ABSTRACT
H-type tracheo-oesophageal fistula (H-TOF) and congenital oesophageal stenosis (COS) are both rare anomalies. Only six cases of H-TOF in association with COS have been described in the literature. Characteristically, diagnosis is delayed, often well beyond the neonatal period. We report a patient who was accurately diagnosed on day 12 of life, and outline several of the key clinical dilemmas encountered in managing a neonate with this combination of rare congenital anomalies.
Subject(s)
Esophageal Stenosis/congenital , Esophageal Stenosis/surgery , Tracheoesophageal Fistula/surgery , Esophageal Stenosis/diagnosis , Humans , Infant, Newborn , Male , Tracheoesophageal Fistula/diagnosisABSTRACT
Renal candidiasis is a rare but well recognised complication of intensive care treatment in neonates. We report a problematic case with obstructing pelvi-ureteric junction (PUJ) fungal balls that was refractory to standard measures of adequate nephrostomy drainage, pelvic irrigation with amphotericin B, and systemic antifungal treatment. In an attempt to avoid potentially difficult open surgery, a novel treatment using a streptokinase solution (3,000 IU/ml) for irrigation was performed. This was successful in clearing the fungal balls, relieving obstruction and rendering the urine sterile. The present case highlights a potential role for streptokinase in cases of renal candidiasis refractory to current treatment protocols.