Diabetic ketoacidosis and prolonged
hyperchloraemic acidosis in a patient
treated with risperidone
by Steven Fong, Alex Bazeos, Julia Thomas and Tahseen A. Chowdhury
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. The development of
metabolic syndrome is widely recognised with the use of atypical antipsychotic agents, and not
infrequently DKA has been described with some of these drugs. We describe a complex patient
with HIV who presented with severe DKA and prolonged hyperchloraemic acidosis, which we
postulate was associated with risperidone therapy. (Specialties Endocrinology: 26th June 2008) More...
Postpartum cardiomyopathy:
a diagnostic dilemma
by H.A. Khwaja, S.S. Khwaja, M. Fakhry, B.A. Addas and S. Al-Awdah
Postpartum cardiomyopathy (PPCM) is the development of heart failure in the last month of
pregnancy or within 5 months after delivery without an identifiable cause in a previously healthy
female. It is a rare condition, which carries a high maternal mortality. We describe the case of a
35-year-old South Asian woman who presented with dyspnoea, fatiguability, peripheral oedema
and abdominal distension. Given the non-specific symptoms, echocardiographic findings
indicative of left ventricular systolic dysfunction established the diagnosis of PPCM. (Specialties Cardiac Imaging; Cardiology: 26th June 2008) More...
Acute hepatic necrosis in a case of acute cholecystitis
by Jason A. Bolton, Bijendra Patel and Hannah Simms
A 73-year-old Asian gentleman was admitted via the Accident and Emergency Department
with upper abdominal pain, jaundice, fever and rigors. Past history included non-insulin
dependant diabetes, asthma, psoriasis and alcoholism. His drug history included methotrexate.
A diagnosis of acute cholecystitis was made and ultrasound findings were consistent with this.
The patient started to improve but on day 8 of his admission he suddenly deteriorated and
arrested. The post mortem revealed complete hepatic necrosis as an unexpected cause of death.
There are a number of factors which may be contributory in this case. The fact that our patient
expired so rapidly with complete hepatic necrosis was not in keeping with the typical chronic
course one might expect. We should always bear in mind the potential for fatal hepatic injury
in patients presenting with hepatobiliary symptoms with a past history of alcohol abuse and
methotrexate therapy. (General Surgery: 8th June 2008) More...
Gastrocutaneous fistula: case report
and literature review
by Alex Hotouras, Adhip Mandal, Veera Karri and Aarti Varma
We report the case of a 91-year-old lady who presented with a gastrocutaneous fistula in the absence of any recent surgery. We review the literature and discuss this uncommon surgical
problem. (Breast Surgery, Gastroenterology;
General Surgery: 28th February 2008) More...
Anuria due to bilateral ureterolithiasis after appendectomy in a child
by A.J. Roeth, C.J. Krones, J. Conze, K.M. Ruhl, G. Steinau and
V. Schumpelick
We report on a boy who presented with acute renal failure and bilateral ureteral obstruction 5 days after an uneventful appendectomy. In contrast to the few cases described in the literature,
bilateral ureterothiasis was the pathogenesis of ureteric obstruction. The clinical signs and
diagnostic findings, and an overview of the literature are presented. The severity of permanent
renal damage in a child underlines the importance of this report. (General surgery; Paediatric surgery: 28th February 2008) More...
Mycobacterium chelonae: a rare cause of
subcutaneous nodules in a patient on
long term corticosteroids
by Christopher Strickland and Ali S.M. Jawad
Subcutaneous nodules are a common clinical finding. Common causes include rheumatoid
nodules, gouty tophi, neurofibromatosis type 1, Madelung's disease (benign symmetric
lipomatosis), Dercum's disease (adiposis dolorosa) and tuberous xanthomas. Other causes
include: hibernoma, lipoblastoma, angiolipoma, liposarcoma, glomus tumour, leiomyoma, eccrine
spiradenoma, neuroma, granular cell tumour and cysts (epidermal, pilar, sebaceous, dermoid). We
present a rare cause of subcutaneous nodules in a patient on long term corticosteroids. (Rheumatology: 29th January 2008) More...
A non-traumatic technique for removal
of the great saphenous vein at
varicose vein surgery
by Haris A. Khwaja and David M. Nott
Varicose vein surgery is one of the commonest surgeries performed in the Western world.
Utilisation of a plastic stripper and olive or a perforation/inversion metallic stripper has been
used to remove the great saphenous vein in the thigh. We describe a non-traumatic technique
for removal of the great saphenous vein that has minimal complications. (Vascular surgery: 24th January 2008) More...
Bilateral patellar tendon rupture: an unusual
case of trampoline injury
by Alex Hotouras, Nemandra Sandiford and Sudhir Rao
We report the case of a healthy 44-year-old gentleman who sustained bilateral patellar tendon
rupture while jumping on a trampoline. Although this kind of injury has been reported in
the literature previously, it is extremely rare in healthy individuals. We believe it is the
first documented case associated with the use of a trampoline. (Accident and emergency medicine and
surgery (including trauma); Orthopaedic surgery: 20th November 2007) More...
Midgut malrotation as a rare cause of
chronic abdominal pain: a case report
and review of literature
by A. Bajwa, H. Sheth and F. Hughes
Abnormalities in midgut rotation occur during the physiological herniation of the midgut between
the 5th and 10th week of gestation. The most significant abnormality is a narrow small bowel
mesentery which is prone to volvulus. This occurs most frequently in the neonatal period.
Less commonly, midgut malrotation presents in adulthood with either acute volvulus or
chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge.
We report a case of a 31-year-old female patient who presented with a 6-year history of
non-specific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed
with midgut malrotation following an upper gastro-intestinal series. The patient was treated with
a laparoscopic Ladd’s procedure and at 3 months was gaining weight and had stopped vomiting.
A laparoscopic Ladd’s procedure is an acceptable alternative to the open technique in treating
symptomatic malrotation in adults. (General surgery; Laparoscopic surgery: 16th November 2007) More...
Early port site hernia causing small bowel
obstruction after laparoscopic
appendicectomy
by M.R.E Abdel-Halim, S.M Higgs and M.H Niayesh
Laparoscopic appendicectomy is increasingly performed. We report a case of small bowel
obstruction caused by early port/drain site hernia diagnosed on the 6th day following
laparoscopic appendicectomy. (General surgery; 25th July 2007) More...
An unusual case of ‘collapse query cause’
by A Barclay and C Weaver
A 60-year-old woman attended A&E following an unwitnessed ‘collapse query cause’. Over 4 months she recalled involuntary movement of her eyes and head to the left and, on one occasion, complete rotation of her body. She had subtle neurological signs. Imaging identified the cause of these adversive seizures. (Accident and Emergency Medicine and Surgery (including Trauma); Neurology; 13th June 2007) More...
Clopidogrel and intraocular surgery: complicated or uncomplicated?
by Tahrina Salam and M.F. Raines
This case series of 16 patients demonstrates the postoperative complications associated with continued clopidogrel use and intraocular surgery. No intraocular or postoperative complications were noted but a 25% risk of subconjunctival haemorrhage following subtenons anaesthesia was noted. (Ophthalmology, General practice, Surgery; 13th June 2007) More...
Acute idiopathic mesentero-axial gastric volvulus in adolescence: a rare occurrence
by N Srinivasaiah, A Nichanametla, R Kasaraneni, D Tennant, K Seymour and L Horgan
Gastric volvulus is a rare entity first described in 1866. Gastric volvulus in neonates, infants and younger children accounts for 5–15% of the total. Acute idiopathic mesentero-axial gastric volvulus is a rare sub-type and there are only a few cases reported in children. There is a paucity of reports of its occurrence in adolescents. We present the first one of its kind, matching the classical description. (General Surgery; 13th June 2007) More...
Conservative management of large intrapulmonary haemorrhage following penetrating chest trauma
by DJ Marsh, S Mills and FW Cross
Penetrating chest wounds can hide a range of life threatening injuries and often require emergency surgical management. It is important that the patient be assessed and managed according to clinical need and response to medical intervention. This is a case of a patient with a large intrapulmonary haematoma who was managed conservatively and made a good recovery without need for surgery. (Thoracic Surgery; 13th June 2007) More...
Torted intra-abdominal testicular tumour
mimicking an appendix mass
by Weiliang Chua, Alec Engledow, Dimitri Raptis and Austin Obichere
Torted intra-abdominal testicular tumours are rare. While the commonest diagnosis of a right
iliac fossa mass is an appendix mass, rarer causes should not be disregarded, thus avoiding
sub-optimal management and enabling the best possible clinical outcome.
(General Surgery; 17th May 2007) More...
Ingested fishbone mimicking a gastric
submucosal tumour
by A. Bajwa, H. Seth and F. Hughes
Gastric complications following unintentional foreign body ingestion are extremely rare. We report the case of a 48-year-old lady who presented with a right upper quadrant mass and was
diagnosed with a likely submucosal tumour of the stomach. After surgical resection she
was found to have an impacted fishbone mimicking a gastric tumour.
(General Surgery; 14th May 2007) More...
Autoimmune neutropaenia complicating Sjögren’s Syndrome: haematological and clinical improvement with granulocyte colony stimulating factor
by M. D. Tarzi, S. Gupta, J Hanslip, H. J. Longhurst and A. S. M. Jawad
Connective tissue diseases are associated with granulocyte-specific autoantibodies and autoimmune
neutropaenia. Reduced levels of circulating neutrophils may predispose to recurrent
infections, particularly of the respiratory tract, although severe and opportunistic infections
have also been reported. There is only one previous description of the use of granulocyte colony
stimulating factor (GCSF) in Sjögren’s Syndrome complicated by autoimmune neutropaenia,
reporting poor response and tolerability. We present here the successful use of GCSF in a 42-yearold
woman with Sjögren’s Syndrome, autoimmune neutropaenia and chronic mastoiditis.
(Rheumatology; 14th May 2007) More...
Parathyroid incidentalomas: case report
and literature review
by A. Hotouras and P. Sinha
We report the case of a 60-year-old woman with a multinodular goitre who underwent total
thyroidectomy and was found intraoperatively to have a parathyroid ‘incidentaloma’. The surgical
approach to the management of patients with incidental parathyroid disease is discussed and
a review of the literature is presented.
(ENT/Head Neck Surgery, General Surgery, Endocrinology; 14th May 2007) More...
Large bowel obstruction due to gallstone:
‘gallstone coleus’
by S. Doddi, N. N. Basu, T. Kamal, T. W. Hennigan and P. Sinha
We report the case of an 82-year-old lady who presented with large bowel obstruction. The
computed tomography scan revealed an obstructing gallstone in the sigmoid colon. At
colonoscopy the stone was seen in the sigmoid colon proximal to a diverticular stricture. After
balloon dilatation of the stricture under general anaesthesia, the stone was removed. This
approach should be the treatment of choice; only if this fails should surgical treatment be
considered. (General Surgery; 19th April 2007) More...
Acute abdomen and angioedema:
a classic presentation
by Mohamad Hachem, Thomas Rix and Salem Shubber
Hereditary angioedema (HAE) is an infrequent disorder characterised by abnormalities in the
levels and/or function of complement C1 esterase inhibitor (C1 INH). Clinical manifestations of
HAE are due to recurrent episodic swelling of the subcutaneous or submucosal tissue. When
swelling involves the gastrointestinal mucosa, patients may present with nausea, vomiting,
diarrhoea, and severe abdominal pain. However, HAE is almost never suspected as a potential
cause of acute abdomen. We describe a typical case of hereditary C1 esterase inhibitor deficiency
in a 37-year-old woman presenting with recurrent acute abdomen and who had undergone
negative surgical interventions before diagnosis was eventually established. Both the diagnostic
and therapeutic approach to this rare condition is discussed in this report. (Accident and Emergency Medicine, Surgery (including Trauma); 28th March 2007) More...
Chronic cough and the use of indoor
'plug-ins'
by Veronica Varney
The British Thoracic Society has issued recommendations on the management of cough in adults
(September 2006). They confirm that chronic cough is common, and affects up to 16% of the
population with a female predominance. Common causes are discussed and include smoking,
asthma, rhinitis, and reflux with obesity and side effects of drugs. Their management/treatments
are reviewed. Exposure to pollutants and environmental irritants are stated as aggravating factors,
with outdoor pollution from traffic and allergens mentioned in outline. This report includes
four cases of cough which ceased after indoor ‘plug ins’ were switched off; these devices
release aerosols of perfumed fragrances into the environment for a persistent pleasant odour
of flowers. (Respiratory Medicine; 28th March 2007) More...
Subcutaneous oedema as a presenting
feature of polymyositis/dermatomyositis: a poor prognostic indicator?
by Lisa Dunkley and Ali S. M. Jawad
Widespread subcutaneous oedema is a rare presenting feature of polymyositis (PM)/dermatomyositis
(DM). It was reported in the initial description of the disease by Wagner in 1877 but only
nine cases have since been reported in the literature and it is not listed in standard textbooks of
rheumatology. We present a further case of subcutaneous oedema as a presenting feature of
dermatomyositis, briefly review the existing literature and postulate that this presentation
represents a subset of the disease with a poorer prognosis. (Rheumatology; 1st March 2007) More...
Pneumothorax and Birt–Hogg–Dube
syndrome: diagnostic and therapeutic aspects
by S. N. Andrews, R. Krishnadas, R. G. Berrisford and P. O. Froeschle
We report a case of spontaneous recurrent pneumothorax in a 32-year-old male with a family history of Birt–Hogg–Dube syndrome. Specific aspects of the surgical treatment for a
pneumothorax within this particular setting are discussed as well as the potential underdiagnosis
of this complex genodermatosis. The literature linking the syndrome to spontaneous pneumothorax
is reviewed. (Respiratory Medicine, Thoracic Surgery; 1st March 2007) More...
A perforated jejunal diverticulum
by Jaimini Cegla, Puja Chudasama, Tushar Agarwal and Shahid Chaudhary
A 65-year-old lady presented with a 5-day history of watery diarrhoea and right-sided abdominal
pain. Overnight she developed localised peritonitis in the left iliac fossa. An abdominal computed
tomography scan revealed free fluid in the abdominal cavity, free air in the retroperitoneum
and a small bowel perforation. An emergency laparotomy was carried out which revealed
multiple jejunal diverticula, one of which had perforated. Jejunal diverticula have a prevalence
of approximately 1% in the general population. Perforation of a jejunal diverticulum is a rare
complication. Clinically, this diagnosis may be easily confused with other causes of an acute
abdomen. In an elderly person, especially if known to have jejunal diverticulosis, one must have
a high index of suspicion for perforation. (General Surgery; 20th February 2007) More...
Self-castration: a case report
by S. Haleem, S. J. Griffin and G. K. Banerjee
We present a case of an apparently well gentleman performing self-castration. On presentation he
was in shock. After resuscitation his wound was explored and haemostasis achieved. While such
presentations are seen with a background of psychiatric illness, our patient did not suffer from
such disorders. This case emphasises the importance of a multi-disciplinary holistic approach for
optimum patient care. (Psychiatry, Urology; 20th February 2007) More...
Dominant inheritance of primary glenoid
dysplasia: report of two cases
by Stuart N. Andrews, Tim D. Bunker and Sarah F. Smithson
Primary glenoid dysplasia, although a relatively rare diagnosis, has been well described clinically
and published in the orthopaedic literature. However, very few cases of familial occurrence
of the disease have been reported. We present two cases of the condition in a father and son.
Both presented in childhood with recurrent shoulder pain and radiologically display primary
glenoid dysplasia. Our cases would strongly suggest autosomal inheritance may occur in this
dominant condition. (Orthopaedic surgery, Paediatrics; 20th February 2007) More...
A case of rose thorn tenosynovitis
by Pamela Mangat and Ali S. M. Jawad
Penetrating injuries with retained foreign bodies are a frequent cause of synovitis affecting the extremities. The management of plant thorn synovitis raises a number of diagnostic and treatment challenges. (Rheumatology, Radiology; 20th February 2007) More...
Spontaneous rupture of mucinous cystadenoma of the pancreas
by Atindriya Biswas and Satyajit Bhattacharya
Pancreatic cysts that develop after abdominal trauma are generally considered to be pseudocysts. We present a patient with a post-traumatic peri-pancreatic cyst that later ruptured suddenly, leading to an acute abdomen. Following an urgent laparotomy and excision of the cyst, post-operative histopathological assessment showed this to be a mucinous cystadenoma of the pancreas. We have reviewed the literature on spontaneous rupture of mucinous cystadenomas of the pancreas. (HPB Surgery; 2nd February 2007) More...
Sistrunk's 1920 description of thyroglossal cyst excision
by A. M. Balfour, H. M. Al-Reefy and M. G. Dilkes
In 1920 Walter Ellis Sistrunk described the classic operation of
thyroglossal cyst excision including the central portion of the
hyoid bone and a core of tissue around the thyroglossal tract to
open into the oral cavity at the foramen caecum. We present this
paper and discuss its relevance to current practice. (Landmark case report, Otolaryngology, Paediatric Surgery; 28 November 2006) More...
A case of haemoptysis diagnosed using digital video endoscopy
and treated with the holmium-YAG laser
by H. M. Al-Reefy, A. M. Balfour and M. G. Dilkes
We report a case of persistent haemoptysis, initially
investigated by chest physicians. An Ear, Nose and Throat (ENT)
opinion was sought because no source for the bleeding could be
found. On video-endoscopic examination of the trachea using a
three chip digital camera system, a vascular lesion, possibly an
arteriovenous malformation, was seen on the anterior tracheal
wall. This was successfully coagulated using the holmium-YAG
laser, with resultant cessation of bleeding. (Radiology, Respiratory medicine; 21 September 2006) More...
Post-traumatic lymphangioma of the forearm in a young adult male
by M. Guruswamy, R. S. Ahluwalia and V. Shiv Shanker
Lymphangioma resulting from trauma has rarely been described in
the upper limb. Following direct blunt trauma it has previously
been reported in the head and neck region as well as the
abdomen. We report a rare case of post-traumatic soft tissue
cystic swelling within the flexor aspect of the forearm, which
was shown to be a lymphangioma. We describe the clinical
features, MRI findings, and surgical treatment of this lesion. (Trauma; 21 September 2006) More...
Differential diagnosis of an incarcerated inguinal hernia: extraperitoneal endometrioma of the round ligament
by Jack J. K. Ku, Michael Marfan, Michael O’Shea, Adam Louie, John Lynch and Anthony Griffin
General surgeons may encounter endometriosis when extraperitoneal forms of the disease mimic a symptomatic inguinal hernia in premenopausal women. Diagnosis is often difficult, especially in the absence of menstrual symptoms, and is often made during surgical groin exploration. We present a case of extraperitoneal endometrioma simulating a symptomatic inguinal hernia and discuss the pathogenesis and management. (General Surgery, Gynaecology; July 20th 2006) More...
Pseudoaneurysm of the superficial temporal artery: case report
and review of the literature
by J. Shalhoub, M. Hamish, M. B. Sikkel and A. H. Davies
Since the first description by Bartholin in 1740, 386 cases of
aneurysms of the facial vasculature have been reported in the
world literature. Of these, less than 200 were of the
superficial temporal artery (STA) [1]. Such STA lesions are
commonly pseudoaneurysms presenting within weeks of direct
trauma. We present a case of STA pseudoaneurysm following a
closed head injury. (Vascular Surgery, Trauma; May 25th 2006) More...
Delayed diagnosis of abdominal pain
by T. E. Rix and P. Sinha
We report the case of a 48-year-old woman with abdominal pain
who was misdiagnosed with sigmoid volvulus, causing a delay in
the correct diagnosis of caecal volvulus. The reasons for this
misdiagnosis are explored, to bring attention to this common and
potentially fatal error, and to the features and management of
caecal volvulus. (General surgery; May 25th 2006) More...
Severe penetrating neck injury, successfully repaired epiglottis
by V. Savinsky and G. Roshchin
Penetrating traumatic laryngeal--pharyngeal injuries are
relatively rare and traumatic injuries to the epiglottis are
extremely rare. The incidence varies between countries. Most of
these cases are dealt with by ear, nose and throat specialists,
and trauma surgeons deal with such trauma when concomitant
injury is present. In our institution laryngeal--pharyngeal
trauma occurs 3--5 times per year. The literature records one
case of penetrating injury to the epiglottis with complete
transection but without an attempt at surgical repair [1]. This
report describes a traumatic laceration with subtotal
trans-section of epiglottis which was successfully repaired. (Emergency medicine, Trauma; May 25th 2006) More...
An acute on chronic presentation of Vogt--Koyanagi--Harada (VKH)
disease
by Aryan Lawe, Gareth Lewis and Mark Westcott
VKH disease is an idiopathic chronic granulomatous inflammatory
disorder. It has ophthalmic, neurological and cutaneous
manifestations. The clinical picture is variable and dependent
on the stage of presentation. We report on a patient who
presented with a mixed picture of early and late onset symptoms
with clinical findings of acute on chronic inflammation. (Ophthalmology, Neurology; May 1st 2006) More...
A case of chronic non-erosive sero-negative polyarthritis
associated with pyoderma gangrenosum
by Katherine Irving and Ali S. M. Jawad
We report a patient presenting with a seronegative polyarthritis
who later developed pyoderma gangrenosum. The presumptive
diagnosis was seronegative rheumatoid arthritis and associated
pyoderma gangrenosum. However, the arthritis, although steroid
responsive, did not respond to treatment with the usual DMARD
therapies and appears to mirror the activity of the pyoderma
gangrenosum. The normal X-rays, the negative rheumatoid factor
and the normal colonoscopy are also consistent with a diagnosis
of primary pyoderma gangrenosum with associated arthritis. (Rheumatology, Dermatology; May 1st 2006) More...
A giant inguinoscrotal hernia: a case report and review of the
literature
by W. Al Sarakbi, A. Agrawal and N. Taffinder
The authors report a case of giant inguinoscrotal hernia.
Problems arise in management for both the patient and the
surgeons because of the rarity of reported cases as there is no
standard surgical procedure in place for their treatment. A
literature review leads to a discussion of the various methods
of surgical intervention described to overcome the dilemma of
surgical repair. (General Surgery; November 4th 2005) More...
A case report of Boerhaave's syndrome
by Sreekanth Reddivari, Carlo Nunes, Emyr Humphries and Christopher Fox
We report a case of Boerhaave's syndrome in a previously fit
57-year-old lady with an aetiological association with a
co-existing duodenal ulcer. We discuss the diagnostic
difficulties presented by this case, the importance of prompt
diagnosis and intervention, and the problems involved in the
management that are highlighted in this case. This is an
extremely rare but well recognised entity. A 1980 review by Kish
cited only 300 cases worldwide; a small percentage were
diagnosed post mortem (John BE, Zua MS. Boerhaave's
syndrome---an elusive diagnosis. Tenn Med 1997; 90: 56--8). (Gastroenterology; September 21st 2005) More...
Semantic processing in a coma patient
by Boris Kotchoubey, Jerome Daltrozzo, Norma Wioland, Veronique
Mutschler, Philippe Lutun, Niels Birbaumer and Albert Jaeger
Electrical brain responses to words semantically related versus
unrelated to their context were recorded in a coma patient on
days 6 (Glasgow Coma Scale, GCS = 6) and 22 (GCS = 9).
Significant differences between related and unrelated words
(which were completely matched in their physical features) were
consistently observed in both examinations. This is the first
evidence for semantic stimulus processing in coma. (Neurology, Medical psychology, Critical care; September 2005) More...
An unusual injury resulting in a jejuno-rectal stump fistula
by S. Banerjee, O. D. Faiz, P. A. Kane and A. J. M. Leather
We report a case where anal intercourse resulted in a jejuno-rectal stump fistula. This occurred
in a 70-year lady who had undergone formation of ileal conduit and end colostomy earlier in
the same year. (Colorectal surgery; July 2005) More...
Metastatic prostate cancer presenting with hoarseness
by Irina Rybalova, Claudia F. E. Kirsch, Jin K. Choe and Basil S. Kasimis
Metastatic involvement resulting in voice alteration may occur
from vocal cord infiltration or recurrent laryngeal nerve
involvement. We present a case of metastatic prostate
adenocarcinoma to the left infrahyoid neck compressing the
larynx resulting in hoarseness. A case report with one-year
follow-up is presented. The patient is a 65-year-old male with
hoarseness and a left infrahyoid prostate metastases measuring 8
by 10 cm, effacing the left pyrifom sinus and shifting the true
and false vocal cords to the right of midline, with cord
morphology and mobility maintained. Definitive radiation therapy
reduced the infrahyoid metastases with resolution of hoarseness.
Phonatory alteration from metastatic prostate carcinoma is rare.
We present a case of hoarseness resulting from displacement of
the larynx from infrahyoid metastases, which resolved after
reduction in size of the metastases with radiation therapy.
(Oncology, Ear, nose and throat; May 2005) More...
Hypothyroidism presenting as recurrence of previously surgically
decompressed carpal tunnel syndrome
by V. Reid, A. S. M. Jawad and J. D. Perry
We report the case history of a 45-year-old woman who presented
with symptoms of bilateral carpal tunnel syndrome 8 years after
a successful surgical decompression of both tunnels. (Endocrinology, General surgery; April 2005) More...
Paget's disease of bone in non-Caucasians in East London: a
report of eight cases and a review of the literature
by Katherine Irving and Ali S. M. Jawad
Paget's disease of bone is more prevalent in populations of
northern European origin and is thought to be rare in
non-Caucasians. The population of the east end of London is
multi-cultural with 45% from ethnic minorities. We report the
case histories of eight non-Caucasian patients with Paget's
disease of bone. (Rheumatology; April 2005) More...
Scalp metastasis from squamous cell carcinoma of lung
by Li-Cher Loh, Sree Raman, Suryani Mohd Yusoff, Wan Azura Wan Yaacob and Shalini Kumar
We report a case of a 53-year-old man with a solitary nodular growth on the scalp in the right temporal region, noted during his hospital admission for bilateral knee replacement. A chest X-ray revealed a large circumscribed opacity in the left lung field. Bronchoscopy revealed a tumour at the carina. Histology of biopsies from the bronchoscopy and the scalp lesion showed an identical moderately differentiated squamous cell carcinoma. The patient survived 2.5 months after the onset of symptoms. While skin metastasis is recognised but rare in primary lung cancer, metastasis to the scalp is particularly unusual. (Respiratory Medicine; April 2005) More...
Oedematous Bauhinitis: a rare endoscopic diagnosis in ileocaecal
disease
by C. J. Krones, J. Conze, J. Grommes, S. Truong, H. Griefingholt and V. Schumpelick
Isolated Bauhinitis is a rare cause of non-specific abdominal symptoms in adults.
Modern descriptions of the disease are lacking. We report two current cases with an overview of the
literature and a discussion of the aetiology, clinical signs, diagnostic findings, and treatment guidelines.
Colonoscopic and histological findings are used to diagnose the condition. Conservative treatment is the
mainstay of management, but recurrent symptoms often lead to the necessity for ileocaecal resection. (Gastroenterology; March 2005) More...
Chest wall implantation of lung cancer following chest tube
drainage of a pleural effusion
by Li-Cher Loh, Tarmizi Thayaparan, Suryani Mohd Yusoff, Rosna Yunus and Shalini Kumar
A 67-year-old man with a lung mass developed a large painful chest wall swelling adjacent
to a chest drainage tube site. The swelling occurred after a second chest drain was performed for a rapidly
relapsing pleural effusion, and the biopsy showed that it was an adenocarcinoma. We conclude that chest wall
tumour implantation was caused by the chest tube drainage of the malignant pleural effusion, and that this
accelerated the patient's deterioration. Our case illustrates the possibility of chest tube seeding of
tumour cells from pleura to chest wall. (Respiratory Medicine; March 2005) More...
An unusual
cause of difficult asthma: talc granulomatous disease
by A. R. L. Medford, M. N. Sheppard, A. G. Nicholson, D. M. Geddes
and G. D. Phillips
A 44-year-old
woman presented with poorly controlled asthma and nodular radiological
changes. A VATS lung biopsy confirmed talc granulomatous disease
possibly related to her previous work as a dental technician.
A detailed occupational history is mandatory. Talc granulomatous
disease is one important alternative diagnosis in poorly controlled
asthma. (Respiratory
medicine; occupational medicine; January 2005)
More...
Acute occlusion
of the aorta following bilateral aortoiliac procedures
by Muzzafer Chaudery and Frank Cross
Percutaneous transluminal
angioplasty is a very common procedure and it is considered quite
a safe and effective technique. We present a case of a patient
who developed acute occlusion of the aorta and iliac vessels following
bilateral aortoiliac angioplasty. There have been cases reported
of acute iliac and femoral occlusion following bilateral aortoiliac
angioplasty but so far there has not been a reported case of acute
occlusion of the aorta following aortic and bilateral iliac procedures.
(Vascular
Surgery; January 2005)
More...
Reactive
arthritis following tonsillitis by Urmi Bapat and Antony
Narula
Reactive arthritis following upper respiratory
tract infections is well known. The usual age group is
young adults and management of the arthritis with anti-inflammatory
medication is the mainstay
of treatment. We present a case of reactive arthritis following
tonsillitis, which was successfully
treated by tonsillectomy. (Otolaryngology;
rheumatology; general medicine; January 2005)
More...
Paget's
disease by Ali S. M. Jawad and J. David Perry
Sir James Paget's
seminal description of the clinical findings of the bone disease
that now bears his name in 1877 holds true today, but his reference
to the disease as osteitis deformans, implying an inflammation
of the bone, is not accurate, and it is now called osteodystrophia
deformans.. (Landmark
Case Report; Rheumatology; November 2004)
More...
Perforation
of the sigmoid colon as a result of Meckel's
diverticulitis in a child by N. Butz, C. J. Krones, G.
Bohm, K. Lindemann-Docter, G. Steinau and V. Schumpelicky
We report a case
of sigmoid perforation caused by Meckel's diverticulitis. The
aetiology, clinical findings and guidelines for therapy are described.
Complications of Meckel's diverticulum should be considered in
the differential diagnosis of young patients with recurrent non-specific
abdominal pain. If in doubt, operative exploration should be performed.
(Gastroenterology;
General Surgery; October 2004)
More...
The epic 1954 operation that led to one of surgery's major
advances: carotid endarterectomy by John E. Connolly
The first report of a successful operation
for carotid stenosis in 1954 owes credit to the neurologist Fischer
who noted that carotid disease is localized and thus could conceivably
be bypassed or locally excised. With this knowledge Professor
Pickering of St Mary's Hospital, London, wisely obtained a carotid
arteriogram on one of his patients and suggested to Rob and Eastcott
that they surgically correct the block. Their famous successful
operation in 1954 startled the medical world. However, only after
clinical trials conclusively showed the benefit of carotid endarterectomy
in preventing stroke, was it widely accepted. Modern advances
in the technique of the procedure are listed. (Landmark
Case Report; General Surgery; Vascular Disease; October 2004)
More...
`A Yankee dodge': the first British public demonstration of anaesthesia by S. M. Usher and S. Chieveley-Williams
Centre for Anaesthesia, Royal Free and
University College Medical School , University College London
, London , UK . (Anaesthesia; Landmark Case
Report; September 2004)
More...
Harvey Cushing and Cushing's syndrome by Ashley B. Grossman
Harvey Cushing's first description of
the eponymous disease attributed to him is reproduced here together
with a modern commentary.(Endocrinology;
Landmark Case Report; September 2004)
More...
Spontaneous biliary peritonitis: two unusual cases by MG Berry and James T. Allardice
Two patients with biliary peritonitis without demonstrable perforation are described. Despite
biliary peritonitis almost invariably following biliary tract perforation, none could be identified
with contemporary imaging. This condition is extremely rare, difficult to diagnose pre-operatively and has high mortality. (General Surgery; Hepatology; Gastroenterology; August 2004) More...
Thomas Addison and his disease by
A.B Grossman
Thomas Addison’s description of
the disease named after him first appears in a book entitled ‘On
the constitutional and local effects of disease of the supra-renal
capsules’ published by Samuel Highley of 32 Fleet Street
London in 1855. (Endocrinology; Landmark
Case Reports; May 2004) More...
Bilateral scapular fractures following
low voltage electrocution byB. S.
John, F. Poyner and V. Holloway
Musculoskeletal injuries following low
voltage electrocution are extremely rare. We present the case
of a 54-year-old gentleman who had an accident while working with
240-volt live wires. The absence of any associated trauma should
not rule out the presence of scapular fractures in such cases..(Orthopaedics,
Emergency medicine; May 2004)
More...
Renal colic: an unusual presentation
of non-Hodgkin's lymphoma of the urinary bladder by
P. Hadway, A. A. Riaz, K. L. Lotzof and J. S. Gelister
Secondary involvement of the urinary bladder
in non-Hodgkin's lymphoma is relatively common, but primary malignant
lymphomas of this organ remain exceedingly rare. We report a case
presenting atypically with renal colic and briefly review the
relevant literature.(Urology, oncology;
May 2004) More...
A breakthrough in the treatment
of empyema: what we have learnt 50 years on from Tillett and Sherry’s
original case report by N C Barnes,
S M Benjamin
The scientists William S. Tillett and
Sol Sherry were responsible for the introduction of intrapleural
fibrinolytics as therapeutic agents, thus supplementing antimicrobial
therapy in the treatment of empyema. (Respiratory
Medicine; Landmark Case Reports; April 2004)
More...
Cardiac transplantation: since
the first case report by S M Benjamin
and N C Barnes
Launching our new Landmark Case Reports
library section, we present Christiaan Barnard's original report
discussing the world's first successful heart transplant operation.
(Landmark Case Reports; March 2004)
More...
Squamous cell carcinoma complicating
chronic osteomyelitis by Matthew
L.Costa†, Christopher Ingham†, Ian Seddon‡ and V. Shiv Shanker†
The internal fixation of fractures is
associated with a risk of infection. Open fractures in particular
are susceptible to such infection. Treatment is difficult and
patients can develop a chronic osteomyelitis. We present the case
of a patient who developed chronic osteomyelitis with a persistent
discharging sinus following internal fixation of an open fracture
of tibia. (Orthopaedics and Oncology; March
2004) More...
Laparoscopic management of testicular
tumour in undescended intra-abdominal testis with torsion
by Deep Goel, Sanjay Aggarwal, A.Sadana,
C.S.Ramachandran and Vijay Arora
Testicular tumours occur more frequently
in an undescended testis than in anormally developed testis. Moreover,
they usually present as a palpable mass but occasionally they
can present with pain as a result of torsion. We present the case
of a 30-year-old male who was found to have a testicular tumour
which had developed in an intra-abdominal testis and presented
with pain as the main symptom. Based on clinical and radiological
data, orchidectomy was then carried out laparoscopically. (General
Surgery; March 2004)
More...
Haematoma of the psoas muscle
after posterior spinal instrumentation and Enoxaparin prophylaxis
by A.M.Sarwat and J.C.Sutcliffe
This case report describes the rare complication
of psoas muscle haematoma following posterior lumbar spine fixation
and routine anti-thrombotic prophylaxis.
(Neurosurgery; March 2004) More...
Concurrent infection with pulmonary
nocardiosis and Salmonella bovis bacteraemia in a previously healthy
female by
R. K. P. De Palma, D. P. J. Macleod, T. S. Seemungal and L. M.
E. Kuitert
We report the case of a woman from sub-Saharan
Africa who presented with pyrexia, pulmonary lesions and a urinary
tract infection (UTI). She was found to have multiple infections,
i.e. Salmonella bovis bacteraemia, Escherichia coli UTI, and pulmonary
nocardiosis. In the presence of lymphopaenia, a Human Immunodeficiency
Virus (HIV) antibody test was performed and was positive. (Infection
and Immunity, Respiratory Medicine; February 2004) More...
Infrarenal abdominal aortic aneurysms
associated with proximal dissection by
A. C. Qureshi, H. S. Flora, M. Matson and R. J. Ham
A case is described presenting with aortic
dissection who was found to have a significant infrarenal aortic
aneurysm. Various treatment options were considered for both
conditions including open operation, conservative management and stent repair.
(Vascular disease; February 2004)
More...
Penetrating gunshot injury to the chest with unusual intraluminal passage of the bullet by
C.J.Desai and R.R.Hutchins
The authors present an unusual case
of penetrating chest trauma.This serves to remind
clinicians that all possibilities should be considered when managing
trauma victims(Trauma;
January 2004) More...
Foster Kennedy syndrome secondary to oligodendroglioma by
S.M.Joshi, R.J.D.Hewitt and F.Afshar
Foster Kennedy syndrome (FKS) is
rare.It is characterised by the presence of ipsilateral
optic atrophy,contralateral papilloedema and ipsilateral
anosmia.Since its first description in 1911, it has never
been reported in oligodendroglioma.
(Neurosurgery, Oncology; January 2004)
More...
Secondary vesical calculus following translocated IUCD in urinary bladder by
E S. Garba and A. O. Oguntayo
An uncommon case of bladder calculus
arising from a translocated intrauterine contraceptive devise
(IUCD)(Gynaecology;
September 2003) More...
A magnetic fixation and orientation system for orthognathic surgery planning models by H. Popat and P. J. Sandler
A useful method of handling orthognathic
treatment models is described that utilises magnetic attachment
of study models to
an articulator, allowing rapid and reliable manipulation between
pre- and post-operative positions of the maxilla and/or
mandible.(Maxillofacial
surgery; September 2003) More...
Giant
Hemangioma or Metastatic Disease of Malignant Gastrointestinal
Tumour? Diagnoses Through 'New-Line' Therapy (Oncology,
Radiology; June 2002)
Adult
Intussusception Caused By Peutz-Jeghers Hamartoma - An Unusual
Presentation (General
Surgery; July 2002)
Complete
Femoral Nerve Block Following Blind Ilioinguinal Local Anaesthetic
Blockade For Inguinal Hernia Repair (General
Surgery, Anaesthesia; July 2002)
Central
Venous Cannulation as a Cause of Upper Airway Obstruction (Anaesthesia,
Critical Care; July 2002)
Nonocclusive
Mesenteric Infraction: A Rare Complication of Continuous
Ambulatory Peritoneal Dialysis (Nephrology;
October 2002)
Paraneoplastic
Syndrome Presenting as Progressive Cognitive Decline (Neurology,
Oncology; August 2002)
Painful
Leg and Loss of Vision in a Diabetic (Vascular
disease; July 2002)
‘Expressed’ Dysphasia (Neurology;
July 2002)
Atypical Metastases
From Squamous Cell Cancers
(Oncology; July 2002)
An Unusual
Primary Pulmonary Carcinoma (Respiratory
medicine, Oncology; July 2002)
Hernia Ovary
Inguinale With Ovulating Luteal Cyst: A Case Report (General
surgery; May 2002)
Closed Total
Talar Dislocation - A Case Report (Orthopaedics;
May 2002)
A case of
Mycobacterium avium-intracellulare pulmonary disease and
Crohn's disease
(Gastroenterology, Infection and Immunity, Respiratory Medicine;
May 2002)
Osteoid
Osteoma of Left Pars Inter-Articularis of Fourth Lumbar Vertebra
(Orthopaedics; May
2002)
Blunt abdominal
trauma with unexpected anaphylactic shock due to rupture of hepatic
cysts (Emergency
medicine; April 2002)
Primary Leomyosarcoma
of the Femur and Bony Metastases from the Breast in the Same Patient
(Orthopaedics; March
2002)
Fractured
Penis: Another Complication of Sildenafil (Urology;
January 2002) More...
Critical Ischaemia
Following Endovascular Instrumentation: Resolution With General
Anaesthetic (Vascular
disease; April 2002)
Invasive Pulmonary
Mucormycosis With Vascular Involvement (Infection
and immunity; January 2002)
A Painful
Swollen Shoulder (Vascular
disease; January 2002)
Differential
Diagnosis of Optic Nerve Swelling (Ophthalmology;
May 2001)
Hydatid
Disease Presenting As Pancreatitis (General
surgery; April 2001)
Common Variable
Immunodeficiency Causing Granulomatous Disease of the Abdominal
Aorta With Aneurysm Formation (Vascular
disease; February 2001)
Case History
of Infected Eczema Treated With Essential Oils (Alternative
therapies; May 2001)
Primary Varicella
Infection Presenting in Old Age (Virology;
February 2001)
Intra-Abdominally
Retained Knife Following Lower Thoracic Stab Wound: A Potential
Hazard (Trauma;
February 2001)
