Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). (2014)

Type of publication:
Journal article

Author(s):
*Chandra A, *Clarke R, *Shawkat H

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202864.abstract

 

A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy (2014)

Type of publication:
Journal article

Author(s):
*Moores KL, *Wood MG, *Foon RP

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Uterine torsion is rare in pregnancy and the cause in most cases is unknown. It is associated with fetal compromise, with perinatal mortality reported to be around 12%. Our case describes an acute torsion, presenting in pregnancy with severe abdominal pain and vomiting with a viable 32-week gestation. Emergency caesarean section was performed and the 180degree uterine torsion was diagnosed intraoperatively. Posterior hysterotomy was required for delivery prior to detorsion of the uterus. This report describes that prompt recognition and intraoperative vigilance can achieve a successful maternal and fetal outcome in this rare and difficult obstetric scenario.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202974.abstract

Chest pain with raised troponin, ECG changes but normal coronary arteries (2014)

Type of publication:
Journal article

Author(s):
*Amjad A,  *Ali A, *Bashir A,  *Ali M,  *Azam MN

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
A 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak. She was immediately transferred to regional cardiothoracic unit for urgent surgical intervention. This case report illustrates the importance of a good clinical history, physical examination and timely investigations. It also emphasises that not all chest pain events with elevated troponin level are due to acute coronary syndrome and that alternative diagnoses should still be considered.

Link to more details:

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-201975.abstract

 

Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries (2014)

Type of publication:
Journal article

Author(s):
*Singh R, *Manoharan G, *Moores TS, *Patel A

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Achilles tendon ruptures tend to occur more commonly in healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. The injury is usually due to sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot and violent dorsiflexion of a plantar flexed foot, all of which occur during high impact activities. We present the first reported case of interactive activity with Nintendo Wii games that have resulted in Achilles tendon rupture in a 46-year-old man. There have been no previous reports of Achilles tendon rupture with Nintendo Wii usage; it is a relatively uncommon mode of injury and is rare in terms of epidemiology of motion sensing video game injuries. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-202657.abstract

 

Primary uterine osteosarcoma presenting synchronously with bilateral breast carcinomas (2014)

Type of publication:
Journal article

Author(s):
*Powell G, Barth L, Todd R, Ganesan R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Primary uterine sarcomas are infrequent neoplasms and most commonly leiomyosarcomas or endometrial stromal sarcomas. We report a rare case of primary uterine osteosarcoma discovered in a woman in her 60s following staging CT imaging for bilateral breast carcinomas. Examination of the subsequent hysterectomy specimen showed a tumour composed of malignant spindle cells and osteoclast-like giant cells associated with osteoid and neoplastic bone, in keeping with primary uterine osteosarcoma. Distinction of osteosarcoma from the more common carcinosarcoma is important due to the worse prognosis impacting on treatment decisions. In addition, synchronous presentation of this unusual tumour with bilateral breast carcinomas raises the possibility of a mutual genetic pathogenesis. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://bmj-casereports.highwire.org/content/2014/bcr-2013-201502.abstract

Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: is it common? (2014)

Type of publication:
Journal article

Author(s):
Mohammed I, *Zaatari MS, Tyrogalas N, Khalid MI

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Asymptomatic spontaneous coronary artery spasm is rare and there are no case reports in literature presenting with acute ST elevation on routine ECG. We present the case of a 68-year-old Caucasian man who presented to a primary care physician for a routine ECG as part of hypertension follow-up. ECG revealed ST elevation in inferior leads II, III and aVF with reciprocal ST depression in leads I, aVL and also ST depression in anterior leads V1, V2 and V3 suggesting ongoing inferoposterior ST elevation myocardial infarction. The patient was completely well, stable and asymptomatic and he was rushed immediately to the coronary care unit via emergency ambulance. The patient was subjected to a battery of urgent investigations which were all normal. Also an urgent coronary angiogram was undertaken which showed completely normal coronary anatomy. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-202586.abstract

Unusual fracture combination in a paediatric acute ankle (combined medial talar compression fracture with medial malleolus fracture in an immature skeleton): a case report. (2014)

Type of publication:
Journal article

Author(s):
*Crosswell S, Rhee SJ, *Wagner WW

Citation:
Journal of Surgical Case Reports, 2014, vol./is. 2014/10, 2042-8812;2042-8812 (2014)

Abstract:
Talar compression fractures are uncommon orthopaedic injuries, especially in the immature skeleton. Fractures of the talar body constitute >5% of all foot and ankle fractures. The combination of a medial compression fracture and corresponding medial malleolar fracture is rare and not previously reported injury in the literature. We present a case report of a skeletally immature 15-year-old Caucasian male who sustained a medial malleolar and corresponding medial talus fracture after being ejected from his pushbike. This report outlines the potential difficulties in diagnosing an unusual fracture combination and the importance of initial management including necessary diagnostic imaging to identify such injuries. Through this case, we aim to highlight the need for having high suspicions of underlying fractures in paediatric trauma cases. The long-term complications and risks of osteonecrosis of the talus can have detrimental effect on a patient’s outcome; therefore, we also emphasize the need for regular monitoring and long-term follow-up. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. The Author 2014.

Association of primary care factors with hospital admissions for epilepsy in England, 2004-2010: National observational study (2014)

Type of publication:
Journal article

Author(s):
Calderon-Larranaga A, Soljak M, Cowling TE, Gaitatzis A, *Majeed A

Citation:
Seizure, September 2014, vol./is. 23/8(657-61), 1059-1311;1532-2688 (2014 Sep)

Abstract:
PURPOSE: There has been little research on the accessibility and quality of primary care services for epilepsy and emergency hospital admissions for epilepsy.
METHODS: We examined time trends in admissions for epilepsy in England between 2004-2005 and 2010, and the association of admission rates with population and primary care factors. The units of analysis were the registered populations of 8622 general practices. We used negative binomial regression to model indicators from the Quality and Outcomes Framework, the UK's primary care pay for performance scheme, to measure the accessibility and quality of care for epilepsy, and supply of general practitioners, after adjustment for population factors.
RESULTS: The mean indirectly standardised admission rate decreased from 122.9 to 102.6 (-16.5%; P<0.001) over the study period, while the mean percentage of patients seizure free increased from 65.3% to 74.9% (P<0.001). In the multivariable analysis, a one unit increase in the percentage of seizure free adult patients on epilepsy drugs predicted a 0.20% decrease (IRR=0.9980; 95% CI: 0.9974-0.9986) in admission rate. The percentage of patients who were able to book a GP appointment over two days ahead predicted a 0.12% decrease (IRR=0.9988; 95% CI: 0.9982-0.9994). The deprivation score of practice populations (IRR=1.0179; P<0.001) and general practitioner supply (IRR=1.0022; P<0.001) were both positively associated with admission rates.
CONCLUSION: Patient access to primary care appointments and percentage of patients who have been recorded as seizure free for 12 months were associated with lower admission rates. However the effect sizes are small relative to that of population deprivation.