BMJ case reports
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Perineal hernia is an uncommon complication of abdominoperineal resection of the rectum. Gracilis muscle flaps can be used to reconstruct the pelvic floor. ⋯ Surgical repair of postoperative perineal hernia using a gracilis flap spares the morbidity of abdominal-based reconstruction and provides a good option for patients in whom the abdomen is unavailable. Use of a myocutaneous flap adds strength to the repair when compared to reconstruction with the gracilis muscle alone, owing to the strength imparted by the dermis.
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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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A 27-year-old woman with a history of depression and previous overdose presented within 60 min of ingestion of 50 g of caffeine powder. Initially alert but hypotensive and tachycardic, the patient developed a broad complex tachycardia followed by a seizure and multiple ventricular fibrillation (VF) arrests. ⋯ She developed a postcardiac arrest systemic inflammatory response syndrome with episodes of acute pulmonary oedema, profound vasoplegia, hypothermia and coagulopathy. After 5 days in the ICU, the patient was stable enough to be transferred to the ward, with a persistent sinus tachycardia, and was discharged 3 days later with cardiology and psychiatry follow-up.
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Case Reports
Blunt traumatic internal carotid artery dissection with delayed stroke in a young skydiver.
We describe a case of a 33-year-old skydiver who presented to the emergency department after a traumatic landing following a parachuting episode. He initially presented with right knee pain secondary to a tibial plateau fracture. ⋯ An urgent work-up showed right middle cerebral artery thrombosis with right internal carotid thrombosis and dissection. We have discussed some possible mechanism of injury in skydiving that may have predisposed to the occurrence of cervical dissection in our patient.
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This is a case of a 57-year-old gentleman with a history of chronic obstructive pulmonary disease (COPD) who presented with diarrhoea of more than 4 weeks in length. On chest x-ray, he was incidentally found to have a large cavitating lesion in his right lung. ⋯ The CT-guided biopsy confirmed a methicillin-resistant Staphylococcus aureus positive lung cavitation, most likely secondary to his poor dentition. A full dental clearance was performed, and he was treated with a course of intravenous vancomycin and oral clindamycin with good effect.