Hemolytic uremic syndrome (HUS) which is characterized by a triad of hemolytic anemia, low platelet count and acute renal failure was first described by Gasser and others in 1955. (1,2) Initially it used to have a mortality rate of 50 % to 80%. But the improved diagnostic methods and treatment strategies has reduced the mortality to 2%-8%. Three types of HUS have been identified, typical HUS after enterohemorrhagic. Escherichia coli, shiga toxin 1 & 2 (Stx-HUS/D+HUS) producing bloody diarrhea, atypical HUS (a HUS/D-HUS) with complement abnormalities and not associated with diarrhea and pneumococcal associated HUS-mediated by neuraminidase in the presence of streptococcus pneumonia infection. Multiple systems are involved in the pathology including gastrointestinal, renal, hematological, brain, pancreas and myocardium. (3,4,5) Here we present a case of an infant with atypical HUS who also developed obstructive hydrocephalus following respiratory infection due to streptococcus pneumonia. This is the first case report in the English literature so far.
Pheochromocytoma, the neuroendocrine tumors arising from chromaffin tissue, poses a very significant challenge to the anesthetists, especially when they are undiagnosed. They present with varied symptoms and sometimes they are silent and nonfunctional. The anesthetic management of these tumor excisions varies depending on the surgical approach and perioperative hemodynamic instability encountered by the anesthetist. Here, we are presenting three different cases of pheochromocytoma who underwent adrenalectomy in our hospital with varied presentation and their successful anesthetic management.
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