Brit J Hosp Med
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Multiple sclerosis is a common disease of the CNS. The first of these articles (Hassan-Smith and Douglas, 2011) examined its epidemiology and diagnosis. ⋯ However, equally important is the management of problems related to chronic multiple sclerosis and knowledge of which symptomatic treatments may be helpful. Finally, the prognosis is discussed; vital when counselling newly diagnosed patients.
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This article outlines the case of a 62-year-old man who presented with a deep vein thrombosis, pulmonary embolus and right middle cerebral artery territory ischaemic stroke in association with a patent foramen ovale with right-to-left shunting. Despite anticoagulation, he was noted to have desaturation and tachypnoea when upright, without other symptoms or cardiovascular compromise, that resolved on lying down. The article describes the syndrome of platypnoea-orthodeoxia, characterized by breathlessness, hypoxia and/or cyanosis while in the upright position that improves on lying down, its relationship to this case, and its resolution by closure of the patent foramen ovale.
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A young woman presented with severe chest pain and an inverted takotsubo cardiomyopathy following adrenaline injection for treatment of an allergic reaction. To the authors' knowledge, this is the first reported case of inverted takotsubo cardiomyopathy following systemic adrenaline administration. The case strongly suggests a central role of catecholamines in the pathogenesis of takotsubo cardiomyopathy.
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Supportive therapy with extracorporeal membrane oxygenation for acute respiratory distress syndrome.
Acute respiratory distress syndrome is a severe form of respiratory failure characterized by acute onset of significant hypoxaemia (PaO2:FiO2<200mmHg) with diffuse bilateral pulmonary air-space shadowing on chest X-ray, without clinical signs of heart failure (Bernard et al, 1994). It has a heterogeneous aetiology with wide-ranging pulmonary and extra-pulmonary causes.