BMJ case reports
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Review Case Reports
Aneurysmal bone cyst of thoracic spine: case report and brief review of literature.
A 16-year-old girl was admitted with insidious onset, gradually progressive spastic sensori-motor paraparesis, with a sensory level at D10 dermatome without bowel or bladder involvement for the last 2 months following trivial trauma on the lower back. MRI of the spine showed a low-to-intermediate signal intensity, heterogeneous mass with multiple fluid levels. A diagnosis of aneurysmal bone cyst was made. ⋯ Histopathology of the mass showed cyst cavity filled with haemorrhage surrounded by bony trabeculae confirming the diagnosis. Following excision the patient had excellent recovery. We report this case owing to its rarity and to emphasise the importance of surgery if there is cord compression.
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Case Reports
Value of an automatic external defibrillator printout as a diagnostic tool after successful AED use on a child.
A 6-year-old girl without any medical history experienced a drowning incident for a duration of 2 min, according to witnesses. This was followed by cardiopulmonary resuscitation, during which the automatic external defibrillator (AED) detected a shockable rhythm and subsequently delivered a single electroshock. ⋯ This case report confirms the assumption that the AED can adequately perform rhythm analysis on children and convert VF into sinus rhythm. Moreover, the AED printout can provide information about the rhythm that is necessary for the diagnosis of an underlying cardiac disease.
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Case Reports
Inhaled β-agonist therapy and respiratory muscle fatigue as under-recognised causes of lactic acidosis.
A 49-year-old man with chronic obstructive pulmonary disease (COPD) presented with significant tachypnoea, fevers, productive cough and increased work of breathing for the previous 4 days. Laboratory data showed elevated lactate of 3.2 mEq/L. Continuous inhaled ipratropium and albuterol nebuliser treatments were administered. ⋯ No infectious source was found and the lactic acidosis cleared as the patient improved. The lactic acidosis was determined to be secondary to respiratory muscle fatigue and inhaled β-agonist therapy, two under-recognised causes of lactic acidosis in patients presenting with respiratory distress. Lactic acidosis is commonly used as a clinical marker for sepsis and shock, but in the absence of tissue hypoperfusion and severe hypoxia, alternative aetiologies for elevated levels should be sought to avoid unnecessary and potentially harmful medical interventions.
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A 54-year-old man presented with recurrent episodes of transient ischemic attacks and acute stroke secondary to a floating thrombus in the right vertebral artery (VA) with narrowing of the right VA. He was initially treated medically with anticoagulation, antiplatelets and statins but developed multiple fresh infarcts. He was then referred for endovascular treatment, which was performed in a novel way.
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Ornithine transcarbamylase (OTC) deficiency is the most common inborn error in the metabolism of the urea cycle with an incidence of 1 in 14,000 live births. Pregnancy can trigger potentially fatal hyperammonemic crises. We report a successful pregnancy in a 29-year-old primiparous patient with a known diagnosis of OTC deficiency since infancy. ⋯ Management principles include avoidance of triggers, a low-protein diet and medications which promote the removal of nitrogen by alternative pathways. Triggers include metabolic stress such as febrile illness, particularly gastroenteritis, fasting and any protein loading. In our case the patient, in addition to a restricted protein intake, was prescribed sodium benzoate 4 g four times a day, sodium phenylbutyrate 2 g four times a day and arginine 500 mg four times a day to aid excretion of ammonia and reduce flux through the urea cycle.