RESUMO
OBJECTIVES: To investigate the management of children with life-threatening airway obstruction from large mediastinal masses. METHODS: Review of the medical records of children with mediastinal masses and severe airway obstruction who were admitted to a multidisciplinary pediatric intensive care unit. RESULTS: Eight patients with 12 life-threatening events were identified. Five events (in 4 patients) occurred before hospital admission, and 3 patients had more than 1 choking episode. Five patients underwent cardiorespiratory resuscitation (2 before admission), and 2 underwent emergency endotracheal intubation because of severe airway obstruction; the eighth patient could not be weaned off the ventilator until the mediastinal mass was resected. Median time from appearance of the initial symptoms to diagnosis was 8.5 days, and median time from the onset of alarming signs to admission was 2 days. CONCLUSIONS: Severe airway obstruction in children with an anterior mediastinal mass is not rare and can lead to complete obstruction, requiring cardiorespiratory resuscitation. Physician awareness and preparedness for respiratory complications are essential for proper management of children with mediastinal masses.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/prevenção & controle , Neoplasias do Mediastino/complicações , Pediatria/métodos , Broncoscopia , Linfoma de Burkitt/complicações , Linfoma de Burkitt/patologia , Linfoma de Burkitt/cirurgia , Reanimação Cardiopulmonar , Criança , Pré-Escolar , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Intubação Intratraqueal , Linfoma de Células T/complicações , Linfoma de Células T/patologia , Linfoma de Células T/cirurgia , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Respiração Artificial , Tireoidite Supurativa/complicações , Tireoidite Supurativa/patologia , Tireoidite Supurativa/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: Pregnancy outcome and the effect of pregnancy on cardiac function were assessed in women cured of childhood cancer. STUDY DESIGN: Forty women who received doxorubicin as part of a chemotherapy protocol for a neoplastic disorder in childhood were followed up at the same center during pregnancy and after delivery. RESULTS: Thirty-seven women (72 pregnancies) completed follow-up. Pregnancy outcome was favorable in the 29 women with fractional shortening values of >or=30% before pregnancy, and their myocardial function was sustained. In 8 women with fractional shortening of <30% before pregnancy, pregnancy outcome was less favorable; a 19% decrease in fractional shortening was observed after pregnancy, and this finding was not significant (P=.08). CONCLUSION: Pregnancy outcome in women who received doxorubicin for malignancy in childhood is generally favorable. However, those with baseline left ventricular dysfunction should be considered at increased risk for worse pregnancy outcome and further deterioration in myocardial function.
Assuntos
Antineoplásicos/efeitos adversos , Doxorrubicina/efeitos adversos , Cardiopatias/induzido quimicamente , Neoplasias/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Adolescente , Adulto , Criança , Feminino , Seguimentos , Coração/fisiopatologia , Cardiopatias/fisiopatologia , Humanos , GravidezRESUMO
We report an 8-year-old boy with acute leukemia who developed ecthyma gangrenosum secondary to infection with Exserohilum spp., a rare cause of human disease. The skin, paranasal sinuses and lungs were involved. To the best of our knowledge, this is the first report of ecthyma gangrenosum caused by Exserohilum spp. This case emphasizes the importance of prompt skin biopsy for early diagnosis and treatment of this life-threatening infection.