BMJ case reports
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We report the first case of cardiopulmonary arrest (CPA), caused by oesophageal achalasia, which recovered completely with cardiopulmonary resuscitation (CPR) followed by therapeutic hypothermia. A 53-year-old woman arrived at our hospital with recovery of spontaneous circulation (ROSC) after cardiac arrest. Dysphagia, vomiting and general fatigue had progressed for a week before. ⋯ A large amount of food, air and saliva was suctioned with a nasogastric tube, and the patient was admitted to the intensive care unit for therapeutic hypothermia. Neurological recovery was evident. On the 11th day, pneumatic dilatation was performed and she was discharged on the 33rd day.
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Pancreaticopleural fistula (PPF) is an uncommon complication of chronic pancreatitis leading to a large and recurrent pleural effusion. Since the patients presented predominantly with respiratory symptoms, diagnosis and treatment were often delayed. ⋯ Multidetector CT is an easily accessible method that is able to show both the thoracic and abdominal findings non-invasively. The clinical and imaging features of this unusual entity are discussed.
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Acromegaly is a rare metabolic condition in adults caused due to over secretion of growth hormone mostly due to pituitary gland adenomas. Disproportionate skeletal, tissue and organ growth are characteristic of acromegaly but the changes may be so insidious that most of the times go unnoticed by the patient and family. ⋯ Dental professionals may be the first healthcare providers to be visited by these patients and thereby prove instrumental in early diagnosis. Here we report the diagnosis of a case of acromegaly in a dental setup.
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A 28-year-old woman presented to accident and emergency department with a 1-day history of right-sided abdominal pain. She was afebrile, and haemodynamically stable, and the initial diagnosis was acute appendicitis. A transvaginal ultrasound scan was performed and was suggestive of appendicitis. ⋯ Postoperatively the patient complained of persisting pain, which settled over 2 days with analgesia and antibiotics. This case is an extremely unusual case of epiploic appendagitis and acute appendicitis. It demonstrates the importance of pelvic laparoscopy in all females with presumed appendicitis, even in the presence of an initial pathology.
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It is unusual for pneumothorax to occur spontaneously during pregnancy. Its occurrence during or following caesarean section is extremely uncommon with only three other cases reported previously. ⋯ We report the successful management of a multigravida female patient, who developed spontaneous pneumothorax following caesarean section, performed under spinal anaesthesia. Tube thoracostomy was required for management and the patient had an uneventful recovery.