A Case of Congenital Nasal Pyriform Aperture Stenosis

The cause of congenital nasal pyriform aperture stenosis is unclear. The development of the facial skeleton occurs between the fifth and the eighth week of gestation. It is at this stage that the stenosis occurs due to overgrowth of the ossification of the maxilla. Infants are obligate nasal breathers. Incomplete and milder forms of nasal airway obstruction may be present with mild respiratory distress, cyanosis, respiratory failure, asphyxia and eventual death. The diagnosis is done by CT, which demonstrates marked narrowing of the nasal inlet. Mild stenosis can be managed conservatively with humidification and topical decongestants but if conservative treatment fails, surgical intervention is candidate. We report a case of congenital nasal pyriform aperture stenosis. The patient, a 2-day old male neonate, had cyanosis during feeding and noisy breathing relieved by crying. His symptoms and signs were improved with surgical intervention without development disturbances.

A Case of Improved Adrenal Insufficiency with Corticostreoid Treatment, Secondary to Adrenal Hemorrhage

The large size and vascularity of the neonatal adrenal glands are vulnerable to traumatic and asphyxial injuries. This condition varies in presentation, which the most common is an abdominal mass alone or mass with jaundice and anemia. Some infants show signs of adrenal insufficiency. Abdomial ultrasonogram is the most valuable diagnostic tool. To result in adrenal insuffiency, hemorrhage must involve both adrenals and at least 90% of the adrenocortical tissue must be destroyed. To affect infant may show signs of hypovolemic shock, electrolyte imbalance and metabolic acidosis. Treatment for adrenal insufficiency must be immediate and vigorous, and consists of intravenous glucose, fluid, and electolyte replacement. And conservative treatment failure is candidate for steroid replacement. We experienced a case of bilateral hemorrhage with adrenal insufficiency, who improved with hydrocortisone.