Anesthetic implications of primary cardiac tumors in infants and children

OBJECTIVE: To determine the degree of hemodynamic and airway compromise in infants and children undergoing anesthesia for primary cardiac tumors. DESIGN: Retrospective study. SETTING: Tertiary-care, academic children's hospital. PARTICIPANTS: Patients <18 years old who had undergone anesthesia and surgery for resection or biopsy of a primary cardiac tumor (n = 25). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Charts were reviewed for intraoperative complications, defined as (1) hypotension (20% decrease from baseline) during or after induction; (2) failure to gain airway control by insertion of an airway or endotracheal intubation, inability to ventilate after administration of a muscle relaxant, need for change in patient position, rigid bronchoscopy, or cardiopulmonary bypass for adequate oxygenation; and (3) new arrhythmias. Hypotension during induction occurred in 4 patients (16%), 3 of whom were hemodynamically unstable preoperatively. Hypotension after induction was found in 2 (8%) patients. Hypotension occurred more frequently in patients with obstruction to blood flow and arrhythmia (n = 3), obstruction to blood flow only (n = 1), and arrhythmia only (n = 1). No patient had airway difficulty related to the tumor, although one intrapericardial tumor mimicked an anterior mediastinal mass. New arrhythmias occurred in 3 (12%) patients. CONCLUSIONS: The subgroup of patients at greatest risk are patients with a combination of obstruction to blood flow and arrhythmias. Despite the alarming diagnosis, the intraoperative course tends to be fairly stable in most cases. Extensive pericardial tumors may produce the same airway concerns as anterior mediastinal masses, but airway complications do not seem to be a problem with intrachamber tumors.     

Calcifying pseudotumor of scrotum: a case report

Calcifying fibrous pseudotumors of the testicular and paratesticular soft tissue are relatively rare. We would like to report the first documented case of calcifying fibrous pseudotumor of the tunica vaginalis in Indian medical literature. This is a case of a 55 year old male who presented with a painless scrotal mass of 10 years duration. Histological sections showed dense hyalinised bands of collagen with focal collections of plasma cells and lymphocytes. Multiple round to oval concentrically laminated psammomatous bodies were seen.     

Concurrent Cryptosporidium and Candida infections in a buffalo calf (Bubalus bubalis)

Cryptosporidiosis and candidiasis are opportunistic infections of neonates. An investigation was contemplated to study the enteric lesions associated with concurrent infections by the pathogens in a male bubaline calf, aged 8 weeks, which died on March 23, 2010. The gross lesions were comprised of hyperplastic changes and erosion of the microvillus surface of the enteric epithelium. The histological sections revealed invasion of the mucosal cells by two types (Cryptosporidium spp. and Candida spp.) of pathogens. The deeper layers of the intestine did not reveal appreciable architectural changes, except for the presence of inflammatory cellular elements in the lamina propria. The sections stained with Ziehl–Neelsen revealed bright red, oval to spherical bodies (3–5 μm), and those stained with Gomori's Methanamine silver nitrate revealed black-colored fungal spores and pseudohyphae. Based on morphological and in vitro cultural characteristics, the pathogens were identified as Cryptosporidium spp. and Candida spp., respectively. The lesions seem to be consequential events to synergistic invasion of the enterocytes by the pathogens. Complex changes in the microenvironment of the gut, incidental to in situ release of hydrolytic enzymes, toxins, and products of host–parasite interaction liberated at the site of infection by the pathogens, have been reported and discussed.