BMJ case reports
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A 53-year-old woman with spinal muscular atrophy and a 7-year history of nocturnal non-invasive ventilation (NIV) use via nasal mask and chinstrap was admitted electively. Outpatient review suggested symptomatic hypercapnia and hypoxaemia. Use of her usual NIV resulted in early morning respiratory acidosis due to excess mouth leak, and continuous face mask NIV was instigated while in hospital. ⋯ Control of respiratory failure was achieved and, vitally, independent living maintained. Intermittent MPV was practicable and effective where the limits of ventilator tolerance had otherwise been reached. MPV may reduce the need for tracheostomy ventilation and this case serves as a reminder of the increasing options routinely available to NIV clinicians.
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Overall survival for patients with glioblastoma multiforme (GBM) has been consistently shown to improve when the surgeon achieves a gross total resection of the tumour. It has also been demonstrated that surgical adjuncts such as 5-aminolevulinic acid (5-ALA) fluorescence--which delineates malignant tumour tissue--normal brain tissue margin seen using violet-blue excitation under an operating microscope--helps achieve this. ⋯ This technique led to gross total resection of all T1-enhancing tumour with the avoidance of neurological deficit. The authors recommend this technique in patients when awake surgery can be tolerated and gross total resection is the aim of surgery.
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Loperamide is a common over-the-counter antidiarrheal considered safe in a broad range of dosages and thought devoid of abuse potential. We describe the first case of a patient with loperamide dependence due to misuse of its opiate-like effects achieved by chronic massive oral ingestions. ⋯ Loperamide has potential for euphoric effects and information on how to facilitate such effects is easily available. It is important for physicians to be aware of the potential for misuse of and dependence on loperamide, with symptoms mimicking opiate use.
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A man in his mid-50s presented with a painful and swollen right thigh and buttock. This was accompanied by a month long history of flank pain, back pain, vague abdominal pain, limp, fever and weight loss. On examination, there was extensive erythaema, heat, tenderness, oedema and crepitus over his right buttock and thigh. ⋯ After CT imaging, a psoas abscess (PA) and caecal mass were identified. Subsequent right hemicolectomy, PA drainage and debridement of his right thigh were performed. This case reminds clinicians of the many non-specific ways a PA can present and that a high level of suspicion assists in making a timely diagnosis.
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Case Reports
ECG phasic voltage changes associated with spontaneous pneumothorax in a patient with vanishing lung syndrome.
Alternating or phasic ECG voltage changes are most commonly associated with intrinsic myocardial electrophysiological perturbations or mechanical oscillation within a pericardial effusion. Rare descriptions of electrical alternation have been reported with pneumothorax. We present a case of a 53-year-old woman with vanishing lung syndrome who presented with spontaneous left pneumothorax and phasic ECG voltage changes that resolved after re-expansion of the lung.