Oral benadryl and central venous catheter abuse-a potentially "lethal combination"

This article describes the potential for lethal abuse of central venous catheters in oncology patients and its effects especially on the cardiovascular system. Central venous catheters are frequently used to provide immediate vascular access allowing patients to obtain lifesaving therapy or have painless blood-drawing procedures. However, they may also serve as a vehicle for abuse and misuse of medications increasing the potential for morbidity and mortality. We present a unique instance where a pediatric patient attempted suicide by self-injecting crushed diphenhydramine (Benadryl) capsules into her central venous catheter. The patient developed acute but transient ST segment elevation and echocardiographic evidence of severe pulmonary hypertension. She was treated symptomatically with oxygen and diuretics over a period of weeks, while her pulmonary hypertension completely resolved. The injection of oral medications into the central circulation is typically associated with transient pulmonary hypertension and clinical features of pulmonary embolism, especially in preparations containing talc. Although the pulmonary hypertension can be transient, it could be fatal. Physicians must be alert to the potential for abuse and misuse of central venous catheters especially in the chronically ill pediatric patients.     

Experience with autologous pericardial patch closure of ventricular septal defect

Background Conventionally, Ventricular Septal Defects (VSDs) are repaired with synthetic patch—Dacron (polyethylene terephthalate) or Goretex (expanded polytetrafluoroethylene). Recently, we began using glutaraldehyde—treated autologous pericardial patch to repair VSDs. We review our experience. Material and Method Between July to November 2005, 60 children had their VSDs repaired with glutaraldehyde—treated autologous pericardium. There were 40 males and 20 females, aged between 5 months and 12 years with a median age of 1 year. The diagnosis was isolated VSD in 37 patients, multiple VSD in 3; Tetralogy of Fallot (TOF) in 15 and Double Outlet Right Ventricle (DORV) in 5 patients. The chest was opened by a median sternotomy incision. After establishing cardiopulmonary bypass, a strip of pericardium was harvested from the patient and fixed in 0.6% glutaraldehyde (Polyscientific, Bayshore, NY) for about 20 minutes. It was then washed out with 0.9% saline solution. The defect was repaired with 4/0 or 5/0 prolene suture using a continuous suture technique. Results There was no hospital mortality. Postoperative echocardiogram revealed trivial shunts in 10 patients. Follow up was for 3 to 6 months (mean 2 months). No patient required reoperation for residual VSD. Conclusion Glutaraldehyde—treated autologous pericardium is an excellent material for surgical patch clousre of VSD. It is easily available and does not require sterilization. Further follow-up is required to assess its long term efficacy.     

Morphosurgical correlation of outcomes in complete double outlet right ventricle

Even though surgical experience with wide spectrum of double outlet right ventricle (DORV) is available, the experience with extreme form of complete DORV where both great arteries completely arise from the right ventricle is limited. We present our experience with this unique subset where the systemic outflow is far removed from the interventricular foramen and hence, the systemic ventricle. In this situation, biventricular repair can be technically demanding and challenging. Between June 2002 and February 2006, 12 patients underwent biventricular repair of this subset. The VSD was subaortic in all; eight patients had infundibular and valvar obstruction. Aorta was anterior and to the right, with the pulmonary artery far posterior and to the left. The interventricular foramen was patched with a long Gore-Tex patch to route the LV flow to the aorta. Eight patients had infundibular resection and right ventricular outflow tract (RVOT) enlargement with an autologous monocusp pericardial patch. No patient required a valved conduit. There was no operative mortality. In one patient, there was a small residual VSD that was not of haemodynamic significance. There was no RVOT and left ventricular outflow tract obstruction and no RV inflow obstruction. The early and mid-term results are good.     

Impaired exercise parameters in pediatric heart transplant recipients: comparison of biatrial and bicaval techniques

The exercise performance of pediatric heart transplant recipients and the effects of bicaval anastomosis were studied in 19 children using a Bruce protocol. Although all children had decreased exercise capacity and heart rates when compared with normals, the bicaval anastomosis patients had similar endurance and peak heart rates as the standard biatrial group.