Harefuah
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Anaphylactic shock as a result of trauma is very rare. We describe a 20-year-old Druze soldier who presented with anaphylactic shock due to rupture of a splenic echinococcal cyst induced by blunt trauma to the left chest wall and upper abdomen. The main clinical manifestations, which developed within minutes of the trauma, were high fever, pruritus, edema of the lips and eyelids, dyspnea, stridor and rhinorrhea. ⋯ Surgery revealed an intact echinococcal cyst in the left lobe of the liver and another in the spleen. The splenic cyst was torn, filled with blood and its contents had spread throughout the splenic tissue, but without peritoneal spillage. Recovery was complete after splenectomy and resection of the hepatic hydatid cyst.
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Malignant hyperthermia syndrome (MHS) is rare, inherited, and triggered by volatile anesthetics and depolarizing muscle relaxants. While potentially fatal, if recognized and treated early recovery is usual. However, the condition is often not recognized until an extreme increase in temperature develops with profound circulatory depression. ⋯ Until our malignant hyperthermia diagnostic center was opened, such tests could not be performed in Israel. Since then we encountered a 22-year-old man who developed the partial picture of malignant hyperthermia syndrome during anesthesia for inguinal herniorrhaphy. He received dantrolene and recovered. 4 months later in vitro contracture tests with caffeine and halothane performed on biopsied muscle confirmed the diagnosis.
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Combinations of lithium carbonate and tricyclic antidepressants are effective in the treatment of resistant unipolar depression. We present a case in which addition of lithium carbonate to a maximal dose of desipramine provided rapid and sustained improvement in a severely depressed 57-year-old woman. She had previously failed to respond to maximum doses of antidepressant drugs of 2 different classes. Although the lithium-tricyclic combination was successful in our case, we caution against its routine use.
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Popliteal artery entrapment syndrome (PAES), a rare cause of lower limb ischemia, is due to an anomalous relationship between the popliteal artery and the gastrocnemius muscle in the popliteal fossa. Hypertrophy of the muscle, or its anomalous insertion, can displace or compress the artery, leading to stenosis or obstruction. ⋯ Due to its high spatial and density resolution, CT scan can differentiate between bony structures, vessels, muscles, and fatty tissue in the popliteal fossa. It is therefore a very useful supporting examination in PAES and can demonstrate whether or not stenosis or occlusion of the artery results from causes outside the artery itself.
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Congenital afibrinogenemia is a rare hereditary disorder which has been described in only 150 families. The main clinical manifestations include spontaneous bleeding into the skin and into the gastrointestinal and genitourinary tracts. Skeletal manifestations are seldom reported. ⋯ Development of antibodies to treatment with fibrinogen is rare. We report congenital afibrinogenemia in a 25-year-old man with rare complications which included skeletal manifestations such as bone cysts, and the development of antibodies to fibrinogen. Fibrinogen levels could only be maintained in the normal range by continuous infusion of cryoprecipitate, but not by bolus injections.