a rapidly fatal outcome. The clinicopath ologic features and the methods of diagnosis for this highly malignant neoplasm are reviewed and a new case is reported.

Ophthalmological aspects of metastatic neuroblastoma: Report of 22 consecutive cases

A review of 22 consecutive cases with ophthalmologic manifestations of neuroblastoma is reported. These cases constitute 27.5% of 80 neuroblastoma patients managed during a 21 -year period at the American University of Beirut, Medical Center. Nineteen of these patients had orbital metastases and one had Horners syndrome. Analysis of the data support the findings reported by others, indicating that the clinical course of the disease in the Middle-East is not different from that noted in the western world.

Carotid neurofibroma in a child

Abstract A case of a neurofibroma arising in the left common carotid artery, just proximal to its bifurcation, and occurring in a six year old boy is reported. The successful surgical management is described. The rarity of this lesion in this location and age group prompted this report.