Serious complications of an obstructive upper airway infection in a young child

A 15-month old boy was admitted to our intensive care unit (ICU) cyanotic, unresponsive, apneic, pulseless, with fixed, dilated pupils and a Glasgow Coma Score (GCS) of 3/15. Prompt cardiopulmonary resuscitation (CPR) was initiated and cardiac function was resumed after 10 minutes. The boy was intubated but could not be ventilated because of a thick, viscous secretion obstructing the trachea and causing total airway obstruction. Bronchoscopy revealed laryngotracheitis as the reason for airway obstruction. A computed tomography (CT) scan of the brain showed diffuse edema and ischemic brain injury, which were considered responsible for the boy\u27s comatose situation. Clinical status remained unchanged for 11 days, after which the boy was transported to another hospital. In children presenting with upper airway obstructing syndromes, not responding to therapy, the diagnosis of bacterial tracheitis should be considered and the child should be monitored in a pediatric intensive care unit

Pheochromocytoma - case report

Prikazan je slučaj feokromocitoma desne nadbubrežne žlijezde u 13-godišnjeg dječaka koji je hospitaliziran zbog hipertenzivne krize. Heteroanamnestički smo doznali za dugotrajne glavobolje, gubitak tjelesne mase, učestala preznojavanja uz polidipsiju i poliuriju. Dijagnoza je postavljena na temelju povišenih vrijednosti kateholamina u urinu, a tumor je lokaliziran ultrazvučno, magnetskom rezonancijom (MR-om) te I131 -metajodobenzilgvanidin (I131 -MIBG) scintigrafijom. Zadovoljavajuća kontrola hipertenzije postignuta je kombinacijom blokatora alfa i beta-adrenergičkih receptora te ACE inhibitora, nakon čega je učinjena desnostrana torakofrenolaparotomija i adrenalektomija, bez većih intraoperativnih i postoperativnih komplikacija. Dječak se prati klinički i laboratorijski, a nalazi zasad upućuju na izlječenje.We present a 13 year-old-boy with pheochromocytoma localized in the right adrenal gland, who was hospitalized due to severe hypertension. For a long period of time he suffered from headaches, loss of weight, excessive sweating with polydipsia and polyuria. The diagnosis was made based on high urinary catecholamine excretion and the tumor was localized by ultrasonography, magnetic resonance imaging (MRI) and radionuclide scanning with iodine 131-labeled metaiodobenzylguanidine (I131 -MIBG scintigraphy). After acceptable control of hypertension was achieved by alpha and beta-adrenergic blocking agents and use of ACE inhibitors, right sided thoracophrenolaparotomy and adrenalectomy was performed, without any major intra-operative or postoperative complications. The boy was followed-up and his clinical and laboratory findings show no abnormalities so far