Oral surgical management of a patient with glycogen storage disease type I

Tumorigenic Potential of Granulocyte Colony-Stimulating Factor Therapy-A Case Report and Review of Literature

An association between granulocyte colony-stimulating factor therapy (G-CSFT) in patients with glycogen storage disease type Ib (GSDIb) and the development of giant cell lesions of the maxillofacial complex has emerged. We have reported, to the best of our knowledge, the fourth case of giant cell granuloma (GCG) in a patient with GSDIb undergoing G-CSFT. GSDIb can present with hypoglycemia, hypertriglyceridemia, and neutropenia. G-CSFT has often been used in the treatment of recurrent infections or sepsis caused by neutropenia and to treat inflammatory bowel disease and diarrhea. The current reported data are lacking in both the association and the potential causation of G-CSFT and the development of giant cell tumors. Given the prevalence of GSDIb and its therapy, oral and maxillofacial surgeons should be aware of the tumorigenic potential of G-CSFT in patients with GSDIb. In the present report, we have described the case of a 17-year-old patient with GSDIb undergoing GCSFT who presented with a peripheral and central GCG. She was treated but presented again 13 months later with concerns for a new primary lesion. We have also discussed GSDIb, G-CSFT, and the current data, highlighting the association between G-CSFT for GSDIb, the potential mechanism of GCG development, the use of adjuvant therapy, and the need for close follow-up of this population. The purpose of the present case report is to highlight the presentation, management, and follow-up of giant cell lesions in patients with GSDIb treated with G-CSFT.

Anaesthetic management of a patient with Leigh's syndrome

PURPOSE

Leigh's syndrome, a progressive neurodegenerative disorder of infancy and childhood, is clinically characterized mainly by developmental delay, nervous system dysfunction and respiratory abnormalities such as aspiration, wheezing, breathing difficulties, gasping, hypoventilation and apnoea. Acute exacerbation and respiratory failure may follow surgery, general anaesthesia or intercurrent illnesses. Hyperlecithinemia is variably present. Histopathological findings include necrosis, vascular proliferation, astrocytosis and demyelination of several brain areas. We present a 30-month-old patient with Leigh's syndrome anaesthetized for extracorporeal shockwave lithotripsy, and describe the anaesthetic considerations.

CLINICAL FEATURES

Leigh's syndrome was diagnosed at five months of age based on failure to thrive, lethargy, hypotonicity, choreo-athetosis and lactic acidaemia, with basal ganglia hypodense areas demonstrated by brain computerized tomographic scan. Muscle pyruvate dehydrogenase complex and NADH coenzyme Q oxidoreductase activity were 25% and 13% of control. No preoperative respiratory symptoms or signs were present. Preoperative fasting lasted two hours and gastric aspiration was negative. Anaesthesia was induced with ketamine and midazolam im, and N2O in oxygen, and maintained with propotol and N2O. No volatile anaesthetics were used. Intravenous fluids given were 1/2 normal saline and glucose 5% administered. Besides laryngospasm during anaesthetic induction, relieved by sublingual succinylcholine injection, the perianaesthetic course was uneventful. The lungs were mechanically ventilated and lithotripsy was performed. No adverse sequelae have occurred, and the patient was discharged one day later.

CONCLUSION

Perioperative management of patients with Leigh's syndrome requires cautious attention to the metabolic, neurological and respiratory aspects of the disease, and appropriate selection of anaesthetic drugs.

Anaesthetic management of a patient with glycogen storage disease type 1b

PURPOSE

A rare case of a ten-year old patient with type 1b glycogen storage disease (GSD), scheduled for extracorporeal shockwave lithotripsy (ESWL), is described.

CLINICAL FEATURES

Patients with type 1b GSD manifest a range of clinical symptoms, including mental retardation, hepatosplenomegaly, renal enlargement, stomatitis, hypoglycaemic convulsions, bleeding diathesis, lactic acidosis and leukopaenia, thus creating a challenge for the anaesthetist. Following preanaesthetic administration of glucose-containing fluids, general anaesthesia was induced and the patient was mechanically ventilated. Except for mild hypoglycaemia after induction of anaesthesia, and moderate intraoperative metabolic acidosis which was attributed to the underlying disorder, anaesthesia was uneventful. No postoperative complications occurred and the patient was discharged home three days after lithotripsy. Clinical features of this rare inborn error of metabolism are reviewed and the approach for the anaesthetic management is discussed.

CONCLUSIONS

A skillful perioperative management of patients with type 1b GSD can be achieved by cautious attention to the metabolic and homeostatic derangements that occur with the disease.

Acute management of glycogen storage disease type Ia

Rapid metabolic deterioration may occur in patients with some glycogen storage diseases (GSDs) regardless of presenting complaint. Hepatic, renal, and hemostatic abnormalities may also complicate diagnosis and treatment of trauma victims. We report the case of a man presenting with an epidural hematoma and a history of GSD type Ia.