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While intermittent hemodialysis (HD) is the most efficient method of removing lithium in patients with lithium toxicity, continuous renal replacement therapy is an acceptable alternative in the setting of intradialytic hypotension. This form of dialysis can reduce the need for vasopressors during HD, which increases mortality.
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Background: Cholesteatomas are growths of squamous epithelium that can form inside the middle ear and mastoid cavity and damage nearby structures causing hearing loss when located at the petrous apex. The primary goal of petrous apex cholesteatoma resection is gross total removal with tympanoplasty and canal-wall up or canal-wall down tympanomastoidectomy. At present, there is no definitive surgical approach supported by greater than level 4 evidence in the literature to date. Methods: A systematic review was conducted utilizing PubMed, Embase, and Scopus databases. Articles were screened and selected to be reviewed in full text. The articles that met inclusion criteria were reviewed for relevant data. Data analysis, means, and standard deviations were calculated using Microsoft Excel. Results: After screening, five articles were included in the systematic review. There were a total of eight pediatric patients with nine total cholesteatomas removed. Conductive hearing loss was the most common (77%) presenting symptom. Perforations were noted in seven ears (86%). Recurrence was noted in 50% of patients with an average recurrence rate of 3.5 years (SD = 1.73). Average length of follow-up was 32.6 months (SD = 21.7). Canal-wall up was the most utilized technique (60%) and there were zero noted surgical complications. Five of the seven (71%) patients that experienced hearing loss from perforation noted improved hearing. Conclusion: Due to its rarity, diagnostic evaluation and treatment can vary. Further, multi-institutional investigation is necessary to develop population-level management protocols for pediatric patients affected by petrous apex cholesteatomas.
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Introduction and importance: Pulmonary artery aneurysms are rare anomalies of the pulmonary vasculature. They are often asymptomatic and frequently an incidental finding on imaging or autopsy. It is imperative to closely monitor pulmonary artery aneurysms as they can result in sudden dissection, rupture, and death. Due to the rarity of this disease, the number of studies on pulmonary artery aneurysm management are limited and debated in the literature. Case presentation: We report a case of an initially symptomatic patient with dyspnea on exertion with an incidental finding of a large 5.0 × 6.4 cm pulmonary artery aneurysm that responded well to conservative management. Her dyspnea self-resolved and the decision was made to closely monitor the patient every three months with serial computed tomography angiography imaging. Clinical discussion: Idiopathic aneurysms of the main pulmonary artery are rare with a poorly understood pathogenesis primarily due to the limited number of cases. There are no clear guidelines for management, but the least invasive approach should be used due to the risk of serious adverse events. Pharmacologic treatment of underlying comorbidities and serial computed tomography angiography imaging should be considered as conservative management. Conclusion: Six months later, she remains hemodynamically stable and the aneurysm has decreased in size by 15%. This case highlights that conservative management should be considered first line therapy in asymptomatic, hemodynamically stable patients regardless of aneurysm size.
