BMJ case reports
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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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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 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.
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A patient presented with symptoms consistent with non-ST elevation myocardial infarction (NSTEMI) and was given appropriate antiplatelet and anticoagulant therapy. Despite treatment of the NSTEMI and fluid resuscitation the patient remained persistently hypotensive. ⋯ Post surgery the patient had an uneventful recovery. We present this case to highlight the importance of considering dissection as a differential in patients presenting with chest pain and the lack of symptoms a patient with such a severe dissection can display.