http://casereports.bmj.com This feed contains articles for BMJ Case Reports Subject Collection "Ethics" BMJ Case Reports http://casereports.bmj.com http://casereports.bmj.com/cgi/content/short/2013/apr29_1/bcr2012008538?rss=1 Research suggests that a significant proportion of inpatients in general medical wards may lack capacity to make treatment decisions, a situation that often goes unrecognised by clinicians. We would like to briefly discuss two cases from a non-psychiatric setting, where a mental disorder served to inhibit the individual's ability to weigh-up associated risks when deciding to refuse potentially life-sustaining healthcare interventions. In both cases the history of mental disorder was well established yet, for markedly different reasons, the respective presentation was such that the influence of the disorder on decision-making was not evident to the treating teams. Linn, K. Sayer, C. O'Connor, G. Magee, T. 2013-04-29 doi:10.1136/bcr-2012-008538 Reflections on mental capacity assessments in general hospitals BMJ Publishing Group Ltd APR29_1 2013 201200853 2013-04-29 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jan25_1/bcr2012006962?rss=1 This is a case report involving an elderlyJehovah's Witness woman with a history of chronic anaemia who suffers cardiac arrest and is resuscitated. This case illustrates, even in an emergency setting, (1) the value of obtaining relevant history, (2) addressing code status within the framework of achievable goals of care and (3) the need to revise both history and goals of care, as more information becomes available. We also propose aspects of this discussion that would benefit from future research. Irfan, A. Hublikar, S. Cho, J. H. Hill, J. 2013-01-25 doi:10.1136/bcr-2012-006962 The value of history and goals of care with code status; even in an emergency setting BMJ Publishing Group Ltd JAN25_1 2013 201200696 2013-01-25 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2012/jun28_1/bcr0320125997?rss=1 An older patient presented with a 4-week history of tender lump in the right groin. Appearances were consistent with strangulated inguinal hernia and theatre was arranged. At operation, the lump was found to be an abscess communicating with the abdominal cavity. Alternative diagnosis requiring further operative management was considered but consent was deemed inadequate to proceed. Operation was abandoned and CT examination arranged. CT unexpectedly identified a cholecystocutaneous abscess discharging through the right inguinal region. The patient made good clinical recovery with ongoing drainage of the abscess and did not require any further operative treatment. Geraghty, A. Kettlewell, S. Arestis, N. 2012-06-28 doi:10.1136/bcr.03.2012.5997 Cholecystocutaneous abscess: diagnostic difficulty in a groin lump BMJ Publishing Group Ltd JUN28_1 2012 32012599 2012-06-28 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2012/feb20_1/bcr1220115403?rss=1 An 81-year-old female Jehovah's Witness (JW) patient with severe aortic stenosis required aortic valve replacement (AVR). However, the patient's religious beliefs precluded the use of primary blood components. Since the definitive treatment of AVR required bloodless open heart surgery, careful peri-operative plans were set forth by a multi-disciplinary team involving the cardiothoracic surgeon, haematologist and anaesthetist. The patient went on to successfully recover postoperatively. This case highlights: 1) The importance of carefully navigating through the most recent clinical and ethical protocol involved in the surgical management of JW's. 2) The importance of preparing individually tailored pre, intra and postoperative plans that are delivered through a multi-disciplinary clinical team to ensure the best and safest possible outcomes. Park, J. J. Lang, C. C. Manson, L. Brackenbury, E. T. 2012-02-21 doi:10.1136/bcr.12.2011.5403 Aortic valve replacement in a Jehovah's Witness: a case of multi-disciplinary clinical management for bloodless surgery BMJ Publishing Group Ltd FEB20_1 2012 122011540 2012-02-21 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2012/feb07_1/bcr1220103626?rss=1 Disorders of sex development (DSD) include congenital conditions where developments of chromosomal, gonadal or anatomical sex are atypical. Ostrer in 2000, reported a prevalence of 1:20 000 for 46 XY DSD and complete gonadal dysgenesis. A 21-year-old patient consulted for sexual ambiguity at the out-patient department of the Philippine general hospital. At birth, the perceived female external genitalia and clitoromegaly, led the parents to register and eventually rear the patient as a female. At puberty, he developed masculine features and growth of phallus. Patient was more interested in male activities and began to identify himself as male in the community. The discrepancy between his birth certificate and his male gender jeopardised his ambition to become a policeman; this led him to seek medical consult. On physical examination, he was phenotypically male. The external genitalia showed the phallus length of 3.5 cm and perineoscrotal hypospadias. Chromosomal sex was normal 46 XY with neither numerical nor structural aberrations in all cell lines, serum testosterone was low and gonadotrophins were elevated. Whole abdominal CT scan showed bilaterally undescended testes and a 4.5 cm blind vaginal pouch seen on genitogram. Bilateral orchidectomy with first stage repair of hypospadias was performed. On histopathology, the right testis was fibrotic and the left testis showed minimal testicular tissue with absent spermatids. The clinical, endocrine, cytogenetic and histopathologic data are consistent with gonadal dysgenesis syndrome. Hamin, J. N. Arkoncel, F. R. P. Lantion-Ang, F. L. Sandoval, M. A. S. 2012-02-10 doi:10.1136/bcr.12.2010.3626 46 XY gonadal dysgenesis in adulthood 'pitfalls of late diagnosis' BMJ Publishing Group Ltd FEB07_1 2012 122010362 2012-02-10 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2011/jul28_1/bcr0620114328?rss=1 The authors report the incidental finding of a dilated cisterna magna with an abnormal configuration to the falx in a newborn infant with Marfan syndrome who was recruited to a research study involving whole body MRI. To our knowledge, dilation of the cisterna magna has not previously been reported in patients with Marfan syndrome. Potential implications for antenatal diagnosis, the ethics of recruiting healthy volunteers for research and directions for future work are discussed. Vasu, V. Child, A. H. Modi, N. Rutherford, M. Cowan, F. 2011-07-28 doi:10.1136/bcr.06.2011.4328 Dilated neonatal cisterna magna and Marfan syndrome BMJ Publishing Group Ltd JUL28_1 2011 62011432 2011-07-28 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2011/mar10_1/bcr1020103456?rss=1 This report describes a 26-year-old man who was so emotionally attached to his mother that the mere thought of separating from her caused immense anxiety. The death of his mother after a brief illness resulted in prolonged bereavement. However, the patient started seeing and talking to his mother after her death, which led to huge improvement in his mood and social functioning. His wife brought him in for consultation but no obvious psychopathology was detected. This gave rise to the dilemma of whether to consider this a real psychopathology and treat it, or to disregard this reported hallucination. No active treatment is being given to this patient at the moment. Muhammad Gadit, A. A. 2011-03-15 doi:10.1136/bcr.10.2010.3456 Insightful hallucination: psychopathology or paranormal phenomenon? BMJ Publishing Group Ltd MAR10_1 2011 102010345 2011-03-15 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2010/feb02_1/bcr1020092383?rss=1 A patient with a history of metastatic bronchial carcinoma and end stage heart disease was admitted to hospital, after an accidental fall, because of epistaxis requiring nasal tamponade and blood transfusions. On day 2 the patient suffered from acute dyspnoea and finally respiratory and cardiac arrest. The patient was successfully resuscitated despite a do not resuscitate order (DNR order). A bolus aspiration of the nasal tamponade's gauze was discovered as the reason for the arrest. This case report underlines the ethical dilemma in patients with an otherwise undisputed DNR order when the arrest is: (1) easy to resolve but not easy to detect; (2) iatrogenic in nature; and (3) is occurring in an unmonitored area (for example, the ward) as compared with an arrest in a well monitored area (for example, the intensive care unit and operating room). Mehlig, A. Haberthuer, C. 2010-02-02 doi:10.1136/bcr.10.2009.2383 Do not resuscitate order in a patient with iatrogenic life threatening complications due to a bagatelle BMJ Publishing Group Ltd FEB02_1 2010 102009238 2010-02-02 CASE-REPORT