Atrial rupture in a child from cardiac massage by his parent.

A 4-year-old boy presented with a single seizure following a viral syndrome. He had a pericardial effusion on admission, and this increased suddenly on the third day of hospitalization, producing cardiac tamponade. After blood was aspirated from the child's pericardial cavity, the father revealed that he performed cardiac massage on his son following the seizure. A laceration of the right atrium was repaired at operation, and the boy made a good recovery. Cardiopulmonary resuscitation by lay persons is not without hazard, and patients with such a history should be watched carefully for the possibility of damage to intrathoracic structures.

Initial fluid therapy for children with meningitis with consideration of the syndrome of inappropriate anti-diuretic hormone.

A review of 85 children with meningitis admitted to the University Children's Hospital at Hermann Hospital revealed that only six patients (7%) had sufficient clinical and laboratory evidence to be compatible with the diagnosis of inappropriate secretion of antidiuretic hormone (SIADH). This is in contrast with various communications in the pediatric literature that have reported an association between the two conditions of as high as 85%. Hyponatremia (serum sodium 135 mEq/L) was observed in 27 (32%), but neither the initial laboratory data nor the subsequent follow-up data supported the diagnosis of SIADH. Moderate to severe dehydration was documented in 16 patients (19%) and suspected in more than 50% of the cases (serial weight determinations indicating an increase in weight from admission to discharge). Although the incidence of neurologic sequelae in this series was not influenced significantly by the presence or absence of hyponatremia, SIADH, or fluid restriction, the numbers are still small. Based on these data, routine fluid restriction cannot be recommended unless there is confirmatory evidence of SIADH.

A high-pressure-liquid-chromatography method for the determination of corticosterone in rat plasma.

A high-pressure-liquid-chromatography (HPLC), isotope dilution method for the determination of corticosterone in rat plasma is reported. Main characteristics of the technique are: efficient separation of the steroid from 18-HO-DOC and 11-deoxycortisol; two easy pre-purification steps consisting of an acetone extraction-deproteinization and fractionation on Sephadex LH-20; a sensitivity of 5 ng per injection and the possibility of determining 25 ng corticosterone in approximately one milliliter rat plasma.

Aortic valve injury 10 years after tetralogy of Fallot repair.

Although recognized by pediatric cardiac surgeons, aortic insufficiency as a technical complication after tetralogy of Fallot repair is poorly documented, especially if it occurs late. The case of a boy with aortic insufficiency 10 years after complete tetralogy repair is described. No documentation in the literature other than summary statements in textbooks of this occurrence was found.