A & A case reports
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A 74-year-old man presented for outpatient endoscopy because of dysphagia and the sensation of a mass in the back of his throat. Esophagogastroduodenoscopy demonstrated a soft tissue mass in the proximal esophagus that prolapsed into the hypopharynx on withdrawal of the endoscope. ⋯ The patient was transferred to the hospital for further treatment. Surgical resection revealed a rare giant fibrovascular polyp, which may be associated with asphyxiation and sudden death.
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A 30-year-old man developed unexplained rhabdomyolysis, persistently increased creatine kinase and severe debilitating muscle cramps. After a nondiagnostic neurologic evaluation, he was referred for a muscle biopsy, to include histology/histochemistry, a myoglobinuria panel, and a caffeine halothane contracture test. ⋯ His identical twin brother, who was suffering from similar complaints, was found to share the same mutation. They each require oral dantrolene therapy to control symptoms, despite difficulty in identifying health care providers familiar with treating this disorder.
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Below-knee amputation neuromas may be hard to detect radiographically. This case report demonstrates that in a below-knee amputee with negative imaging but with classic neuropathic pain, successful diagnostic ultrasound-guided nerve-selective peripheral nerve block may be performed to diagnose the problem; subsequent resection of the neuroma may relieve severe neuropathic pain.
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A 34-year-old parturient developed third-degree atrioventricular block, in the setting of hypotension, after spinal anesthesia for cesarean delivery. The arrhythmia fully resolved with anticholinergic and sympathomimetic drugs. Considering the increasing maternal morbidity and potential risk of maternal cardiac arrest, this critical state is reviewed, and a treatment algorithm is suggested.