BMJ case reports
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Case Reports
Localised bullous eruptions and epidermal detachment from the extravasation of hydroxyethyl starch (Voluven).
Extravasation occurs frequently with intravenous infusions. In this case report we describe the occurrence of epidermal detachment and multiple cutaneous bullous eruptions in a patient's forearm following the extravasation of hydroxyethyl starch (Voluven, Fresenius Kabi)-a colloid solution derived from corn starch, which is used to replace lost blood volume. ⋯ Despite a prolonged admission in hospital from other perioperative complications, he made a full recovery and was successfully discharged home. The probable pathogenesis relevant to extravasation of Voluven is discussed; as well as its management principles.
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A 24-year-old man presented with pain, sticky discharge and loss of vision in the right eye. He has had typical skin manifestations of porphyria cutanea tarda (PCT) since 6 years and ophthalmological symptom for 6 weeks. On ophthalmological examination, visual acuity was light perception in the right eye and 6/12 in the left. ⋯ Artificial tear instillation was started every hour along with topical antibiotic coverage in both eyes. Additionally, ultraviolet protective sunglasses and hat for photo-protection was advised. The vision in the right eye improved to 5/60 along with subsidence of retinal detachment on repeat USG B-scan after 3 weeks.
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Acute comparment syndrome (ACS) is a surgical emergency, in which tissue pressure becomes greater than perfusion pressure leading to tissue ischaemia. It is typically a consequence of trauma. We present a case in which a patient suffers blunt trauma to the thigh, but develops ACS 2 years after this injury and consequently endures 10-episodes of ACS (no perciptating event or cause) in the same thigh over 10 years. ⋯ A thorough literature search deemed this case to be the first reported recurrent spontaneous ACS of the thigh. Prompt recognition and treatment of ACS is vital. Clinicians should thoroughly investigate such patients postoperatively and involve vascular/plastic surgeons and interventianal radiologist to provide optimum care and prevent recurrence.
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Dengue is a mosquito-borne infection affecting children and adults worldwide. In newborn infants, the dengue virus can cause diseases, especially in infants born to pregnant women hospitalised with dengue or postpartum women with fever. The authors report a case of a term newborn infant who presented with haemodynamic instability and thrombocytopaenia at the age of 7 days, without a history of clinical dengue infection in the mother. ⋯ The authors confirmed the diagnosis using the dengue NS1 antigen on the first day of admission. The treatment included fluid management and platelet transfusion. The patient recovered well and was discharged from the hospital on the 10th day of hospitalisation.
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In this case report, we describe a 28-year-old woman with multipar gestation who developed postcaesarean atonia and severe pelvic haemorrhage which continued in spite of peripartum hysterectomy. A balloon tamponade tool was formed with Foley catheter and a condom, and was inserted into the pelvis through the vaginal cuff. The tampon was inflated up to 2200 mL and the pelvic tamponade was applied and bleeding was controlled. ⋯ Pelvic bleeding ceased. After monitoring for a week, no postoperative fever, infection, pelvic abscess and haematoma were observed. Use of Foley catheter-condom as a pelvis pressure tampon tool may be a simple and effective method which can be easily used to control pelvic bleeding.