BMJ case reports
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Case Reports
Computational fluid dynamics simulation of an anterior communicating artery ruptured during angiography.
We present a computational fluid dynamics (CFD) analysis of the hemodynamic environment of an anterior communicating artery that spontaneously ruptured immediately following three-dimensional rotational angiography. Subsequent digital subtraction angiography allowed for the localization of the point of rupture within the aneurysm dome. CFD analysis demonstrated a concentrated jet that impinged directly at the site of rupture. Peak systolic pressure and wall shear stress were both maximal near the rupture location.
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We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. ⋯ The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.
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Perineal hernia is an uncommon complication of abdominoperineal resection of the rectum. Gracilis muscle flaps can be used to reconstruct the pelvic floor. ⋯ Surgical repair of postoperative perineal hernia using a gracilis flap spares the morbidity of abdominal-based reconstruction and provides a good option for patients in whom the abdomen is unavailable. Use of a myocutaneous flap adds strength to the repair when compared to reconstruction with the gracilis muscle alone, owing to the strength imparted by the dermis.
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A 66-year-old man had a history of an anterior myocardial infarction followed by a successful cardiopulmonary resuscitation and a posthypoxic myoclonus, also known as Lance-Adams syndrome (LAS). Eight years ago, he was admitted to the emergency department with the same myoclonic jerks during an intercurrent respiratory infection. After treatment with clonazepam and resolution of the infection, the myoclonus promptly disappeared. This case report suggests that relapses of successfully treated LAS can occur in vulnerable patients, as it's a chronic form of myoclonus.
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Case Reports
Intubating laryngeal mask airway combined to fibreoptic intubation in subglottic stenosis.
We reported a successful airway management in a patient with unknown tracheal stenosis admitted in the emergency room for benzodiazepine overdose. The use of intubating laryngeal mask airway in combination with fibreoptic intubation was easy and safe in this patient; procedures such as ventilatory control and patient oxygenation were continued during intubation attempts, lessening the likelihood of desaturation. This method allowed the diagnosis of tracheal stenosis and soft endotracheal intubation.