BMJ case reports
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Anaphylactic reaction to contrast media during selective coronary angiography is a rare occurrence. It can be occasionally resistant to medical treatment leading to cardiovascular collapse and death. ⋯ We report a case of a severe contrast media-induced anaphylactic shock which failed to respond to the supportive medical management and the timely insertion of IABP for further circulatory support that prevented death in a patient who had an elective diagnostic coronary angiography. The clinical diagnosis of anaphylaxis was challenging at the onset of shock as the typical rash developed after a few minutes.
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Flagellate dermatitis shows very characteristic lesions: linear erythema or hyperpigmentation in various areas of the skin. It is a side effect of bleomycin, an immunosupressive drug used for several types of cancers. All physicians must be aware of this disease so they can make a rapid diagnosis and interrupt the causative agent. Our patient presented during chemotherapy for a Hodgkin's lymphoma pruritic, erythematous lesions on the lower limbs and the back diagnosed as flagellate dermatitis due to bleomycin.
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Isolated or primary intraventricular haemorrhage (PIVH) is rare and usually caused by hypertension, vascular malformations, aneurysms and moyamoya disease. Lenticulostriate artery aneurysm (LSA) is also a rare entity, and LSA aneurysm rupture causing primary intraventricular haemorrhage is extremely rare. There are only a few case reports. ⋯ They are usually associated with various vascular conditions. We report two rare cases of LSA aneurysms presenting as PIVH, one being medial and other being lateral distal LSA aneurysm. Both were normotensives, and one was associated with arteriovenous malformation.
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Postdural puncture headache (PDPH) is the most common complication of obstetric regional anaesthesia and the most likely cause of headache in a woman who underwent epidural anaesthesia during delivery. Cerebral venous sinus thrombosis (CVST) is an uncommon cause of postpartum headache. Anaesthesia in obstetrics may lead to long-lasting intracranial hypotension resulting in CVST. ⋯ The latter condition may be treated either by an epidural blood patch or bed rest and hydration. We report a case of a 36-year-old woman who developed CVST and multiple venous infarcts after an attempted epidural procedure during delivery. She was treated conservatively with bed rest, hydration and low-molecular-weight heparin and the patient recovered completely.
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Parastomal hernia is a recognised complication following stoma formation, representing a challenging problem to surgeons. At least three approaches for parastomal hernia repair have been described: fascial suture repair, relocation of stoma and local repair with use of mesh. In simple fascial suture repair only open techniques have been described. ⋯ The recurrence rate and complications of parastomal hernia repair remain very high. We have invented a simple fascial suture laparoscopic repair of parastomal hernia with the use of the Crochet hook needle (EndoClose). This new technique may result in reduced pain, earlier discharge from hospital and reduced risk of infection as there is no mesh used as well as reduced risk of seroma formation.