The Medical journal of Malaysia
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Case Reports
Ways to overcome non-draining indwelling pleural catheter in malignant pleural effusion.
The indwelling pleural catheter (IPC) is a 16-Fr-multifenestrated catheter. It has become an accepted practice in the management of malignant pleural effusion, especially in patients with non-expandable lung. ⋯ After failing saline flushing and low-pressure wall suction, intrapleural alteplase was instituted through the IPC with a favourable outcome, and she continued to drain daily thereafter. The present case highlights the safety of intrapleural alteplase via IPC in the non-expandable lung.
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Fosfomycin (FMT) was first isolated in 1969 and has gained popularity in the past few decades, specifically in the treatment of uncomplicated urinary tract infection (UTI). A retrospective study was undertaken to study the pattern of FMT use in our outpatient clinics. ⋯ Diabetes was an independent risk factor for inappropriate FMT prescription. This represented an opportunity for antimicrobial stewardship in treating diabetic patients with uncomplicated UTI when this agent is chosen.
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Case Reports
Right vertebral artery injury as a result of misplaced internal jugular vein catheter withdrawal.
Central venous cannulation is a common procedure done for various medical indications. The use of the central venous cannula is associated with various immediate complications such as pneumothorax, vascular injury, and arrhythmia. ⋯ This is a condition that can be difficult to diagnose and has a significant impact on patient's quality of life. Clinicians and radiologists should be alert to this possibility to prevent further morbidity resulting from the iatrogenic injury.
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Case Reports
The great masquerade: Empyema thoracis as an unusual presentation of primary lung malignancy.
Primary lung malignancy presenting as empyema is rare, with a reported incidence of 0.3%. We report a case of a 60- year-old man presenting with unilateral pleural effusion; diagnostic thoracocentesis confirmed Salmonella empyema. ⋯ We discuss the mechanism of post-obstructive pneumonia in lung cancerassociated empyema and the utility of bedside ultrasound in diagnosis of lung masses. Clinicians are alerted to the possibility of lung malignancy in elderly patients presenting with empyema.
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Traumatic abdominal wall hernia (TAWH) after blunt injury is uncommon. Diagnosis requires careful examination and high index of suspicion. ⋯ He developed incarceration after 12 hours of admission and subsequently underwent primary repair without mesh. As TAWH is usually associated with other concomitant injuries, it is important that we are meticulous to rule out other serious concomitant injuries.