Refractory Chronic Constipation in an Adolescent Female Later Diagnosed With Internal Anal Sphincter Achalasia.

Internal anal sphincter achalasia (IASA) is a rare anorectal disorder that presents as chronic refractory constipation in pediatrics. With a poor response to conventional constipation-based therapy, it is often misdiagnosed as other conditions, such as ultra-short-segment Hirschsprung disease. This case report describes a rare case of IASA in an adolescent female, emphasizing the importance of ruling out other differentials, including Hirschsprung disease, via rectal biopsy and thus allowing for earlier targeted therapy to improve lifestyle conditions.

Laparoscopic cholecystectomy for the adult with unrepaired tetralogy of Fallot: a case report.

A 24-year-old woman with a history of unrepaired tetralogy of Fallot was scheduled to undergo laparoscopic cholecystectomy. Her significant history included tetralogy of Fallot with pulmonary atresia, hypoplastic left pulmonary artery, pulmonary vascular obstructive disease, a functioning right subclavian artery to right pulmonary artery shunt (modified Blalock-Taussig palliative procedure) with a similar shunt on the left side that is occluded. The patient underwent general endotracheal anesthesia for laparoscopic cholecystectomy for cholelithiasis and pancreatitis.

Serial pharmacokinetic dosing of aminoglycosides: a community hospital experience.

The aminoglycoside antibiotics are useful in the treatment of gram-negative bacillary infections but are potentially toxic. A method to maximize their therapeutic benefit while minimizing their risk of toxicity is desirable. Serial pharmacokinetic dosing has been proposed as a method to achieve these goals.