Congenital cutaneous candidiasis in a premature neonate: A case report

Congenital cutaneous candidiasis (CCC) is a rare and usually benign disorder that develops within the first week of life. It predominantly presents with diffuse maculopapular and papulopustular erythematous desquamating patches. We report a preterm neonate with respiratory distress syndrome and skin diffuse maculopapular lesions at birth. Candida albicans was isolated from skin and gastrointestinal fluid culture; she underwent medical treatment with topical and systemic antifungal with clinical improvement and skin lesions resolution.     

Use of the laryngeal mask prior to definitive intubation in a difficult airway: A case report

The laryngeal mask, a relatively new airway adjunct, consists of a large tube with an inflatable shallow mask at its distal end which forms a seal around the glottic opening. We describe a case of a difficult intubation in the emergency department of an obese patient with microagnathia, a short bull neck, and a nasopharyngeal hemorrhage in which a laryngeal mask was used to temporarily manage the airway prior to definitive intubation. In difficult airway cases where it is impossible to ventilate the patient by face mask or intubate the trachea, ventilation with the laryngeal mask may be an alternative to transtracheal jet ventilation or cricothyrotomy. The laryngeal mask may be useful in managing the difficult airway provided that the risks of an inadequate seal, obstruction, coughing and laryngospasm, and lack of protection from aspiration are recognized.     

Sirolimus treatment for neonate with blue rubber bleb nevus syndrome: A case report

BACKGROUNDBlue rubber bleb naevus syndrome (BRBNS) is a rare disease that usually presents with multiple venous malformations in the skin and gastrointestinal tract. Lesions located in the gastrointestinal tract always result in chronic gastrointestinal bleeding and severe anemia. The successful management of BRBNS with sirolimus had been reported in many institutions, due to its impact on signaling pathways of angiogenesis. However, the experience in treatment of neonates with BRBNS was limited.CASE SUMMARYA 38-day-old premature female infant born with multiple skin lesions, presented to our center complaining of severe anemia and hematochezia. Laboratory examination demonstrated that hemoglobin was 5.3 g/dL and contrast-enhanced abdominal computed tomography showed multiple low-density space-occupying lesions in the right lobe of the liver. She was diagnosed as having BRBNS based on typical clinical and examination findings. The patient was treated by transfusions twice and hemostatic drugs but symptoms of anemia were difficult to alleviate. A review of BRBNS case reports found that patients had been successfully treated with sirolimus. Then the patient was treated with sirolimus at an average dose of 0.95 mg/m²/d with a target drug level of 10-15 ng/mL. During 28 mo of treatment, the lesion was reduced, hemoglobin returned to normal, and there were no adverse drug reactions.CONCLUSIONThis case highlights the dosing regimen and plasma concentration in neonates, for the current common empiric dose is high.     

Use of the intubating laryngeal mask airway in pre-hospital care: a case report.

In trauma management, the importance of early and effective control of the airway is acknowledged universally. Attention to the airway is particularly vital when a casualty has sustained serious head or facial injuries. A cuffed tracheal tube has generally been regarded as the airway adjunct of choice in such cases. However, the attempted insertion of a tracheal tube under direct laryngoscopy is associated with a number of practical problems in pre-hospital trauma care. A case is described in which the intubating laryngeal mask airway (ILMA or LMA-Fastrach) was used successfully in the pre-hospital setting to secure the airway of a patient who had sustained serious head and facial injuries in a road traffic collision. The indications for the use of the ILMA in pre-hospital care are discussed.     

Unexpected difficult airway due to an undiagnosed congenital lingual thyroglossal duct cyst in a neonate without stridor: A case report

Lingual thyroglossal duct cysts can be a rare cause of feeding difficulties in infants. Here, we describe a case of an infant with vomiting and feeding difficulty diagnosed with Hirschsprung''s disease. However, she developed an unexpected difficult airway during anesthesia induction due to an undiagnosed lingual thyroglossal duct cyst.     

Childhood airway manifestations of lymphangioma: a case report

Lymphangioma is a congenital malformation of the lymphatic system, often involving areas of the head and neck. The involved structures may include enlarged tongue and lips, swelling of the floor of the mouth, and direct involvement of the upper respiratory tract. The definitive treatment for lymphangioma is surgery, often during the first years of life. Despite surgical removal, lymphangioma may persist. Anesthetic concerns include bleeding, difficulty visualizing the airway, extrinsic and intrinsic pressure on the airway causing distortion, and enlarged upper respiratory structures, including the lips, tongue, and epiglottis. This is a case report of a 9-year-old patient with lymphangioma who had impacted teeth and a suspected odontogenic cyst. There seems to be little information on the optimal anesthetic management for this age group. The challenges with airway management, including bleeding, laryngospasm, and a difficult intubation, are outlined. Awareness of potential airway involvement and possible complications is necessary to provide a safe anesthetic to a patient with lymphangioma. A review of the literature, airway management techniques, and current airway equipment will be discussed.     

妊娠继发嗜血细胞综合征1例报告

嗜血细胞综合征又称嗜血细胞淋巴组织细胞增 多 症( hemophagocytic lymphohistiocytosis , HLH) ,是一组异质性疾病,其特征是 T 细胞、巨噬细胞和组织细胞激活失控导致的高炎症状态,并伴有细胞因子过度产生.HL H是成人最严重的临床疾病之一,病死率为40％,年龄较大和血小板减少是患...     

Wellens' syndrome: a case report

The pattern of clinical findings and electrocardiography (ECG) changes known as Wellens' syndrome is associated with significant stenosis of the proximal left anterior descending coronary artery. Cases can be classified according to the ECG pattern into type 1 (biphasic T waves) or type 2 (deeply inverted T waves, especially in leads V2 and V3). We present here an unusual case of Wellens' syndrome in which the ECG pattern changed from type 2 to type 1 during observation, and in which the coronary lesion was in the middle rather than the proximal part of the left anterior descending artery.     

Isaacs综合征

目的探讨Isaacs综合征的临床特点及发病机制。方法报道1例Isaacs综合征患者。结果和结论Isaacs综合征以全身肌肉均可累及的持续性自发性肌肉痉挛、强直、僵硬和放松困难，休息和睡眠时症状不消失为特点，表现为肌纤维颤搐及肌束颤动。Isaacs综合征是一种针对电压门控钾离子通道抗体介导的自身免疫性疾病。     

Boerhaave syndrome: a case report

Spontaneous rupture of the esophagus (Boerhaave syndrome) is a rare condition that has many possible causes, among them violent retching. The definitive treatment for the ruptured esophagus is surgical repair. Potential complications include infection in many forms, pleural effusion, and pneumothorax. This case study presents an overview of the syndrome, including morbidity, mortality, and treatment. The patient in this case is a 61-year-old man who had 1 episode of violent vomiting resulting in a perforation of the esophagus with communication into the right chest cavity. The patient underwent surgical repair of the rupture with placement of a feeding tube and creation of an esophageal diversion to promote healing of the surgical site.     

无脾综合征一例报告

病例:患儿,女,2008年12月3日出生。家属发现患儿出生后即有口唇及指(趾)端青紫,哭闹时尤为明显,足掌及手掌皮肤也可见青紫样改变,后在江苏省无锡市儿童医院行心脏彩超提示:先天性心脏病[单心室(右心室)、单心房、     

Use of the Cook airway exchange catheter in "bridging" the potentially difficult extubation: a case report

The Cook airway exchange catheter (CAEC) is a long, flexible, hollow tube designed to facilitate the exchange of an in situ endotracheal tube. The primary use of the CAEC had been as a tube exchanger in the critical care setting. The unique characteristics of this device led us to use and report the use of the CAEC in the anesthetic management of a morbidly obese patient with significant tracheal deviation secondary to an enlarged thyroid gland. The potential strategies that we considered in this case were (1) extubating the patient in a deep plane of anesthesia; (2) extubating conventionally, with the patient awake; and (3) extubating the patient awake, with a "bridge" to full extubation. After carefully weighing the options, we decided to use the CAEC as a tool that would allow us, if the patient did well, to go forth to full extubation, or, if the patient's condition deteriorated, to return to reintubation, or even oxygen insufflation, which would create a "bridge" to extubation.     

Locked-in syndrome: report of a case

Locked-in syndrome is a unique clinical condition associated with ventral pontine lesions. The locked-in state is characterized by tetraplegia and mutism with maintenance of alertness as well as vertical eye movements and eye blinking, by which communication is possible. A case of locked-in syndrome in a 58-year-old man that demonstrates the clinical manifestations of the disorder is reported. Unless the physician is familiar with the signs and symptoms of the locked-in syndrome, the diagnosis may be missed and the patient may erroneously be considered comatose.     

Severe hyperbilirubinemia in a neonate with hereditary spherocytosis due to a de novo ankyrin mutation: A case report

BACKGROUNDHereditary spherocytosis (HS) is a common type of hemolytic anemia caused by a red cell membrane disorder. HS type 1 (HS1) is mostly caused by mutations in ankyrin (ANK1). Newborns with HS1 usually only exhibit anemia and mild jaundice. We herein report a case of HS1 and discuss its clinical characteristics.CASE SUMMARYA 2-d-old male full-term newborn was admitted to our hospital with severe, intractable neonatal jaundice. Laboratory investigations showed hemolytic anemia and hyperbilirubinemia and excluded immune-mediated hemolysis. The patient underwent two exchange transfusions and one plasmapheresis resulting in significantly reduced serum bilirubin. Hematologic analyses and genomic DNA sequencing studies were performed. The trio clinical exome sequencing revealed a de novo null heterozygous mutation in the patient''s ANK1 gene: c.841C > T(p.Arg281Ter). This mutation results in the premature termination of the ANK1 protein.CONCLUSIONOur case demonstrates that genetic analysis can be an essential method for diagnosing HS when a newborn has severe hyperbilirubinemia.     

肠外营养致再喂养综合征一例

再喂养综合征是营养不良患者接受营养支持的常见并发症，尤其是数月内体质量下降超过10%的患者。患者常表现为低血压、呼吸急促、胸闷、意识障碍等临床表现，需要与其他疾病鉴别。当患者发生再喂养综合征时，去除诱因、纠正电解质紊乱、及时对心肺功能进行支持、调整营养治疗方案等能够获得较好的治疗效果。本例就1例营养不良患者接受营养支持发生再喂养综合征进行有相应的积极对症支持治疗进行介绍。     

Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long term placement of a laryngeal mask airway

The severity of airway obstruction varies in infants with Pierre-Robin syndrome (PRS). Some have severe upper airway obstruction that results in respiratory failure and even death. We report a case of neonate with isolated PRS who had a severe airway obstruction and respiratory failure after birth. She had complications of bilateral pneumothorax, subcutaneous emphysema, and hypoxaemia due to difficult tracheal intubation. Respiratory failure recurred immediately after extubation; she was resuscitated by inserting a laryngeal mask airway. The laryngeal mask airway was left inserted for 6 days. It was successful in this patient and eliminated the need for invasive surgical procedures. In conclusion, the relatively long term use of a laryngeal mask airway, which has not been reported before, could be an alternative therapy for patients with PRS with airway obstruction.