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Volume 10

We report a case of East African trypanosomiasis in a 26-year-old traveler returning from Tanzania, including a series of pictures of the progression of the inoculation chancre. Trypanosoma brucei rhodesiense-specific DNA was detected in the blood until 8 days after treatment. We hypothesize that the previously observed suramin toxicity may be an immunological response to...
(p 12-16, Infection and Immunity: 26 March 2011)
Cases of cystic hygroma are rare and this report highlights the need for further research into treatment options. A 24-year-old Lithuanian woman was referred for further investigation of a painless but restricting right-sided neck swelling. This case report discusses the differential diagnosis and up-to-date management of cystic hygroma in the adult.
(p 5-11, General Surgery: 26 March 2011)
We present a case of severe symptomatic hypercalcaemia secondary to hyperthyroidism alone. Hypercalcaemia was managed with pamidronate which unfortunately resulted in transient hypocalcaemia. The key message is that thyroid function should be checked in all patients who present with hypercalcaemia and that endocrine input is needed sooner rather than later for appropriate...
(p 110-112, Endocrinology: 22 December 2010)
Dirofilariasis is a parasitic infection caused by a nematode, which typically infects dogs. Incidental human infection remains rare but is increasing. Dirofilariasis typically presents as a subcutaneous lesion or pulmonary nodules. Here we present the case of a 32-year-old British man who presented with mealtime symptoms from obstruction of Stensen’s duct. On histology...
(p 107-109, Maxillofacial Surgery: 22 December 2010)
Spontaneous renal haemorrhage secondary to renal angiomyolipoma, or Wunderlich syndrome, is rare. Renal angiomyolipomata are composed of abnormal vasculature, smooth muscle and adipose tissue. They are more likely to be symptomatic if they are larger than 4 cm, presenting with a history of flank pain, a palpable mass and rarely gross haematuria. Our case illustrates a...
(p 117-119, General Surgery; Histopathology; Urology: 20 December 2010)
Breast hamartoma is an uncommon pathological entity. It is exceedingly rare to find ductal carcinoma in situ or invasive carcinoma within a breast hamartoma. We report one such case treated at our unit.
(p 113-116, Breast Surgery; Oncology: 20 December 2010)
Neuromyelitis optica (NMO) and systemic inflammatory diseases are not mutually exclusive. Even when other autoantibodies are present, myelitis extending over 3 vertebral segments with NMO-IgG positivity discloses the diagnosis of NMO. We report the case of an isolated myelitis extending over 6 vertebral segments due to neuromyelitis optica (NMO). Despite the absence of...
(p 103-106, Neurology; Rheumatology: 1 December 2010)
Relapse of Wegener granulomatosis (WG) can be associated with occult inflammation and nasal carriage of Staphylococcus aureus. We report a 79-year-old woman who had a recurrent sclerosing orbital pseudotumor, due to limited WG complicated by Streptococcus anginosis abscess. No sinusitis, other localized infection, or systemic disease was identified by physical examination...
(p 95-102, Rheumatology: 1 December 2010)
Neurocristic hamartoma results from the aberrant development of cells derived from the neural crest. It is a type of dermal melanocytosis. These tumours may contain neuro-sustentacular and fibrogenic components in addition to a dermal melanocytic component. The elements within these tumours reflect the spectrum of differentiation that results from migration of neural...
(p 91-94, Oncology: 10 November 2010)
We describe central nervous system blast crisis on a background of chronic myeloid leukaemia in remission in a 70-year-old man. After successful elimination of blasts in the cerebrospinal fluid, this patient received craniospinal irradiation (CSI). He remains well 30 months after CSI and has no significant long-term toxicity. CSI is usually reserved for patients under the...
(p 89-90, Oncology: 25 October 2010)
Static winging of the scapula is a rare diagnosis. It may be caused by pathology of the scapula or the chest wall. Solitary osteochondroma of the scapula is one of the rare causes and may present an initial diagnostic difficulty. We present a case of an 18-year-old man who presented with non-specific pain in his right shoulder following a fall. Initial examinations and...
(p 86-88, Emergency Medicine; Trauma; Orthopaedics: 22 October 2010)
A 73-year-old lady became bed bound with progressive generalized weakness 2 weeks after the introduction of sodium fusidate for osteomyelitis. She was already on simvastatin for years. Electromyography showed no spontaneous muscle activity from any of the muscles sampled. The temporal relationship of symptom onset after introduction of fusidic acid and full recovery after...
(p 82-85, Neurology: 22 October 2010)
Infliximab is one of the most widely used tumour necrosis factor-alpha (TNF-α) inhibitors for control of Crohn disease. We report the case of a patient with ileocolonic Crohn disease developing major arterial thrombosis after treatment with infliximab. After conservative management and infliximab withdrawal, thrombus dissolution and vessel recannalisation were observed....
(p 78-81, Gastroenterology: 22 October 2010)
Femoral neck fractures are common in the elderly and are broadly grouped into either intracapsular or extracapsular fractures. We report an unusual femoral neck fracture that had features of both and discuss the management of such a case.
(p 74-77, Orthopaedic surgery; Trauma surgery: 22 October 2010)
Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) is a rare rheumatologic condition frequently missed but easily treated. We describe a case of RS3PE and explore the literature surrounding this arthritis.
(p 71-73, Rheumatology: 22 October 2010)
A 72-year-old male was admitted with painful swelling of his left arm. Physical examination revealed supraclavicular lymphadenopathy with swollen left arm and a stony-hard prostate on rectal examination. Routine blood tests were normal. Doppler test showed deep vein thrombosis in the left arm. Tomography of chest, abdomen and pelvis showed generalized lymphadenopathy,...
(p 67-70, Oncology: 22 October 2010)
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.
(p 63-66, General Surgery: 22 July 2010)
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...
(p 55-58, Vascular surgery: 22 July 2010)
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.
(p 51-54, Orthopaedic surgery; Vascular surgery: 22 July 2010)
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...
(p 46-50, Histopathology; Urology: 22 July 2010)
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...
(p 42-45, Neurology; Oncology; Urology: 22 July 2010)
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...
(p 38-41, Cardiology; General Surgery; Hepatology: 22 July 2010)
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...
(p L6-L9, Landmark case report: 22 July 2010)
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...
(p 34-37, Orthopaedic surgery; Plastic surgery: 27 June 2010)
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...
(p 28-33, Cardiothoracic surgery: 27 June 2010)
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.
(p L1-L5, Landmark case report: 10 May 2010)
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.
(p 25-27, Gastroenterology; Radiology: 6 April 2010)
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...
(p 19-24, Haematology; Oncology: 6 April 2010)
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.
(p 13-18, Orthopaedics; Radiology: 16 February 2010)
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.
(p 8-12, Oncology; Orthopaedics: 16 February 2010)
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...
(p 1-7, Gastroenterology; Hepatology: 16 February 2010)

Editor-in-Chief

Frank Cross
Consultant Vascular and General Surgeon
The London Clinic, UK

Editors

Neil Barnes
Consultant Physician
Barts Health NHS Trust, London, UK
Ali Jawad
Professor of Rheumatology
Barts Health NHS Trust, London, UK

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