Pre-operative embolization, surgical resection, and follow-up evaluation of a giant intercostal schwannoma.

Intercostal schwannomas can present incidentally and lead to compressive thoracic symptoms. These slow-growing and benign tumors typically arise from intercostal nerves and are supplied by intercostal arteries, which may increase the risk of hemorrhagic complications with surgical resection. Due to the rarity of intercostal schwannomas, there exists no standardized management algorithms. Pre-operative angiography and embolization can supplement surgical thoracotomy and resection by decreasing intra-operative hemorrhage and minimizing the risk of anterior spinal cord hypoperfusion.

Complications of radiofrequency ablation of hepatic, pulmonary, and renal neoplasms.

Percutaneous thermal ablation has emerged as a viable technique for treatment of numerous solid organ malignancies. As the number of these procedures increases, so do the complications that are seen. Most common complications are generally related to bleeding from the target organ during or after the procedure and from thermal injury to adjacent structures. The nature of these injuries depends on the particular organ being treated, therefore it it best to categorize them this way. We will review the more common complications seen following the ablation of tumors in the liver, kidney, and lung, discuss the clinical presentation associated with each, and suggest precautions to help avoid them in the future. Understanding the potential risks associated with this procedure is critical for treatment planning and fundamental for performing these procedures safely.

Wandering liver: multidetector CT features and the importance of multiplanar reformations.

The terms wandering liver, hepatic torsion, and hepatic vagrancy have been applied to cases in which hepatic hypermobility results in displacement of the liver from its normal position within the right upper quadrant of the abdomen. This is thought to result from multiple factors, including the lack of normal hepatic suspensory ligaments, persistence of the ventral mesentery, and lack of inferior vena cava tethering Siddins and Cade (Aust N Z J Surg 60:400-403, 1990). A wandering liver has been described in both adults Siddins and Cade (Aust N Z J Surg 60:400-403, 1990), Tate (Am Surg 59:455-458, 1993), Chiavarini and Chang (Radiology 115:47-48, 1974), Cope and Levy (South Afr Med J 40:366-369, 1966), Sharov (Vestn Roentgenol Radiol 35:63-64, 1960), Puthenpurayil et al. (AJR 177:1113-1115, 2001), Fuentes et al. (AJR 188:331-333, 2007) and children Feins and Borger (AJR 188:331-333, 2007), Al-Ali et al. (Pediatr Radiol 27:287, 1997), and it is usually associated with bowel obstruction Siddins and Cade (Aust N Z J Surg 60:400-403, 1990), Tate (Am Surg 59:455-458, 1993), Chiavarini and Chang (Radiology 115:47-48, 1974), Cope and Levy (South Afr Med J 40:366-369, 1966), Sharov (Vestn Roentgenol Radiol 35:63-64, 1960), Fuentes et al. (AJR 188:331-333, 2007), Feins and Borger (AJR 188:331-333, 2007). We report a case of an incidental wandering liver in an adult without associated obstruction, diagnosed by multidetector computed tomography with multiplanar reformations.

Circumstances surrounding the deaths of hospitalized children: opportunities for pediatric palliative care.

OBJECTIVES: Little is known regarding the assessment and treatment of symptoms during end-of-life (EOL) care for children. This study was conducted to describe the circumstances surrounding the deaths of hospitalized terminally ill children, especially pain and symptom management by the multidisciplinary pediatric care team. DESIGN: Patients in the neonatal intensive care unit, pediatric critical care unit, or general pediatric units of Vanderbilt Children's Hospital who were hospitalized at the time of death, between July 1, 2000, and June 30, 2001, were identified. Children eligible for the survey had received inpatient EOL care at the hospital for at least 24 hours before death. A retrospective medical record review was completed to describe documentation of care for these children and their families during the last 72 hours of life. RESULTS: Records of children who had received inpatient EOL care were identified (n = 105). A majority (87%) of children were in an intensive care setting at the time of death. Most deaths occurred in the pediatric critical care unit (56%), followed by the neonatal intensive care unit (31%). Pain medication was received by 90% of the children in the last 72 hours of life, and 55% received additional comfort care measures. The presence of symptoms other than pain was infrequently documented. CONCLUSIONS: The duration of hospitalization for most children dying in this inpatient setting was sufficient for provision of interdisciplinary pediatric palliative care. Management of pain and other symptoms was accomplished for many children. The documentation of pain and symptom assessment and management can be improved but requires new tools.