BMJ case reports
-
Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis, of unknown aetiology and a propensity to involve almost all organ systems. The anaesthesiologists should be aware of the associated airway pathologies, pain management techniques and adverse effects of drug therapies being used to treat RA. In this respect, we describe a 60-year-old female patient who presented with a diagnosis of RA with pulmonary fibrosis, and was scheduled for orthopaedic surgery for subcapital fracture of femur which was successfully managed using intrathecal bupivacaine and midazolam.
-
The recreational use of ketamine is increasing in popularity due to its dissociative and paralytic effects, ease of availability and low cost. However, serious and frequently irreversible damage to the urinary tract is a recently recognised side effect of recreational ketamine use. ⋯ Medical management of such patients is largely limited to analgesia alone, and cessation of ketamine use before irreversible damage occurs remains the best means of avoiding the radical reconstructive surgery required in end-stage disease. This case and an accompanying review of the available literature illustrate the importance of early recognition of ketamine bladder syndrome in recreational users.
-
Review Case Reports
Cardiac tamponade as the first manifestation of systemic lupus erythematosus in children.
Systemic lupus erythematosus (SLE) is a serious chronic autoimmune disease with intense inflammatory response and damage in many target organs including joints, skin, kidneys, heart and nervous system. Cardiac tamponade is extremely rare as a cardinal presentation of SLE in children with only a few cases reported in the literature. We report two cases of a 9-year-old boy and an 11-year-old girl presenting with acute cardiac tamponade and later recognition of elevated anti-double-stranded DNA (anti-dsDNA) titre. We also present a literature review about similar cases in children and we stress on the importance of screening all cases of acute cardiac tamponade in children with antinuclear and anti-dsDNA antibodies to avoid any delay in SLE diagnosis and treatment.
-
Case Reports
Congenital pseudarthrosis of clavicle: illustrated operative technique and histological findings.
Congenital pseudarthrosis of the clavicle is a rare condition present at birth but often diagnosed later in childhood. Indications for surgical treatment include pain, deformity or neurovascular compromise. ⋯ The majority of patients who undergo surgery because of cosmetic or functional problem heal well and proceed with a normal, unrestricted life. However, for those patients who are not bothered by the cosmetic appearance of the pseudarthrosis and are asymptomatic in that they are not functionally limited, non-surgical treatment is a viable option.
-
A 14-year-old boy was submitted to cardiac transplant due to a dilated cardiomyopathy. On the fourth day of immunosuppression (corticosteroids, mycophenolate mofetil and tacrolimus), he developed right focal seizures and drowsiness. Blood pressure was in the normal range and laboratory findings in cerebral spinal fluid and blood were unremarkable, with drugs in non-toxic levels. ⋯ Tacrolimus was stopped with regression of MRI abnormalities and clinical recovery. Posterior reversible encephalopathy associated with tacrolimus is a rare but potentially serious complication of solid organ transplants. A prompt diagnosis and correct treatment is essential to avoid irreversible brain damage.