HighlightsDesmoid tumours are the second commonest tumour in FAP after colonic adenomas.Desmoid tumours do not metastasise but are locally aggressive.Patients with FAP should be examined regularly post-panproctocolectomy since desmoid tumours may arise.
The authors report a case of a 20-year-old woman who was diagnosed with pulmonary cystic echinococcosis. She was admitted to hospital with a 1-week history of unresolving cough, coloured sputum with occasional haemoptysis and fever despite oral antibiotics. Radiology revealed a cavitating right lower lobe lung abscess. After 4 weeks of treatment, follow-up radiology showed incomplete resolution. Bronchoscopy revealed a white, avascular cystic lesion in the right lower lobe and serology testing for was positive. Repeat imaging eventually confirmed the cystic lesion with the 'air bubble'sign. A thorough travel history, a high index of clinical suspicion and close follow-up are essential in making a diagnosis of pulmonary cystic echinococcosis.
A case of non-fatal drowning with a successful outcome despite a submersion time of 25 min is described. Our case report emphasizes the role of accidental hypothermia in the survival of drowning victims with hypoxic brain injury, and supports the use of therapeutic hypothermia in the resuscitation of these patients. LEARNING POINTS• Accidental hypothermia protects against brain injury by shunting oxygenated blood towards the vital organs, and by decreasing the oxygenation needs of tissues.• Therapeutic hypothermia protects against brain injury by slowing metabolism and by decreasing reperfusion injury.• Drowning victims with restoration of spontaneous circulation who remain comatose should not be actively re-warmed to temperatures above 32-34°C. KEYWORDSNon-fatal drowning, hypothermia CASE PRESENTATION A 20-year-old Eastern European man was brought to the emergency department after being rescued from seawater following a motor vehicle accident that occurred in the early hours of a winter morning. The car he was driving broke through a crash barrier and fell into the sea in a yacht marina, and he remained immersed in cold water for around 25 min before being rescued.The patient was found to be pulseless on site, and cardiopulmonary resuscitation (CPR) was started immediately. Cardiac monitoring initially showed pulseless electrical activity followed by a period of asystole, and return of spontaneous circulation was obtained after 10 min of CPR. The patient was then hypothermic (rectal temperature 31.1°C), bradycardic (35 bpm) and hypotensive (89/44 mmHg), with fixed dilated pupils. Arterial blood gases initially showed severe respiratory acidosis (pH 6.85) with a high lactate of 13.8. Intravenous atropine was given, followed by an infusion of adrenaline, which led to an improvement in heart rate (112 bpm) and blood pressure (112/42 mmHg). He was left hypothermic at 31.1°C.The patient was admitted to the intensive therapy unit (ITU), sedated with propofol and intubated. Intravenous piperacillin-tazobactam was started since the patient had aspirated a large amount of murky seawater. Laboratory investigations revealed neutrophilia, hypernatraemia and normal coagulation. Computed tomography showed generalized brain oedema and bilateral dependent lung consolidations. His vital parameters remained stable, the acidosis improved and his body temperature rose spontaneously (Fig. 1).On his second day in the ITU, the patient was noted to have episodes of limb jerking for which intravenous phenytoin was started. On day 5, sedation was stopped and the patient opened his eyes spontaneously and obeyed simple commands. The next day he was transferred to a medical ward, where he improved gradually, with no further seizures on oral phenytoin. An electroencephalogram and magnetic resonance imaging of the brain were normal.On the medical ward, he started verbalising appropriately at times. However, he was noted to be intermittently agitated and delusional, stating that his friends from abroad had come to see him while he was...
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