Implications of refeeding syndrome in postoperative total parenteral nutrition
by Angelos Assiotisa and Haussam Elenin
Refeeding syndrome is a serious complication of enteral or parenteral feeding of malnourished patients. The learning point from this case report is to raise awareness that total parenteral nutrition is not a simple undertaking. Diagnosing refeeding syndrome requires a high index of suspicion and close collaboration with hospital pharmacists and nutritionists. (General Surgery: 22 July 2010) More...
A rare case of bone metastases from adenocarcinoma of the parotid gland
by J. Conibear, C. Jayadev, A. Sharma, P. Achan and S. Amen
A woman with known adenocarcinoma of the right parotid gland presented with bony metastasis in her left proximal femur. This was histologically confirmed and the patient underwent prophylactic intramedullary nail and hip screw fixation of her left proximal femur. This represents the first report of adenocarcinoma of parotid origin metastasising to a long bone in an adult. (Specialities Oncology, Orthopaedic surgery: 22 July 2010) More...
Bunina bodies
by S.T.Y. Ugradar and J.E. Martin
In 1961, Van Reeth and colleagues described the presence of intracellular inclusion bodies in the anterior horn cells of a patient with Pick dementia and atypical amyotrophic lateral sclerosis (ALS). A year later, Tat’yana Bunina, a neuropathologist from the USSR, described inclusion bodies with almost identical morphology, in the spinal cords and brain stems of two cases of familial ALS. She initially believed that they were a virus. However, electron microscopy and subsequent work involving intracerebral inoculation with material from various forms of ALS failed to demonstrate any signs of transmissibility. It is intriguing to speculate that Bunina’s original description of Bunina bodies may have been the original first clue on a path to unravelling the pathogenetic process in ALS. (Landmark Case Report: 22 July 2010) More...
Persistent subclavian artery stenosis following surgical repair of non-union of a fractured clavicle
by K.M. Burnand, S. Lagocki, R.P. Lahiri, T.Y. Tang, A.D. Patel and J.M.F. Clarke
Arterial thoracic outlet syndrome (TOS) is a rare vascular abnormality. Its common cause is a cervical rib but it is seldom detected secondary to trauma of the clavicle, particularly in association with surgical repair of a fractured clavicle. An athletic 45-year-old man developed a recurrent ischaemic upper limb after repair to a non-union fractured clavicle. He underwent multiple separate procedures including embolectomy, angioplasty, thrombolysis and subclavian stent insertion. Definitive diagnosis was made using 3D reconstructed computer tomography. He had a subclavian artery stenosis with arm abduction as a result of loss of curvature of the clavicle after orthopaedic reconstructive surgery. The best surgical approach for this problem remains controversial. (Vascular surgery: 22 July 2010) More...
Horseshoe kidney and primary renal carcinoid tumour: a case report of a rare entity
by Jonathon Peter de Hoog, Spencer Murray and Wayne Chou
Carcinoid tumours are unique neuroendocrine neoplasms, displaying low-grade malignant potential and arising frequently within the gastrointestinal tract and respiratory tree. Primary carcinoid arising within the renal system is uncommon, whilst carcinoid tumour arising within a horseshoe kidney is rare. We describe a case of primary renal carcinoid occurring within a horseshoe kidney. (Histopathology; Urology: 22 July 2010) More...
Persistent haemarthrosis following total knee arthroplasty caused by unrecognised arterial injury
by Paul Whittingham-Jones, Irshad Baloch, Jonathan Miles and Barry Ferris
Arterial injury is a rare complication of knee replacement. We present a delayed presentation which was proven with arteriography and successfully treated with embolisation rather than open surgery. In atypical clinical pictures of swelling and equivocal inflammatory markers, clinicians should consider the differential diagnosis of persistent arterial bleeding. (Orthopaedic surgery; Vascular surgery: 22 July 2010) More...
Myasthenia gravis improvement in a patient receiving sunitinib for metastatic renal cell carcinoma
by Jean S.Z. Lee, Rateb Samman, Oliver C. Cockerell, Kate Fife and Tim Eisen
We present a case of a 59-year-old gentleman with myasthenia gravis and metastatic renal cell carcinoma that resolved on sunitinib. The clear temporal relationship between the patient receiving sunitinib for renal cell carcinoma and the resolution of his myasthenia gravis suggests that the improvement was due either to a paraneoplastic condition responding to treatment of the underlying malignancy or to a direct effect of sunitinib. (Neurology; Oncology; Urology: 22 July 2010) More...
Spontaneous liver haematoma as a result of thrombolytic therapy
by Jeremy Lynch and Simon Etkind
Spontaneous liver haemorrhage due to thrombolysis is an extremely rare and life-threatening condition. This is the only report of spontaneous liver haemorrhage following thrombolysis in the literature that has been managed non-operatively, and proves such an approach is possible. The clinical findings and management of this case are discussed in relation to the relevant literature. (Cardiology; General surgery; Hepatology: 22 July 2010) More...
Amiodarone-induced torsades de pointes in a patient with HIV on combination antiretroviral therapy
by Fahad Alsindi, Cliona Murphy and David Martin
A case of prolongation of the QT interval and associated life-threatening ventricular arrhythmia is presented. The particular features of this case include HIV positivity, acute coronary ischemia, and treatment with drugs known to increase QT interval. The relationship between these potential causes is analyzed and discussed. This is the first report of such a complication of combined therapy with amiodarone and antiretroviral medication. (Cardiothoracic surgery: 27 June 2010) More...
Free flap reconstruction following lower leg trauma in the presence of rhabdomyolysis
by R.P. Lahiri, A. Roshan, K.M. Burnand and A.J. Durrani
Rhabdomyolysis is considered a relative contra-indication to free tissue transfer because of the formation of free radicals that cause endothelial damage to the microcirculation. We describe the case of a young man who required free tissue transfer coverage of a large open fracture of his right tibia and fibula. This was performed successfully in the presence of rhabdomyolysis. (Orthopaedic surgery; Plastic surgery: 27 June 2010) More...
Wegener’s granulomatosis and multiple cranial neuropathies
by Saahil Mehta, Sebastian Lucas, Frank Cross and David P. D’Cruz
Wegener’s granulomatosis, first described by Friedrich Wegener in 1936, is a systemic vasculitis that characteristically causes necrotizing granulomas of the respiratory tract and necrotizing cresentic glomerulonephritis. This article describes the history and modern treatment of the disease in conjunction with a clinical case. (Landmark Case Report: 10 May 2010) More...
Acquired factor VIII inhibitor and lupus anticoagulant presenting with prolonged aPTT: a case report
by Jeremiah D. Dreisbach, Luke P. Dreisbach, David E. Young and Philip B. Dreisbach
Acquired factor VIII inhibitor is a rare occurrence and may cause severe bleeding by interfering with the coagulation cascade. We report an interesting case of a 59-year-old white man with an acquired factor VIII inhibitor and lupus anticoagulant. Clinical findings included large hemorrhagic areas of the extremities, a prolonged activated partial thrombin time (aPTT) that did not correct with mixing studies and an elevated Bethesda assay. Treatment consisted of high-dose steroids with a tapering dosage. An acquired factor inhibitor should be considered in patients presenting with a prolonged aPTT that does not correct with mixing studies. (Specialties Haematology; Oncology: 6 Apr 2010) More...
A deceptive magnetic resonance cholangiopancreatogram?
by Andrew N. Jordan, Shilpa Kodati and Sebastian Zeki
A case describing a curious MRCP appearance is presented, which, placed in the clinical context, suggested an unusual tropical cause for the patient’s presentation and generated great debate between physicians, surgeons and radiologists. (Specialties Gastroenterology; Radiology: 6 Apr 2010) More...
Radiation-induced periosteal osteosarcoma
by J. Dhaliwala, V.P. Sumathib and R.J. Grimer
Radiation-induced sarcomas are a well-recognized late complication of radiation therapy. We present a rare case of a periosteal osteosarcoma of the femur developing 10 years after radiation treatment for a soft tissue sarcoma to highlight the clinical and radiological features of this rare complication of therapy and to describe its management. (Specialties Othopaedics; Radiology: 16 Feb 2010) More...
Late recurrence of pelvic osteosarcoma: a case report and review of the literature
by B.G.I. Spiegelberg, K. Gokaraju, M.T. Parratt, A.M. Flanagan, S.R. Cannon and T.W.R. Briggs
A rare case of local recurrence of a high-grade osteosarcoma of the pelvis is described, 19 years after initial presentation, highlighting the need for continued long-term follow-up of patients with osteosarcoma. We review the literature concerning osteosarcoma of the pelvis, local recurrence and treatment with custom-made hemipelvic replacements. (Specialties Oncology; Orthopaedics: 16 Feb 2010) More...
Thrombotic thrombocytopenic purpura (TTP) associated with interferon therapy of hepatitis C
by Iryna S. Hepburn and Robert Schade
Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) is a rare but known complication of chronic viral hepatitis C (HCV). Even less frequently treatment of HCV with interferon-alpha (INFα) may become complicated with TTP/HUS, although only a few such reports have been published. We report a 43-year-old woman who developed TTP on two separate occasions soon after beginning treatment with IFN-alpha and ribavarin for HCV. (Specialties Gastroenterology; Hepatology: 16 Feb 2010) More...
A case of Epstein–Barr virus (EBV) meningoencephalitis in a patient with rheumatoid arthritis
by Dennis Nyuk Fung Lim
A case of Epstein–Barr virus (EBV) meningoencephalitis in a 74-year-old white man with rheumatoid arthritis is reported. The potential predisposing factors for EBV meningoencephalitis, the diagnostic approach and the management highlighted by this case are discussed. (Specialties Infection and immunity; Neurology; Rheumatology: 31 Dec 2009) More...
Supra-auricular cutaneo-cutaneous fistula
by J. Dhaliwal, M. Daniel, J. Shah, G. O’Donoghue and G. Warner
A case of cutaneo-cutaneous fistula superior to the external auditory canal extending from the mastoid skin to the skin over the zygoma is reported. The adult patient presented with recurrent discharge and swelling of the skin over the zygoma and mastoid bones. Definitive treatment was in the form of complete excision of the fistula tract. (Specialties ENT/head and neck surgery; Microbiology: 24 Dec 2009) More...
Lung sequestration and foregut cyst misleading staging investigations for colonic cancer
by N. Tregay, R. Krishnadas, E. Toy and P. Froeschle
We report the diagnostic challenges raised by the uncommon synchronous finding of a lung sequestration and foregut cyst in a 76-year-old male scheduled for radical treatment of his colonic cancer. Following a computed tomography (CT) scan of the chest and a combined positron emission tomography (PET)-CT scan these lesions initially suggested a primary lung cancer with single-station mediastinal nodal disease. At the end of an inconclusive non-invasive diagnostic pathway, histopathologic diagnosis was obtained by video-assisted thoracoscopy, converted into a limited thoracotomy. Even though advanced imaging techniques are providing an overall improvement in diagnostic accuracy, invasive biopsy continues to represent an additional option in complex cases. (Specialties Radiology, Thoracic surgery: 7 Dec 2009) More...
Growing adrenal mass misdiagnosed as the cause of hirsutism in a patient with an ovarian Leydig cell tumor
by Maria H. P. Dietvorst, Suzanne Poots and Peter van Wijngaarden
A case is described involving a 71-year-old hirsute woman with a growing adrenal tumor and a high serum testosterone level, which did not normalize after adrenalectomy. Following this she was found to have a testosterone-producing ovarian Leydig cell tumor. This case provides key features that can help distinguish adrenal and ovarian causes of hirsutism. (Specialties Oncology: 17 Nov 2009) More...
Post-partum palpitations
by R.K. Riezebos
Supraventricular tachycardias are the most commonly encountered arrhythmias during and shortly after pregnancy. This case report describes several ECG-based diagnostic considerations and briefly reviews the current standards of care. (Specialties Cardiology: 17 Nov 2009) More...
Management of expanding lateral abdominal wall haematoma following blunt trauma
by Dimitri Aristotle Raptis, Dimitrios Lytras, Amir Darakhshan, James Skipworth, Julian Hague and Duncan Brennand
Lateral abdominal wall haematoma following blunt trauma can be a life-threatening condition and requires prompt diagnosis and treatment. We present the imaging findings and treatment modalities used for a young man presenting to the emergency department with abdominal pain and bruising. (Specialties Accident and Emergency Medicine and Surgery (including Trauma), Radiology, Vascular Surgery: 17 Nov 2009) More...
Spontaneous resolution of an intramuscular supraspinatous cyst: a case report and literature review
by Jagwinder Dhaliwal and Butt Sohail
Intramuscular supraspinatous cysts are rare and usually related to partial supraspinatous tendon tears. Conventional magnetic resonance imaging (MRI) and MRI arthrography are the most commonly used modalities for imaging such rotator cuff pathology. Treatment and follow-up of such cysts is not well documented in the literature. We report the successful conservative management and follow-up of a patient with a supraspinatous cyst. A patient presented with a 2-month history of right shoulder pain following painting and decorating. An MRI scan showed a supraspinatous cyst and thinning of the supraspinatous tendon. The patient was treated conservatively and at 6 months follow-up was found to be asymptomatic. A repeat MRI scan confirmed complete resolution of the supraspinatous cyst. (Specialties Orthopaedic surgery, Radiology: 17 Nov 2009) More...
Spontaneous spinal haematoma: a case report and literature review
by Jagwinder Dhaliwal, Mushtaq Ahmed and Sam Horriat
Spontaneous spinal epidural haematoma is a rare condition that may lead to spinal cord or cauda equina compression resulting in severe neurologic impairment. Predisposing factors include anticoagulation, vascular malformation, disc herniation. Both surgical and more recently conservative modes of treatment have been described in the literature. This is the first reported case of a successful conservative management and follow-up of a spontaneous spinal epidural haematoma in a 90-year-old patient. The patient presented with acute onset of back pain and weakness of the legs. The patient was treated conservatively and made a complete recovery. Haematoma resolution was confirmed with a repeat magnetic resonance imaging scan. (Specialties Neurosurgery, Orthopaedic surgery: 17 Nov 2009) More...
Corning and cocaine: the advent of spinal anaesthesia
by Alex Looseley
The inception of spinal anaesthesia can be traced to James Leonard Corning, a New York neurologist who inadvertently administered cocaine spinal anaesthesia in 1885. In 1898 August Karl Gustav Bier, a German surgeon, pioneered the successful use of operative spinal anaesthesia in lower limb surgery. Early spinal anaesthesia was fraught with complications but through advances in aseptic technique, anaesthetic agents and equipment, the seminal work of Corning and Bier has evolved into a widely established anaesthetic modality. (Landmark Case Report; 15th September 2009) More...
Intestinal strangulation and sub-acute bowel obstruction in direct inguinal hernia
by P. Vasas, J. Gosling, F.P. Prete and J.A. McCullough
Strangulation, secondary to reduced blood flow, is a well-known complication of herniae. Signs of bowel activity do not rule out the possibility of vascular compromise. Raised inflammatory markers and a positive computed tomography scan can lead to a preoperative diagnosis, but the mortality rate remains high. (Specialties General surgery: 13 Jul 2009) More...
Interpretation of C-reactive protein values in systemic lupus erythematosus
by Elena Nikiphorou and Debasish Pyne
A significant rise in C-reactive protein (CRP) levels in patients with systemic lupus erythematosus (SLE) often reflects a co-existent infection or associated serositis. A number of investigators have proposed that the level of CRP can differentiate between infected and non-infected SLE patients. However, there have been conflicting views as to the usefulness of CRP measurement in SLE. Hind et al.[1] showed modest elevations in serum CRP with an acute flare, but substantially higher levels of CRP with intercurrent infection. Becker et al.[2] investigating a series of 41 patients showed that, even in the presence of florid disease activity, in the absence of infection the CRP value did not exceed 60 mg/l. ... (Specialties Rheumatology: 1 Jul 2009) More...
Late metastases to the pancreas from resected renal cell carcinoma masquerading as multiple endocrine neoplasia
by Danijela Tatovic, David Farrugia, Frank Jewell and Thomas Ulahannan
We report the case of 58-year-old gentleman with pancreatic masses, possibly of neuroendocrine origin, with the history of renal carcinoma, primary hyperparathyroidism and pituitary cyst. Histological analysis after pancreatectomy revealed metastases from renal cancer. This unusual case illustrates the challenging differential diagnosis between multiple endocrine neoplasia (MEN) syndrome and metastatic renal cell cancer. (Specialties Endocrinology, Oncology: 28 May 2009) More...
Large bowel obstruction secondary to gallstone impaction at a sigmoid diverticular stricture: the radiological features
by Saravanan Munusamy, Kumar Subramanian and Chris Loughran
Intestinal obstruction secondary to displacement of a stone from the gall bladder into the intestinal tract is relatively uncommon. The commonest site of calculus impaction is at the ilio-caecal valve. Occasionally, however, the gall stone may either pass through the valve into the colon or perforate directly into the transverse colon and impact in the distal colon. The extruded calculus is often only faintly calcified and may be difficult to identify on plain radiographs. We describe a case where multislice computed tomography of the abdomen enabled an accurate diagnosis to be made. Prompt surgical treatment was subsequently undertaken. We report the imaging findings with particular emphasis on the importance of computed tomography in establishing the diagnosis. (Specialties Radiology: 29 April 2009) More...
Atraumatic splenic rupture secondary to infectious mononucleosis: a case report and literature review
by Alex Looseley, Alex Hotouras, Quentin M. Nunes and Antony P. Barlow
Although splenomegaly is found in approximately two thirds of patients with infectious mononucleosis (IM), splenic rupture is uncommon. However, it constitutes the single largest cause of mortality in this group. True atraumatic splenic rupture is very rare and is seen in only 0.5% of all cases of IM. We present a case of a 22-year-old man with atraumatic splenic rupture associated with infectious mononucleosis and highlight key considerations in diagnosing and managing this potentially fatal complication. (Specialties Critical Care, General Surgery: 16 March 2009) More...
First use in the UK of the Gore® bioabsorbable inguinal hernia plug
by D.A. Raptis and S.G.E. Barker
‘Plug and patch’ hernia repair techniques have been developed to minimise tissue dissection and suturing, minimise post-operative pain, to return the patient to ‘normal’ levels of activity promptly, as well as to help decrease recurrence rates. As an extension to this concept of repair, a new collagen-based bioabsorbable plug has been developed in an attempt to eliminate those remaining few complications still deemed to be associated with non-absorbable material systems. Recent animal studies appear promising. However, there are as yet few case reports and certainly no randomised controlled trials to support either short-term, or long-term clinical efficacy. Three patients were the first to receive the new Gore bioabsorbable hernia plug (GBHP) in the UK. The operating technique was that for a standard, open, tension-free ‘plug and patch’ hernia repair. Patient A was a 27-year-old male with a direct inguinal hernia. Patient B was a 67-year-old male with an indirect inguinal hernia. Patient C was a 73-year-old male with bilateral, direct inguinal herniae. The new GBHP is composed entirely of the co-polymer polyglycolic acid: trimethylene carbonate and studies have shown that it is bioabsorbed entirely in approximately 6 months. This allows the once hernia ‘defect’ to become filled with collagenous scar tissue, that helps maintain the architecture of the posterior abdominal wall. The insertion of the new (and currently single-sized) GBHP was straightforward for the direct hernias. It was more difficult to insert in to the indirect hernia defect, which necessitated that the product be cut down to a more appropriate size. (Specialties General Surgery: 16 March 2009) More...
Prinzmetal’s angina refractory to medical treatment
by Rudolf Martin Duehmke, Sadia Khan, Jeremy Woodward and Leonard Shapiro
We describe a case of Prinzmetal’s angina that is refractory to medical therapy but responded fully after percutaneous coronary intervention. This case shows that there is a role for percutaneous coronary intervention in refractory variant angina as long as a culprit lesion within the vasospastic segment can be identified. (Specialties Cardiology: 3rd December 2008) More...
Vascular sequelae of aortic arch thrombo-emboli
by X. Cai, Z. Khalpey, J.D. Gates and E.C. Gravereaux
An 88-year-old woman presented with thrombo-embolic disease of the left upper extremity manifested by the classical signs of pain, paresthesias, pallor, pulselessness, and poikilothermia. She was found to have a thrombo-embolus in the left distal brachial artery as well as two large thrombi in the aortic arch and proximal descending aorta. Initial surgical intervention included a left upper extremity embolectomy with subsequent restoration of blood flow to the left arm. Due to the patient’s advanced age, comorbidities, and availability of medical therapy, it was decided to treat her aortic thrombi through anti-coagulation with coumadin. (Specialties Vascular medicine; Vascular surgery: 3rd December 2008) More...
Abnormal liver function following total parenteral nutrition in a patient with short bowel syndrome
by Neel Sharma and Raza Malik
Total parenteral nutrition (TPN) is an essential means of maintaining nutrition in those who are unable to do so via an enteral route. However, long term TPN can pose potentially serious complications, in particular liver related damage. This article describes a case of abnormal liver function following total parenteral nutrition and discusses the methods of potentially reducing such complications. (Specialties Gastroenterology: 26th November 2008) More...
Unilateral chronic rhinosinusitis
by Z. Ahmad, C. Repanos and N. Swanborough
Foreign bodies within the para-nasal sinuses are a reported cause of chronic unilateral rhinosinusitis. The most commonly cited cause is of dental origin. One previously reported case cited a foreign body from the repair of an orbital blow-out fracture. Suspicion of a sinugenic foreign body cause may only be aroused by a thorough history and examination, usually confirmed by imaging. We report a case of 57-year-old man was referred to ENT with persistent right nasal blockage and catarrh for over a decade. It transpired that he had previously had surgery using a silastic graft for a blow-out fracture. This is only the second reported case in the world literature of recurrent sinusitis from a graft placed to repair an orbital blow-out. A history of significant facial injuries should be considered and then actively investigated in unilateral chronic rhinosinusitis. The advent of ultra-low dose sinus computed tomography scans may encourage a more inquisitive surgeon to further investigate rhinosinusitis with imaging. (Specialties ENT; Head and neck surgery: 18th November 2008) More...
Accessory cystic duct identification in laparoscopic cholecystectomy
by U. Parampalli, S. Helme, G. Asal and P. Sinha
We report the case of a 53-year-old lady who underwent laparoscopic cholecystectomy and was found to have an accessory cystic duct close to the fundus. Careful dissection of the liver bed was done and the duct clipped preventing a bile leak. The presence of such ducts though rare should be identified during surgery to prevent potential complications. (Specialties Hepatobiliary Surgery; Colorectal Surgery: 10th November 2008) More...
Colonic cancer invading appendicectomy incision: a case report and literature review
by I. Uchendu, A. Hotouras, S. Jonalagadda, K. Osman, A. Mandal and D. Mathur
We report the case of a 62-year-old man who presented with puckering and tethering of his appendicectomy scar; he was found to have an underlying caecal carcinoma. We review the literature regarding this uncommon presentation of caecal cancer. (Specialties General Surgery; Colorectal Surgery: 1st October 2008) More...
Metastases in cutaneous and subcutaneous scars: an intriguing phenomenon that may herald the presence of a colon cancer
by Doru Alexandrescu
The occurrence of cutaneous metastases from colon cancer to cutaneous scars is being increasingly recognized and reported in the literature. Although the most common scenario involves scars resulting from prior resection of the cancer, rare instances represent distant involvement of scars from unrelated procedures. As well as being of interest as an intriguing biological phenomenon, recognition of cutaneous metastases can be of clinical relevance by pointing towards the existence of an occult internal malignancy. (Specialties: 1st October 2008) More...
Compartment syndrome: a unique presentation
by Zain Khalpey, Christopher Gross, Tec Chong and Jonathan Gates
Compartment syndrome is a potentially limb- and life-threatening clinical entity resulting from elevated intra-compartmental pressures. A high clinical suspicion is paramount in diagnosis since full recovery is time-sensitive. We present a unique case of chronic myelomonocytic leukemiainduced (CMML) compartment syndrome which illustrates the importance of quick diagnosis and treatment. (Specialties Accident and Emergency Medicine and Surgery (including Trauma); Orthopaedic Surgery; Vascular Surgery: 1st October 2008) More...
Bilateral septic arthritis of the knee secondary to group G streptococcal endocarditis
by Shah Jehan, Rupali Rajpurohit and Ellile Pushpanathan
We report on an 81-year-old male with bilateral septic arthritis of the knee joints, who was treated with multiple joint washouts and intravenous antibiotics. As far as we know, there has been no case report in the English literature, on bilateral septic arthritis of the knee secondary to group G b-haemolytic streptococcal endocarditis. (Specialties Cardiology; Microbiology: 29th September 2008) More...
A case of non-menstrual toxic shock syndrome
by Hamida Begum, Daniel Glassman, Anita Sharma, Satya Das and Tahseen A. Chowdhury
A 20-year-old woman was admitted with a short history of high fever, rash, gastrointestinal
symptoms, vaginal discharge and hypotension. Whilst toxic shock syndrome was considered, no gynaecological source of infection was found. Subsequent isolation of Staphylococcus aureus from a cutaneous blister led to confirmation of the diagnosis. (Specialties Infection and Immunity: 29th September 2008) More...
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)
