Case Reports

We present a case report concerning fatal bacteremia caused by Pantoeaagglomerans in a critically ill patient.

Pantoea is a genus of Enterobacteriacae Gram-negative bacteria family that includes at least 20 species; mostly isolated in the ecological niches.

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The case of a 33y old man is presented, who after a car accident, was transferred to the ED with a right hip dislocation and slightly obtunded but in a stable hemodynamic condition. After an emergent CT scan, a thoracic aortic rupture along with intestine rupture and retroperitoneal hematoma were noted. The patient was administered 1 g tranexamic acid (TXA) and 1 g fibrinogen concentrate (FC) preoperatively and then was transferred to the OR, where primarily, under monitored anesthetic care (MAC) the aortic trauma was restored intraluminally and then, under general anesthesia, he underwent laparotomy and hip dislocation reduction. During operation, no diffuse bleeding was noted, nor was any transfusion of blood or blood product necessary. After a short ICU stay the patient was discharged in good general health state. The aim of this case report is to present a case of traumatic aortic rupture bleeding, effectively managed with prophylactic tranexamic acid (TXA) and fibrinogen concentrate (FC) administration without need of any kind of transfusion. Continue reading

Η βελτίωση των χειρουργικών τεχνικών αλλά κυρίως των χημειοθεραπευτικών σχημάτων αύξησε κατά πολύ την επιβίωση των ασθενών με κακοήθη νόσο των πνευμόνων. Οι ασθενείς που έχουν υποβληθεί σε θωρακοχειρουργική επέμβαση για κακοήθη νόσο πνευμόνων, έχουν αυξημένη πιθανότητα να υποβληθούν σε μια νέα διαγνωστική ή θεραπευτικήεπέμβαση, λόγω υποτροπής της αρχικής νόσου, ή εμφάνισης ενός δεύτερου πρωτοπαθούς όγκου του πνεύμονα.

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Adamantinomas are rare primary low grade malignant bone tumors’ (<1% of all bone cancers), which are usually located in tibial diaphysis. We present a case of lung metastasis in a 45 year old female who underwent left knee amputation because of tibial adamantinoma.

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Thymoma is one of the most common tumors of the anterior mediastinum in adults, arising from thymic epithelial cells. Complete surgical resection is the treatment of choice in myasthenic patients with thymoma. A 41 year-old male, with myasthenia gravis and thymoma was scheduled for thymectomy. Ten months ago, he developed pneumonia. He had a history of pneumonia (10 months ago) complicated by severe adult respiratory distress syndrome (ARDS), managed successfully with a short-term support with extracorporeal membrane lung assist device NovaLung. Long-term impairments in lung volume and diffusion capacity have been reported in adult respiratory distress syndrome survivors. Total intravenous anesthesia technique and especially muscle relaxants infusion require special attention in this group of patients. Our management strategies in this case included careful assessment of respiratory function, avoidance of premedication, use of short-acting anesthetic agents (propofol, remifentanil), use of suggamadex for reversal of rocuronium-induced neuromuscular block, and intraoperative monitoring with a train-of-four monitor and monitoring in an intensive care unit for 24 hours after surgery.

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This case report focuses on the anesthetic management of a patient with Myasthenia Gravis who underwent left-sided colectomy, due to the presence of a tumor on the left colic (splenic) flexure. Myasthenia gravis is a chronic autoimmune neuromuscular disease which is characterized by differ-ent degrees of weakness of skeletal muscles. The anesthetic management and treatment of every patient with myasthenia gravis should be performed carefully, due to the fact that many periopera-tive complications may occur. In our case anesthetic technique included the combination of general anesthesia, with the use of neuromuscular agent and thoracic epidural blockade with the use of a catheter, which permitted intermittent boluses doses and continuous infusion of local anesthetics and opioids. Neuromuscular blockade was reversed with the use of sugammadex. Patient’s periop-erative management was effective and uneventful.

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The deficiency of the natural heart pacemaker, the conduction disturbances and the appearance of arrhythmias are common complications after cardiac surgery. Placement of epicardiac electrodes (ventricular, atrial, or both) during cardiac surgery remains common practice, even though few patients will actually need some kind of temporary epicardiac pacing for various periods of time. Temporary epicardiac pacing may be ventricular, atrial or atrioventricular, depending on the specific features of each patient and it aims at preserving the cardiac rhythm, securing the desired heart rate and achieving an acceptable cardiac output. Temporary epicardiac pacing is not without danger, since, under specific circumstances, it may have a negative impact on the hemodynamics of the patient, to the point of circulatory collapse. It may also cause ventricular tachycardia (R on T phenomenon) and cardiac arrhythmias (if pacing is not synchronized to the heart’s natural pacemaker). Ventricular Pacing and Sensing (VVI) is accomplished by the placement of electrodes only on the ventricles, which a priori means a certain degree of hemodynamic compromise, due to the loss of atrial contribution in preserving cardiac output. In certain occasions, this impact may be even more significant. This case report concerns  a patient who underwent Coronary Artery Bypass Grafting (CABG) and after placement of the electrodes of temporary epicardiac ventricular pacing he presented significant decrease in systemic arterial pressure and the appearance of cannon A waves on central venous pressure (CVP) tracing every time the pacemaker was triggered. These phenomena, which receded after the disconnection of the pacemaker, consists a case of Pacemaker Syndrome.This problem was solved by adjusting the pacemaker’s frequency at a rate lower than that of the patient’s natural pacemaker.

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Noonan syndrome (NS) is an autosomal dominant disorder characterized by anatomic and pathophysiologic abnormalities.Anesthetic management in these cases has many challenges regarding airway management and cardiovascular stability.We present a case report of a 11-year-old male child who was scheduled for maxillofacial surgery under general anesthesia.

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