Acute isolated sphenoid sinusitis in a 4-year-old child: a rare case with an atypical presentation (Views : 8158 times)
Written by:
Aikaterini Monti, Maria Farini, Constantine Katsanoulas
Case reports
Abstract
Acute, isolated, sphenoid sinusitis is unusual, especially in children. Its incidence is about 2.7% of all sinus infections and is even rarer in children under the age of six years. It is frequently misdiagnosed because of its atypical presentation and it can cause serious complications because of the sphenoid sinus' anatomical relations with many intracranial structures.
We report a case of a previously healthy 4 year old boy, whose sole symptom at presentation was drowsiness. Physical examination and initial laboratory investigations were normal. Diagnosis was made after computed tomography of the head revealed left sphenoiditis. Although under treatment, the child manifested meningism during the first day of hospitalization, which subsided the next day. He was treated with ceftriaxone plus clindamycin and had a good outcome, without complications or neurological sequelae.
Key words: sphenoiditis, intracranial complications, children
Anthracycline-related cardiotoxicity: risk factors and therapeutic options in childhood cancers (Views : 8637 times)
Written by:
Nadia Puma, Antonio Ruggiero, Vita Ridola, Palma Maurizi, Ilaria Lazzareschi, Giorgio Attinà , Stefano Mastrangelo, Gabriella de Rosa, Riccardo Riccardi
Review articles
Abstract
Anthracyclines play an important role in chemotherapeutic regimens for a wide spectrum of childhood tumors, but they can cause cytotoxic damage to cardiac cells, especially in combination with radiotherapy. Furthermore, cardiotoxicity increases with the cumulative dose and may lead to congestive heart failure and cardiomyopathy. Other factors, including age, pre-existing cardiac disease, length of follow-up, gender, route of administration, concomitant exposure to some chemotherapeutic drugs, trisomy 21 and black race, play a role in increasing the risk of cardiac dysfunction. The prevention of anthracycline-induced cardiotoxicity is mandatory as children are expected to survive for decades after being cured of their cancer. The purpose of this work is to point out the major risk factors of cardiotoxicity in children and to summarize some strategies to limit or prevent this complication and to treat the development of acute heart failure.
Keywords: anthracycline, cardiotoxicity, childhood cancer, risk factors, prevention, acute heart failure
Difficult airway management in the emergency room using an airway scope (Views : 7112 times)
Written by:
Masatomo Kitamura, Hiroshi Dohgomori, Kazufumi Okamoto
Case reports
Abstract
In the emergency room, some cases need adequate airway management. We present a patient whom we intubated using a new device. This device might be an option in airway management but some considerations should also be taken into account.
Key words: airway management, sco-pe, secretions, bleeding
Emerging considerations in the reversal of neuromuscular blockade and residual block (Views : 11933 times)
Written by:
Wayne T. Nicholson, Juraj Sprung, Christopher J. Jankowski
Review articles
Abstract
Incomplete recovery following reversal of neuromuscular blockade can present as a clinical problem in surgical patients. Emerging pharmacologic solutions may prevent such adverse outcomes in the future. We briefly review two methods of pharmacologic reversal of neuromuscular blockade. Both methods of reversal are effective. However the early studies of the new compound, sugammadex has been shown to achieve a more rapid, stable reversal of steroidal based neuromuscular blocking agents compared to neostigmine. Due to the novel mechanism of action of this agent, sugammadex has been demonstrated to be effective even when administered during profound neuromuscular block, without evidence of recurarization.
Key words: sugammadex, Org 25969, cyclodextrin, rocuronium, cholinesterase inhibitor
Inpatient management of alcohol withdrawal: a practical approach (Views : 28478 times)
Abstract
Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will be severe enough to require pharmacologic intervention. The total cost to the United States economy from alcohol abuse was estimated to be $185 billion for 1998. This review attempts to put forth a practical and evidence based approach towards the inpatient management of alcohol withdrawal. Various agents and their pharmacology are described. Strength of evidence regards to efficacy and shorter inpatient stays is examined.
Key words: substance abuse, pharmacology, addiction, pathophysiology, critical care
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