Qatar Medical Journal - Volume 2010, Issue 1

A middle-aged lady admitted with metastatic breast cancer developed acute respiratory problems with bilateral pulmonary infiltrates after five days of cytotoxic administration, as an acute adverse drug reaction to the docetaxel that resolved completely after high dosage of dexamethasone.

A nine-year old girl presented in shock preceded by fever vomiting, lower abdominal pain and rebound tenderness with signs of peritonitis. Ultrasonography supported a diagnosis of acute appendicitis confirmed later by the presence of peritoneal fluid and by histopathology. She had also the clinical picture of meningo-encephalitis with positive meningeal signs and an abnormal electroencephalogram (EEG). Cerebrospinal fluid (CSF) showed high protein, normal cell count and normal pressure. Brain CT scan and MRI were normal. The polymerase chain reaction (PCR) in the blood was highly positive for Epstein Barr virus (EBV). She improved dramatically after urgent appendectomy with supportive management. This case is unusual in presenting with a combination of acute appendicitis, peritonitis and shock associated with acute encephalitis.

Mechanical ventilation is of two types: Invasive and Non-invasive. Invasive mechanical ventilation involves endotracheal intubation and tracheostomy. This requires sedation, involves the risk of infection, has major complications and is also extremely uncomfortable for the patient. Non-invasive positive pressure ventilation (NIPPV) includes Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP). NIPPV reduces the risk of infection and complications and has the added advantage of patient comfort. However, it should be noted that, for the use of NIPPV, the patient should be breathing spontaneously.

Background: The herpes zoster vaccine is effective in preventing herpes zoster and postherpetic neuralgia in immunocompetent older adults. However, its safety has not been described in depth.

A great variety of procedures have been proposed for the cure of sacrococcygeal pilonidal disease. A bilobed fasciocutaneous flap, based on the parasacral perforators, is described. This retrospective study was conducted to evaluate our experience with bilobed fasciocutanous flaps and to review current publications about flap surgery for the treatment of sacrococcygeal pilonidal sinus. Eight bilobed fasciocutanous flaps have been performed between February 2004 and September 2006. Eight males, aged 19 to 35 years (mean age: 26.2 years), presented with chronic and recurrent pilonidal disease. The duration of the disease was ranged from 2 to 6 years (mean age: 3.8 years). The sinuses were excised in a vertical, elliptical fashion and the defect closed using a bilobed fasciocutanous flap. This flap was designed using the parasacral perforators and tailored to obliterate the midline defect. Primary wound healing was achieved in all patients. Large defects after excision can easily be closed using the bilobed fasciocutaneous flap. The flap provides a tensionless wound closure. Hospitalisation is brief, and the postoperative course is comfortable. No recurrence was seen in any of the eight cases. This procedure is indicated in patients in whom wide skin resection is required, because of the tension-free skin closure in such cases. This technique enabled regional reconstruction, conserved tissues, and provided satisfactory aesthetic results. Therefore, this procedure can be considered an additional, useful tool in the treatment of pilonidal sinus.