BMJ case reports
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Case Reports
Incidental pathologically proven pulmonary hamartoma in a patient with carcinoma tongue.
Pulmonary hamartomas are usually clinically silent and found incidentally on chest radiographs. They can lead to diagnostic confusion especially in patients who have been previously treated for primary cancers at other sites. ⋯ In this case, evaluation of a solitary pulmonary nodule (SPN) in a patient with carcinoma of tongue led to the diagnosis of pulmonary chondroid hamartoma. This highlights the fact that a pulmonary nodule in a patient with progressive cancer at another site does not always indicate pulmonary metastasis.
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A 44-year-old lady with a history of lumbar back pain presented to the emergency department complaining of severe back pain radiating to her buttocks. Positive examination findings were a loss of sensation in the perianal area and 348 ml of retained urine. An urgent MRI showed compression of the cauda equina by a herniated disc. ⋯ During follow-up, the patient was reviewed by a consultant spinal surgeon, a urologist and our cauda equina nurse at every appointment, as per the cauda equina pathway specifically designed and implemented by our spinal unit. This report shows the complex nature of cauda equina syndrome and broad functional deficit patients can suffer from. It shows the benefits of prompt diagnosis and surgery, together with intensive, multidisciplinary follow-up and treatment, all of which are possible by a specially created, cauda equina protocol.
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Pyogenic granuloma (PG) is a kind of inflammatory hyperplastic soft tissue lesion of the oral cavity. The lesion, however, is not related to infection and arise as a reactive growth in response to various stimuli. ⋯ Bleeding may be at times very severe and difficult to control. We present the case of a profusely bleeding young PG in a young teenage child.
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Smoking-related interstitial fibrosis (SRIF) is a relatively new term used to describe chronic interstitial fibrosis that can develop in smokers. The association of SRIF with pulmonary hypertension has not been described. We present a 55-year-old man with an extensive smoking history who presented for evaluation of insidious onset of dyspnoea on exertion and hypoxaemic respiratory failure. ⋯ Open lung biopsy was consistent with SRIF. Vascular intimal proliferation consistent with pulmonary hypertension was also noted. Right heart catheterisation yielded mild pulmonary hypertension and treatment was initiated with tadalafil and bosentan.
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Case Reports
Subacute combined degeneration of the spinal cord following recreational nitrous oxide use.
We describe a case of a young woman who developed myelopathy and peripheral neuropathy following 1 year of recreational nitrous oxide (N2O) use. She presented with uncomfortable tingling sensation in her feet and poor balance. Physical examination revealed mild weakness and hyper-reflexia in the lower limbs. ⋯ T2-weighted MRI scans showed hyperintensity changes at the posterior column from the second to the fifth cervical vertebrae. She made a full recovery following injections of vitamin B12 and physiotherapy. This case discusses subacute combined degeneration of the spinal cord on a background of N2O abuse.