Platypnoea-orthodeoxia after left total knee replacement.

Platypnoea-orthodeoxia syndrome (POS) is a rare disorder characterised by both dyspnoea (platypnoea) and arterial desaturation (orthodeoxia) in the upright position, with improvement in the supine position. We report an unusual case in which an 82-year-old woman developed severe hypoxaemia with POS after left total knee replacement. A significant difference in alveolar-arterial blood gas oxygen tension was demonstrated, and hypoxaemia failed to respond to 100% oxygen supply. A patent foramen ovale with a right-to-left shunt was evident on transoesophageal echocardiogram employing colour Doppler and agitated normal saline studies. Interestingly, the patient's symptoms resolved within 6 months with ongoing chest physiotherapy, without surgical or medical intervention.

Ruptured hepatocellular carcinoma disguising as heterotopic pregnancy.

The incidence of hepatocellular carcinoma (HCC) in pregnancy is rare but is typically aggressive, with a 1-year survival rate of 23%. One of the complications of HCC is spontaneous rupture, resulting in haemoperitoneum. A 36-year-old pregnant Chinese immigrant who was positive for hepatitis B virus and in her first trimester presented to the emergency department of Wyong Hospital, Hamlyn Terrace, New South Wales, Australia, with severe epigastric and right upper quadrant pain and haemodynamic instability. Spontaneous rupture of a heterotopic pregnancy was initially suspected. However, histopathological staining of the lesions excised during surgery revealed HCC. To our knowledge, this is the first case of spontaneous rupture of HCC with haemoperitoneum during pregnancy in Australia. As developed countries receive global migrants, similar cases may be seen in the future. Epidemiological studies suggest that immigrants from China and Vietnam have the highest incidence of chronic hepatitis B virus carrier status.

Foot Pressure Changes Before and After Ankle Fusion: A Pedobarograph Study.

We performed a case-control study with the purpose of establishing the pressure patterns in the soles of the feet of patients with ankle osteoarthritis, determining whether the pattern changed after treating the arthritis with ankle joint fusion (arthrodesis), and whether the change is significant. We also studied the benefits of ankle fusion with respect to the Short-Form 36-item Health Survey and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. The study included 18 participants (9 in the study group and 9 in the control group) to reach statistical significance with a 95% confidence interval (CI). A demonstrable increase was found in both forefoot and hind-foot pressures in the study group preoperatively compared with the control group. Also, a demonstrable increase was found in the pressure in both the forefoot (mean difference 50.56 ± 267.39 kPa) and the hindfoot (mean difference 57.44 ± 160.27 kPa) from preoperatively to postoperatively. This difference was not statistically significant (p = .59 [t(8) = 0.57]; 95% CI 256.10 to -154.98) for the forefoot pressures and for the hindfoot pressures (p = .31 [t(8) = 1.08]; 95% CI 180.64 to -65.76). The Short-Form 36-item scores significantly improved from preoperatively to postoperatively (p = .000054 for the physical component and p = .018 for the mental component). The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score also improved significantly (p = .0000005). The foot pressures, as measured by using the insole sensors, showed an increase in forefoot and hindfoot pressures that was not statistically significant.

Cervicofacial and mediastinal emphysema complicating tooth extraction in an elderly patient: a preventable complication.

Subcutaneous emphysema is widely documented in the literature and well known by doctors and dentists. However, subcutaneous emphysema following tooth extraction is not very common.We report the case of a 72-year-old female who presented to the emergency department of the Bunbury Hospital in Bunbury in the state of Western Australia in Australia, with subcutaneous emphysema of the face and neck with extension into the mediastinum, following a complicated tooth extraction in 2016. It was a dramatic and scary occurrence for both the patient and dentist, but totally preventable. The investigations and treatment could have been very invasive. However, with limited and essential management, the process was kept simple and safe for the patient.