Perioperative care following complex laryngotracheal reconstruction in infants and children

Laryngotracheal reconstruction [LTR] involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent [two-stage LTR] or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time [single-stage LTR]. With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway

Congenital neuroblastoma with liver metastasis presenting with Hashimoto Pritzker disease.

A two-month-old female child presented with discrete skin-colored papules on the forehead and scalp. She was earlier diagnosed to have neuroblastoma of the adrenal gland which had metastasized to the liver. Histological sections of the skin lesion showed a nodule composed of sheets of cells with abundant eosinophilic cytoplasm and an occasional grooving of the nucleus. These cells were CD 68 positive. Eosinophilic abscesses were seen in between the neoplastic cells.

Coccidioidomicosis. Presentacion de un caso. Revision de la literatura. / Coccidioidomycosis. Report of a case. Review of the literature

Debido a la poca cantidad de casos publicados en la Argentina, se decide revisar la literatura y presentar el caso de un paciente de 16 anos, portador de una coccidioidomicosis diseminada. Se comenzo la terapia con anfotericina B, con escasa mejoria, razon por la cual se decidio el uso de una nueva droga antifungica ketoconazol, y ademas un coadyuvante terapeutico de escaso uso en nuestro medio: el Factor de Transferencia. Se realiza un resumen de la epidemiologia en nuestro pais y de las distintas modalidades terapeuticas hasta este momento