Heyde's syndrome: diagnosis and management by the novel single-balloon enteroscopy

ABSTRACT

Hong Kong Med J 2009;15:301-3 | Number 4, August 2009
CASE REPORT
Heyde's syndrome: diagnosis and management by the novel single-balloon enteroscopy
YT Hui, WM Lam, Nancy MS Fong, PK Yuen, Jodis TW Lam
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
We present a case of obscure gastro-intestinal bleeding due to small bowel angiodysplasia in a 68-year-old woman with severe aortic valve stenosis. The diagnosis was confirmed and subsequently managed using single-balloon enteroscopy.
 
Key words: Angiodysplasia; Aortic valve stenosis; Endoscopy, gastrointestinal; Gastrointestinal hemorrhage
 
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Enophthalmos caused by an orbital venous malformation

ABSTRACT

Hong Kong Med J 2009;15:299-300 | Number 4, August 2009
CASE REPORT
Enophthalmos caused by an orbital venous malformation
CF Chung, Jimmy SM Lai
Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong
 
 
Orbital vascular malformations usually present with proptosis. We report a case where a patient with an orbital venous malformation presented with enophthalmos. Since many underlying orbital pathologies, including orbital metastases, can cause enophthalmos, it is important to investigate patients properly. Computed tomographic imaging of the orbit remains the most useful tool in the management of patients with enophthalmos.
 
Key words: Enophthalmos; Orbit; Vascular malformations
 
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An unusual complication after strabismus surgery

ABSTRACT

Hong Kong Med J 2009;15:297-8 | Number 4, August 2009
CASE REPORT
An unusual complication after strabismus surgery
Flora HS Lau, TF Leung, Dorothy SP Fan
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong
 
 
Orbital cellulitis is rarely reported after strabismus surgery; fewer than 10 cases have been reported. Nonetheless, orbital cellulitis is a potentially sight- and life-threatening condition. A high index of suspicion, use of a multidisciplinary approach, early diagnosis, aggressive treatment, and close monitoring are all important means of avoiding potentially irreversible visual loss and systemic complications. We report a case where early use of aggressive treatment to manage a post-strabismus surgery infection led to a good outcome.
 
Key words: Cellulitis; Orbital diseases; Postoperative complications; Strabismus
 
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Unusual traumatic triceps tendon avulsion rupture: a word of caution

ABSTRACT

Hong Kong Med J 2009;15:294-6 | Number 4, August 2009
CASE REPORT
Unusual traumatic triceps tendon avulsion rupture: a word of caution
Alexander PH Chan, CK Lo, HY Lam, KY Fung
Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
 
 
Triceps tendon rupture is a rare condition. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. A 67-year-old woman presented with injuries caused by direct impact to her right elbow after a fall. X-rays of the elbow demonstrated the cardinal clinical 'gap' and 'flake' signs. It is necessary to be aware of this injury and perform a careful examination at the time of the initial presentation, as the signs of this injury are usually subtle. Most reported primary repairs have been performed with non-absorbable transosseous sutures. In this case report, we show how using suture anchors for reattachment is a technically feasible alternative operative method providing a good surgical outcome.
 
Key words: Elbow; Muscle skeletal; Rehabilitation; Rupture; Tendon injuries
 
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Splenic tuberculosis associated with monoclonal gammopathy of undetermined significance and pericarditis

ABSTRACT

Hong Kong Med J 2009;15:291-3 | Number 4, August 2009
CASE REPORT
Splenic tuberculosis associated with monoclonal gammopathy of undetermined significance and pericarditis
WI Cheung, Vincent KS Leung, Ivy SC Luk, Tony KL Loke, James CS Chan, TN Chau
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
 
 
Tuberculosis usually affects the respiratory system, but it may present atypically involving multiple systems, extrapulmonary systems, and manifest as a protein disorder. Here we report a case of splenic tuberculosis associated with monoclonal gammopathy of undetermined significance, and pericarditis. The diagnosis, confirmed by a plugged biopsy of the spleen, precluded the need for splenectomy in this patient and allowed prompt initiation of treatment, thereby avoiding the complications of tuberculous pericarditis and splenic infection.
 
Key words: Multiple myeloma; Pericarditis; Tuberculosis, splenic
 
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Primary hepatic peripheral T-cell lymphoma in a patient with chronic hepatitis B infection

ABSTRACT

Hong Kong Med J 2009;15:288-90 | Number 4, August 2009
CASE REPORT
Primary hepatic peripheral T-cell lymphoma in a patient with chronic hepatitis B infection
Vincent KS Leung, SY Lin, Tony KL Loke, TN Chau, CY Leung, TP Fung, SH Lam
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
 
 
We report a case of primary hepatic peripheral T-cell lymphoma in a patient with hepatitis B virus-related cirrhosis. This patient presented with a solitary hepatic lesion with computed tomography and magnetic resonance imaging features that did not resemble hepatocellular carcinoma. Subsequent biopsy of the lesion revealed that it was a peripheral T-cell lymphoma. The patient was successfully treated with multi-agent chemotherapy followed by radiofrequency ablation. Although hepatocellular carcinoma is the most frequently encountered primary hepatic tumour in patients with hepatitis B virus-related cirrhosis, primary hepatic lymphoma should also be borne in mind. Nevertheless, primary hepatic lymphoma is a rare entity, and has no proven association with chronic hepatitis B infection.
 
Key words: Carcinoma, hepatocellular; Hepatitis B; Liver cirrhosis; Lymphoma
 
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Myocardial rupture associated with bolus injection of contrast medium during computed tomographic study in a patient with acute myocardial infarction: a rare but lethal complication

ABSTRACT

Hong Kong Med J 2009;15:285-7 | Number 4, August 2009
CASE REPORT
Myocardial rupture associated with bolus injection of contrast medium during computed tomographic study in a patient with acute myocardial infarction: a rare but lethal complication
Vincent Lai, KC Hau, HY Lau, WC Chan
Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
 
 
Well-documented potential cardiovascular complications associated with the use of contrast media include bradycardia, hypotension, arrhythmia, and conduction disturbances. Rupture of the myocardium after acute myocardial infarction is a known cause of death, but has yet to be recognised as a potential complication of the use of a bolus injection of contrast medium. On the contrary, contrast-enhanced computed tomographic studies have been performed widely for the diagnosis and evaluation of myocardial infarction. We report a case of complicated myocardial rupture after a single bolus injection of contrast medium during a computed tomographic study in an elderly woman with acute myocardial infarction, which led to cardiac tamponade and rapid death. Although rare, this should alert us to the need for cautious use of contrast medium in patients with acute myocardial infarction.
 
Key words: Contrast media; Heart rupture, postinfarction; Injections, intra-arterial; Tomography, X-ray computed
 
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Implantation of a breathing pacemaker in a tetraplegic patient in Hong Kong

ABSTRACT

Hong Kong Med J 2009;15:230-3 | Number 3, June 2009
CASE REPORT
Implantation of a breathing pacemaker in a tetraplegic patient in Hong Kong
Jamie CM Lam, Carmen TK Ho, TL Poon, HY Kwok, Ripley K Wong, SW Chiu, Mary SM Ip
University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
 
 
A 38-year-old man had been tetraplegic and ventilator-dependent after sustaining a traumatic cervical spine fracture at the C1/C2 level in 1991, at the age of 22 years. He had been bedbound and mechanically ventilated since then. A multidisciplinary management team approached him in 2003 and helped him to become ambulatory and independent in his daily activities of living. We successfully implanted the diaphragm pacing stimulation system in this patient in 2004. Diaphragm pacing by phrenic nerve stimulation is well accepted in western countries, and has been in clinical application for children and adults for decades. Its use facilitates ambulation and improves the quality of life of tetraplegic individuals with chronic ventilatory failure.
 
Key words: Electric stimulation therapy; Quadriplegia; Quality of life; Spinal cord injuries
 
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Colonic injury from electric arcing: a significant complication of argon plasma coagulation

ABSTRACT

Hong Kong Med J 2009;15:227-9 | Number 3, June 2009
CASE REPORT
Colonic injury from electric arcing: a significant complication of argon plasma coagulation
Simon CY Law, James CH Wong, Hester YS Cheung, CC Chung, Michael KW Li
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
Argon plasma coagulation is increasingly used in endoscopic haemostasis. This case report illustrates the potential for thermal injury at a staple line remote from the area of argon plasma coagulation treatment as a result of electrical arcing. Increasing numbers of colorectal anastomosis and reconstruction procedures are now being performed using stapling techniques and the use of argon plasma coagulation in these patients has become a common situation in clinical practice. Information about this potential danger should be well disseminated to endoscopists and surgeons to avoid preventable complications. The presence of a staple line nearby should be considered a contra-indication for argon plasma coagulation.
 
Key words: Argon; Gastrointestinal hemorrhage; Hemostasis, endoscopic; Laser coagulation; Radiation injuries
 
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Generalised dystonia: clinical diagnosis is possible

ABSTRACT

Hong Kong Med J 2009;15:224-6 | Number 3, June 2009
CASE REPORT
Generalised dystonia: clinical diagnosis is possible
Binila Chacko, Pratibha Seshadri, Thambu D Sudarsanam
Department of Medicine, Christian Medical College and Hospital, Vellore 632 004, India
 
 
Neurodegeneration with brain iron accumulation type 1 (previously known as Hallervorden-Spatz syndrome) is a rare neurodegenerative disorder characterised by its typical clinical and radiological features. We present a case of an adolescent girl with rapidly progressive dystonia in whom the diagnosis of the above disorder was made prior to radiological investigation. This report has been made to highlight the diagnostic relevance of a good history and clinical examination. This is particularly important in a developing country where diagnostic radiological investigations are expensive.
 
Key words: Dystonia; Iron; Pantothenate kinaseassociated neurodegeneration; Retinitis pigmentosa
 
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