American journal of perinatology
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Review Case Reports
Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate.
Percutaneously placed central venous lines have become an intricate part of the medical management of the very low birth weight infant. It is critically important that health care providers involved with the placement of these catheters be familiar with the possible subtle sites for catheter misplacement. We present two case reports of inadvertent ascending lumbar vein catheterization with a percutaneously placed Silastic catheter where the saphenous vein was used for venous access. The literature is reviewed with regard to the history of use, indications, placement, and associated complications of these catheters.
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Review Case Reports
Surgery for pancreatic tumors during pregnancy: a case report and review of the literature.
Seven cases of surgery of pancreatic tumors during pregnancy have been reported in the literature. Six of the cases resulted in live term births. The patient discussed herein, a 37-year-old para 2-0-0-2 white female, had surgery for the removal of a pancreatic mass at 20 2/7 weeks' gestation. ⋯ Three days after admission, the fetus was noted to have poor biophysical testing and a caesarean delivery was performed. The infant was found to have a large intracerebral hemorrhage, which most likely occurred antenatally, and life support was discontinued shortly after birth. We conclude from this that surgery for a pancreatic mass in pregnancy should be approached cautiously, and the risk to both the mother and fetus should be considered.
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The survival rate of very low birthweight infants (weighing less than 1500 gm) has dramatically increased over the past two decades. Consequently, high-tech intensive care is offered to an increasing number of infants with borderline viability, previously considered as miscarriages. We reviewed the most recent literature on the results of intensive care used in the subgroup of extremely low birthweight infants, weighting less than 750 gm or 800 gm. ⋯ The available data show that virtually for every "healthy" surviving extremely low birthweight infant there is also at least one surviving child who is moderately to severely handicapped. The overall consequences and implications of high-tech care of these borderline viability infants, once considered as nonviable, are not necessarily improved over those of the former, less aggressive, approach. Since these results have grave consequences for the involved families and society, we urgently need to involve these parties more actively in decision making.