Rapports de cas cliniques et médicaux

Clavipectoral fascial plane block (CPB) is an attractive method of providing perioperative analgesia in patients with fractured clavicles. It is safe, easy to perform, and provides satisfactory analgesia with minimum complication risk. This report describes CPB in a 67-year-old woman with multiple comorbidities who underwent successful clavicle fracture fixation either as a stand-alone anaesthetic technique or combined with general anaesthesia. Correctly performed CPB could effectively reduce perioperative analgesic use, particularly in patients unsuitable for commonly used analgesics, while providing adequate analgesia for a prolonged duration.

Juvenile polyps are common benign mucosal lesions in the gastrointestinal tract, with the colon being a frequently affected site. This case series examined three pediatric patients who underwent endoscopic polypectomy for juvenile polyps in a tertiary hospital. The objective was to analyze their presentation, management and outcomes. The patients in this series all presented with rectal bleeding, which aligns with previous studies highlighting rectal bleeding as the most common symptom in juvenile polyps. Interestingly, none of the patients experienced associated abdominal pain, consistent with findings from studies conducted in Asia. Notably, all the children in this series presented more than a year after the onset of rectal bleeding, indicating a longer duration compared to studies from Asia, where the average was 7.6 months. Endoscopic polypectomy, explicitly using the cold snare technique, was successfully performed in all cases without any reported complications. This procedure involves the removal of polyps during an endoscopic examination, followed by a histopathological examination to assess the risk of malignancy. The findings from this examination guide further surveillance or treatment. In this case series, all the juvenile polyps presented with Rectal bleeding with no associated abdominal pain and all were left-sided and presented after over a year of rectal bleeding and cold snare. Endoscopic polypectomy was used safely in their management with no reported complications in our setting.

Marfan syndrome is a rare multi-systemic genetic disorder primarily affecting connective tissue. It manifests prominently in musculoskeletal, orbital and cardiovascular systems. Neonatal Marfan syndrome (nMFS) is distinguished by the occurrence of premature death resulting from rapidly progressive congestive heart failure. This case report presents the clinical presentation of a newborn girl exhibiting dysmorphic features, bilateral myopia and severe cardiac involvement. Genetic analysis revealed a previously unidentified mutation at nucleotide 3964 (c.3346G > A) within intron 26 of the fibrillin-1 gene. This mutation is located in the neonatal region encompassing fibrillin-1 exon 24 to 32. The patient was initially treated with atenolol, followed by a combination of atenolol and irbesartan, which potentially contributed to a reduction in the rate of aortic root dilation. While medical management can delay the progression of cardiac dysfunction, surgical intervention should be reserved as a last option.