BMJ case reports
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A 30-year-old man with a 10-year history of neurofibromatosis type 2 (NF-2) and minimal hearing in his left ear, presented with rapidly progressive disease and risk of total hearing loss. He was started on imatinib and achieved stable disease for 4 months, after which the drug was ceased due to toxicity. He was then treated with bevacizumab for 8 months with a best response of stable disease.
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Case Reports
Using a bradykinin blocker in ACE inhibitor-associated angioedema in the emergency department.
We report two cases of ACE inhibitor-associated angioedema and critical airway compromise, where the use of a selective bradykinin 2 receptor blocker resulted in rapid symptom resolution and prevented intubation to protect the airway.
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Case Reports
Blunt traumatic internal carotid artery dissection with delayed stroke in a young skydiver.
We describe a case of a 33-year-old skydiver who presented to the emergency department after a traumatic landing following a parachuting episode. He initially presented with right knee pain secondary to a tibial plateau fracture. ⋯ An urgent work-up showed right middle cerebral artery thrombosis with right internal carotid thrombosis and dissection. We have discussed some possible mechanism of injury in skydiving that may have predisposed to the occurrence of cervical dissection in our patient.
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An 18-year-old man presented to the emergency department with an acutely swollen right upper limb having spent the previous day canoeing. Venography confirmed right subclavian venous thrombosis at middle one-third of right clavicle with no evidence of cervical rib or other structural abnormalities. Following heparinisation, catheter directed thrombolysis was performed which restored luminal flow. ⋯ Paget-Schroetter syndrome or effort thrombosis involves subclavian venous thrombosis associated with strenuous activity of upper extremities. In these cases, catheter directed thrombolysis with first rib resection provides greater patency rate than anticoagulation therapy alone. Acute kidney injury following mechanical thrombolysis is rarely reported in the literature.
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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.