Spinal subdural haematoma: a rare complication of low-molecular-weight heparin therapy

ABSTRACT

Hong Kong Med J 2008;14:64-6 | Number 1, February 2008
CASE REPORT
Spinal subdural haematoma: a rare complication of low-molecular-weight heparin therapy
SY Chau, SC Tiu
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong
 
 
A 52-year-old man presented with chest pain, diarrhoea, rash, and arthritis. The use of lowmolecular- weight heparin for suspected pulmonary embolism or angina led to a spinal subdural haematoma 3 days later. He was retrospectively confirmed to have Salmonella paratyphi infection. The clinical presentation and management of spinal subdural haematomas, and the incidence and manifestations of reactive arthritis related to Salmonella infections are briefly discussed.
 
Key words: Hematoma, subdural; Heparin, lowmolecular- weight; Salmonella paratyphi
 
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Late-onset postpartum eclampsia: still a diagnostic dilemma?

ABSTRACT

Hong Kong Med J 2008;14:60-3 | Number 1, February 2008
CASE REPORT
Late-onset postpartum eclampsia: still a diagnostic dilemma?
VM Santos. FG Correa. FRD Modesto. PR Moutella
Department of Internal Medicine, Armed Forces Hospital, Brasília-DF
 
 
Eclampsia is still a major cause of perinatal morbidity and mortality in developing countries but postpartum eclampsia has rarely been described. We present a case in which a 22-year-old Brazilian woman without a typical history of pre-eclampsia presented with eclampsia after the fourth postpartum day. The clinical diagnosis was corroborated by angiography and magnetic resonance imaging of the brain. The findings of nine similar cases reported in the literature are reviewed to compare data and highlight possible diagnostic pitfalls when managing this condition.
 
Key words: Cerebrovascular disorders; Eclampsia; Magnetic resonance imaging; Postpartum period; Pregnancy
 
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Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate

ABSTRACT

Hong Kong Med J 2007;13:485-9 | Number 6, December 2007
CASE REPORT
Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate
Ralph KH Cheung, KK Leung, KC Lee, TC Chow
Department of Orthopaedics and Traumatology, Caritas Medical Centre, Shamshuipo, Hong Kong (currently at Accident and Emergency Department, Caritas Medical Centre, Hong Kong)
 
 
Fractures associated with osteoporosis are common among elderly people and postmenopausal women. Bisphosphonate is an effective anti-resorptive drug commonly used for the prevention and treatment of osteoporosis. There are, however, concerns about potential side-effects during long-term treatment with alendronate. We report a case where an 82-year-old woman who had been taking alendronate for 10 years presented with two episodes of non-traumatic femoral shaft fracture. An iliac bone biopsy showed severely suppressed bone turnover, suggestive of adynamic bone disease. We suspect the bone turnover suppression was related to the prolonged use of alendronate.
 
Key words: Alendronate; Diphosphonates; Femur; Osteoporosis; Treatment outcome proteins c-kit
 
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Squamous cell carcinoma arising from an epidermal cyst

ABSTRACT

Hong Kong Med J 2007;13:482-4 | Number 6, December 2007
CASE REPORT
Squamous cell carcinoma arising from an epidermal cyst
MY Chiu, ST Ho
Department of Orthopaedics and Traumatology, Caritas Medical Centre, Shamshuipo, Hong Kong
 
 
There are few case reports in the English literature concerning malignant transformation of an epidermal cyst into squamous cell carcinoma. We report a case of squamous cell carcinoma arising from a 40-year epidermal cyst in the proximal left thigh of a 74-year-old man. The epidermal cyst had increased in size in the previous 3 years. The patient presented with a discharge from the lesion. Ultrasonography and magnetic resonance imaging of the lesion suggested malignancy. An intra-operative frozen section of an incisional biopsy of the lesion found it to be an epidermal cyst with suspected malignant change, so a marginal excision of the lesion was performed. Squamous cell carcinoma arising from the epidermal cyst was confirmed histologically. A wide excision was done in order to obtain an adequate resection margin. A computed tomographic scan of the thorax and abdomen found no evidence of metastases. No evidence of recurrence was noted in the latest follow-up, 2 years postoperatively.
 
Key words: Carcinoma, squamous cell; Epidermal cyst; Skin neoplasms
 
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Oesophageal gastro-intestinal stromal tumour presenting with rupture into pleural cavity

ABSTRACT

Hong Kong Med J 2007;13:478-81 | Number 6, December 2007
CASE REPORT
Oesophageal gastro-intestinal stromal tumour presenting with rupture into pleural cavity
CS Wong, T Chan, YC Chu, LF Cheng, YF Mak, KY Lee, MC Au Yeung
Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
Gastro-intestinal stromal tumours are rarely found in the oesophagus and it is uncommon for these tumours to present with rupture. In this paper, we report a case where the tumour ruptured through the distal oesophagus. As a result, the patient underwent surgical tumour dissection. A histopathological examination of the tumour mass confirmed that it was a gastro-intestinal stromal tumour. In this report, we review the diagnosis, pathology, and treatment of a patient presenting with a ruptured oesophageal gastro-intestinal stromal tumour.
 
Key words: Gastrointestinal stromal tumours; Hydropneumothorax; Imatinib; Protooncogene proteins c-kit
 
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Perforation of the gall bladder following typhoid fever-induced ileal perforation

ABSTRACT

Hong Kong Med J 2007;13:475-7 | Number 6, December 2007
CASE REPORT
Perforation of the gall bladder following typhoid fever-induced ileal perforation
Vaibhav Saxena, Somprakas Basu, CLN Sharma
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
 
 
Gall bladder perforation is a potentially life-threatening condition. Spontaneous perforation is infrequent and rarely seen in the absence of gallstones but gall bladder perforation is an occasional complication of typhoid fever. If such perforations are not treated in time, mortality rates are very high. We report a case of gall bladder perforation complicating typhoid fever following enteric perforation of the ileum necessitating sequential laparotomies during the same admission.
 
Key words: Gallbladder diseases; Ileal diseases; Intestinal perforation; Typhoid fever
 
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Lithium overdose causing non-convulsive status epilepticus--the importance of lithium levels and the electroencephalography in diagnosis

ABSTRACT

Hong Kong Med J 2007;13:471-4 | Number 6, December 2007
CASE REPORT
Lithium overdose causing non-convulsive status epilepticus--the importance of lithium levels and the electroencephalography in diagnosis
KK Yip, WT Yeung
Department of Medicine, Ruttonjee and Tang Shiu Kin Hospitals, Wanchai, Hong Kong
 
 
We report a case of lithium overdose in a patient who presented in non-convulsive status epilepticus. The lithium toxicity was probably due to interaction with Moduretic. The diagnosis was not suspected until electroencephalography was performed. This case underscores the importance of therapeutic drug level monitoring of lithium, especially where toxicity is suspected, and the indispensable role electroencephalography plays by allowing a correct diagnosis to be made promptly.
 
Key words: Electroencephalography; Lithium/ poisoning; Neuromuscular diseases; Status epilepticus
 
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Carcinoid tumour of the kidney in a Chinese woman presenting with loin pain

ABSTRACT

Hong Kong Med J 2007;13:406-8 | Number 5, October 2007
CASE REPORT
Carcinoid tumour of the kidney in a Chinese woman presenting with loin pain
HY Chung, WH Lau, SM Chu, RJ Collins, PC Tam
Department of Surgery, Queen Mary Hospital, Pokfulam Road, Hong Kong
 
 
Renal carcinoid tumours are uncommon. The aetiology is not yet fully understood and there is still no useful diagnostic tool for detecting them. We report our experience managing a Chinese woman with a primary renal carcinoid tumour.
 
Key words: Carcinoid tumor; Kidney neoplasms
 
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Arthroscopy-assisted combined external and internal fixation of a pilon fracture of the tibia

ABSTRACT

Hong Kong Med J 2007;13:403-5 | Number 5, October 2007
CASE REPORT
Arthroscopy-assisted combined external and internal fixation of a pilon fracture of the tibia
Ozgur Cetik, Hakan Cift, Mahmut Ari, Baris Cornert
Kirikkale University, School of Medicine, Department of Orthopedics and Traumatology, Kirikkale, Turkey
 
 
There are serious problems with existing methods of treating pilon fractures of the tibia caused by high-energy trauma. The method chosen to treat these fractures should not raise the risk of infection while effectively restoring the joint surface. We successfully treated a 42-year-old male patient with a pilon fracture caused by high-energy trauma using an arthroscopy-assisted unilateral external fixator and minimally invasive internal osteosynthesis. We used arthroscopy to reposition the fracture fragments and restore the joint surface. The fracture fragments were fixed with screws immediately after being repositioned. We believe that arthroscopy-assisted combined external and minimally invasive internal fixation is the treatment of choice for these fractures. We used external fixation to improve the fracture alignment, arthroscopy for restoring the joint surface, and minimally invasive screws to ensure fragment stability.
 
Key words: Arthroscopy; External fixators; Fracture fixation, internal; Tibial fractures
 
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Bryan artificial cervical disc arthroplasty in a patient with Klippel-Feil syndrome

ABSTRACT

Hong Kong Med J 2007;13:399-402 | Number 5, October 2007
CASE REPORT
Bryan artificial cervical disc arthroplasty in a patient with Klippel-Feil syndrome
Clarence HS Leung, WK Ma, WS Poon
Department of Neurosurgery, Prince of Wales Hospital, Shatin, Hong Kong
 
 
Technological advances have made more options available for surgical intervention in spinal disorders. From spinal fusion to artificial disc implantation, these advancements have brought great benefits, allowing preservation of spinal motion and flexibility after intervertebral discectomy. Yet the use of artificial discs as a treatment for congenital spinal disorders has been documented in only a handful of publications. We report a case where a Bryan artificial cervical disc arthroplasty was used to maintain and preserve the mobility and function of the cervical motion segments adjacent to fused vertebral lesions in a 33-year-old woman with Klippel-Feil syndrome who presented with chronic neck pain and signs of early myelopathy. The rationales for using the Bryan disc prosthesis system in patients with Klippel-Feil syndrome and its advantages over conventional surgical interventions are discussed.
 
Key words: Arthroplasty, replacement; Cervical vertebrae; Klippel-Feil syndrome; Spinal cord compression
 
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