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Accidental protonitazene intoxication: clinical management and detection of a novel opioid.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-261722
Jonathan Meltzer, Alexandra Boucher, Sabine Cohen, Julia Morere
{"title":"Accidental protonitazene intoxication: clinical management and detection of a novel opioid.","authors":"Jonathan Meltzer, Alexandra Boucher, Sabine Cohen, Julia Morere","doi":"10.1136/bcr-2024-261722","DOIUrl":"10.1136/bcr-2024-261722","url":null,"abstract":"<p><p>We describe the management by a pre-hospital medical team of a typical opioid toxidrome in a young man after consumption of an unknown substance with complete reversion after injection of unusually high doses of naloxone.The initial toxicological screening was negative. The secondary identification of protonitazene was performed several months after the first intoxication, both in the substance consumed and in the patient's blood samples. Protonitazene is a morphine derivative representing an emerging drug whose consumption is underestimated, escaping conventional toxicological screening and detected for the first time in France.The implementation of rapid detection procedures by the Lyon toxicology laboratory and the testing of these procedures during a second intoxication of the same patient allowed for the diagnosis to be reached again in record time.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Septic shock and purpura fulminans secondary to Streptococcus pneumoniae bacteraemia in an immunocompetent individual.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-263010
Niamh McDonnell, Keavy Conroy, Prakash Madhavan, Geraldine McCormack, Eileen Sweeney, Kevin Molloy
{"title":"Septic shock and purpura fulminans secondary to <i>Streptococcus pneumoniae</i> bacteraemia in an immunocompetent individual.","authors":"Niamh McDonnell, Keavy Conroy, Prakash Madhavan, Geraldine McCormack, Eileen Sweeney, Kevin Molloy","doi":"10.1136/bcr-2024-263010","DOIUrl":"https://doi.org/10.1136/bcr-2024-263010","url":null,"abstract":"<p><p>A woman in her 40s presented to the emergency department with a 3-day history of headache, vomiting and fever. Vital signs on arrival indicated septic shock, including fever of 40°C, tachycardia of 110 beats per minute and hypotension of 78/55 mm Hg. A retiform purpuric rash on her limbs, with mottling of skin on the tips of her nose and ears, developed subsequent to admission. This rash was identified as purpura fulminans in the context of disseminated intravascular coagulopathy. Blood cultures isolated <i>Streptococcus pneumoniae</i> (serotype 22F), confirming invasive pneumococcal disease (IPD) as the cause of her septic shock. A life-threatening clinical course ensued with multiorgan involvement. This case adds to the limited body of literature describing IPD and purpura fulminans in immunocompetent individuals. Similar presentations are associated with a high mortality rate. In this case, the patient survived; however, she had significant sequelae of her infection, requiring a left transmetatarsal amputation.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ocular ischaemic syndrome due to giant cell arteritis.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-262251
Ethan Charles Wilkinson, Michael McLucas, Tom Ayton, Anthony Dunlop
{"title":"Ocular ischaemic syndrome due to giant cell arteritis.","authors":"Ethan Charles Wilkinson, Michael McLucas, Tom Ayton, Anthony Dunlop","doi":"10.1136/bcr-2024-262251","DOIUrl":"10.1136/bcr-2024-262251","url":null,"abstract":"<p><p>Giant cell arteritis (GCA) is a large vessel vasculitis with devastating visual consequences if left untreated. Classically, GCA has a predilection for the short posterior ciliary arteries which supply the optic nerve head, causing sudden painless visual loss with the development of arteritic anterior ischaemic optic neuropathy (AAION). Other ocular manifestations of GCA include central retinal artery occlusion, oculomotor nerve palsy, posterior ischaemic optic neuropathy and ocular ischaemic syndrome (OIS). OIS is a rare clinical entity, typically stemming from severe, unilateral carotid artery disease. It may present with anterior segment ischaemia heralded by hypotony and corneal oedema. Rarely, it may occur in cases of GCA. We describe an atypical presentation of OIS and oculomotor nerve palsy with contralateral AAION in an elderly patient with a delayed diagnosis of biopsy-proven GCA. This case exemplifies the importance of suspicion, early diagnosis and initiation of treatment in GCA to prevent irreversible loss of vision.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cutaneous metastasis of high-grade serous ovarian cancer.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-264315
Theis Mariager, Juliane Zickert, Luit Penninga, Carsten Sauer Mikkelsen
{"title":"Cutaneous metastasis of high-grade serous ovarian cancer.","authors":"Theis Mariager, Juliane Zickert, Luit Penninga, Carsten Sauer Mikkelsen","doi":"10.1136/bcr-2024-264315","DOIUrl":"https://doi.org/10.1136/bcr-2024-264315","url":null,"abstract":"","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pancreatic carcinosarcoma: a rare type of pancreatic neoplasia with long-term survival.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-262648
Shahid Gilani, Mubashir Adekunle Ibrahim, Qudsia Mujeeb, Ibrahim Khir
{"title":"Pancreatic carcinosarcoma: a rare type of pancreatic neoplasia with long-term survival.","authors":"Shahid Gilani, Mubashir Adekunle Ibrahim, Qudsia Mujeeb, Ibrahim Khir","doi":"10.1136/bcr-2024-262648","DOIUrl":"https://doi.org/10.1136/bcr-2024-262648","url":null,"abstract":"<p><p>A woman in her 60s presented with persistent abdominal pain and jaundice. She had a history of BRCA1 gene mutation and was previously treated for triple-negative early breast cancer. Abdominal ultrasound and CT scan of the abdomen revealed a mass around the pancreatic head. Magnetic resonance cholangiopancreatography showed a dilated common bile duct and a normal pancreatic duct. Liver function improved after endoscopic retrograde cholangiopancreatography and biliary stent placement. Staging CT confirmed no distant metastasis. The patient underwent Whipple's procedure to remove the pancreatic lesion. Histology from the resection confirmed carcinosarcoma with positive margins, along with lymphovascular, perineural and nodal involvement. She was offered adjuvant chemotherapy with a combination of Folinic acid, 5-fluorouracil, Oxaliplatin and Irinotecan (FOLFIRINOX). Due to derangement in liver enzymes after one cycle of chemotherapy, an MRI scan confirmed liver metastasis. The same chemotherapy regimen was continued in a palliative setting, initially showing a partial response to the liver metastases, but subsequently resulting in a long-term complete radiological response. Pancreatic carcinosarcoma is a rare type of cancer with no clear consensus on the appropriate management. In this case, FOLFIRINOX palliative chemotherapy led to long-term disease control. Future studies on molecular profiling may provide insights for genotype-driven, personalised treatment strategies for similar cases.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pathological complete response with cocktail chemotherapy in mediastinal seminoma.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-261999
Petros Fessas, Linda Charalambous, Sarah Morgan, Anand Sharma
{"title":"Pathological complete response with cocktail chemotherapy in mediastinal seminoma.","authors":"Petros Fessas, Linda Charalambous, Sarah Morgan, Anand Sharma","doi":"10.1136/bcr-2024-261999","DOIUrl":"https://doi.org/10.1136/bcr-2024-261999","url":null,"abstract":"<p><p>A mediastinal mass can present a diagnostic challenge, especially when symptoms necessitate urgent treatment. Mediastinal seminoma, a rare extragonadal germ cell tumour, shares clinical features with testicular seminoma, such as slow growth and high sensitivity to chemotherapy and radiotherapy. This case is of a man in his 40s presenting with cough and chest discomfort, with imaging revealing a large anterior mediastinal mass that was causing left diaphragmatic paralysis due to phrenic nerve involvement. Urgent CT of chest, abdomen and pelvis and tissue biopsy supported the diagnosis of mediastinal seminoma, prompting the immediate initiation of chemotherapy with an induction dose of etoposide and cisplatin, followed by the cisplatin, vincristine, methotrexate, bleomycin alternating with actinomycin D, cyclophosphamide, etoposide regimen. This approach led to significant tumour reduction, facilitating complete surgical resection and sparing of the right phrenic nerve. Despite early fluorodeoxyglucose-positron emission tomography suggesting residual activity, resection histopathology confirmed no malignant cells. The patient achieved a favourable outcome, underscoring the importance of rapid treatment initiation, effective chemotherapy regimens and multidisciplinary management in mediastinal seminoma cases.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
S1Q3T3, pulmonary embolism diagnosed primarily from ECG results in a patient with dysphagia and low Wells score.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-264036
Praveen Rahul Ratnayake
{"title":"S1Q3T3, pulmonary embolism diagnosed primarily from ECG results in a patient with dysphagia and low Wells score.","authors":"Praveen Rahul Ratnayake","doi":"10.1136/bcr-2024-264036","DOIUrl":"https://doi.org/10.1136/bcr-2024-264036","url":null,"abstract":"<p><p>A man in his late 60s with previous chronic obstructive pulmonary disease and insulin-dependent diabetes presented with a 10-day history of shortness of breath and cough and progressive breathlessness accompanied with significant weight loss over 6 months. On examination, it revealed poor swallow, dysphagia for both solid foods and liquids and not taking any regular medications due to problems with swallowing. On further history taking, the patient had a positive first relative family history for oesophageal cancer and lung cancer on the paternal side. Patient acutely desaturated and increased New Early Warning Score during the evening on call, and prominent S1Q3T3 was seen on ECG, which prompted immediate anticoagulation and CT pulmonary angiogram confirmed an acute thrombus with significant right heart strain. This case highlights the importance and sometimes neglected signs of right heart strain and elusive recognition of the S1Q3T3 phenomenon in acutely unwell and deteriorating patients to aid in the diagnosis of pulmonary embolism.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distal femoral bone defect treatment using an engineered hydroxyapatite cylinder scaffold made from rattan wood.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-264131
Charalampos Pitsilos, Peter V Giannoudis
{"title":"Distal femoral bone defect treatment using an engineered hydroxyapatite cylinder scaffold made from rattan wood.","authors":"Charalampos Pitsilos, Peter V Giannoudis","doi":"10.1136/bcr-2024-264131","DOIUrl":"https://doi.org/10.1136/bcr-2024-264131","url":null,"abstract":"<p><p>Distal femoral non-union presents significant challenges, often requiring complex treatment strategies to achieve bone healing. In this case, a young male patient with an open fracture of the distal femur developed an atrophic non-union, 9 months after initial fixation. The patient underwent surgical intervention with debridement, leading to a 2.2 cm bone defect and placement of a cylindrical synthetic bone graft (b.Bone), combined with bone marrow aspirate concentrate. This approach aimed to provide structural support and enhance biological healing. The choice of the cylindrical graft was due to its optimal fit and support for the anterior femoral cortex. Postoperative outcomes were favourable, with successful bone healing, confirmed radiologically, and restoration of function. This case demonstrates the potential of synthetic bone substitutes augmented with biological agents as a promising alternative to traditional grafts in managing complex non-unions.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thrombolysis for superior vena cava syndrome post bone marrow transplant: a paediatric experience.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-19 DOI: 10.1136/bcr-2024-264072
Anu Sharma, Katarzyna Swist-Szulik, Robert Wynn, Srividhya Senthil
{"title":"Thrombolysis for superior vena cava syndrome post bone marrow transplant: a paediatric experience.","authors":"Anu Sharma, Katarzyna Swist-Szulik, Robert Wynn, Srividhya Senthil","doi":"10.1136/bcr-2024-264072","DOIUrl":"https://doi.org/10.1136/bcr-2024-264072","url":null,"abstract":"<p><p>Our case highlights timely diagnosis and management of pulmonary embolism (PE) and superior vena cava syndrome in a child with a background of Chediak-Higashi syndrome who underwent a bone marrow transplant, the probable precipitant being concomitant autoimmune haemolytic anaemia. He was successfully managed in paediatric critical care with a catheter-directed tissue-type Plasminogen activator (tPA) thrombolysis without any complications. He is currently 3 years post transplant with good immune reconstitution.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postpneumonectomy space infection eight years after mediastinal repositioning procedure.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-18 DOI: 10.1136/bcr-2024-263481
Edward Staniforth, Rhona Taberham, Lucy Cogswell, Elizabeth Belcher
{"title":"Postpneumonectomy space infection eight years after mediastinal repositioning procedure.","authors":"Edward Staniforth, Rhona Taberham, Lucy Cogswell, Elizabeth Belcher","doi":"10.1136/bcr-2024-263481","DOIUrl":"https://doi.org/10.1136/bcr-2024-263481","url":null,"abstract":"<p><p>Postpneumonectomy syndrome is a rare complication following pneumonectomy. Repositioning of the mediastinum via insertion of prosthetic implants into the postpneumonectomy space can provide symptomatic relief. We present a case of a man in his early 70s presenting with empyema necessitans 8 years after the implantation of silicon-saline prostheses for the management of postpneumonectomy syndrome. Excision of the chest wall sinus, re-do right thoracotomy and removal of the infected silicon-saline prostheses and postprocedural intrapleural irrigation led to resolution. There was no evidence of mediastinitis. At the 1-year follow-up, the patient remained well, with a centralised mediastinum without further evidence of infection of the postpneumonectomy space. This is to our knowledge the first reported case of chronic infection of a repositioned mediastinum in the context of postpneumonectomy syndrome.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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