BMJ case reports
-
A pleasant 74-year-old man was discharged home following a complication-free transurethral resection of his prostate (TURP) and successful trial without catheter. Unfortunately, on postoperative day 6, he presented to A&E with chest pain requiring emergency intervention for a confirmed myocardial infarction. A drug-eluting stent was inserted into his right coronary artery and he was started on dual antiplatelet therapy of aspirin and clopidogrel. ⋯ The dual antiplatelet treatment was restarted on day 4 postlaparotomy, following debate between both the cardiology and urology teams regarding its appropriate reintroduction. On day 7, he was rushed back to the theatre for a re-laparotomy after CT confirmed reaccumulation of clot following an acute deterioration at ward level. The patient made an excellent recovery and was discharged home with regular outpatient follow-up.
-
Obesity is an important risk factor for cardiovascular morbidity and mortality. In the UK, one in four people are considered overweight or obese and that number is expected to rise to one in three by 2020. Employees of the National Health Service (NHS) are no exception with up to half of healthcare workers considered overweight or obese. ⋯ Weight gain has been reported during the Christmas period albeit not as much as was traditionally believed according to the results of recent research. Conversely, weight loss has been reported in Muslims who fast during the Islamic month of Ramadan; however, this amount tends to be modest and weight gradually returns to pre-Ramadan status according to a meta-analysis of the literature. We report a case of an NHS healthcare worker - which is the first of its kind that illustrates the role that fasting and other factors have played a role in causing dramatic oscillations in his weight.
-
A 66-year-old woman with a history of tissue aortic valve replacement and chronic back pain presented to the emergency department with a suspected right leg deep vein thrombosis. A recent outpatient MRI had revealed discitis. A ventricular fibrillation cardiac arrest occurred in the emergency department. ⋯ The patient experienced postoperative complete heart block and a right hemisphere cerebrovascular accident, however she is now recovering well. This case describes an unusual case of infective endocarditis secondary to C. hominis, with disc, leg, coronary artery and brain septic embolisation. Infective endocarditis is an important differential diagnosis in multisystem presentations.
-
We present an interesting case of a 49-year-old woman with hypothermia and associated Osborn waves (also called J waves) on ECG. She was found on the floor of her home and difficult to arouse. On arrival to the emergency department (ED), her rectal temperature was 87.5°F. ⋯ She was extubated and was transferred to the medical floor for continued supportive care. Osborn waves on ECG resolved within 12 h of achieving normal range body temperature. The patient was eventually discharged home with medical follow-up.
-
A 44-year-old woman had a temporal glioma and was admitted to the hospice with pain that was not controlled despite escalating opioids. Her pain levels rose after every dose increase resulting now in continuous pain, making her very low in mood. Her short-term memory had also declined in a stepwise fashion with each increase in opioids. ⋯ The opioids continued to be decreased incrementally every 1-2 days until the pain had disappeared completely. She was stabilised on a dose almost one-seventh of her original regime. Mood and memory also improved as opioids decreased and she was discharged home after 8 days.