BMJ case reports
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Sore throat is a common complaint in the outpatient and emergency room settings. Typically, little workup is necessary and includes visual inspection with or without swabs for bacterial infection. We present a case that demonstrates an important entity to be excluded by simple history and physical examination in patients presenting with pain in the throat or neck. ⋯ Most cases of spontaneous pneumomediastinum are uncomplicated, as mediastinal pressures rarely mount to dangerous levels. However, when the patient presents with distended neck veins, cyanosis or marked dyspnoea, further action is necessary. Lastly, since pneumomediastinum can be caused by oesophageal rupture and occasionally present with concurrent pneumothorax, these dangerous entities must be excluded.
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Case Reports
Encephalopathy in an infant with infantile spasms: possible role of valproate toxicity.
An infant presented with global developmental delay and infantile spasms. EEG was suggestive of hypsarrhythmia. She was started on sodium valproate, clonazepam and adrenocorticotropic hormone injection. ⋯ Marginal elevation of serum valproic acid prompted us to use the Naranjo ADR probability score to confirm the diagnosis. This case highlights the fact that valproate toxicity can manifest with normal liver function and serum ammonia levels. This is the youngest reported case with this rare form of valproate-induced encephalopathy.
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Case Reports
Paradoxical air embolism and neurological insult during removal of a pulmonary artery catheter introducer.
A 54-year-old man was admitted to the intensive care unit following cardiac surgery. On day 6 postoperatively, approximately 2-3 min following the removal of the pulmonary artery (PA) catheter introducer sited in the right internal jugular vein, the patient became agitated, confused and then unresponsive. He was urgently moved onto the bed, laid supine, sedated with a propofol infusion, intubated and mechanically ventilated. ⋯ The following morning, sedation was discontinued and the trachea extubated. The patient was later transferred to the ward and then discharged home with no evidence of neurological deficit. This case reminds us of the importance of strict adherence to safety protocols when manipulating centrally positioned catheters and the high prevalence of undiagnosed PFO.
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Case Reports
Midgut malrotation with congenital peritoneal band: a rare cause of small bowel obstruction in adulthood.
Midgut malrotation commonly presents in the neonatal period, and rarely manifests its symptoms in adulthood with an estimated incidence of 0.2-0.5%. Nevertheless, the symptoms are non-specific with no strong pointers towards the clinical diagnosis. Consequently, the diagnosis is usually disclosed with imaging or surgery. We report a case of small bowel obstruction secondary to a congenital peritoneal band with underlying midgut malrotation in a 48-year-old man.
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In this case report, we describe a 28-year-old woman with multipar gestation who developed postcaesarean atonia and severe pelvic haemorrhage which continued in spite of peripartum hysterectomy. A balloon tamponade tool was formed with Foley catheter and a condom, and was inserted into the pelvis through the vaginal cuff. The tampon was inflated up to 2200 mL and the pelvic tamponade was applied and bleeding was controlled. ⋯ Pelvic bleeding ceased. After monitoring for a week, no postoperative fever, infection, pelvic abscess and haematoma were observed. Use of Foley catheter-condom as a pelvis pressure tampon tool may be a simple and effective method which can be easily used to control pelvic bleeding.