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Caruso R, Vicente E, Quijano Y, Ferri V. New era of robotic surgery: first case in Spain of right hemicolectomy on Hugo RAS surgical platform. BMJ Case Rep 2023; 16:e256035. [PMID: 38154867 PMCID: PMC10759092 DOI: 10.1136/bcr-2023-256035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
We describe the first robot-assisted right hemicolectomy performed in Spain using the new Hugo RAS (robotic-assisted surgery) (Medtronic, Minneapolis, Minnesota, USA). No conversion was registered, and no intraoperative complications or technical failures of the system were recorded. The operative time was 200 min, the docking time was 5 min and the length of the hospital stay was 8 days. We conclude that a right hemicolectomy using the Hugo RAS system is safe and feasible. Our earlier experience provides important skills for those who are starting to use this new robotic system.
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Affiliation(s)
| | - Emilio Vicente
- HM Sanchinarro University Hospital, Madrid, Maryland, Spain
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Vukičević Lazarević V, Šola AM, Vlahović I. Unexpected cause of dyspnoea in a patient with allergic rhinitis. BMJ Case Rep 2021; 14:e244075. [PMID: 34593549 PMCID: PMC8487185 DOI: 10.1136/bcr-2021-244075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A defect in one part of the immune system may affect the whole system. As a result, there may be a myriad of immunological diseases, which are often masked with the one disease that has the most prominent symptoms. This case report presents a patient with long-lasting allergic rhinitis who recently developed dyspnoea in exertion with suspected asthma development. After extensive diagnostic processing, asthma was dismissed, and diagnosis of selective IgA deficiency and coeliac disease with consequential iron deficiency anaemia was established. The patient was treated with parenteral iron and a gluten-free diet, which corrected her anaemia and led to the disappearance of dyspnoea. This paper aims to show the interplay between different immunological disorders and the possible causal connection between them.
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Affiliation(s)
- Vesna Vukičević Lazarević
- Imperial College London Faculty of Medicine, London, UK
- Special Hospital for Pulmonary Diseases, Zagreb, Croatia
| | | | - Ivan Vlahović
- Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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James S, Thozhuthumparambil KP. Cat scratch disease sepsis in an immunocompromised patient. BMJ Case Rep 2021; 14:14/7/e239932. [PMID: 34257108 DOI: 10.1136/bcr-2020-239932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
As a greater number of households have pets, the likelihood of zoonotic infections can rise too. Although in most healthy individuals these infections are self-limiting, they are more serious and can lead to adverse outcomes in the immunocompromised. There is minimal information available for the immunocompromised patient who are pet owners or on pet handling. We report a case of cat scratch disease-related sepsis in an immunocompromised patient. This case illustrates the need for a detailed history, including a pet history, in immunocompromised patients presenting with fever of unknown origin and the need for UK-based information for the immunocompromised on pet care and risks associated with having a pet.
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Affiliation(s)
- Sunil James
- Acute Medical Unit, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Abstract
We present a case of a 64-year-old woman who developed severe non-exertional hyperthermia (NEHT) due to excessive anticholinergic effects from her psychiatric medications. The patient was found unresponsive in a non-air-conditioned room where the outside temperature was over 33°C. She presented with altered mental status, hypotension and an oral temperature of 42°C. Drug–drug interactions from her home medications for depression, bipolar disorder and seizures (amitriptyline, cyclobenzaprine, benztropine, topiramate, clonazepam, trazodone) were suspected. Blood cultures grew Staphylococcus hominis. The patient quickly returned to baseline with supportive care in the intensive care unit. She was treated for the Staph hominis bacteraemia with a 7-day course of vancomycin. Due to her quick recovery and lack of neurological findings, severe NEHT with associated bacteraemia was determined to have caused her presenting symptoms. This patient’s multiple anticholinergic medications increased her susceptibility to develop NEHT by inhibited sweating, this patient’s natural cooling mechanism.
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Affiliation(s)
- Ahila Manivannan
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Dana Kabbani
- Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Diane Levine
- Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
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Abstract
A severe case of COVID-19 was observed in an otherwise healthy 28-year-old man who had taken oxandrolone 40 mg/day as an anabolic steroid. The patient had been taking oxandrolone for enhanced bodybuilding 30 days prior to presenting to an outpatient clinic with COVID-19 symptoms. The patient reported that his symptoms have rapidly worsened over the course of 4 days prior to presenting at the clinic. As part of an experimental antiandrogen treatment for hyperandrogenic men suffering from COVID-19, he was administered a single 600 mg dose of the novel antiandrogen proxalutamide. Twenty-four hours after administration of this dose, marked improvement of symptoms and markers of disease severity were observed. To our knowledge, this is the first case that potentially links anabolic steroid use to COVID-19 disease severity.
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Affiliation(s)
- Flavio Cadegiani
- Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, São Paulo, Brazil
- Corpometria Institute, Brasilia, Distrito Federal, Brazil
| | - Erica M Lin
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Andy Goren
- Applied Biology Inc, Irvine, California, USA
| | - Carlos G Wambier
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Affiliation(s)
- Uday Yanamandra
- Department of Hematology, Army Hospital Research and Referral, Delhi, India
| | | | - Rajat Bahl
- Department of Hematology, Army Hospital Research and Referral, Delhi, India
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Subedi P, Syed MP, Shah T, Siddiqui AD. Spontaneous large anterior chest wall haematoma causing haemorrhagic shock during enoxaparin therapy. BMJ Case Rep 2020; 13:13/6/e235887. [PMID: 32487524 DOI: 10.1136/bcr-2020-235887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Pawina Subedi
- Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Masood Pasha Syed
- Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Tanvi Shah
- Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
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Inskip M, Mavros Y, Sachdev PS, Fiatarone Singh MA. Interrupting the trajectory of frailty in dementia with Lewy bodies with anabolic exercise, dietary intervention and deprescribing of hazardous medications. BMJ Case Rep 2020; 13:13/4/e231336. [PMID: 32341088 PMCID: PMC7202785 DOI: 10.1136/bcr-2019-231336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An 87-year-old man with dementia with Lewy bodies, living in residential aged care, exhibited rapid functional decline and weight loss associated with injurious falls over 9 months. Independent clinicians (geriatrician and exercise physiologist) assessed him during an extended wait-list period prior to his commencement of a pilot exercise trial. The highly significant role of treatable factors including polypharmacy, sarcopenia and malnutrition as contributors to frailty and rapid functional decline in this patient are described. The results of a targeted intervention of deprescribing, robust exercise and increased caloric intake on his physical and neuropsychological health status are presented. This case highlights the need to aggressively identify and robustly treat reversible contributors to frailty, irrespective of advanced age, progressive ‘untreatable’ neurodegenerative disease and rapidly deteriorating health in such individuals. Frailty is not a contraindication to robust exercise; it is, in fact, one of the most important reasons to prescribe it.
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Affiliation(s)
- Michael Inskip
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia .,Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Yorgi Mavros
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Perminder Singh Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Maria A Fiatarone Singh
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.,The University of Sydney, Sydney Medical School, Camperdown, New South Wales, Australia.,Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
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Kang MS, Sandhu CS, Singh N, Evans T. Initiation of levothyroxine in a patient with hypothyroidism inducing adrenal crisis requiring VA ECMO: a tale of preventable disaster. BMJ Case Rep 2019; 12:12/8/e230601. [PMID: 31471362 DOI: 10.1136/bcr-2019-230601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 31-year-old man with a recent diagnosis of hypothyroidism presented to the emergency department as a transfer from the clinic for severe hypotension and hypoglycaemia. The patient endorsed a 2-week history of severe fatigue, weight loss, nausea and non-bloody emesis. He was aggressively hydrated and vasopressors were initiated. Despite these measures, the patient remained hypotensive and went into pulseless electrical activity. Return of spontaneous circulation was achieved via advanced cardiac life support protocol, and venous arterial extracorporeal membrane oxygenation (ECMO) was initiated. On day 3 of hospitalisation, the patient was weaned off ECMO support, and subsequent autoimmune work-up confirmed the diagnosis of autoimmune polyglandular syndrome type 2 with positive antiperoxidase antibodies (267 IU/mL), supporting the diagnosis of Hashimoto's thyroiditis.
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Affiliation(s)
| | | | | | - Timothy Evans
- Pulmonary Medicine and Critical Care, UCSF, Fresno, California, USA
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Patel S, Weaver MD, Roy S. Miliary tuberculosis and herpes pharyngitis after a trip to a developing country: dangers of biologics. BMJ Case Rep 2018; 2018:bcr-2018-224459. [PMID: 30279249 DOI: 10.1136/bcr-2018-224459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The use of biologic drugs has expanded since its introduction in the late 1990s. With growing medical use and newer biologic drugs in development, opportunistic infections like Mycobacterium tuberculosis remain important adverse effects. It carries major public health concerns, yet evidence-based clinical guidelines for more routine interval screening in patients taking immunosuppressants and exposed to tuberculosis (TB) are lacking. We illustrate a case of an elderly Indian-born man living in the USA with psoriatic arthritis who was on adalimumab for 10 years. He presented with disseminated TB and herpes simplex virus type 1 (HSV-1) pharyngitis, a year after an innocuous trip to India. Our case draws attention to the adverse effects of biologic drugs and highlights the importance of regular rescreening for a high-risk population. As the use of biologic treatment increases, physicians must be vigilant in more frequent screening, monitoring and identifying related opportunistic infections, notably M. tuberculosis infections.
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Affiliation(s)
- Sanket Patel
- Internal Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Martin Douglas Weaver
- Internal Medicine, Cooper University Hospital, Camden, New Jersey, USA.,Physical Medicine and Rehabilitation, Jackson Memorial Hospital, Miami, Florida, USA
| | - Satyajeet Roy
- Internal Medicine, Cooper University Hospital, Camden, New Jersey, USA
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Bukhari S, Khan M, Kumar N, Mohan V. Increased risk for thionamide-induced agranulocytosis in elderly patients: a case presentation and literature review. BMJ Case Rep 2017; 2017:bcr-2017-220924. [PMID: 28716776 DOI: 10.1136/bcr-2017-220924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thionamides, such as methimazole and propylthiouracil, are used for the management of hyperthyroidism. Agranulocytosis is a rare adverse effect of thionamides and elderly patients are especially vulnerable. Here we discuss a case of an 80-year-old woman who developed agranulocytosis and pneumonia approximately 4 weeks after starting low dose methimazole therapy. Despite aggressive treatment with broad-spectrum antibiotics and granulocyte colony stimulating factor, she developed multiorgan failure and died. Our goals are to identify risk factors common to elderly patients and hopefully improve outcomes in this population when prescribed thionamides.
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Affiliation(s)
- Sumera Bukhari
- Department of Internal Medicine, St Francis Medical Center, Seton Hall University, Trenton, New Jersey, USA
| | - Muhammad Khan
- Department of Internal Medicine, St Francis Medical Center, Seton Hall University, Trenton, New Jersey, USA
| | - Naresh Kumar
- Department of Internal Medicine, St Francis Medical Center, Seton Hall University, Trenton, New Jersey, USA
| | - Vinuta Mohan
- Department of Endocrinology, St Francis Medical Center, Seton Hall University, Trenton, New Jersey, USA
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