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Pneumopericardium is an unusual complication of mediastinal emphysema in infants. It is rarely recognized clinically, yet the symptoms and signs are characteristic, and the prompt relief of the gas tamponade by pericordotomy is lifesaving. Six infants with this condition have been observed in the past 2 years, and all were receiving positive pressure mechanical respiration. Two were recognized clinically, and prompt surgical measures were instituted with success.It is the purpose of this paper to call attention to this condition, discuss the etiology, the signs and symptoms, surgical relief, and prevention. Report of CasesCase 1.\p=m-\Awhite boy, 3\m=1/2\months old was admitted because of progressive enlargement of the head, and studies revealed noncommunicating hydrocephalus. A ventriculoatrial operation was planned, and as the ankle phlebotomy was being performed prior to surgery, under endotracheal anesthesia, the heart sounds became progressively distant. The pulse was quenched, and cardiac arrest occurred. No subcutaneous emphysema was noted. A left thoracotomy was quickly done, and a glistening membrane bulged into the chest wound. There was no pneumothorax, but mediastinal emphysema was present. The distended membrane was identified as markedly distended pericardium filled with gas, which escaped under pressure when this sac was incised. The heart appeared small in its large cavity, and no beat was noted. Manual stimulation reestablished sinus rhythm in a few seconds. The duration of the cardiac arrest was 3 minutes. The pericardium was closed, except for a 2.0 cm. window, and the left chest was closed under water seal. Recovery was without incident, and 12 days later, the ventriculoatrial shunt was carried out without further complication.The child was last seen at one year of age, with the shunt functioning well, and the child starting to stand by himself.

A SERIES of studies has been undertaken to determine the effects of radioactive tantalum (Ta 182) in the central nervous system of experimental animals under normal and pathological conditions. As a preliminary phase of this study, an attempt has been made to define the tissue reactions to powdered non-radioactive tantalum in various sites in the brain and spinal cord and to evaluate the differences in tissue behavior resulting from variations in the size of the tantalum particles.Tantalum was introduced into surgery by Burke 2 in 1940 and has since been put to a variety of uses in that field. It has been successfully employed as plates, clips, foil, wire, gauze and powder. Although experimental studies have usually indicated that little reaction is elicited by tantalum in tissues, some observations have been at variance, notably those of Delarue, Linell and McKenzie. 4 They placed tantalum foil in the subarachnoid space over the traumatized cerebral cortex of dogs and reported thickening of the dura, encapsulation of the tantalum, thickening of the leptomeninges and adhesions to the traumatized cortex. Cone, Pudenz and Odom, 8 and Pudenz and Odom 6 found, on the other hand, that tantalum placed in the subdural space over the traumatized cerebral cortex of cats became encapsulated with a thin membrane, the inner layer of which was formed by the slightly thickened arachnoid. Robertson and Peacher 7 used tantalum foil over the traumatized cerebral cortex of human patients. At reexploration, they found that the tantalum had been encapsulated by a thin fibrous membrane, which was loosely adherent to the dura and to the arachnoid, but that no adhesions were present between the foil and the underlying cerebral cortex. Graf and Hamby 5 employed finely divided tantalum as a contrast medium for demonstration of sinuses resulting from intervertebral disc protrusions. In one of their patients reexploration was carried out. The only reaction found was the presence of a few multinucleated cells near the tantalum particles.These reports have been selected because they indicate that certain physical forms of tantalum elicit a considerable response from the tissues about

The authors have developed a technique of occluding intracranial aneurysms by the direct injection of a tissue adhesive. Previous work in our laboratory had revealed the unusual intravascular characteristics and physiological properties of isobutyl-2-cyanoacrylate (IBC). These findings had indicated the feasibility of utilizing IBC in the treatment of intracranial aneurysms by its direct injection. We have now treated twenty patients by this method. Eighteen aneurysms were injected during open craniotomy and two were treated by closed stereotactic injection utilizing electronic radiography. Follow-up data, ranging from 1 to 6 years after operation, are available on these patients. Sixteen patients (80% of the series) have had good to excellent results. Our experience and the application of this technique as a potential tool in the treatment of intracranial aneurysms are discussed.