We report the use of Gabapentin (Neurontin), an anticonvulsant and analgesic, as a non-opioid adjunct agent in the treatment of a term newborn infant with neonatal abstinence syndrome (NAS). Initial treatment with methadone to prevent withdrawal symptoms was not fully effective. Despite the addition of clonidine, an alpha-2 agonist, he was still unable to be weaned off opioids. The addition of gabapentin reduced symptoms, allowing for successful taper off methadone, and discharge from the hospital. As a non-opioid agent, gabapentin is a drug with potential for assisting with the difficult task of treating NAS refractory to standard opioid therapy due to its sedative and analgesic properties without any respiratory depression.
Muscle tissue may be damaged as a consequence of both mechanical and metabolic factors. Serum levels of skeletal muscle enzymes or proteins are markers of the functional status of muscle tissue. Creatine kinase, lactate dehydrogenase, aldolase, enolase, aspartate aminotransferase are the most useful serum markers of muscle injury. However none of them are as specific as creatine kinase. Persistent elevation of serum creatine kinase in individuals with normal neurological and laboratory examinations has been called idiopathic hyperCKemia. The management of patients with persistently elevated serum levels of creatine kinase, usually without clinical symptoms, is a difficult and puzzling problem for anesthetists. By the presentation of this hereby the case report herein, it is aimed to share the experience gained from a patient, who has been diagnosed with idiopathic hyperCKemia.
A 62 year old woman suffered from unspecific upper abdominal pain. Abdominal imaging showed multiple liver tumors highly suspicious for malignancy. Although a first needle biopsy was suggestive for an echinoccocus cyst, repeated serologic testing for echinococcosis was negative. Only after surgical resection of one tumor nodule, a spontaneously healed Echinococcus multilocularis could be diagnosed. Therefore echinococcosis should always be considered as a possible differential diagnosis of liver tumors in Central Europe. Spontaneous death of Echinococcus multilocularis hydatids as described in this case is rare, but might be underreported in the literature.
Gorlin-Goltz syndrome (GGS) is an uncommon inherited disorder characterized by numerous basal cell carcinomas, odontogenic keratocysts and musculoskeletal malformations. A spectrum of other neurological, ophthalmic, endocrine and genital manifestations is known to be variably associated with this triad. Diagnosis of the syndrome is based on major and minor criteria. It is important to make an early diagnosis and a proper management of GGS to reduce the severity of complications including cutaneous and cerebral malignancy. We present a case of GGS in a 39-year-old male who met three major and several minor criteria.
We present two cases of sinus venosus type atrial septal defect associated with right anomalous pulmonary venous return to the superior vena cava with echocardiography and computed tomography angiography. Sinus venosus type atrial septal defect is a rare anomaly and can be diagnosed with transesophageal or transthoracic echocardiography. However it is often difficult to detect associated pulmonary venous return anomalies and other congenital anomalies with echocardiography. Multidedector CT is a non-invasive technique that may provide useful information on localization and dimensions of ASD and associated anomalies. It is also important to detect these anomalies prior to cardiac and aortic surgical procedures.
