RESUMO
Anesthesia is a rapidly evolving medical specialty, centered around the patient's safety, and enhancement of surgical outcomes. In their daily practice, anesthesiologists encounter complex challenges, and always search for, and practice the best evidence-based medicine, which allows them to overcome the challenges, and to obtain the maximum benefits of the intervention, with minimal side effects. Regional anesthesia is considered a favorable modality with significant potential in selected patients and is becoming more popular day by day. In this regard, we present a case report of a 65-year-old man, with multiple co-morbidities, who needed urgent surgery to remove a gangrenous gall bladder. After discussion with the surgical colleagues, thoracic segmental spinal anesthesia (SA) was performed, and the patient underwent an open cholecystectomy awake with spontaneous respiration. The procedure went well, and the patient recovered quickly. This case presentation highlights the potential benefits of segmental SA in managing some selected cases.
RESUMO
BACKGROUND: FMF is a common disease in the Mediterranean populations and may be complicated by AA amyloidosis. The coexistence of adrenal and thyroid amyloidosis in AA amyloidosis secondary to familial Mediterranean fever (FMF) is an extremely rare reported condition. We presented a previously unreported triad of adrenal, thyroid, and cardiac amyloidosis secondary to FMF. Presentation of Case. We reported a 23-year-old Palestinian male patient presented with hypotension, vomiting, diarrhea, and abdominal pain. The patient was subsequently diagnosed to have an adrenal crisis with both amyloid goiter and cardiac amyloidosis. CONCLUSION: It is crucial to recognize the adrenal crisis in patients with AA amyloidosis secondary to FMF who present similarly to acute FMF inflammatory episodes. The adrenal crisis has high morbidity and mortality, especially if not recognized early in the course of the disease.
