A&A practice
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MYH9-related disease (MYH9-RD) is an inherited rare autosomal dominant macrothrombocytopenia. Patients with MYH9-RD have giant platelets and leukocyte inclusion bodies caused by mutations in the MYH9 gene encoding the non-muscle myosin heavy chain II-A. ⋯ As with other inherited thrombocytopenias, the risk of increased bleeding during perioperative period or delivery is a major concern. We report here the first successful cesarean delivery of a woman with MYH9-RD treated with eltrombopag during the last month of pregnancy.
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Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for persistent neuropathic pain, but the permanent implantation of stimulator leads and the pulse generator can be difficult and is sometimes associated with complications. We used a single-incision approach to tunnel and implant the leads and pulse generator for DRG stimulation treatment in a patient suffering from intractable foot pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications. A single-incision implantation technique for DRG stimulator implantation may simplify implantation and decrease the risk of complications.
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Case Reports
Left Ventricular Apex Venting in High-Risk Redo Sternotomy With Severe Aortic Insufficiency: A Case Report.
Redo cardiac surgery in patients with severe aortic insufficiency can present unique challenges to the anesthesiologist. We report a case highlighting the challenge and importance of interdisciplinary planning between cardiothoracic surgeons and anesthesiologists prior to high-risk surgery. Failure to place an endoaortic balloon and percutaneous coronary sinus catheter due to anatomical abnormalities prompted the adoption of an alternate technique involving apical ventricular venting to assist sternal reentry. Apical left ventricular venting was successfully used to prevent ventricular dilation and dysfunction during institution of cardiopulmonary bypass with significant aortic regurgitation and hypothermia-induced ventricular fibrillation.
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Anterior laryngeal web is a rare anomaly which is usually asymptomatic in infancy. This translates into a high incidence of unanticipated difficult intubation in these patients with consequent airway morbidity in the form of tracheostomy. ⋯ After multiple failed intubation attempts with direct laryngoscopy, use of CMAC video laryngoscope improved the glottic view, enabled us to diagnose the presence of a thick anterior laryngeal web and intubate the child. We have also highlighted a pivotal history which may improve its preoperative detection.