BMJ case reports
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Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. ⋯ At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.
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Overall survival for patients with glioblastoma multiforme (GBM) has been consistently shown to improve when the surgeon achieves a gross total resection of the tumour. It has also been demonstrated that surgical adjuncts such as 5-aminolevulinic acid (5-ALA) fluorescence--which delineates malignant tumour tissue--normal brain tissue margin seen using violet-blue excitation under an operating microscope--helps achieve this. ⋯ This technique led to gross total resection of all T1-enhancing tumour with the avoidance of neurological deficit. The authors recommend this technique in patients when awake surgery can be tolerated and gross total resection is the aim of surgery.
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Gastrointestinal stromal tumours (GISTs) are generally rare but are known to be the most common mesenchymal tumours of the gastrointestinal tract. We present a case of a patient who presented with persistent obstructive gastrointestinal and urological symptoms, a sense of incomplete evacuation and bleeding per rectum. A colonoscopy was performed and a biopsy was taken of a submucosal mass in the distal rectum that revealed a GIST with positive KIT immunostaining. ⋯ Six months after initiation of the neoadjuvant therapy a rectum resection with manual side-to-end coloanal anastomosis was performed. Pathology showed a GIST of 5 cm located 0.1 cm from the distal section plane. Our case shows that in patients with a large invasive distal rectal GIST, neoadjuvant imatinib therapy can facilitate anal sphincter sparing surgery.
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Case Reports
High renal regional oxygen saturation in femoral arteriovenous fistula after neonatal cardiac surgery.
The use of an indwelling arterial catheter is standard practice in the postoperative monitoring of paediatric cardiac surgery patients. Arteriovenous fistula related to this procedure can be difficult to diagnose. Regional haemoglobin oxygen saturation (rSO2) using near-infrared spectroscopy and central venous oxygen saturation (ScvO2) are monitored to follow the balance between oxygen consumption and delivery. ⋯ High rSO2 and high ScvO2 are less frequently described. We report the discovery of an iatrogenic arteriovenous fistula in a neonate after cardiac surgery who had unexpectedly high values of renal rSO2 and femoral ScvO2. High renal rSO2 after femoral instrumentation should alert the physician to the possibility of arteriovenous fistula.
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Iodine-based contrast agents are widely used in angiographic and other radiological procedures. Clinicians are familiar with many of the potential adverse events from contrast agents including allergic reactions and contrast-induced nephropathy. This case describes a lesser known adverse event: 'contrast-induced thyrotoxicosis' and its implications on the presentation and management of a patient with severe coronary artery disease. The management of this case was difficult and required a long inpatient admission with use of prednisolone, propylthiouracil and planned treatment with radioiodine to control the thyrotoxicosis, as well as the use of several rate-limiting agents and antianginal medications to control atrial fibrillation and prevent further episodes of angina.