Singap Med J
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Hydatid cyst disease remains a considerable public health problem, especially in pastoral and farming regions. Although the spleen is the third most commonly affected organ after the liver and lungs, splenic hydatid cyst is an uncommon entity even in areas that are endemic for echinococcosis. The recurrence rate after surgical therapy of the liver hydatid cyst is reported as 6.8-22.3 percent. ⋯ The most common surgical therapy is splenectomy, and the other option is spleen preserving surgery. We report the first case of recurrent splenic hydatid cyst in the spleen and liver synchronously after surgical therapy for liver hydatid disease. The patient was treated with liver resection and spleen preserving surgery.
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Review Case Reports
Use of adjunctive treatments in improving patient outcome in Fournier's gangrene.
Fournier's gangrene is a polymicrobial necrotising soft tissue infection (NSTI) affecting the perineum and scrotum. It is rapidly progressive and destructive, and is associated with high morbidity and mortality. ⋯ We report Fournier's gangrene in a 60-year-old diabetic man and his successful treatment with skin grafting, which utilised a multidisciplinary approach and adjuncts, including negative-pressure wound therapy and hyperbaric oxygen therapy. We also review the literature related to these adjuncts and discuss their usefulness in the management of NSTIs.
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Cor triatriatum is a congenital heart malformation that is characterised by the division of the left or right atrium into two separate chambers by a membrane or diaphragm. Reports among adults are scarce, as most cases are diagnosed during childhood. The risk of mortality is increased when cor triatriatum is complicated by pulmonary hypertension. ⋯ Echocardiography showed a membrane dividing the left atrium into two. Doppler studies revealed a reversal of normal flow, similar to mitral stenosis. The right ventricle was dilated, with reduced long axis function.
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A middle-aged male smoker presented with atypical chest pain. Initial electrocardiogram (ECG) showed Brugada Type 1 pattern. Subsequent ECGs demonstrated evolving anterior ST elevation myocardial infarction (STEMI), consistent with the elevated cardiac enzymes. ⋯ In retrospect, subtle changes were noted in the initial ECG, which could have alerted one to the STEMI. However, the presence of a Brugada Type 1 pattern masked the ECG changes of anterior STEMI and made the diagnosis difficult. A discussion of the literature surrounding Brugada syndrome is undertaken, including its clinical features, risk stratification and management.