BMJ case reports
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A 33-year-old lady in the second trimester of pregnancy presented to the emergency department having suffered a cardiac arrest at home. An emergency caesarean section was performed in the resuscitation area. ⋯ She was transferred to our tertiary centre for an emergency coronary angiography and was successfully treated, making a full recovery. This case report examines the relatively rare entity of myocardial infarction in pregnancy and looks at the mechanisms underlying this.
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A 63-year-old man underwent endoscopic evaluation of the rectal stump for rectal bleeding and suffered a massive cerebral air embolism with severe neurological impairment and subsequent death. The patient underwent a Hartmann's procedure 9 month previously for ischaemic bowel and was noted to have portal hypertension at laparotomy. We hypothesise that air entered the venous plexus around rectum and entered the azygos vein via a porto-systemic shunt and travelled retrogradely via the superior vena cava to the venous sinuses of the brain.
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Lemierre's syndrome is a rare yet potentially fatal cause of sore throat. Recently published literature suggests an increase in the incidence of this 'forgotten disease', highlighting Lemierre's syndrome as a clinically important differential diagnosis of sore throat. We present a case report of an 85-year-old man who developed a sore throat, which illustrates the re-emergence of Lemierre's syndrome. Reducing the morbidity and mortality from this disease requires a high index of clinical suspicion to ensure prompt diagnosis and initiation of appropriate multidisciplinary management.
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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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Emergent repair of umbilical hernias in cirrhotic patients is associated with a high risk for morbidity and mortality. We propose a new technique, umbilical paracentesis, for reduction of incarcerated hernias in the patient with ascites. Under ultrasound guidance, removal of ascitic fluid from the umbilical hernia sac can reduce the local pressure and thereby allow for easy hernia reduction, thus avoiding the need for an emergent operation.