Endovascular treatment of traumatic carotid cavernous fistula with trapping technique.

Conventional endovascular treatment for carotid cavernous fistula (CCF) involves a direct delivery of either coils, detachable balloon or both to the fistula with end point of CCF resolution and carotid artery preservation. But in few cases with severe laceration of carotid artery, the feasible endovascular technique applicable is by blocking the filling of fistula from cerebral circulation. This method known as trapping technique which implicates carotid artery occlusion, was performed in our present case with good result.

The immediate postoperative complications and outcomes of kidney transplantation in children.

Objective: To evaluate the preoperative status of children admitted for renal transplantation, and their supportive care, complications and outcomes during the immediate postoperative period in the intensive care unit (ICU). Design: Prospective observational study Setting: ICU, Teaching Hospital, Peradeniya (THP) Patients: Children who underwent renal transplantation at THP from July 2004 to October 2008 Measurements: Data regarding preoperative status and postoperative ICU complications was recorded in an Excel work sheet. Results: Of 28 recipients of kidney transplantation at this centre during the specified period, 19 were male with a mean age of 9.6 (range 2-16) years. The commonest cause of end stage renal disease (ESRD) was obstructive uropathy (28.6%). All received live donor transplantation. The mean (±SD) pre-transplant haemoglobin (Hb) and blood urea were 9.28± 2.42g/dl and 2l.97±10.17mmol/L respectively. Of the patients78.5% did not meet the minimum satisfactory Hb levels. Pre-operatively, 68.4% of the patients were hypertensive in spite of 18 (64.3%) of them being on regular antihypertensive treatment. One patient (3.6%) had haemodialysis (HD), 8 (28.6%) had peritoneal dialysis (PD) and 2 (7.1%) had had both prior to transplant. Seventeen (60.7%) were pre-emptive transplants. The mean (± SD) creatinine and creatinine clearance were 460.91±261.55 micromol/L and 22.89±25.98 ml/min/1.73m2 respectively. Mean (±SD) duration of mechanical ventilation during the immediate postoperative period was 4.88±2.80 days while the mean (±SD) ICU stay was 6.44 ± 3.35 days. Postoperative ICU complications occurred in 75% of transplant recipients. Hypertension (46%), metabolic complications such as acidosis, hyperglycaemia, hypocalcaemia, hyponatraemia (32%), heart failure (29%), convulsions (25%) and sepsis (25%) were the more common. Post-transplant creatinine and creatinine clearance were 60.69±31.19 micromol/L and 114±48 ml/min/1.73m2 respectively. No deaths or lost grafts were reported during the study period. Conclusion: Kidney transplantation in the current context warrants a significant duration of ICU therapy postoperatively in children.

Idiopathic purpura fulminans in dengue hemorrhagic fever.

Purpura fulminans is a rapidly progressive thrombotic disease that has been described during both severe bacterial and viral infections. Disseminated intravascular coagulation (DIC), antiphospholipid antibodies and acquired or congenital C and S protein deficiency are thought to play a role in its pathogenesis. Here we report the case of a 4-year-old girl who developed gangrene of all her fingers and toes following dengue shock syndrome complicated by DIC and also discuss its management.

Manifestaciones dermátologicas en la enfermedad meningocóccica aguda / Dermatological manifestations in the acute meningococcica disease

Algunas infecciones ocasionadas por microorganismos gramnegativos, presentan manifestaciones cutáneas características que son ocasionadas por la invasión microbiana directa de la piel o los tejidos subcutáneos. Las lesiones cutáneas de la septicemia meningococcica aparecen en etapas tempranas de la enfermedad y pueden proporcionar indicios para permitir un diagnóstico precoz. Los eventos sistémicos que acompañan al cuadro clínico como la trombocitopenia y la coagulación intravascular diseminada contribuyen con las manifestaciones hemorrágicas cutáneas. Presentamos el caso de un hombre de 31 años con cuadro clínico de rápida evolución con compromiso importante del estado general y síntomas neurológicos, asociado a la aparición de púrpura cutánea