Transplantation of Crossed Fused Renal Ectopia

Crossed fused renal ectopia is a type of congenital fused anomaly of the kidney. This type of kidney, when encountered, can be used as a donor organ to provide useful solution to the critical shortage of available organs for transplantation

PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

<p>Abstract</p> <p>Aim</p> <p>To report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA)</p> <p>Case presentation</p> <p>A 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA) device with fentanyl. On the morning following operation the patient was found to be unusually drowsy and unresponsive to stimuli. Her GCS level was 11 with plantars upgoing bilaterally. A provisional diagnosis of stroke was made. Urgent transfer to a high-dependency unit (HDU) was arranged and she was given ventilatory support with a BiPap device. CT was performed and found to be normal. Arterial blood gas (ABG) analysis showed respiratory acidosis with PaCO₂81 mmHg, PaO₂140 mmHg, pH 7.17 and base excess -2 mmol/l. A total dose of 600 mcg of fentanyl was self-administered in the 16 hours following emergence from general anaesthesia. Naloxone was given with good effect. There was an increase in the creatinine level from 90 μmol/L preoperatively to 167 μmol/L on the first postoperative day. The patient remained on BiPap for two days that resulted in marked improvement in gas exchange. Recovery was complete.</p

Vascular Injuries Associated with Video Gaming

With the continued increase of video gaming around the world, we present a review of the literature on vascular injuries associated with gaming to explore any common mechanisms of vascular injuries sustained and make recommendations to prevent them. A 2017 systematic review of all reported vascular injuries associated with video gaming was performed using Medline and PubMed searches including the following keywords: “Thrombosis” or “Artery” or “Vascular” or “ethrombosis” and “Video game” or “Wii” or Nintendo” or “Wiiitis” or “Computer game.” A total of 11 case reports reporting 12 vascular injuries associated with gaming were identified. Nine vascular injuries from gaming were associated with venous thromboembolism (VTE). Nearly 67% of cases resulted in major pulmonary emboli, one fatal. In the majority of VTE cases, the only risk factor known was prolonged immobility. All cases had negative thrombophilia screens or no history of thrombophilia. Two injuries occurred from intense physical activity on Nintendo Wii causing internal carotid artery dissection and permanent disability. One case was of an intraventricular hemorrhage from an arteriovenous malformation rupture occurring during gaming causing neurological deficits. Most vascular injuries from gaming were related to VTE. Immobility appears to be the solitary risk factor reported in most of the cases, an unusual finding with regard to the multifactorial nature of VTE pathogenesis. We recommend gamers not remain immobile for more than one continuous hour, taking breaks to mobilize or perform lower limb exercises

Femoral canal lipoma presenting as chronic venous insufficiency

Lower limb venous obstruction secondary to a lipoma is a rare occurrence. Patients with these benign soft tissue tumors can be asymptomatic, or may experience symptoms of pain, parasthesia, paralysis and swelling secondary to compression on adjacent neurovascular structures. Duplex ultrasound examination is the first-line investigation, but has its limitations. We report on a case of venous obstruction syndrome misdiagnosed as chronic venous insufficiency on duplex ultrasound examination, from a deep-seated giant lipoma compressing on the common femoral and distal external iliac vein in a patient with Dercum's disease