Severe fibrosing mediastinitis with atypical presentation: Effective control with novel therapeutic approach.

Fibrosing mediastinitis (FM), also known as sclerosing mediastinitis, is an uncommon but serious disease involving the mediastinal structures. A high index of suspicion is essential to establish the diagnosis of FM and starting the appropriate therapy for patients. Here, we report a case of a young female who presented with chest symptoms and subsequently underwent different laboratory and radiologic investigations and an excisional biopsy. The findings of these investigations were consistent with the diagnosis of idiopathic FM. Her disease was associated with complete occlusion of three pulmonary veins and the left main pulmonary artery. The patient was treated with initial high-dose steroids followed by maintenance steroid and methotrexate therapy with very good long-term disease control. Clinical response, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate were used to monitor disease activity and response to therapy.

Managing traumatic brain injury in children: When do we need a computed tomography of the head?

Accidents still represent a major cause of death and disability in children. The resultant traumatic brain injury (TBI) usually needs a multidisciplinary approach of management. Although computed tomographic (CT) head scan is generally a preferred investigation in TBI, however, clear guidelines are required to help decision making by different team members on "when a head CT scan is needed", its limitations, and "when it is likely to be informative". The answers to these queries are highlighted, in the present article, with other aspects of treatment of children with TBI. This article discusses different worldwide-accepted approaches for managing children with TBI, and places special emphasis on the issue of "indications for a head CT scan".

Mycobacterium chelonae complex bacteremia from a post-renal transplant patient: case report and literature review.

In this report we present a case of a young lady with abdominal abscesses and septicemia caused by Mycobacterium chelonae complex. Identification of the organism and initiation of the appropriate antimicrobial therapy was delayed, resulting in significant morbidity and multiple hospital admissions. Gram staining of these organisms from blood culture can be easily overlooked or confused with either debris or diptheroids. We concluded that detection of Gram-positive rod colonies should prompt an acid-fast stain to distinguish diphtheroids from rapidly growing mycobacteria in immunosuppressed patients.

Thoracoscopic treatment of pulmonary hydatid cyst in a child.

Hydatid disease has a wide geographic distribution around the world. In human, the lungs are the second most commonly affected sites. Pulmonary hydatidosis is much more frequently encountered in children than in adults. Surgical treatment has remained the standard option in the management of hydatid disease. However, surgeons were able to replicate the principles of conventional surgery using minimally invasive techniques. Herein, we report a case of pulmonary hydatid cyst in a 9-year-old girl treated successfully using the thoracoscopic approach.

Traumatic aortic pseudoaneurysm.

A case report of a 5 years old male child, with a history of crash injury--(blunt trauma)--on the chest. Computed tomography (CT) scan, magnetic resonance imaging (MRI) of the chest revealed an aneurysm involving the arch of the aorta. An aortogram showed its exact extension. Chest X-Ray showed collapsed left lung (due to pressure of aneurysm on left main bronchus). Surgery was done o aortic arch: Resection of the aneurysm, and patch repair of aorta, under profound hypothermic circulatory arrest (PHCA) and CPB. Left bronchial tear was also closed. Post operatively the patient was ventilated for about 36 hours to allow for lung expansion. The patient had a smooth postoperative course. Intensive chest physiotherapy and repeated bronchoscopies helped in recovering the left lung function.