A&A practice
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Case Reports
Erector Spinae Plane Catheter for Postoperative Analgesia After Thoracotomy in a Pediatric Patient: A Case Report.
Thoracotomy is associated with significant postoperative pain. While postoperative pain control after thoracotomy is most commonly managed with a thoracic epidural or paravertebral catheter, both are fraught with significant risks and are technically challenging to perform in pediatric patients. The erector spinae plane block is a relatively novel, easy-to-perform block used to provide thoracic wall analgesia. We present a case of a pediatric patient undergoing thoracotomy whose postoperative pain was managed with an erector spinae plane catheter.
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Infection with either mobilized colistin resistance-1 gene-positive gram-negative bacteria or invasive Candida lusitaniae occurs rarely throughout the United States. Here we report the existence of both invasive infections occurring in a single, complex patient who initially presented with necrotizing pancreatitis and gastrointestinal bleeding. We detail the patient's history and perioperative course for enterocutaneous fistulae takedown and ureteral stenting, describe a template of preventative steps taken in the perioperative environment to prevent nosocomial pathogen transmission, and provide a brief overview of both the mobilized colistin resistance-1 gene and C lusitaniae.
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Preeclampsia presenting as severe hyponatremia is an enigma of modern obstetric practice. The hyponatremia can cause severe maternal neurological morbidity, including cerebral edema and seizures. ⋯ Despite this, the literature remains ambiguous about its incidence, the pathophysiology is poorly understood, and guidelines on preeclampsia (including those of the American College of Obstetricians and Gynecologists) do not discuss the issue. This case of preeclampsia associated with severe hyponatremia in a laboring woman highlights these issues.
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Case Reports
Pulmonary Artery Catheter Thrombus in a Patient With Essential Thrombocytosis: A Case Report.
Essential thrombocytosis (ET) is a rare chronic myeloproliferative disorder characterized by elevated platelet counts. The management of patients with ET undergoing coronary artery bypass graft remains unclear. Often, patients who are deemed "high risk" for thrombotic events receive cytoreductive therapy before surgery, while patients deemed "low risk" do not receive cytoreductive therapy. Here, we present a case of a patient with ET with only a mild elevation in platelets deemed "low risk" for thrombotic complications who was found to have a small intracardiac thrombus around the pulmonary artery catheter before initiation of cardiopulmonary bypass.