BMJ case reports
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Case Reports
A novel false-positive cause in testis scintigraphy in the diagnosis of testis torsion.
Testis scintigraphy is the most reliable modality in the diagnosis of testis torsion since it directly reflects the vascularity of the testis. The 'rim sign' is considered as the pathognomonic sign of the missed torsion. However, there are some possible false-positive cases. In this case report, we would like to present an unexpected false-positive cause of the 'rim sign' in testis scintigraphy in an 18-year-old male patient.
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Acquired fistulas between the tracheobronchial tree and the gastrointestinal tract are rare but serious complications of laparoscopic sleeve gastrectomies with significant morbidity and mortality. With the rising popularity and widespread acceptance of bariatric surgery techniques, the occurrence of gastrobronchial fistulas is being increasingly recognised. ⋯ Upper gastrointestinal series showed the presence of a communicating fistula between the stomach and the lung, with extravasation of contrast into the lung. The aim of this paper is to highlight the importance of considering the diagnosis of a gastrobronchial fistula in cases of persistent respiratory infections in the postoperative period following bariatric surgery and to review its incidence, clinical manifestations and treatment.
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The authors present the case of a 45-year-old lady who presented to the emergency department with sudden onset of right hemiparesis, numbness, dysarthria, dysmetria, left upper motor neuron facial palsy and left extensor plantar. Initial laboratory investigations, ECG and MR angiography were normal. ⋯ Transthoracic echocardiography revealed large mobile mass in left atrium which was resected and the patient remained well postoperatively. Anticoagulants do not play any protective role making resection as the only effective treatment.
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Angioedema secondary to the use of ACE-inhibitors is well recognised, with a high rate of airway intervention required. Several treatments have been described, but little evidence exists for any of them. We describe the successful use of fresh frozen plasma in two cases.
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A 3-year-old man with an implanted cardioverter-defibrillator (ICD) for type 2 Brugada syndrome was admitted to coronary care unit with ventricular fibrillation electrical storm and consequent appropriate recurrent ICD shocks. The rhythm did not settle with conventional antiarrhythmics such as β-blockers and amiodarone. ⋯ He has remained free of problems for 1 year. This case-report summarises these novel treatments for electrical storm in Brugada syndrome and the mechanism behind them.