Percutaneous upsizing of a Blalock-Taussig shunt

Percutaneous upsizing of surgically placed Blalock-Taussig shunts is an uncommon practice. We report the case of an 8-month-old infant with single-ventricle physiology, who - due to comorbidities - was deemed unsuitable to proceed with Glenn operation. The 3.5-millimetre Blalock-Taussig shunt was stented successfully with a 5-millimetre pre-mounted stent, resulting in an increase in shunt diameter and oxygen saturation by nearly 30% and 10%, respectively.     

An infected urachal cyst presenting as an acute abdomen – A case report

INTRODUCTIONAn infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of which are rare in adulthood.PRESENTATION OF CASEWe report the case of a 45-year-old obese Russian lady who presented with a 2-week history of suprapubic pain radiating to the right iliac fossa. Although previously fit and well, she had a history of 17 miscarriages. Both USS and CT suggested a complicated inflammatory mass in the lower abdomen. Ultimately the diagnosis was made by laparotomy, which revealed an abscess of an urachal cyst. The infected cyst and bladder dome were excised. The patient made a good recovery with an uneventful follow up.DISCUSSIONUrachal cysts are the commonest type of urachal anomaly. Infection is the usual mode of presentation amongst adult cases otherwise the condition usually remains asymptomatic. An infected urachal cyst is an important diagnosis to make as complications include sepsis, fistula formation, and rupture leading to peritonitis. Treatment is by complete excision, however, techniques have been debated.CONCLUSIONThis is a rare but important diagnosis however we recommend that in patients with atypical histories, it should be included in the differential diagnosis.     

Pediatric chondrodermatitis nodularis helicis

Chondrodermatitis nodularis helicis (CNH) is a rare condition of the pinna affecting mainly adults. A pediatric case of this condition is presented in the current report, and the literature of pediatric CNH is reviewed.     

Interbody Fusions in the Lumbar Spine: A Review

HSS Journal ® - Lumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to...     

Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension

OBJECTIVES: To review the literature on the use of hypertonic saline (HS) in treating cerebral edema and intracranial hypertension. DATA SOURCES: Review of scientific and clinical literature retrieved from a computerized MEDLINE search from January 1965 through November 1999. STUDY SELECTION: Pertinent literature is referenced, including clinical and laboratory investigations, to demonstrate principles and efficacy of treatment with HS in patients with intracranial space-occupying pathology. DATA EXTRACTION: The literature was reviewed to summarize the mechanisms of action, efficacy, adverse effects, systemic effects, and comparisons with standard treatments in both clinical and laboratory settings. DATA SYNTHESIS: HS has an osmotic effect on the brain because of its high tonicity and ability to effectively remain outside the bloodbrain barrier. Numerous animal studies have suggested that fluid resuscitation with HS bolus after hemorrhagic shock prevents the intracranial pressure (ICP) increase that follows resuscitation with standard fluids. There may be a minimal benefit in restoring cerebral blood flow, which is thought to be mitigated through local effects of HS on cerebral microvasculature. In animal models with cerebral injury, the maximum benefit is observed in animals with focal injury associated with vasogenic edema (cryogenic injury). The ICP reduction is seen for < or =2 hrs and may be maintained for longer periods by using a continuous infusion of HS. The ICP reduction is thought to be caused by a reduction in water content in areas of the brain with intact blood-brain barrier such as the nonlesioned hemisphere and cerebellum. Most comparisons with mannitol suggest almost equal efficacy in reducing ICP, but there is a suggestion that mannitol may have a longer duration of action. Human studies published to date reporting on the use of HS in treating cerebral edema and elevated ICP include case reports, case series, and small controlled trials. Results from studies directly comparing HS with standard treatment in regard to safety and efficacy are inconclusive. However, the low frequency of side effects and a definite reduction of ICP observed with use of HS in these studies are very promising. Systemic effects include transient volume expansion, natriuresis, hemodilution, immunomodulation, and improved pulmonary gas exchange. Adverse effects include electrolyte abnormalities, cardiac failure, bleeding diathesis, and phlebitis. Although unproven, a potential for central pontine myelinolysis and rebound intracranial hypertension exists with uncontrolled administration. CONCLUSIONS: HS demonstrates a favorable effect on both systemic hemodynamics and intracranial pressure in both laboratory and clinical settings. Preliminary evidence supports the need for controlled clinical trials evaluating its use as resuscitative fluid in brain-injured patients with hemorrhagic shock, as therapy for intracranial hypertension resistant to standard therapy, as firstline therapy for intracranial hypertension in certain intracranial pathologies, as small volume fluid resuscitation during spinal shock, and as maintenance intravenous fluid in neurocritical care units.