Journal of medical case reports
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Deep accidental hypothermia (body temperature below 28 degrees C) is rare and has a high mortality rate. Successful resuscitation usually occurs in the young, but a prompt intervention using a portable extracorporeal cardiopulmonary circulation device can also provide a good outcome for older persons. ⋯ This successful resuscitation of an 82-year-old patient demonstrates that a prompt intervention by a medical team that trains together, using a mobile cardiopulmonary bypass device via a percutaneous approach, can potentially provide good outcomes for all victims of deep accidental hypothermia, both in the operating suites and the emergency department.
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Lisfranc fracture dislocations of the foot are rare injuries. A recent literature search revealed no reported cases of injury to the tarsometatarsal (Lisfranc) joint associated with sledding. ⋯ Lisfranc injuries are often caused by high-velocity, high-energy traumas. Careful examination and thorough testing are required to identify the injury properly. Computed tomography imaging is often recommended to aid in diagnosis. Treatment of severe cases may require immediate open reduction and internal fixation, especially if the risk of compartment syndrome is present, followed by a period of immobilization. Complete recovery may take up to 1 year.
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Internal jugular vein thrombosis (IJVT) is a rare but potentially fatal condition. It usually arises following trauma to the internal jugular vein but is also seen in association with coagulopathies and advanced malignancies as part of a para-neoplastic syndrome. ⋯ This case illustrates an unusual presentation of a rare condition. In this case, the precise aetiology is unclear as the IJVT may have been related to a coagulopathy or the presence of advanced malignancy and occurred despite adequate anticoagulation.
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Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. ⋯ We present two case reports of severe lactic acidosis most probably associated with high doses of metformin in patients with no known contraindications for metformin prescription. In both patients no other condition was identified to cause such severe lactic acidosis. Although controversial, lactic acidosis should be considered in patients taking metformin.
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Concomitant pulmonary and hepatic toxicity secondary to nitrofurantoin is a rare but serious complication of the use of Nitrofurantoin. ⋯ Adverse drug reactions are an important cause of concomitant lung and liver toxicity and the mainstay of treatment is drug withdrawal.