BMJ case reports
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Perineal hernia is an uncommon complication of abdominoperineal resection of the rectum. Gracilis muscle flaps can be used to reconstruct the pelvic floor. ⋯ Surgical repair of postoperative perineal hernia using a gracilis flap spares the morbidity of abdominal-based reconstruction and provides a good option for patients in whom the abdomen is unavailable. Use of a myocutaneous flap adds strength to the repair when compared to reconstruction with the gracilis muscle alone, owing to the strength imparted by the dermis.
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We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. ⋯ The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.
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Case Reports
Intubating laryngeal mask airway combined to fibreoptic intubation in subglottic stenosis.
We reported a successful airway management in a patient with unknown tracheal stenosis admitted in the emergency room for benzodiazepine overdose. The use of intubating laryngeal mask airway in combination with fibreoptic intubation was easy and safe in this patient; procedures such as ventilatory control and patient oxygenation were continued during intubation attempts, lessening the likelihood of desaturation. This method allowed the diagnosis of tracheal stenosis and soft endotracheal intubation.