Treatment is usually based on systemic antimycotic agents (Amphotericin B, Azoles: Fluconazole, Flucytosine). Prophylactic treatment is still a matter of debate. It is not routinely recommended in ICU, but is commonly used in transplant patients.
Congenital gastrointestinal anomalies include spectrum of malformations, simple ones as well as complex, which are associated with anomalies of other organs and systems of organs. Most infants (50-60%) with imperlbrate anus also have genitourinary, cardiovascular, gastrointestinal and vertebral anomalies. This case report is of a female newborn with prenatally diagnosed duodenal atresia and right hydronephrosis. Clinical investigation revealed an imperforate anus with vestibular fistula. A plain abdominal X-ray showed a "double-bubble" sign, characteristic for duodenal atresia. Intraluminal membrane was excised and sigmoid colostomy was performed in general anesthesia on the first day of life. Ultrasound and intravenous pyelography confirmed a hydronephrotic right kidney and obstructive megaureter after Pena. In the fifth month of life, the ureter was tapered and reimplanted. Six months later, posterior sagittal anorectoplasty was performed. In the seventeenth month of life the colostomy was closed This child attained normal growth and development, normal bowel control, fecal continence without soiling, obstipation and urinary infections.
It was confirmed that foregut atresias ara commonly accompanied by associated abnormalities. That is why the fourth gestational week is important when both gastrointestinal and urogenital systems are developed. When midgut differentiates into its own derivates, the frequency of congenital anomalies decreases for a short period, and then increases again during foregut development (seventh and eighth gestational weeks). There were no information on environmental teratogenic factors in maternal history. These abnormalities may be explained by complex urorectal development and separation of two systems.
Adequate transport improves the survival rate of the patients with craniocerebral injuries. Also the time that has elapsed from the moment of injury to the moment of arrival to the hospital also influences the survival rate, but the final outcome, too. Transport of pediatric patients is globally neglected. Transport of unstable, critically ill and injured patients accompanied by inexperienced and unspecialized staff is followed an increased mortality rate.
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