n engl j med 368;21 nejm.org may 23, 2013 1953 Some volunteers had been staff­ ing the medical tent for years — one nurse had worked at the Bos­ ton Marathon more than 25 times. Sickened and stressed runners poured into our makeshift hos­ pital. A runner stumbled in and vomited into a bag. We helped him onto a cot, where he sat shivering. “You’re OK,” a nurse said gently, wiping his face. But h...

A dialysis patient with hyperammonaemia: inferior mesenteric-caval shunt as a cause of portal-systemic encephalopathy Sir, We report here a rare case of portal-systemic encephalop-athy with occasional loss of consciousness caused by an inferior mesenteric-caval shunt via the internal iliac vein in a peritoneal dialysis (PD) patient who was switched to haemodialysis (HD). A 71-year-old man with ...

Central pontine myelinolysis temporally related to hypophosphataemia Central pontine myelinolysis (CPM) is known to be associated with the rapid correction of severe hyponatraemia. However, there have been case reports of CPM occurring in normonatraemic patients. 1 Here we describe two patients in whom chronic alcohol abuse led to profound hypophosphataemia that was closely temporally related t...

D uring the summer of 2007, migratory joint pain developed in my (E.B.B.) 86-year-old father, previously an ironworker, farmer, and World War II veteran. Because of occasional tick attachments, a Borrelia burgdorferi ELISA was performed; antibodies were not detected, and no treatment was instituted. In the fall, subtle memory loss developed, and he fell twice a few weeks apart. Dad jok-ingly bl...

Following the report of two Canadian Aboriginal patients with severe hepatic failure by Mhanni et al. (2006), 1 suffering from hyperammonemia, hyperornithinemia, and hyperhomoci-trullinuria (HHH) syndrome, to the best of our knowledge, we are presenting the third and the oldest Aboriginal patient with HHH syndrome. Our patient, a 34-year-old male of Métis descent, with chronic cognitive dysfunc...

CASE PRESENTATION A 63-year-old Indian man presented to the emergency department with fever, nausea, chills, and generalized abdominal pain that had been present for 2 weeks. Th e patient had been in India for the past 3 months and began to feel ill during the last week of his visit. He was seen by a local physician and was found to have abnormal liver function tests and was treated with sparfl...

A 62-year-old man with cirrhotic ascites due to chronic Treatment started urgently with cautious hydration, blood and fresh-frozen plasma transfusions, lactulose hepatitis B infection was admitted because of ascites enemas and neomycin. Three days later, he was orientdeterioration, malaise, fatigue, and mental obtunated in time and place. dation. He was on frusemide 80 mg per os and spironolact...

This was a single-centre, prospective study to assess the frequency of neurological complications and their impact on prolonged hospitalization in 137 liver transplant patients presenting between September 1997 and June 2010. Neurological complications were seen in 22 (16%) patients during their postoperative stay in the intensive care unit. Complications included new-onset, recurrent headache...

Increasing awareness of the clinical entity of accidental hypothermia is apparent from case reports and observations in the medical literature in the last seven years. This paper described two patients, both of whom were sufferers from Parkinson's disease, who developed an episode of accidental hypothermia during which unusual and strikingly similar reversible electro-encephalographic changes w...

Encephalopathy is a well-known side effect of IFOS. This syndrome develops in 10% of patients exposed to the drug and usually disappears after stopping therapy, although some patients may die without recovery (1). It has been proposed that IFOS metabolites may interfere with the function of flavoproteins, leading to the observed CNS disturbances (2), and therapy with methylene blue has been suc...