BMJ case reports
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The authors report a severe anaphylactic reaction to Patent Blue V dye used in sentinel node biopsy for lymphatic mapping during breast cancer surgery to stage the axilla. Patent Blue dye is the most widely used in the UK; however, adverse reactions have been reported with the blue dye previously. ⋯ All surgical patients should give consent for adverse reactions to patent blue dye preoperatively. Alternative agents such as methylene blue are considered.
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A 91-year-old man with chronic low-back pain presented with 1-day history of disturbance of consciousness and myoclonus of all of his extremities and face. Laboratory examinations revealed no abnormalities. Administration of benzodiazepine for the myoclonus resulted in immediate and complete disappearance of the symptoms. ⋯ The day following admission, he discontinued pregabalin. He did not experience recurrence of his symptoms any more. We concluded that the neurological symptoms he experienced were possibly due to pregabalin.
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Review Case Reports
Delayed presentation of congenital diaphragmatic hernia presenting with intrathoracic gastric volvulus: a case report and review.
Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency and its presentation in adulthood is extremely rare. Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. This case describes a middle aged man presenting with post-traumatic acute abdomen and finally being diagnosed as a case of gastric volvulus due to congenital diaphragmatic hernia which was till now asymptomatic and undiagnosed. ⋯ Surprisingly, the intraoperative findings revealed significant adhesions near the diaphragm suggestive of congenital diaphragmatic hernia. Hence, a diagnosis of gastric volvulus due to congenital diaphragmatic hernia was made which remained asymptomatic and undiagnosed till adulthood. He responded well to operative management and remained asymptomatic afterwards.
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Case Reports
Verification of supraselective drug delivery for retinoblastoma using intra-arterial gadolinium.
We present a description of retinoblastoma treated with supraselective intra-arterial chemotherapy, demonstrating selective delivery of the infused chemotherapeutic agent into the tumor bed by MRI. A 7-month-old presented with group E (international classification) unilateral retinoblastoma. ⋯ Intraoperative MRI was obtained within 15 min after treatment and showed increased enhancement of the tumor and subretinal space. We demonstrate here that supraselective administration of chemotherapy into the ophthalmic artery appears to result in drug delivery to the tumor and subretinal space.