Irish journal of medical science
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Case Reports
Serotonin syndrome in an orthopaedic patient secondary to linezolid therapy for MRSA infection.
A 67-year-old patient was admitted for incision and drainage of a recurrent methicillin-resistant Staphylococcus aureus (MRSA) hip abscess. Linezolid therapy was initiated postoperatively. ⋯ Citalopram was stopped and resolution of symptoms occurred within 48 h of discontinuing the offending agent. The symptoms observed in our patient were consistent with the Sternbach criteria for serotonin syndrome.
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Calf swelling is a common clinical presentation with a wide and varied differential diagnosis. The Morel-Lavallee is a rare cause of subcutaneous swelling, caused by post-traumatic shearing of the hypodermis from the underlying fascia. The potential space so created fills with blood, lymph and necrotic fat giving specific findings on MR evaluation. ⋯ The Morel-Lavallee lesion is a rare but important cause of calf swelling. MRI is the mainstay of diagnosis and treatment includes both surgical and minimally invasive modalities.
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Paget's disease of the bone (PDB) is a localized disorder of bone remodeling. Nitrogen-containing bisphosphonates (N-BPs) are the treatment of choice. ⋯ Newly diagnosed patients with PDB should be treated for 6 months with oral N-BPs prior to administration of intravenous ZA. Repeat ZA infusions are necessary only if the serum total ALP levels rise above normal, or if symptoms or complications attributable to PDB persist.
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A deep soft tissue smooth muscle tumour is a rare entity with few cases described in the literature. ⋯ Smooth muscle tumours in the inguinal area are an exceptionally rare occurrence, but clinicians should always consider less routine causes for a painful inguinal mass.
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Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal/localised peritoneal irritation or when the patient's premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. ⋯ In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.