BMJ Case Reports blog

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Emilia Demetriou — Mon, 16 Nov 2009 11:16:05 +0000

This case describes a relatively unusual cause of cavernous sinus thrombosis which is one of those conditions that is ideal for educationally combining applied anatomy and pathology. The report is clear and educational and is an important reminder of a rare but devastating condition.

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Botulism case in Scotland

Dr Dean Jenkins — Wed, 04 Nov 2009 15:04:04 +0000

There are reports of a case of an infant with botulism in Scotland.

“A 16-week-old baby boy is fighting for his life after being diagnosed with botulism.

Logan Douglas was admitted to hospital in Edinburgh where doctors spotted signs of the rare disease and ordered a test.

Health protection experts said there had not been a report of an infant with botulism in Scotland since 1983.”

UK Press Association 4th November

Rapid genome analysis for complex diagnoses

Dr Dean Jenkins — Sun, 01 Nov 2009 20:56:56 +0000

A rapid genome analysis that took only 10 days helped make the correct diagnosis in a critically ill 5 month old Turkish boy.

http://opa.yale.edu/news/article.aspx?id=6988

“In a dramatic illustration of the power of emerging genetic technologies, Yale University researchers have reported making a clinical diagnosis for the first time using comprehensive DNA sequencing of all the protein-coding genes in the genome. The information changed the course of treatment of a baby boy suffering from symptoms of dehydration thousands of miles away in Turkey.

The new approach to DNA sequencing used by Yale researchers and described online Oct. 19 in the Proceedings of the National Academy of Sciences is called whole exome sequencing because it selectively analyzes the 1 percent of the genome that contains genes that code for proteins. This approach has the potential to lead to dramatic new insights into almost every human disease and, as cost of the technology decreases, will be commonly used in clinical settings, predicted Richard Lifton, senior author of the paper and Sterling Professor and chair in the Department of Genetics and professor of internal medicine.”

“Up yours”: smuggling illicit drugs into prison

Emilia Demetriou — Tue, 27 Oct 2009 15:20:16 +0000

“This account of drug dependency and smuggling in UK prisons is a reminder of an important clinical lesson that the most vulnerable in our society may get the poorest quality of care. The authors highlight how prison inmates smuggle and abuse drugs and call for more to be done at a treatment policy level to reduce this behaviour in prisons.”

“Up yours”: smuggling illicit drugs into prison

Surfers ankle: a bony spur of the talar neck

Emilia Demetriou — Tue, 29 Sep 2009 13:32:28 +0000

“”As a sport surfing is generally safe. It is different for competitive surfers where this rapid sport calls for great agility and balance. This case report of an ankle injury demonstrates the type of damage that can be done. The authors describe the clinical investigation of this case and outline the circumstances that led to the injury.”

Surfers ankle: a bony spur of the talar neck

Autologous stem cell therapy for heart failure plus artificial heart bridge

Dr Dean Jenkins — Sat, 26 Sep 2009 09:39:22 +0000

Autologous stem cell therapy for a diseased heart using an artificial heart to bridge for time has been performed in Greece by an Oxford surgeon.

http://news.bbc.co.uk/1/hi/england/oxfordshire/8274259.stm

“Prof Stephen Westaby, from the John Radcliffe Hospital, led the operation on Ioannis Manolopoulos in Greece.

He used an artificial heart to relieve Mr Manolopoulos’s heart while it was injected with stem cells to help it rebuild itself.

Prof Westaby said it was thought to be the first time both had been combined.”

Progressive respiratory distress due to neck mass

Emilia Demetriou — Fri, 18 Sep 2009 14:40:03 +0000

“This well documented case of a life threatening respiratory obstruction from a neck mass is an important reminder of how to approach such emergencies. The authors describe a case of a thyroid mass and its subsequent management.”

Progressive respiratory distress due to neck mass

Finding your doctor through their published case reports

Dr Dean Jenkins — Tue, 15 Sep 2009 11:44:55 +0000

Had a very interesting communication from a BMJ Case Reports author who was contacted by a patient’s family because the patient was suffering from a similar condition to that which the author had just published.

This raises interesting points about the role of the medical literature and the increasing ability of patients and their relatives to research the professional credibility of doctors. This is the modern world but it is it new? Before the Internet patients and relatives would contact by telephone or fax and before the telephone they would probably have written a letter. They always travel if they think the doctor has particular expertise.

There is a limitation of course since you may very well find a doctor with expertise but they may be in another continent and your selective research may have missed a world authority in your local hospital.

Another aspect of this is the networking between the authors themselves. Finding others with similar clinical interests and in publishing their work could lead to the exchange of information and collaboration.

YouTube case series of sporting injuries yields new clinical sign.

Dr Dean Jenkins — Mon, 07 Sep 2009 08:02:12 +0000

A case series of YouTube sporting injuries has identified what could be a useful clinical sign for sports coaches. The ‘fencing response’ (tonic posturing) is an immediate sign and is associated with moderate head injury. It seems to be a separate entity from convulsions, which may also occur, and since it is a clinical sign that is quite easily recognised, it can help direct care after the injury.

Hosseini, AH. Lifshitz, J. Brain Injury Forces of Moderate Magnitude Elicit the Fencing Response. Medicine & Science in Sports & Exercise: September 2009 - Volume 41 - Issue 9 - pp 1687-1697

Intravenous zanamivir

Dr Dean Jenkins — Fri, 04 Sep 2009 13:59:21 +0000

A young woman with severe H1N1 pneumonitis who was previously neutropenic with chemotherapy for Hodgkin’s disease has responded to intravenous zanamivir (Relenza) and methylprednisolone. Her case is reported in the Lancet.¹

Although the use of intravenous zanamivir is unlicensed it exists and is being studied as part of a clinical trial² (with oral Oseltamivir) in humans and others have investigated its use in experimental influenza³. The clinical team had to apply to their hospital formulary, seek consent from relatives and source the treatment directly from GSK. Since the most severe cases of H1N1 pneumonitis are likely to be ventilated it would make sense to gain experience with intravenous antivirals.

The interesting point in this case is the combination of intravenous zanamivir with methylprednisolone in a severe case of H1N1 influenza in a patient with neutropenia. The authors suggest that this warrants further study.

1) Kidd IM, Down J, Nastouli E, Shulman R, Grant PR, Howell DCJ, Singer M. H1N1 pneumonitis treated with intravenous zanamivir. The Lancet, Early Online Publication, 4 September 2009.

2) Pukrittayakamee S. Phase 1, Open-Label Study to Evaluate Potential Pharmacokinetic Interactions Between Orally-Administered Oseltamivir and Intravenous Zanamivir in Healthy Thai Adult Subjects. ClinicalTrials.gov identifier NCT00921726

3) Beigel J, Bray M. Current and future antiviral therapy of severe seasonal and avian influenza. Antiviral Res. 2008 Apr;78(1):91-102. Epub 2008 Feb 4.