BMJ case reports
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Case Reports
Subacute combined degeneration of the spinal cord following recreational nitrous oxide use.
We describe a case of a young woman who developed myelopathy and peripheral neuropathy following 1 year of recreational nitrous oxide (N2O) use. She presented with uncomfortable tingling sensation in her feet and poor balance. Physical examination revealed mild weakness and hyper-reflexia in the lower limbs. ⋯ T2-weighted MRI scans showed hyperintensity changes at the posterior column from the second to the fifth cervical vertebrae. She made a full recovery following injections of vitamin B12 and physiotherapy. This case discusses subacute combined degeneration of the spinal cord on a background of N2O abuse.
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Case Reports
Uterine rupture complicating sequential curettage and Bakri balloon tamponade to control secondary PPH.
A 20-year-old para 2 woman had a preterm delivery at 25 weeks and 6 days, readmitted to the hospital 25 days after delivery with severe secondary postpartum haemorrhage (PPH). Uncontrolled by initial conservative management, she underwent uterine curettage followed by Bakri balloon tamponade. She later had laparotomy for continued bleeding. ⋯ The histology report showed ectatic non-constricted vessels as the cause of the secondary PPH. No myometrial tissue, products of conception or evidence of endometritis. The sequential use of uterine curettage and balloon tamponade in the aetiology of uterine rupture is a rare occurrence.
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A 56-year-old man, presented with bilateral chronic visual loss associated with generalised skin lesions. He had undergone multiple penetrating keratoplasties in his right eye for recurrent corneal infections and perforations. On ocular examination, his left eye was phthisical and his right eye had light perception vision owing to a failed and vascularised corneal graft. ⋯ Skin biopsy showed focal areas of deposition of faint periodic acid Schiff-positive diastase-resistant perivascular material. The high-performance liquid chromatography assessment revealed increased presence of porphyrins in blood and urine, thus confirming a diagnosis of porphyria cutanea tarda. The patient's vision in the right eye improved after undergoing Boston type 1 keratoprosthesis along with general photoprotective measures for the exposed parts of the body.
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Calculi in the cystic duct remnant are one of the causes of postcholecystectomy syndrome. A 36-year-old woman presented thrice to the casualty department with right upper quadrant pain at an interval of 2 months every time. Ultrasound and CT scan of the abdomen was normal except for echoes in the gallbladder region may be clips. ⋯ She had undergone endoscopic retrograde cholangiopancreatography with sphincterotomy with stent in situ outside elsewhere before presenting to us for the third time, which was removed after 6-weeks. The third time, she was taken up for laparoscopic stump exploration, which revealed a stone, which was the cause of her pain. To conclude, stump stone can be a possibility of post cholecystectomy syndrome even after 6 years, and surgeons should be aware of it.