BMJ case reports
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Case Reports
Penetrating neck injury from a screwdriver: can the No Zone approach be applied to Zone I injuries?
The newer approach to management of penetrating neck injuries (PNI) involves the No Zone approach: comprehensive physical examination combined with CT angiography for triage to effectively identify or exclude vascular and aerodigestive injury. This approach, however, has a low negative exploration rate; there is risk of missing occult injuries especially Zone I and III PNI. ⋯ Immediate surgical exploration revealed an occult hypopharyngeal injury in addition to the arterial trauma, which was missed on the CT scan. Hence the No Zone approach needs cautious clinical application, especially in Zone I injuries.
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Opioid-induced constipation (OIC) is one of the major side effects in patients receiving methadone maintenance treatment (MMT). Quite often, constipation becomes a factor significantly affecting therapeutic options and choices. Currently used approaches are symptomatic and in many cases ineffective. ⋯ In this case report, we describe an unexpected outcome of placebo administration in a patient suffering from OIC since her participation in MMT. The patient participated in a triple-blind randomised placebo-controlled trial of naloxone for treatment of OIC. As part of the study crossover design, the patient received 1 week of placebo followed by 1 week of naloxone, and had significant improvement in her bowel functioning when receiving placebo, then returned to baseline during the second week of the study.
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Hookworm-related cutaneous larva migrans (HrCLM) is a skin disease caused by infection with the larvae of animal hookworms. With conditions for infection more favourable in tropical climates, HrCLM in the UK is classically diagnosed in the returning traveller. We present two cases of clinically diagnosed UK-acquired HrCLM from a district general hospital in the south of England. ⋯ Both patients were treated with a single dose of albendazole. These cases may represent an emerging infection in the UK. In the absence of a suggestive travel history, early recognition followed by efficient access to therapy is vital for treating HrCLM transmitted in the UK.
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Case Reports
Spontaneous resolution of a recurrent axillary cystic hygroma following acute infection.
We report a case of spontaneous resolution of a recurrent axillary cystic hygroma in a 4-year-old boy. He presented with a 1-year history of a cystic lump in the left axilla, which intermittently changed in size. Ultrasound suggested it was a lipoma, with raised suspicions of vascular malformation. ⋯ He developed acute infection in the cystic hygroma a week before surgical intervention and was treated with antibiotics for 5 days by his general practitioner. Acute infection led to complete spontaneous resolution of the cystic hygroma within a week. There are no other reported cases in which recurrent cystic hygroma has resolved after a week of acute infection.