Archive for August, 2009

Heart rate monitored hypothermia and drowning following a kayaking accident

August 20, 2009

Published in Cases Journal this week is the report of a 48-year old male Norwegian kayaker who capsized when paddling alone around an island in a Norwegian fjord. After managing to call for help on his mobile phone the kayaker lost consciousness and was found fifty minutes later by air ambulance floating, prone with his head submerged in sea water and was suffering from profound hypothermia with cardiopulmonary arrest. The kayaker was wearing a personal heart rate monitor/pulse watch.

Following cardiopulmonary resuscitation and warming, spontaneous circulation was achieved 3h 27 m after cardiac arrest occurred. The patient spent 21 days in intensive care but was discharged from hospital 32 days after the accident with impaired short term memory and spatial planning abilities. A year after the accident the patient had returned to a normal cognitive ability.

Aside from the patients lucky escape, this report is made particularly interesting by the collection of data from the patient’s mobile phone log, GPS data from the patient, GPS used in the helicopter, the patients pulse watch and medical records, allowing the authors to provide an interesting and detailed timeline of the patients heart rate as the incident unfolds.

kayak

Heart rate data - The graph shows the complete data of recorded heart rate for the whole kayak trip

Read the case in full here.

Title: “Heart rate monitored hypothermia and drowning in a 48-year-old man. survival without sequelae: a case report

Authors: Fredrik Koller Lund, Johan G R Torgersen and Hans Kristian Flaatten

Richard Sear – Editorial Assistant – Cases Network

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Cases Network – Image of the month

August 18, 2009

Every month we select an image from Cases Journal or the Journal of Medical Case Reports (JMCR) that we feel is that little bit extra special.

Below is our choice for this month:

Photograph showing the sigmoid colonic perforation. Figure taken from Joglekar et al., "Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report"

Photograph showing the sigmoid colonic perforation. Figure taken from Joglekar et al., "Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report"

Sigmoid colonic perforation is an acute surgical emergency.

The patient in this case presented with a 3-day history of colicky generalised abdominal pain, gradually getting worse and eventually localising to the right iliac fossa (classical symptoms of acute appendicitis).

A provisional diagnosis of acute appendicitis was made, and consent was taken for appendicectomy. During the operation, a small (2 mm) perforation was found in the distal sigmoid colon through which a chicken bone was protruding outward.

Fewer than 1% of ingested foreign bodies will perforate the bowel. Although most sharp objects pass without complications, once beyond the oesophagus, they carry an increased risk of complications.

Diagnosis of an intestinal perforation can be difficult and the authors emphasise the need for a high degree of suspicion and awareness on the part of the clinician. They stress that situations such as these highlight the importance of obtaining full consent from the patients; this is particularly important when there is a diagnostic dilemma, as this may have future medico-legal implications. It is important to inform patients about an alternative diagnosis.

Our deputy editor said: “Excellent and intreresting case, also very well written“.

For all the clinical details, read the full case report here.

Title: “Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report”

Authors: Sandeep Joglekar, Iqbal Rajput, Sachin Kamat and Sarah Downey

To see a selection of our previous ‘Image of the month’ choices, visit our facebook site here.

EmailFor your chance to nominate a case report for the ‘Image of the month’, simply email us at: info@casesnetwork.com You can even nominate your own case!

Case report of the week: A rare case of primary lung cancer

August 14, 2009

Journal of Medical Case Reports (JMCR) publishes original and interesting case reports that expand medical knowledge and the newly published case by Syed Raza and colleagues, “Primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele: a case report”, is a great article to exemplify our journal’s scope.

There have only been 20 described cases of pulmonary mucinous cystadenocarcinoma (PMC) since it was first reported in 1978. PMC is a distinct but rare variety of lung cancer that, as with most lung cancers, predominantly occurs in older age and with a positive smoking history.

PMC is difficult to diagnose due to the scarcity of cancer cells present within the lesion. In this case the patient presented after collapsing and was diagnosed, based on CT findings, with a complex bronchocele (a dilation of the bronchus).  The patient went on to undergo open lung biopsy and histopathological testing that confirmed the diagnosis of PMC. This case is important in highlighting the need to consider primary PMC when investigating a suspicious bronchocele.

This case report is also excellent for its presentation of imaging and histological findings. Figure 3 from the article (below) is the view from the bronchoscopy that revealed the soft tissue lesion in the bronchus. It provides us with a very interesting insight into the investigation of such conditions.

Bronchoscopic view of Bronchoscopic view of the carina with the mass protruding from the right upper lobe bronchus

Bronchoscopic view. Figure taken from Raza et al., "Primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele: a case report" in the August issue of JMCR

The deputy editor described this report as “an extremely interesting and well written case, that is most suitable for JMCR” . Visit the journal to view the full article of this case and more in the August 2009 issue.

Lindsay Dytham – Editorial Assistant, Cases Network