BMJ case reports
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Tentorial dural arteriovenous fistula (DAVF) as a cause of trigeminal neuralgia is extremely rare. Although less than 10 cases have been reported in the literature, all cases presented with ipsilateral trigeminal neuralgia. Here we report a unique case of tentorial DAVF manifesting as contralateral trigeminal neuralgia. ⋯ Transarterial Onyx embolization resulted in near complete obliteration of the fistula with immediate resolution of facial pain. The patient remains symptom free and without evidence of recurrence during 9 months of follow-up. Transarterial Onyx embolization may be an effective treatment modality for such an usual case.
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Mid-tracheal, postintubation stenosis can be managed with an extended length tracheostomy tube to bypass the stenotic area. However these extra-long tracheostomy tubes are not fenestrated, and when the stenotic tracheal lumen sits against the tracheostomy tube, phonation is not possible as there is no translaryngeal airflow. ⋯ We modified a silicone tracheostomy tube by creating a fenestration on its posterior wall. This relieved the obstruction while still allowing phonation and speech.
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Vulvar Paget's disease is an extremely rare neoplasm that accounts for less than 1% of the vulvar malignancies. We present a case of a 75-year-old woman, who had an eczematoid lesion involving the labia majora and minora bilaterally, with infiltration to the clitoris. ⋯ She underwent radical vulvectomy with bilateral inguinal lymph node dissection. The patient remained disease free at 6-month follow-up.
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Isolated subclavian artery dissection is a very rare condition in the absence of trauma or procedures. A 36-year-old woman with a history significant for uncontrolled hypertension presented with a sudden onset of left shoulder and neck pain that woke the patient from sleep. A CT angiogram of the chest revealed a left subclavian artery dissection. The patient was admitted to the hospital for blood pressure control.
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Case Reports
Early diagnosis and treatment of invasive pulmonary aspergillosis in a patient with cystic fibrosis.
Invasive pulmonary aspergillosis is a rare and fatal complication in patients with cystic fibrosis (CF) who lack concomitant risk factors. The few documented cases in children have all resulted in deaths during hospitalisation. We present the case of a 12-year-old boy with CF who was admitted for an exacerbation which was unresponsive to antibiotic therapy. ⋯ Voriconazole was continued beyond discharge and resulted in improvement of respiratory symptoms. This underscores the importance of early treatment of pulmonary aspergillosis in patients with CF. Unfortunately, the patient died 6 months after diagnosis from a CF exacerbation.