BMJ case reports
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Pulmonary embolism (PE) remains one of the leading causes of cardiovascular mortality. The safety and efficacy of thrombolytic therapy using tissue-type plasminogen activator (tPA) for acute PE in clinical practice remain unclear. We describe a case of life-threatening submassive PE causing extreme refractory hypoxaemia, where thrombolysis was successfully administered. ⋯ Patients, not in shock however, but with evidence of right-ventricular (RV) dysfunction echocardiographically, that is, submassive PE may also benefit. Serum troponin and brain-type natriuretic peptide have been suggested as biomarkers of RV injury that may identify a subset of submassive PE patients who may particularly benefit from thrombolytic therapy. The clinical response of this patient to thrombolysis is important, as it may identify a subgroup of patients with submassive PE who warrant this intervention.
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Emergent repair of umbilical hernias in cirrhotic patients is associated with a high risk for morbidity and mortality. We propose a new technique, umbilical paracentesis, for reduction of incarcerated hernias in the patient with ascites. Under ultrasound guidance, removal of ascitic fluid from the umbilical hernia sac can reduce the local pressure and thereby allow for easy hernia reduction, thus avoiding the need for an emergent operation.
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We describe a 73-year-old man with Crohn's disease and previous sternotomies, who developed Salmonella sternoclavicular osteomyelitis subsequent to a Salmonella enteritidis sepsis and closed fracture of his clavicle. We include evidence from several cases related to sternoclavicular osteomyelitis, and Salmonella osteomyelitis. We continue by summarising the aetologies of these diseases, and risk factors that predispose to them.
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A 66-year-old man had a history of an anterior myocardial infarction followed by a successful cardiopulmonary resuscitation and a posthypoxic myoclonus, also known as Lance-Adams syndrome (LAS). Eight years ago, he was admitted to the emergency department with the same myoclonic jerks during an intercurrent respiratory infection. After treatment with clonazepam and resolution of the infection, the myoclonus promptly disappeared. This case report suggests that relapses of successfully treated LAS can occur in vulnerable patients, as it's a chronic form of myoclonus.
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We describe two patients with laryngeal cyst who underwent microlaryngeal surgery. Peroral rigid laryngoscopy, as an indirect endoscopy, performed via the transoral route, was evaluated as a routine screening tool of the difficult airway in patients with laryngeal neoplasm, in our hospital preoperatively. ⋯ As we saw in these two cases, endoscopic examination alone was inadequate for the assessment of a difficult airway, which may also lack the predictive sensitivity or may cause a high false positive. Usage of video laryngoscopy combined with intubating stylet will improve the intubation success in patients with huge epiglottic cyst.