BMJ case reports
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We present a 17-year-old woman with a 5-year history of systemic lupus erythematosus (SLE). The patient referred to us with the rheumatic involvement of the mitral valve and was treated with mitral valve repair by ring annuloplasty and anterior leaflet augmentation with autologous pericardium. Follow-up, however, disclosed precocious calcification of the valve, necessitating mitral valve replacement.
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Review Case Reports
Dyskalaemia following diffuse axonal injury: case report and review of the literature.
Traumatic brain injury, and its management, commonly causes derangements in potassium balance. There are a number of recognised causative factors including head trauma, hypothermia and iatrogenic factors such as pharmacological agents and permissive cooling. We describe a case of a 19-year-old man with a severe traumatic brain injury. ⋯ Immediately following a decompressive craniectomy, the patient was noted to be profoundly hyperkalaemic; this led to the development of ventricular tachycardia and cardiac arrest, from which the patient did not recover. The effects of brain injury on potassium balance are not well appreciated; the effect of decompressive craniectomy on potassium (K(+)) balance has not been described previously. We would like to emphasise the potential effect of diffuse axonal injury, a severe form of brain injury and decompressive craniectomy on potassium balance.
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A trumpet player presented with sudden onset chest sounds corresponding with systole. He was otherwise asymptomatic, and the complaint resolved spontaneously. He was diagnosed with pneumomediastinum clinically on the basis of the presence of Hamman's crunch, and was discharged home without complication.
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Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis, of unknown aetiology and a propensity to involve almost all organ systems. The anaesthesiologists should be aware of the associated airway pathologies, pain management techniques and adverse effects of drug therapies being used to treat RA. In this respect, we describe a 60-year-old female patient who presented with a diagnosis of RA with pulmonary fibrosis, and was scheduled for orthopaedic surgery for subcapital fracture of femur which was successfully managed using intrathecal bupivacaine and midazolam.