BMJ case reports
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Isolated traumatic carpometacarpal (CMC) dislocation of the thumb is a rare injury. There are many different ways to manage a thumb CMC joint dislocation which ranges from closed reduction with or without Kirschner wires and casting to ligament reconstruction. However, it is still up for debate on the best management for this injury. ⋯ Our patient was managed with manipulation under anaesthesia (MUA). She returned to preinjury activities with no difficulties within 2 months. Good outcomes can be achieved with MUA to manage dislocation of the first CMC joint; however, those with high activity of the hand may also benefit from ligament reconstruction.
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Case series outlining the treatment of three patients with ketamine, in which two of the patients had a sustained antidepressant effect to ketamine without the need for maintenance on antidepressants. These two responders have an established diagnosis of bipolar affective disorder with a history of response to electroconvulsive therapy and lithium, both of which have an influence on the seizure threshold as has ketamine. The mechanism of action of ketamine is yet unclear and although the current focus is on the N-methyl-d-aspartate and alpha-amino-3-4-hydroxy-5methyl-4-isoxazoleproprionic acid receptors, we additionally recommend that its impact on the seizure threshold should be explored with a view to fully elucidating the mechanism of action.
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We describe a rare case of type B thoracic aortic dissection resulting from a forceful sneeze in a 57-year-old man. The presenting clinical features were not typical and consisted of pleuritic chest pain and breathlessness following a forceful sneeze. There was no haemodynamic compromise. The diagnosis was made incidentally when he underwent a CT pulmonary angiography as part of pulmonary embolism work-up.
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A 71-year-old lady was referred by her general practitioner to an orthopaedic clinic for management of shoulder pain. The patient complained of pain in the shoulder and chest region but also described reduced sensation and power in her arm and a worsening of her respiratory symptoms. ⋯ A subsequent CT scan identified Pancoast's tumour. This case highlights the importance of considering non-musculoskeletal causes of shoulder region pain.
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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.