Axillary brachial plexus block with patient controlled analgesia for complex regional pain syndrome type I: a case report

BACKGROUND AND OBJECTIVES: Brachial plexus block (BPB) has been cited as a treatment modality for complex regional pain syndrome type I (CRPS I) of the upper limb. However, there are no reports using axillary BPB with patient controlled analgesia (PCA) for the treatment of CRPS I. This report is based on the retrospective observations of the outcome and effects of axillary BPB with PCA in a patient with CRPS I. CASE REPORT: A 32-year-old man suffered from CRPS I of the right upper limb after surgical release of carpal tunnel syndrome of the right hand. Symptoms and signs over the right hand were alleviated under rehabilitation and conventional pharmacological management, but severe painful swelling of the right wrist persisted. Axillary BPB with PCA was performed on the 32nd postoperative day, which soon resulted in significant reduction of pain with gradual improvement of function of the right wrist. CONCLUSIONS: Axillary BPB with PCA may provide patients with CRPS I of the upper limb a feasible and effective treatment. .     

Airway management of patient with Smith-Lemli-Opitz syndrome for gastric surgery: case report

A case of term, 5-day-old boy, with low birth weight of 2.4 kg, with Smith-Lemli-Opitz syndrome (SLOS) who was first scheduled for gastrostomy tube placement and later for pylorotomy, is discussed. General appearance of face and small chin showed possible difficulties during intubation, which are well known from the literature. Anesthetic plan included possibility of fiberoptic intubation. Mask induction and ventilation had been successful but attempts to intubate patient using fiberoptic bronchoscope had not been feasible and both procedures had been performed using laryngeal mask airway (LMA#1) with spontaneous ventilation without complications. In this case, we are showing the ability to secure the airway in a small infant with SLOS using LMA and the possibility to perform successfully surgery on the gastrointestinal tract.     

Survival of an aortic trauma patient with Ehlers-Danlos syndrome type IV: a case report

Ehlers-Danlos syndrome type IV is the most lethal variant of that illness and is associated with fatal large vessel arterial hemorrhages. The literature reports only two survivors of elective aortic surgery and two survivors of spontaneous aortic hemorrhage. This article presents a 14-year-old boy who had aortic and vena cava blunt trauma and survived.     

Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review

Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was reffered to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned.     

Anesthetic management of a patient with Freeman-Sheldon syndrome: case report

The Freeman-Sheldon syndrome (FSS) is a rare congenital myopathy and dysplasia. The musculoskeletal and soft-tissue manifestations of FSS often require orthopedic and plastic reconstructive surgery. We report a case of a 7-year-old girl with FSS operated for lower limb malformation during spinal anesthesia.     

Airway management in a patient with Goldenhar syndrome: a case report

Children with Goldenhar syndrome are known to present airway management challenges for the anesthesiologist. We present the case of a 10-year-old child with Goldenhar syndrome, in whom a flexible Laryngeal Mask Airway (Intavent Orthofix, Ltd, Maidenhead, UK) was successfully used for eye surgery.     

Anesthetic management of a patient with SAPHO syndrome: a case report

We report a case of SAPHO syndrome accompanying progressive osteoarthritis. In this 43-year-old woman, difficult intubation was expected due to unilateral hyperostosis of the mandible and spinal degeneration. As far as we know, anesthetic management of this disease has not been reported. Therefore we made an anesthetic plan based on spinal degenerative disease which was considered to have similar problems of intubation and the case was managed without problems. As this syndrome is a progressive disorder, careful perioperative management is required each time.     

Splenic malformation in a patient with Klippel-Trenaunay syndrome: a case report

A 22-year-old woman with a diagnosis of Klippel-Trenaunay syndrome presented with pain in the left hypochondrium and vomiting. Investigations revealed a huge splenomegaly with multiple hypodense lesions and irregular, linearly enhanced areas. She underwent splenectomy and had good postoperative recovery. Histopathology showed hemangioma/lymphangioma of the spleen.     

Metachronous ileal cancer after surgery for ascending colon cancer in a patient with Lynch syndrome: A case report

Introduction and importanceColorectal surveillance via colonoscopy in patients with Lynch syndrome reduces the mortality of colorectal cancer. On the other hand, it is unclear whether surveillance for other malignancies, including small bowel cancer, is beneficial. We report a patient with Lynch syndrome who developed ileal cancer after surgery for ascending colon cancer.Case presentationA 47-year-old man visited our hospital for a check-up for positive fecal occult blood. He was diagnosed with ascending colon cancer and met the clinical criteria for the diagnosis of Lynch syndrome based on his past and family history. The Bethesda markers demonstrated high-frequent microsatellite instability. Laparoscopy-assisted right hemicolectomy was performed. He received follow-up colonoscopy the next year, which revealed ileal cancer near the anastomosis. He underwent resection of the second cancer via a laparoscopic approach, and has been free from recurrence for five years.Clinical DiscussionSmall bowel cancer has a dismal prognosis because a high percentage of patients were diagnosed at advanced stages. The diagnosis of metachronous ileal cancer by the first follow-up colonoscopy after surgery for ascending colon cancer offered a long disease-free survival in our patient.ConclusionThe clinical course suggested the importance of inspecting the small bowel in Lynch syndrome patients, especially when colorectal cancer is diagnosed.     

Management of a young patient with combined autoimmunity: Evans syndrome: a case report.

Management of patients with autoimmune disease can present a challenge for clinicians. Combinations of autoimmune disorders carry a worse prognosis and are often difficult to diagnose. Evans syndrome is a rare hematologic disorder characterized by the concurrent presentation of autoimmune hemolytic anemia and immune thrombocytopenic purpura. This paper reports the first case of the dental management of a young patient with Evans, discusses the current literature surrounding the differential diagnosis and treatment of Evans syndrome, and suggests a guide for the oral medicine, pediatric dentist, or hospital dental clinician when treating these patients.     

Spinal anesthesia for a patient with type I sialidosis undergoing abdominal surgery

Type I and II sialidosis are autosomal recessively inherited glycoprotein storage disorders. Until now, there has been no published reports of patients with these conditions requiring anesthesia. We present the case of a 31-year-old male afflicted with type I sialidosis who underwent a surgical jejunostomy. Regional (spinal) anesthesia was carried out uneventfully. We discuss the anesthetic challenges posed by patients with type I and II sialidosis. Airway assessment and management is particularly crucial.     

Open heart surgery of a patient with Basedow's disease: a case report

A case of open heart surgery of Basedow's disease was presented. A 46-year-old female was admitted for mitral regurgitation with heart failure. She suffered from Basedow's disease ten years ago, and was treated with MMI. With this treatment, her thyroid function became normal and did well over the last four years. When open heart surgery (MVR) was performed, examination of her thyroid gland revealed mild hypothyroidism, and the operation could be performed without any thyroidal trouble. We conclude, in case of heart disease with Basedow's disease, the operation can be performed without any thyroidal trouble if the thyroid function is controlled well to euthyroid for a long term. Euthyroid condition lasted 4 years in this case.     

A case of testicular tumor in a patient with Down's syndrome: a case report

A 40-year-old man with Down's syndrome was admitted to our hospital for complaint of painless, swollen right scrotum. Computed tomography revealed a right testicular tumor and mass of iliac fossa. Right high orchiectomy and extirpation of mass were performed. Histological diagnosis of right testicular tumor was seminoma and the mass was an external iliac lymph node metastasis of seminoma. After operation, radiation therapy was performed.     

Reiter's syndrome in a black patient. A case report

Reiter's syndrome is very rare in blacks in southern Africa. The occurrence, with florid symptoms and signs, in a black patient with the HLA B27 antigen is reported.     

Dorsal radiocarpal dislocation in a patient with Goldenhar syndrome: case report

Background

Fracture–dislocations of the carpus are rare, generally occurring after high-energy trauma. Goldenhar syndrome is among a group of genetic abnormalities associated with radial limb defects. We present a case of a dorsal radiocarpal dislocation in a patient with Goldenhar syndrome after a low-energy fall. To our knowledge, there has been no previous report of radiocarpal dislocation in the setting of Goldenhar syndrome.

Methods

This patient with Goldenhar syndrome had a dorsal radiocarpal dislocation in the setting of an absent scaphoid and dysplastic distal radius. A computed tomography scan, recognized as a useful modality to evaluate the wrist and scaphoid, was used to rule out any other osseous trauma or avulsion fractures.

Results

Closed reduction and 6 weeks of immobilization resulted in a successful treatment.

Conclusions

The incidence of radiocarpal dislocations in patients with Goldenhar syndrome and the appropriate long-term treatment for patients with Goldenhar syndrome with radiocarpal dislocations require further investigation.