Neonatal hypothalamic hamartoma: a differentiating nonlethal hamartoblastoma.

The authors report on a patient with a large hypothalamic hamartoma with a cleft lip and palate and seizures. Neuroimaging revealed a large extraaxial, intradural mass in the prepontine and interpeduncular cisterns with significant distortion of the brainstem. A stereotactic transfontanel needle biopsy revealed a cellular lesion that contained immature-appearing neuroepithelial cells consistent with prior descriptions of hypothalamic hamartoblastoma.

Mechanisms of support: coping with loss in a major children's hospital.

Employment in a children's hospital of a major medical center can be stressful for healthcare providers, especially when faced with potential losses of pediatric and adolescent patients. Although it seems natural to believe that emotional distress following the death of a patient would be addressed, this is not always the case. The current manuscript presents results of a survey of healthcare providers at Shands Children's Hospital at the University of Florida, a not for profit teaching hospital.

Cat scratch disease and acute rejection after pediatric renal transplantation.

Cat scratch disease (CSD) can lead to unexplained fever, generalized lymphadenopathy and organomegaly in immunocompetent individuals. CSD has rarely been reported in immunocompromised transplant recipients, where its clinical features would mimic the more common post-transplant lymphoproliferative disease (PTLD). We report three cases of CSD seen recently in children who had received prior kidney transplants.

Primary antiphospholipid syndrome presenting with a branch retinal artery occlusion in a 15-year-old boy.

Acute vascular events are rare in the pediatric population, but there is an association with the presence of antiphospholipid antibodies. When there is no other underlying medical disorder, this is referred to as primary antiphospholipid syndrome. We present a case of a 15-year-old boy who developed an acute superior branch retinal artery occlusion.

Extracorporeal removal of toxic valproic acid levels in children.

Toxic ingestion of valproic acid is difficult to treat as no antidote exists and hemodialysis has been considered ineffective for clearance due to high protein binding of this drug. Recent reports suggest that protein binding of valproic acid is saturated at toxic levels, thereby allowing for removal of free drug by extracorporeal circuits. We describe our experiences in two children with toxic blood levels of valproic acid, in whom we were able to achieve effective clearances by extracorporeal removal without charcoal hemoperfusion.

Reducing risks while improving care.

The inherent risks in critical care and the vulnerability of its patients demand a rigorous attention to detail. This article gives the critical care nurse a sound basis in risk management principles and existing policies, including those of the Joint Commission on Accreditation of Healthcare Organizations. Understanding risk management can help nurses improve patient care while reducing the chances for litigation.

Balloon valvuloplasty for critical pulmonary valve stenosis in a premature infant.

Successful balloon valvuloplasty for critical pulmonary valve stenosis is described in an 800-g infant. A modified catheter was required to cross the valve in the smallest child known to undergo this procedure.

Transcatheter closure of modified Blalock-Taussig shunt with Gianturco-Grifka Vascular Occlusion Device.

A 15-year-old girl with previous repair of a complex cyanotic congenital heart defect had persistence of a modified left Blalock-Taussig shunt that could not be ligated at surgery. Six years later, antegrade delivery of a Gianturco-Grifka Vascular Occlusion Device resulted in complete closure of the shunt. Cathet.