BMJ case reports
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The case report illustrates an acute myocardial infarction (MI) in a 41-year-old hypertensive woman possibly because of an intake of a combination of tranexamic acid and mefenamic acid for dysmenorrhoea and menorrhagia. There are multiple case reports of MI occurring in the setting of the use of antifibrinolytic agents including tranexamic acid. The present case serves as a warning that, even in patients with an apparently low risk for arterial thrombosis, these drugs may be implicated as a precipitant of MI.
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Case Reports
Wellens' syndrome: a classical electrocardiographic sign of impending myocardial infarction.
We describe a case of previously healthy 72-year-old man, who presented with rest angina. The ECG revealed sinus rhythm, biphasic T waves with preserved R waves in V1-V4 precordial leads. Subsequent evaluation revealed the normal serum cardiac marker levels and echocardiography with the coronary angiography showing a critical lesion in the proximal left anterior descending artery. ⋯ In our case, we highlight the subtle though classical ECG findings of Wellens' syndrome and its specific angiographic correlation. It can be of vital importance to identify these changes and intervene in time appropriately so as to avoid the development of myocardial infarction that carries a substantial morbidity and mortality. Important aspects of diagnosis and management have also been reviewed.
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Case Reports
Early treatment causes clinicoradiological reversal of myelopathy due to vitamin B12 deficiency.
Vitamin B12 deficiency has a wide spectrum of clinical presentation with a variety of neurological symptoms and signs. As a result, many patients lack classic features of advanced severe deficiency. ⋯ His serum vitamin B12 levels were low and neuroimaging revealed myelopathy. The patient was treated promptly with cyanocobalamin injections, which lead to a rapid resolution of symptoms and radiological abnormalities.
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Case Reports
Successful low-dose spinal anaesthesia for lower segment caesarean section in a patient with Takayasu arteritis.
Takayasu arteritis is a rare, chronic idiopathic, occlusive inflammation of the aorta and its major branches. It is a rare form of non-specific obliterative panarteritis of unknown aetiology. ⋯ We report a 26-year-old woman multigravida who was diagnosed with Takayasu arteritis who underwent an emergency caesarean section under spinal anaesthesia. In this case study, the whole course of anaesthesia and operation was uneventful due to thorough systemic evaluation and planned anaesthetic management.
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Traumatic injuries of the elbow in children pose a diagnostic challenge. They demand precise knowledge of radiographic anatomy, growth characteristics of healthy and injured bones as well as specific fracture dynamics in this age group. Dislocation of the elbow is rare in children, accounting for 3-6% of all childhood elbow injuries. ⋯ Diagnosis and recognition of the injury pattern was fundamental in the successful management of this case. We recommend the use of CT with three-dimensional reconstructions, to fully understand the fracture pattern and dictate subsequent reduction manoeuvres during closed manipulation. Thus preventing open surgical techniques and their associated morbidities.