PubMed Central (PMC3 - NLM DTD)
Archive of life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH's National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM).
BMJ Case Reports
Mostrando recursos 1 - 20 de 2.453
Upper gastrointestinal bleeding in a patient receiving selective serotonin reuptake inhibitor - Athimulam, Shobana; Sharma, Naveen; Khan, Shahid A
An older woman presented to the hospital with abdominal pain and subsequently had three episodes of melaena, requiring blood transfusions. She was known to suffer with severe depression and was on high-dose fluoxetine. Gastroscopy and colonoscopy failed to reveal an underlying cause for gastrointestinal (GI) bleeding. Possibility of high-dose selective serotonin reuptake inhibitors causing GI bleed was raised. Fluoxetine was discontinued and the patient was commenced on mirtazapine. The patient had no further GI bleeding and had significant improvement in haemoglobin.
Complicated Rapunzel syndrome mimicking intussusception - Singh, Sunita; Wakhlu, Ashish; Pandey, Anand; Gupta, Archika; Ahmed, Intezar; Chandra, Naveen
A 5-year-old girl presented with a 3-day history of pain and distension of abdomen, bilious vomiting, bleeding per rectum and a hard lump in the left iliac fossa. Intussusception was clinically diagnosed. On exploratory laparotomy, trichobezoar showing cast of the stomach, duodenal C-loop and tail were extracted. The stomach cast was impacted at the distal ileum, while its tail traversed the ileum, ileocecal valve and extended up to the hepatic flexor. At the site of impaction, a large ileal perforation, covered by bezoar was present. Hence, x-ray did not reveal pneumoperitoneum. There was no evidence of trichobezoar in the stomach....
Giant placental chorioangioma: a rare cause of fetal hydrops - Barros, Andreia; Freitas, Ana Cristina; Cabral, António Jorge; Camacho, Maria Carmo; Costa, Edite; Leitão, Henrique; Nunes, José Luis
Giant choriangiomas are rare placental tumours, associated with a high prevalence of pregnancy complications and a poor perinatal outcome. Neonatal consequences include severe microangiopathic haemolytic anaemia, thrombocytopaenia and hydrops. The associated high perinatal death rate (30–40%) has led to a number of prenatal therapeutic interventions with limited success in most cases. The authors present a case of non-immune fetal hydrops caused by a giant chorioangioma, diagnosed at 27 weeks of gestational age. Despite tocolytic therapy, the baby was born prematurely (28 weeks of gestational age) and required transfusion of blood derivatives, intensive phototherapy and exchange transfusion. She had an uncomplicated...
Life-threatening hyponatraemia - Egom, Emmanuel Eroume A; Wong, Kenneth Y-K; Clark, Andrew L
A 31-year-old hypertensive woman was admitted to hospital with palpitations. Her hypertension was treated with bendroflumethiazide, which had been increased from 2.5 to 5 mg daily by her general practitioner about 18 months prior to her admission. She was also on ramipril 10 mg once daily. There were no abnormal findings on examination, and a 12-lead ECG showed sinus rhythm, rate 75, with Q waves in leads V1–V2. Telemetry (over 24 h) showed ventricular bigeminy when she had her typical palpitations. Her admission serum sodium and potassium concentrations were 132 and 3.4 mmol/l, respectively. Immediately prior to planned discharge the...
Selective internal radiation therapy with 90Y-SIR-Spheres microspheres for non-resectable colorectal metastases in the liver - Hadaki, M; Praseedom, R; Brais, R; See, T C; Balan, K; Wilson, C B
Almost half the patients with colorectal cancer will develop liver metastasis at some stage during their disease. Potentially curative surgical resection is possible in some of these patients. In those patients unsuitable for surgery, treatment with systemic chemotherapy and external radiation therapy is relatively ineffective. Many studies have described the successful use of selective internal radiation therapy (SIRT) with 90Y-SIR-Spheres microspheres in patients with inoperable liver metastasis. The authors report on a patient who has been in complete remission for 1 year after treatment with SIRT.
A frog in the throat? An expansile mass presenting in the neck with dysphonia - Pankhania, Miran; Judd, Owen; Conboy, Peter J
A neck mass, which rapidly increases in size over several weeks, is concerning for all involved. When accompanied by other symptoms suggesting sinister underlying pathology, efficient management and rapid diagnosis are vital. The causes may include primary or metastatic carcinoma, or lymphoreticular malignancy. Other non-sinister pathology may account for the swelling such as reactive lymph nodes or benign neoplasms. A benign neoplasm of the lymphatic system known as a lymphangioma may rarely be the cause of a mass in the neck in adults. More commonly found in infants, with approximately 40% found at birth, they are seldom encountered in adults....
Initial description of immune reconstitution inflammatory syndrome involving the thyroid gland in an immunocompromised patient - Katusiime, Christine; Ocama, Ponsiano; Kambugu, Andrew
Abscess formation in the thyroid gland is particularly a rare phenomenon and presents a medical and surgical dilemma especially in HIV seropositive patients. The authors report a case of a paradoxical tuberculous abscess immune reconstitution inflammatory syndrome involving the thyroid gland in a 37-year-old woman who presented 12 weeks after initiation of antiretroviral therapy at the Infectious Diseases Institute, Kampala, Uganda. The patient is still undergoing treatment.
Severe megaloblastic anaemia in an infant - Rodrigues, Vera; Dias, Alexandra; Brito, Maria João; Galvão, Isabel; Ferreira, Gonçalo Cordeiro
Vitamin B12 or cobalamin deficiency, a rare clinical entity in pediatric age, is found most exclusively in breastfed infants, whose mothers are strictly vegetarian non-supplemented or with pernicious anaemia. In this article, the authors describe a 10-month-old infant admitted for vomiting, refusal to eat and prostration. The infant was exclusively breastfed and difficulties in introduction of new foods were reported. Failure to thrive since 5 months of age was also noticed. Laboratory evaluation revealed severe normocytic normochromic anaemia and cobalamin deficit. A diagnosis of α-thalassemia trait was also made. Maternal investigation showed autoimmune pernicious anaemia. This case shows the severity...
A 69-year-old man with excessive sweating of the right hemithorax - Gil-Diaz, Aida; Conde-Martel, Alicia; Betancor-Leon, Pedro
The pure autonomic failure is a rare entity, with only a few cases reported in the literature. The authors describe a case with compensatory excessive sweating of the right hemithorax as an initial manifestation of a pure autonomic failure, and the authors review the clinical characteristics of this disease. A 69-year-old man presented excessive sweating of the right hemithorax. Physical examination revealed orthostatic hypotension. No other neurological features were present. The autonomic study showed a low heart rate response to the Valsalva maneuver and reduced supine plasma norepinephrine levels. A pure autonomic failure was diagnosed. Treatment did not improve patient’s...
Hypercalcaemia from genitourinary tuberculosis in a female with multiple exostoses - Anel-Quimpo, Joselynna; Sandoval, Mark Anthony Santiago; Lantion-Ang, Frances Lina
The authors present a puzzling case of nephrolithiasis, hypercalcaemia, amenorrhoea, short stature and gross skeletal deformities in a 30-year-old female. Multiple pituitary hormone deficiency and metabolic bone disease were initially considered but were eventually excluded. The final diagnosis is genitourinary tuberculosis (TB) which caused the hypercalcaemia, nephrolithiasis and amenorrhoea, and also found to have the syndrome of multiple exostoses which explained the gross skeletal deformities and the short stature. After treatment with anti-TB therapy, there was resolution of hypercalcaemia and return of regular menstruation. The short stature and gross skeletal deformities remain as part of the congenital syndrome.
Toothache: an unlikely presentation of secondary breast malignancy - Walden, Ashley; Parvizi, Nassim; Tatla, Taran
An 81-year-old female presented to the maxillo-facial department with a 6-month history of left-sided toothache and upper lip and cheek numbness. She had previously undergone a right mastectomy for breast adenocarcinoma, followed 6 years later by left mastectomy with pneumonectomy for contralateral breast and lung metastases. Following buccal biopsies and MRI of the head and neck, the patient was referred to our head and neck team. The MRI showed a large left maxillary sinus mass and transnasal endoscopic biopsies under general anaesthesia of this confirmed distant breast carcinoma metastasis. The patient was discussed at the Head and Neck Multidisciplinary Team...
Management of Legionella in the intensive care setting - Harris, Nicholas John; Harris, Anna Claire Victoria; Spiro, Michael
In August 2009, during the swine flu pandemic, a 55-year-old male presented to the Emergency Department (ED) with shortness-of-breath and chest pain. He had experienced diarrhoea and vomiting during the 3 weeks preceding admission, and so had sought the advice of his General Practitioner (GP) who had prescribed a course of oseltamivir (Tamiflu). Despite this, his symptoms had worsened, and on arrival in the ED he was found to be tachypnoeic, tachycardic, feverish, anuric and in type I respiratory failure with a compensated metabolic acidosis. He subsequently became hypotensive, and so was transferred to the Intensive Care Unit (ICU) for...
Locked in and out: a case of emerging basilar artery obstruction secondary to vertebral artery dissection thrombolysed with intravenous rt-PA - Al-Raweshidy, Y H; Sinha, D M; Coward, L J; Guyler, P C; O’Brien, A
The authors present a case in which intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) potentially saved a young man from locked-in syndrome or life threatening consequences. The patient presented with acute stroke secondary to vertebral artery dissection and was treated with intravenous rt-PA. There were no post thrombolysis complications and the patient left hospital with mild neurological symptoms. Our report suggests that in cases of acute posterior circulation stroke due to arterial dissection, treatment with intravenous thrombolysis is safe, practicable and effective.
Community-acquired methicillin resistant Staphylococcus aureus: a new aetiological agent of prostatic abscess - Abreu, Diego; Arroyo, Carlos; Suarez, Ruben; Campolo, Horacio; Izaguirre, Juan; Decía, Ricardo; Machado, Miguel; Carvalhal, Gustavo Franco; Clavijo, Jorge
Prostatic abscess is rare. Its potentially serious course requires a high level of clinical suspicion and prompt and effective treatment. The causative germs are usually either enterobacteria or Enterococcus. The authors highlight the importance of considering epidemiological and clinical aspects in the early diagnosis and treatment. Prostatic abscess due to community-acquired methicillin resistant Staphylococcus has three typical characteristics: skin entry point, periprostatic compromise, and anaemia and low prothrombin.