Irish journal of medical science
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A 54-year-old woman was referred to our service with intractable ventricular arrhythmias secondary to a familial long-QT syndrome. Her first presentation was 4 years previously, when she suffered a cardiac arrest, at this time an (Automatic Implantable Cardioverter Defibrillator) AICD device was inserted and she was commenced on sympathetic blockers. She remained symptomatic with ongoing tachyarrhythmias and the subsequent automatic cardioversion or defibrillation was causing significant amount of distress. ⋯ Though open sympathectomy is an established treatment, there are only isolated reports of thoracoscopic sympathetic cardiac denervation in the literature.
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Faecal incontinence resulting from obstetric injury is a socially disabling condition with a significant impact on quality of life. Sacral nerve stimulation (SNS) is a relatively new treatment modality, which offers patients a potential for improved continence. ⋯ SNS offers improvement in continence and quality of life in patients with faecal incontinence whose only other option might otherwise be a permanent colostomy.
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Laparoscopic cholecystectomy has been performed as a day-case procedure for over a decade. This procedure can be associated with a high incidence of pain and post-operative nausea and vomiting (PONV). There is a paucity of information regarding the post-discharge care of these patients. ⋯ The incidence of PONV post-discharge suggests that adding an antiemetic to our take-home analgesic packs may improve patient comfort. The 2-day supply of diclofenac and co-codamol could also be extended as 65% of patients had moderate to severe pain. The information gathered shows the importance of post-discharge follow-up of ambulatory surgery patients.
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Clarithromycin is a commonly used macrolide antibiotic. It is known to cause QT prolongation. Medication induced QT prolongation is a major risk factor for the development of torsade de pointes. ⋯ Knowledge of medications which prolong the QT interval is important to minimize the risk of ventricular arrhythmias, which may lead to sudden death. This is essential in patients with a congenitally long QT interval.