RESUMO
An unusual case of a juxtabronchial lymphoepithelial cyst in an HIV-positive child with post-obstructive pneumonia is presented. The pathogenesis and similarity with parotid lymphoepithelial cysts is discussed.
Assuntos
Cistos/diagnóstico , Infecções por HIV/complicações , Doenças Torácicas/diagnóstico , Criança , Cistos/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Doenças Parotídeas/diagnóstico , Pneumonia/diagnóstico por imagem , Pneumonia/etiologia , Doenças Torácicas/etiologia , Tomografia Computadorizada por Raios XRESUMO
We report a case of congenital pulmonary myofibroblastic tumor, and review prior reports of this rare neoplasm to demonstrate its clinically benign behavior despite histologic features previously interpreted as sarcoma. The patient, a female neonate, presented with severe respiratory distress after cesarean section delivery. A large radio-opaque mass was detected in the right hemithorax and resected by right bilobectomy. The tumor mass, confined to the lung, was composed of interlacing fascicles of plump spindle cells showing myofibroblastic differentiation and complex cytogenetic abnormalities. Though sarcomatous in appearance, with highly cellular areas and numerous mitoses, there has been neither tumor recurrence nor metastases. The patient remains alive and well 1 year after surgery. Review of the few other reported cases confirms the uniformly benign behavior of this tumor.
Assuntos
Fibroblastos/patologia , Fibrossarcoma/congênito , Fibrossarcoma/patologia , Neoplasias Pulmonares/congênito , Neoplasias Pulmonares/patologia , Músculo Liso/patologia , Feminino , Fibrossarcoma/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Recém-Nascido , Neoplasias Pulmonares/diagnóstico por imagem , Radiografia TorácicaRESUMO
We describe a pediatric patient with dyskeratosis congenita, whose symptoms included abdominal pain, vomiting, dysphagia, and hematochezia. Gastrointestinal symptom are prominent in this rare genetic disorder.
Assuntos
Gastroenteropatias/etiologia , Hiperpigmentação/congênito , Leucoplasia/congênito , Doenças da Unha/congênito , Pancitopenia/congênito , Criança , Gastroenteropatias/diagnóstico , Ligação Genética , Humanos , Hiperpigmentação/complicações , Leucoplasia/complicações , Masculino , Doenças da Unha/complicações , Pancitopenia/complicações , Síndrome , Cromossomo XRESUMO
The challenges and results of cardio-vascular surgery at the American University of Beirut Medical Center (AUBMC) during the civil strife in Lebanon are presented. Dependence on local resources is emphasized. Temporary interruption of open-heart surgery in a university setting may be the product of absence of essential materials and/or personnel. Ingenuity and team approach have contributed to the success and survival of the open-heart program. The operative results and mortality rate were indirectly related to the intensity of fighting in the vicinity of a Medical Center that served as a field hospital.
Assuntos
Centros Médicos Acadêmicos , Procedimentos Cirúrgicos Cardíacos , Guerra , História do Século XX , Humanos , LíbanoRESUMO
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.
Assuntos
Embolia/etiologia , Corpos Estranhos/complicações , Migração de Corpo Estranho , Ferimentos Penetrantes/complicações , Aorta , Braço , Artérias , Pré-Escolar , Humanos , Perna (Membro) , Masculino , Embolia Pulmonar/etiologia , Ferimentos por Arma de Fogo/complicaçõesRESUMO
A 6-year-old girl with juvenile dermatomyositis complicated by five duodenal perforations is described. The treatment consisted of suture closure of the perforations, reinforcement of the suture line with an omental graft, and adequate drainage of the closure site. The use of a somatostatin analog was successful in promptly arresting a leak from the duodenal perforations that had persisted for 3 months after the operation despite prolonged bowel rest and total parenteral nutrition. On follow-up observation 2 months later, the patient had no abdominal complaints and was tolerating oral intake without problems.
Assuntos
Dermatomiosite/tratamento farmacológico , Duodenopatias/tratamento farmacológico , Fístula Intestinal/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Criança , Dermatomiosite/complicações , Feminino , Humanos , Fístula Intestinal/complicaçõesRESUMO
A case of hepatic abscess and subsequent septicemia caused by Clostridium bifermentans is described. The abscess manifested itself on the third day after blunt trauma to the torso. The patient had nausea, vomiting, fever, evidence of hepatic dysfunction, and subphrenic gas. This case illustrates the association of hepatic abscess and blunt trauma to the torso.
Assuntos
Traumatismos Abdominais/complicações , Infecções por Clostridium/etiologia , Abscesso Hepático/etiologia , Sepse/etiologia , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Criança , Clostridium/isolamento & purificação , Humanos , MasculinoRESUMO
A 5-year-old boy with neurofibromatosis is described, whose symptoms of abdominal pain and vomiting were due to an intestinal duplication. Intestinal duplication has not been previously reported as a cause of gastrointestinal symptoms in neurofibromatosis. The utilization of ultrasound and computerized tomography scan as useful modalities for the diagnosis of duplication of the bowel is described.
Assuntos
Intestino Delgado/anormalidades , Neurofibromatose 1/complicações , Tomografia Computadorizada por Raios X , Ultrassonografia , Pré-Escolar , Diagnóstico Diferencial , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , MasculinoRESUMO
A 4-year-old girl with a presacral benign mesenchymoma is reported. The nature of the tumor was not recognized preoperatively or intraoperatively. There was evidence of pericapsular infiltration of the soft tissues of the pelvis but not signs of malignancy. A follow-up examination after 3 months indicates that the patient has no clinical evidence of recurrence. Review of the English literature shows the rarity of benign mesenchymoma in childhood and the lack of reports of its occurrence in the pelvis.
Assuntos
Mesenquimoma/patologia , Neoplasias Pélvicas/patologia , Neoplasias de Tecidos Moles/patologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Mesenquimoma/cirurgia , Neoplasias Pélvicas/cirurgia , Região Sacrococcígea/patologia , Região Sacrococcígea/cirurgia , Neoplasias de Tecidos Moles/cirurgiaRESUMO
The rare association of DAA with TOF is reported in a young boy who underwent successfully at the age of 3 months an emergency shunt between the anterior (left) hypoplastic aortic arch and the LPA after the vascular ring was divided. Total correction of the cardiovascular malformation was performed at the age of 4 years. The cardiac catheterization, angiographic and operative findings as well as the management of the case are described. Ten other patients with this combination of anomalies were found on review of the literature, eight of whom had only palliative systemic to pulmonary artery shunts. Knowledge of the morphology of the DAA by angiocardiography is helpful in planning the management. Surgical shunts when done early for the treatment of a patient with repeated anoxic spells may reduce the gravity of psychomotor retardation. A staged surgical repair of TOF is recommended for infants having hypoplastic pulmonary arteries.
Assuntos
Aorta Torácica/anormalidades , Tetralogia de Fallot/complicações , Aorta Torácica/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Tetralogia de Fallot/cirurgiaRESUMO
A review of 52 consecutive cases of congenital diaphragmatic hernia composed of 36 cases of Bochdalek hernia (B.H.) 13 of diaphragmatic eventration (D.E.), and 3 of diaphragmatic agenesis (D.A.) is reviewed critically. The operative mortality rate in Bochdalek hernia was 8.3% but became 20% with reference to the 15 infants with B.H. operated in the first 24 hrs. of life and 31.5% with reference to all 19 infants requiring repair of the diaphragmatic defect during the first day after birth. The operative mortality in D.A. was 100% and was nil in D.E. The mortality appeared related directly to prematurity, early age at operation, preoperative hypoxemia (PaO2 less than or equal to 60), hypercarbia, (PaCO2 greater than or equal to 60), and acidosis (pH less than or equal to 7.0), association with life-threatening anomalies affecting the lungs and its vessels, the heart, the size of the diaphragmatic defect and of the celomic cavity, the postoperative development of NEC and of obstructing intestinal adhesions. Eight of the 33 survivors (24%) with B.H. developed intestinal obstruction secondary to adhesions 2 months to 14 years after operation, of whom 7 required surgical intervention, and 3 bowel resections. The total mortality rate in B.H. was 14% and the rate in this series of combined defects was 15%.
Assuntos
Eventração Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas , Feminino , Hérnia Diafragmática/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-OperatóriasRESUMO
A case of acquired neurogenic megacolon in a child is reported. The condition resulted after a Soave endorectal pull-through procedure for Hirschsprung's disease and was secondary to hypoganglionosis which developed in the pulled-through segment. The clinical, radiological, and pathologic features as well as the successful surgical management of this case are described.
Assuntos
Doença de Hirschsprung/cirurgia , Complicações Pós-Operatórias/cirurgia , Reto/cirurgia , Pré-Escolar , Colectomia , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , RecidivaRESUMO
This is a review of 80 patients with neuroblastoma managed at the American University of Beirut Medical Center between 1963 and 1983. Three patients had ganglioneuroblastoma of whom one showed histologic evidence of maturation into a ganglioneuroma. Four patients were less than 1 month of age and 33 were less than 2 years of age. The site of origin was intra-abdominal in 56 patients of whom 34 were intra-adrenal. Intraspinal involvement was noted in 12 patients, of whom one was a newborn. Treatment and adequate follow-up were possible in 63 patients. Total excision of the tumor was performed in 17 patients, and partial excision in 14. The 2-year and 5-year survival rates were 36% and 25%, respectively. Age, site of the tumor, and degree of cellular differentiation were the only independent variables affecting survival. Eleven of 14 patients younger than 1 year were alive 5 or more years after diagnosis. Cervical, thoracic, and pelvic tumors had a better prognosis than abdominal tumors. Other factors affecting survival were the stage and the mode of therapy. Infants with stage IV-S congenital neuroblastoma had a very poor prognosis. The initial urinary VMA level as well as the presence or absence of calcifications within the tumor had no bearing on prognosis.
Assuntos
Neoplasias das Glândulas Suprarrenais/terapia , Neoplasias do Sistema Nervoso/terapia , Neuroblastoma/terapia , Adolescente , Neoplasias das Glândulas Suprarrenais/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Ganglioneuroma/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias do Sistema Nervoso/mortalidade , Neuroblastoma/mortalidade , Fatores SexuaisAssuntos
Procedimentos Cirúrgicos Cardíacos/tendências , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , LíbanoAssuntos
Doenças do Recém-Nascido/fisiopatologia , Enfisema Pulmonar/fisiopatologia , Transtornos Respiratórios/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Suscetibilidade a Doenças , Hemodinâmica , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/terapia , Pulmão/fisiopatologia , Pneumopatias/fisiopatologia , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/epidemiologia , Enfisema Pulmonar/terapia , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/terapia , Ruptura EspontâneaRESUMO
A review of 40 consecutive infants with cardiovascular lesions requiring surgical intervention, without the use of the heart-lung machine, during a 3 year period is presented. Twenty-one patients were cyanotic and 19 were non-cyanotic preoperatively. In the former group, an operation was performed on an urgent or emergency basis in 8 patients (38%). In the latter group, 12 patients (63%) were in congestive heart failure and needed digitalis and diuretics preoperatively. The most frequent lesions among both groups were TOF and aortic coarctation, each being encountered in 6 patients, to be followed by d-TGA, PDA, and vascular ring, each being observed in 5 patients. The youngest patient was 8 hours old, had ectopia cordis associated with omphalocele, and the oldest was 12 months old, had a vascular ring. The lightest infant weighed 1.6 kg and had ligation of PDA at the age of one month. The most common surgical procedure was a systemic pulmonary artery shunt (13 patients), closure of PDA (5 patients), followed by repair of aortic coarctation using the LSA as a patch (6 patients), and division of vascular ring (5 patients). The operative M.R. was 15% in the whole series, 19% among the 21 cyanotic babies, 11% among the 19 non-cyanotic infants and 40% among the 10 patients operated in the first month of life. No death was noted among the 14 patients operated after the age of 6 months. Late mortality occurred in 4 patients giving a total mortality rate of 38% in this group of 21 infants with cyanotic malformations.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Cardiopatias Congênitas/cirurgia , Cianose/complicações , Cardiopatias Congênitas/classificação , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Humanos , Lactente , Recém-Nascido , Período Pós-Operatório , Estudos Retrospectivos , Fatores de TempoRESUMO
Experience with ten children with superior vena cava obstruction is reported. Five patients had non-Hodgkin's lymphoma, two had Hodgkin's disease, two had benign lesions, and one patient was suspected on clinical and radiologic basis to have a lymphoma. The clinical situation at presentation was often critical and required rapid treatment. Radiotherapy and/or chemotherapy were used initially as lymphoma was the most frequent cause of obstruction. Urgent thoracotomy was resorted to when treatment failed. Survival with no evidence of disease for more than 5 years was observed in three children: one had a cystic lymphangioma, another had a mediastinal abscess, and the third had a Hodgkin's lymphoma. Review of the literature from 1951 to 1976 revealed that only 24/150 children reported with superior vena cava obstruction syndrome had mediastinal tumors; the remainder developed the obstruction after surgical procedures on the heart or vena cava.