BMJ case reports
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Pancreaticopleural fistula (PPF) is an uncommon complication of chronic pancreatitis leading to a large and recurrent pleural effusion. Since the patients presented predominantly with respiratory symptoms, diagnosis and treatment were often delayed. ⋯ Multidetector CT is an easily accessible method that is able to show both the thoracic and abdominal findings non-invasively. The clinical and imaging features of this unusual entity are discussed.
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A 72-year-old man was admitted to our clinic because of pain in the right eye. Corneal oedema, peripheral anterior synechiae formation and intraocular lens were determined in the right eye. The left eye was normal except for nuclear sclerosis. ⋯ In the detailed anamnesis of the patient, we discovered that he had used a topical anaesthetic instead of the prescribed medicine owing to ocular pain. The patient was still using topical anaesthetic eye drops, despite warnings. Finally, evisceration was performed on his right eye because of corneal melting and perforation.
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A 39-year-old man (a lifetime non-smoker) presented with a locked left jaw and leg myoclonus. Clinical and electromyographic findings were in keeping with progressive encephalomyelitis with rigidity and myoclonus (PERM) syndrome. A thoracic CT scan demonstrated a 19 mm right hilar nodule, which was proven to be small cell lung cancer on bronchoscopic biopsy. ⋯ Symptoms were refractory to corticosteroids and IVIg therapy. Rituximab was then initiated, which led to a dramatic and sustained resolution of symptoms. To our knowledge, this is the first case of PERM related to antiglycine receptor antibodies from paraneoplastic syndrome, which resolved with rituximab.
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Case Reports
Using a bradykinin blocker in ACE inhibitor-associated angioedema in the emergency department.
We report two cases of ACE inhibitor-associated angioedema and critical airway compromise, where the use of a selective bradykinin 2 receptor blocker resulted in rapid symptom resolution and prevented intubation to protect the airway.
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It is unusual for pneumothorax to occur spontaneously during pregnancy. Its occurrence during or following caesarean section is extremely uncommon with only three other cases reported previously. ⋯ We report the successful management of a multigravida female patient, who developed spontaneous pneumothorax following caesarean section, performed under spinal anaesthesia. Tube thoracostomy was required for management and the patient had an uneventful recovery.