BMJ case reports
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Medical thoracoscopy is an excellent diagnostic and therapeutic tool for management of pleural diseases. There have been case reports of removal of foreign bodies from pleural spaces with video-assisted thoracoscopic surgery under general anaesthesia by thoracic surgeons. We present a case of successful removal of an 8 cm long metal needle from the pleural space with single port medical semirigid thoracoscopy under local anaesthesia by a chest physician. Removal of a foreign body from the pleural space is one more indication for medical thoracoscopy, however, an experienced chest physician and proper case selection are very important for safety and a successful outcome of this procedure.
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A 64-year-old man was referred to our hospital, for a second opinion, with fever, skin lesions and general muscle pain. He has been treated in another hospital with antibiotics on suspicion of erysipelas. A week later skin lesions developed on the metacarpophalangeal and proximal carpophalangeal joints of the hands and nose. ⋯ The diagnosis was confirmed by the presence of increased serum creatine kinase levels and abnormalities in skin and muscle biopsy. Prednisone (70 mg/kg) was initiated, but after 19 days the patient developed a Pneumocystis jiroveci pneumonia. He died of respiratory failure a few days later.
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This is the remarkable story of survival against all the odds. A passenger had a myocardial infarction complicated by a witnessed cardiac arrest while on a commercial flight through some of the most remote airspace on the planet. ⋯ Passengers and crew worked effectively together, under the guidance of a physician, to provide critical care to the patient while the flight diverted so he could be transferred to an emergency hospital in Beijing for eventual thrombolysis and postresuscitation care. He made a rapid and full recovery to be discharged from hospital, neurologically intact, 10 days later.
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Foreign bodies may occur after a thoracic trauma, but foreign bodies retained after stab wounds are rare. This paper reports the case of a 20-year-old man who was admitted with the diagnosis of haemothorax following a single stab wound on the chest. One month later, he was referred to the authors' clinic with symptoms of pain and swelling under the left scapula due to a previously overlooked foreign body on the chest wall.
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A 53-year-old man with a significant smoking history presented with chronic cough, exertional breathlessness, intermittent fever, weight loss and anorexia. A review of his past medical records revealed he was diagnosed to have sputum smear-positive pulmonary tuberculosis 5 years earlier, for which he had received multiple courses of incomplete antitubercular therapy. This time, though he was primarily suspected to have active pulmonary tuberculosis, lack of microbiological evidence and further investigations including histopathological evaluation of lung lesions confirmed a diagnosis of Marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALToma/BALToma). The patient was managed with radical radiation therapy to which he responded well.