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Bilateral breast masses and bloody nipple discharge in a four-year-old boy
INTERNATIONAL
341
ABSTRACTS
May 1976 to March 1988. At intervals of 4 to 6 weeks the children were repeatedly injected with BLM emulsion (0.3 to 0.6 mg/kg body weight) into the cavity. In 41 patients (87%) the lymphangioma regressed. In 20 patients (43%) the tumor almost disappeared with minimal residual induration. The cystic lymphangioma showed a greater response than the cavernous lymphangioma. The total injected dose used in the cases that responded to therapy was 0.6 to 4 mgikg. In young infants with large cervicomediastinal lymphangiomas, this therapy proved dangerous because the cystic mass grew transiently following local injection with resultant airway compression. BLM is believed to cause tumor regression in cystic hygroma by its direct action on the lymphatic endothelial lining, producing an inflammatory response.-Prem fiti
,The -Kasabach-Meritt Syndrome: Treatment Wii Intermittent Pneumatic Compression. S.E. Aylett, A.F. Wdliums, D.H. Bevun, et al. Arch Dis Child 65:790-791, (July), 1990.
A 6-week-old infant with an angiomatous lesion of the leg complicated by chronic disseminated intravascular coagulation responded well to intermittent pneumatic compression of the limb. The authors believe that when possible this form of treatment should be tried before pharmacological or other interventiortD.M. Burge
Bilateral Breast Masses and Bloody Nipple Discharge in a Four-Year-Old Boy. J.D. Miller, M.D. Brownell, and A. Shuw. J
Pediatr 116:744-747, (May), 1990. Cystic Hygroma in Saudi Arabian Children. A.Y Izzidien AlSamurai, A.J. Juwud, A. Al-Rabeeuh, et al. J R Co11Surg (Edin)
35:178-180, (June), 1990. Seven Saudi Arabian children with large multiloculated cystic hygromas were treated by aspiration or surgical excision. There was one recurrence, in which the lesion was a mixed hemangiomatous/ lymphangiomatous type. Agood cosmetic result was achieved in all patients. Computed tomography is advised to define the extent and composition of the lesions. The authors preference is for surgical excision. A staged procedure reduces trauma and blood loss.--lan K. Drainer
Complex Hemangiomas of Infants and Children. T.R. Weber, R.H. Connors, T.F. Tracy, Jr, et al. Arch Surg 125:1017-1021,
(August), 1990. Twenty-two infants and children, aged newborn to 7 years, were treated for complex, symptomatic hemangiomas. Large hemangiomas are rare, but can be life-threatening if they involve vital structures or produce thrombocytopenia or congestive heart failure. Hemangiomas were located in the liver (7), face or parotid gland (5) neck (4) extremity (2), and mediastinum, chest wallspinal cord, trachea, and retroperitoneum in one patient each. Diagnosis was suggested by physical examination in all patients and confirmed by radiological study in most patients, including computed tomography, arteriography, magnetic resonance imaging, and ultrasound. Treatment was individualized, usually progressed from less to more invasive, and included observation, prednisone therapy, arterial ligation, and resection. All children were eventually cured with minimal morbidity.-GeorgeA. Rowe
Hemangiomas of the Gastrointestinal Tract in Children. A. Can Bus&x Z Kinderchir 45:114-116, (April), 1990.
Hemangiomas of the gastrointestinal (GI) tract are unusual vascular anomalies either in children or in adults. There are significant diagnostic difficulties because of this rarity. However, hemangiomas of the GI tract may be a source of acute or chronic blood loss and anemia. The case histories of two children with severe GI bleeding due to cavernous hemangioma of the duodenum and cecum, respectively, are presented. Progressive hemorrhage from the GI tract was the indication for operative intervention in both children. Each child underwent complete resection of the hemangioma. They are both well and symptom-free 1 year following surgery. The authors draw attention to this uncommon, benign condition that has a relatively high mortality rate due to delays in diagnosis and inadequate treatment.-77romus A. Angerpointner
Although breast enlargement is a common physiological finding in both male and female neonates, this development is unusual in male infants and young children after the first year of life. The authors report a 4-year-old boy with a 2-month history of bilateral breast enlargement associated with bloody nipple discharge. There was no history of drug ingestion or trauma. Estradiol, luteinizing hormone, follicle-stimulating hormone, and B-human chorionic gonadotropin were within the normal range. Culture of the bloody discharge was negative for bacteria. The bilateral breast masses were excised through circumareolar incisions. Gross examination showed multiloculated, blood-filled cysts, microscopically identified as branching, dilated blood-filled ducts. Pronounced fibrosis in the walls of the ducts and in the periductal tissue was observed. The ductal epithelium was focally ulcerated, and vascular granulation tissue was exposed to the duct lumen. The pathological diagnosis was mammary duct ectasia. The authors conclude that open excisional biopsy of breast masses should, as a general rule, be avoided, especially in girls, because of possible compromise to the subsequent breast development. Fine-needle aspiration biopsy may permit accurate diagnosis in breast masses that are not characteristic of the normal infantile breast bud. The timing of surgical intervention for lesions that continue to bleed, cause symptoms such as pain and tenderness, or fail to involute or continue to expand in size is a matter of clinical judgment for which current experience does not provide clear guidelines.-George Holcomb, Jr
THORAX The Effect of Costal Cartilage Resection on Chest Wall Development. D. Martinez, J. Juume, T. Smith, et al. Pediatr Surg Int
5:170-173, (May), 1990. The authors report that although the resection of the costal cartilages is used in the surgical repair of anterior chest malformations, it may have a negative effect on the subsequent growth of the chest, particularly in its anteroposterior (AP) diameter. To study this effect further, the authors conducted a study based on four groups of rabbits with 10 rabbits per group: group I had complete subperichondial resection of the costal cartilages, not including the first cartilage; group II had resection of the internal three fourths of the costal cartilages; group III had total resection of the costal cartilages and a metallic strut was placed behind the lower half of the body of the sternum; group IV was the control group. Each of the groups was reviewed monthly to measure chest growth. In the groups that had total and partial cartilage resection, whether in the presence or absence of a metal strut, there was a marked difference in chest growth deficit, particularly in AP diameter. The authors conclude that costal cartilages must have a role in chest growth and suggest that current practices be evaluated in order to develop techniques that avoid the removal of these cartilages.--Prem Pun’
341
ABSTRACTS
May 1976 to March 1988. At intervals of 4 to 6 weeks the children were repeatedly injected with BLM emulsion (0.3 to 0.6 mg/kg body weight) into the cavity. In 41 patients (87%) the lymphangioma regressed. In 20 patients (43%) the tumor almost disappeared with minimal residual induration. The cystic lymphangioma showed a greater response than the cavernous lymphangioma. The total injected dose used in the cases that responded to therapy was 0.6 to 4 mgikg. In young infants with large cervicomediastinal lymphangiomas, this therapy proved dangerous because the cystic mass grew transiently following local injection with resultant airway compression. BLM is believed to cause tumor regression in cystic hygroma by its direct action on the lymphatic endothelial lining, producing an inflammatory response.-Prem fiti
,The -Kasabach-Meritt Syndrome: Treatment Wii Intermittent Pneumatic Compression. S.E. Aylett, A.F. Wdliums, D.H. Bevun, et al. Arch Dis Child 65:790-791, (July), 1990.
A 6-week-old infant with an angiomatous lesion of the leg complicated by chronic disseminated intravascular coagulation responded well to intermittent pneumatic compression of the limb. The authors believe that when possible this form of treatment should be tried before pharmacological or other interventiortD.M. Burge
Bilateral Breast Masses and Bloody Nipple Discharge in a Four-Year-Old Boy. J.D. Miller, M.D. Brownell, and A. Shuw. J
Pediatr 116:744-747, (May), 1990. Cystic Hygroma in Saudi Arabian Children. A.Y Izzidien AlSamurai, A.J. Juwud, A. Al-Rabeeuh, et al. J R Co11Surg (Edin)
35:178-180, (June), 1990. Seven Saudi Arabian children with large multiloculated cystic hygromas were treated by aspiration or surgical excision. There was one recurrence, in which the lesion was a mixed hemangiomatous/ lymphangiomatous type. Agood cosmetic result was achieved in all patients. Computed tomography is advised to define the extent and composition of the lesions. The authors preference is for surgical excision. A staged procedure reduces trauma and blood loss.--lan K. Drainer
Complex Hemangiomas of Infants and Children. T.R. Weber, R.H. Connors, T.F. Tracy, Jr, et al. Arch Surg 125:1017-1021,
(August), 1990. Twenty-two infants and children, aged newborn to 7 years, were treated for complex, symptomatic hemangiomas. Large hemangiomas are rare, but can be life-threatening if they involve vital structures or produce thrombocytopenia or congestive heart failure. Hemangiomas were located in the liver (7), face or parotid gland (5) neck (4) extremity (2), and mediastinum, chest wallspinal cord, trachea, and retroperitoneum in one patient each. Diagnosis was suggested by physical examination in all patients and confirmed by radiological study in most patients, including computed tomography, arteriography, magnetic resonance imaging, and ultrasound. Treatment was individualized, usually progressed from less to more invasive, and included observation, prednisone therapy, arterial ligation, and resection. All children were eventually cured with minimal morbidity.-GeorgeA. Rowe
Hemangiomas of the Gastrointestinal Tract in Children. A. Can Bus&x Z Kinderchir 45:114-116, (April), 1990.
Hemangiomas of the gastrointestinal (GI) tract are unusual vascular anomalies either in children or in adults. There are significant diagnostic difficulties because of this rarity. However, hemangiomas of the GI tract may be a source of acute or chronic blood loss and anemia. The case histories of two children with severe GI bleeding due to cavernous hemangioma of the duodenum and cecum, respectively, are presented. Progressive hemorrhage from the GI tract was the indication for operative intervention in both children. Each child underwent complete resection of the hemangioma. They are both well and symptom-free 1 year following surgery. The authors draw attention to this uncommon, benign condition that has a relatively high mortality rate due to delays in diagnosis and inadequate treatment.-77romus A. Angerpointner
Although breast enlargement is a common physiological finding in both male and female neonates, this development is unusual in male infants and young children after the first year of life. The authors report a 4-year-old boy with a 2-month history of bilateral breast enlargement associated with bloody nipple discharge. There was no history of drug ingestion or trauma. Estradiol, luteinizing hormone, follicle-stimulating hormone, and B-human chorionic gonadotropin were within the normal range. Culture of the bloody discharge was negative for bacteria. The bilateral breast masses were excised through circumareolar incisions. Gross examination showed multiloculated, blood-filled cysts, microscopically identified as branching, dilated blood-filled ducts. Pronounced fibrosis in the walls of the ducts and in the periductal tissue was observed. The ductal epithelium was focally ulcerated, and vascular granulation tissue was exposed to the duct lumen. The pathological diagnosis was mammary duct ectasia. The authors conclude that open excisional biopsy of breast masses should, as a general rule, be avoided, especially in girls, because of possible compromise to the subsequent breast development. Fine-needle aspiration biopsy may permit accurate diagnosis in breast masses that are not characteristic of the normal infantile breast bud. The timing of surgical intervention for lesions that continue to bleed, cause symptoms such as pain and tenderness, or fail to involute or continue to expand in size is a matter of clinical judgment for which current experience does not provide clear guidelines.-George Holcomb, Jr
THORAX The Effect of Costal Cartilage Resection on Chest Wall Development. D. Martinez, J. Juume, T. Smith, et al. Pediatr Surg Int
5:170-173, (May), 1990. The authors report that although the resection of the costal cartilages is used in the surgical repair of anterior chest malformations, it may have a negative effect on the subsequent growth of the chest, particularly in its anteroposterior (AP) diameter. To study this effect further, the authors conducted a study based on four groups of rabbits with 10 rabbits per group: group I had complete subperichondial resection of the costal cartilages, not including the first cartilage; group II had resection of the internal three fourths of the costal cartilages; group III had total resection of the costal cartilages and a metallic strut was placed behind the lower half of the body of the sternum; group IV was the control group. Each of the groups was reviewed monthly to measure chest growth. In the groups that had total and partial cartilage resection, whether in the presence or absence of a metal strut, there was a marked difference in chest growth deficit, particularly in AP diameter. The authors conclude that costal cartilages must have a role in chest growth and suggest that current practices be evaluated in order to develop techniques that avoid the removal of these cartilages.--Prem Pun’