Large Left Ventricular Fibroma: Case Report and Literature Review.

Benign cardiac tumors are rare and fibroma is second to rhabdomyoma in frequency in pediatric cardiac tumors. We report a case of a 14-year-old male patient, who presented with shortness of breath for 2 years. Echocardiogram and cardiac magnetic resonance imaging indicated a large mass located in the left ventricular lateral wall. The patient underwent surgical excision of the tumor, and histopathological examination confirmed the diagnosis of a cardiac fibroma. The patient had a good postoperative recovery and was discharged on sixth postoperative day.

Continuous peripheral nerve block for postoperative pain control at home: a prospective feasibility study in children.

BACKGROUND AND OBJECTIVES: We assessed the feasibility and efficacy of postoperative pain control by continuous peripheral nerve blockade (CPNB) in children after early home discharge under parental surveillance. METHODS: All children scheduled for primary elective ankle or foot surgery under sciatic popliteal CPNB and general anesthesia were evaluated. After obtaining the surgeon's consent, the children were discharged on either the day (D) of surgery (D0), or on postoperative D1 or D2 (depending on whether they needed a plaster cast or a suction drainage). The CPNB was continuously infused, using an elastomeric pump. Before the procedure, the parents were taught how to assess their children's pain, to use rescue analgesia, and to manage an infusion elastomeric pump device, and when to call the hospital in case of emergency. The children returned to the hospital for catheter removal and the recording of any postoperative event. RESULTS: Forty-seven children were entered into this observational study. Two were discharged home on the same day, 30 were discharged home 1 day after surgery, and 15 were discharged home 2 days after surgery. The mean duration of infusion elastomeric pump at home was 3 days (range, 2 to 4 days). Analgesia was rated as excellent or good in 89% of the cases, and the quality of sleep was always good, except for three patients. Some minor untoward effects were recorded. Two children returned to the hospital because of accidental disconnection of the infusion elastomeric pump from the catheter. Four patients presented skin redness at the puncture site, but no infection was observed, and all catheters remained sterile. No parents called the hospital. The children's quality of life was rated as excellent or as satisfactory overall, by both the children and their parents. CONCLUSIONS: Shortening hospital stays with the use of at-home CPNB under sole parental supervision is feasible, after selecting children with a suitable family environment.

Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years.

Posterolateral fusion has long been considered the "gold standard" technique for surgical treatment of adult spondylolisthesis. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. The goal of this prospective study was to compare the two techniques regarding their clinical outcomes and fusion rates. Fifty-two patients with isthmic spondylolisthesis were operated by the same surgeon. One group (25 patients) had decompression and posterolateral fusion (PLF) with a pedicle screw system ; patients in the other group were treated by decompression, posterior interbody fusion (PLIF) and a pedicle screw system. The two groups were similar with respect to grade of slipping, age, and activity. Seventy-seven percent of the patients had a good or very good result with PLIF and 68% with posterolateral fusion. However, there was no statistical difference in cases with low grade slipping, whereas the difference was significant for cases with high grade slipping. The fusion rate was 93% with PLIF and 68% with PLF, but without any significant incidence on the functional outcome. Based on these findings, we now use posterior interbody fusion for high grade spondylolisthesis which requires reduction or if the disc space is still high. When the slip grade is low, or the disc space is narrow, we prefer posterolateral fusion.