Stanley H. Konefal

Cardiac tamponade in a newborn: a complication of hyperalimentation

Perforation of the heart by central venous catheters is an uncommon but life-threatening complication in the neonatal age group. Prevention requires an open insertion technique, the use of soft Silastic catheters, and the maintenance of the catheter tip above the right atrium. Rapid clinical deterioration with signs of tamponade suggests the diagnosis. Catheter withdrawal, early pericardiocentesis, and pericardiotomy with myocardial repair in selected cases contribute to survival.

Epidermoid Cyst of the Spleen Successfully Treated by Marsupialization

Nonparasitic splenic cysts, although rare, should be considered in the differential diagnosis of persistent vague upper abdominal pain in children and young adults. These cysts, which are less common than traumatic pseudocysts, include hemangiomas, dermoids, lymphangiomas, and, as in the present case, epidermoid variants. Ultrasound is diagnostic. The pathogenesis of these lesions remains obscure. While some continue to advocate splenectomy as definitive treatment, an operation with splenic salvage should be possible, even in centrally located lesions.

An Alternative Method of Securing Broviac Catheters in Children and Infants

A method of securing broviac catheters in children is described. Instead of passing sutures through a Dacron cuff we use polypropylene mesh to transfix the catheter to the skin. This method offers an easy and effective method of preventing accidental dislodgement. It also offers several advantages over previous methods as there are no additional incisions made and less risk to the catheter.

Bilateral breast relapse in acute myelogenous leukemia.

We present the case of an 11.5-year-old girl with M1 acute myelogenous leukemia (AML) who had isolated extramedullary relapse develop in both breasts 12 months after diagnosis and 7 months off chemotherapy. She received further chemotherapy, focal radiation therapy, then underwent a matched, unrelated bone marrow transplant and continues in remission 37 months later. Review of the literature revealed 10 cases in other children younger than 21-years-old with AML and breast involvement. These cases are summarized, and potential pathophysiologic mechanisms of spread are discussed. Breast involvement in AML is rare in children. However, regular breast examinations should be performed as part of routine follow-up in all girls with AML.