Spontaneous coronary artery dissection during cisplatin and capecitabine therapy.

INTRODUCTION: Spontaneous coronary artery dissection is a rare cardiovascular disease that can cause acute myocardial infarction and sudden cardiac death. The mechanism of this pathology and the optimal treatment are not fully understood. PRESENTATION OF CASE: An acute myocardial infarction developed while a fifty five years old woman with a rectal adenocarcinoma was receiving a cisplatin and capecitabine therapy. Coronary angiography demonstrated a multivessel occlusion of coronary arteries. DISCUSSION: The authors discuss several factors that may lead to the spontaneous coronary artery dissection including chemotherapy-induced vasospasm. Chemotherapy based on the cisplatin and capecitabine intake can cause a cardiotoxic effect. CONCLUSION: Thus, spontaneous coronary artery dissection is a disease with an extremely complex etiololy, which does not have a special treatment guide. Management should be considered individually for each case.

Airway management in a child with penetrating pharyngeal wall foreign body injury: a case report.

Penetrating foreign bodies of the oropharynx are encountered in children of all ages, although more frequently between the ages of 3 to 5 years. A thorough preanesthetic evaluation of these patients, including type and extent of injury, must be performed if time allows. As a result of the often emergent nature of these cases, poor patient cooperation, and great potential for airway compromise, special considerations are given to management of the airway. The use of nontraditional equipment may greatly facilitate laryngoscopy and intubation.

Anesthetic management of a difficult airway in a patient with epidermolysis bullosa: a case report.

Epidermolysis bullosa is an inherited skin disease that leads to an array of medical problems. Patients are susceptible to blistering and scar formation following even minor trauma. These patients may present with scarring, limiting the range of motion of their temporal mandibular joint. This case report describes a 15-year-old patient with epidermolysis bullosa presenting for contracture release, with a difficult airway.

Fiberoptic tracheal intubation through a laryngeal mask airway in a child with Treacher Collins syndrome.

Treacher Collins syndrome (TCS) is a rare inherited condition characterized by bilateral and symmetric abnormalities of structures within the first and second bronchial arches. The mechanism of inheritance is autosomal dominant with variable expressivity. Because of this variability in expression, some affected individuals exhibit virtually no overt clinical manifestations. However, most children with TCS present with the following classic facial features: down-sloping palpebral fissures, colobomata of the lower eyelid, scanty lower eyelashes, malar hypoplasia, and micro- or retrognathia. Cleft palate is present in up to 35% of patients and an additional 30-40% have congenital palatopharyngeal incompetence. Abnormalities of the ear are very common and vary from minor malformations to severe microtia and hearing loss. Hearing loss may be due to atresia of the auditory canals or ossicular malformation of the middle ear. Despite these many development abnormalities, TCS patients are usually of normal intelligence. We report the case of a 3 1/2-yr-old patient with TCS undergoing cleft palate repair and discuss fiberoptic intubation through a laryngeal mask airway using two endotracheal (ETT) tubes secured via an ETT connector.