BMJ case reports
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We present a case of a 43-year-old woman who presented with a non-ST elevation myocardial infarction. During her first cardiac catheterisation, she was diagnosed with a chronic total occlusion of the right coronary artery and a flow limiting dissection of her middle left anterior descending artery. The dissection of the left anterior descending artery was stented with two overlapping everolimus-eluting stents. ⋯ It was then found that the patient had a total occlusion of the right coronary artery secondary to dissection. This was also stented with three everolimus-eluting stents with excellent clinical and angiographic results. It is important to consider spontaneous multivessel coronary dissections which can be treated successfully with percutaneous coronary intervention.
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Case Reports
Incidentally detected Monckeberg's sclerosis in a diabetic with coronary artery disease.
We report the case of a 62-year-old diabetic man, who was incidentally detected to have extensive calcification in his upper limb arteries, consistent with Monckeberg's sclerosis. The condition was identified when routine radial puncture attempted in the course of coronary angiography was repeatedly unsuccessful. ⋯ Monckeberg's sclerosis is a poorly understood condition associated with generalised atherosclerosis and chronic kidney disease. The pathogenesis and natural history of Monckeberg's sclerosis are briefly discussed.
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The authors report a severe anaphylactic reaction to Patent Blue V dye used in sentinel node biopsy for lymphatic mapping during breast cancer surgery to stage the axilla. Patent Blue dye is the most widely used in the UK; however, adverse reactions have been reported with the blue dye previously. ⋯ All surgical patients should give consent for adverse reactions to patent blue dye preoperatively. Alternative agents such as methylene blue are considered.
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A 91-year-old man with chronic low-back pain presented with 1-day history of disturbance of consciousness and myoclonus of all of his extremities and face. Laboratory examinations revealed no abnormalities. Administration of benzodiazepine for the myoclonus resulted in immediate and complete disappearance of the symptoms. ⋯ The day following admission, he discontinued pregabalin. He did not experience recurrence of his symptoms any more. We concluded that the neurological symptoms he experienced were possibly due to pregabalin.
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Review Case Reports
Delayed presentation of congenital diaphragmatic hernia presenting with intrathoracic gastric volvulus: a case report and review.
Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency and its presentation in adulthood is extremely rare. Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. This case describes a middle aged man presenting with post-traumatic acute abdomen and finally being diagnosed as a case of gastric volvulus due to congenital diaphragmatic hernia which was till now asymptomatic and undiagnosed. ⋯ Surprisingly, the intraoperative findings revealed significant adhesions near the diaphragm suggestive of congenital diaphragmatic hernia. Hence, a diagnosis of gastric volvulus due to congenital diaphragmatic hernia was made which remained asymptomatic and undiagnosed till adulthood. He responded well to operative management and remained asymptomatic afterwards.