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Volume 11

Beals syndrome is an autosomal-dominant connective tissue disorder, similar in many respects to Marfan syndrome, characterized by multiple flexion contractures, arachnodactyly, severe kyphoscoliosis, abnormal pinnae, and muscular hypoplasia. This relatively new syndrome contrasted with Marfan by much less incidences of eye and heart anomalies and the congenital presence...
(p 115-118, Rheumatology: 28 December 2011)
In 1937, Professor Hulusi Behçet, a Turkish dermatologist, described two cases of relapsing ulceration of the mouth, eye and genitalia, a triple symptom complex that now characterizes the multisystem disorder that was named after him. The periodic relapses led Behçet to attribute these symptoms to a viral infection. This was subsequently found to be inaccurate and current...
(p L1-L2, Landmark case report: 28 December 2011)
Constrictive pericarditis is a difficult diagnosis that requires a high degree of clinical suspicion due to unspecific signs and symptoms. We present a 73-year-old patient with symptoms of chronic heart failure. Cardiac catheterization revealed the diagnosis of constrictive pericarditis, likely as a late consequence after tuberculosis in adolescence. The patient underwent...
(p 111-114, Cardiology: 9 December 2011)
Pacemaker implantation is an established therapy for patients with sinus node disease or atrioventricular block. However, we sometimes encounter cases in which delivery of the leads is technically difficult. The buddy wire technique is known to be useful in delivering stents when difficulties are encountered due to vessel tortuosity or calcification during percutaneous...
(p 107-110, Cardiology: 9 December 2011)
This case report describes a young man in his early 20s who was found to have synchronous adenocarcinoma of the colon and abdominal tuberculosis. This is a rare finding and it is discussed whether a dampened immune response by the cancer allowed a latent tuberculosis infection to become active or vice versa.
(p 103-106, Colorectal surgery; General surgery; Infection and Immunity; Thoracic medicine: 9 December 2011)
Primary mesenteric liposarcoma is a rare malignant tumour of mesenchymal origin. Under the MeSH classification, mesenteric liposarcoma appears to be classified with retroperitoneal neoplasms. Two synchronous mesenteric liposarcomas must be very unusual. We report a rare case of double mesenteric liposarcoma in a 66-year-old female patient. She was treated with wide...
(p 98-102, General Surgery: 9 December 2011)
Solitary fibrous tumour is a rare spindle cell neoplasm of uncertain histogenesis and unpredictable biological behaviour, which was first described in the pleura and subsequently in many extrapleural locations. The clinical, radiologic and histologic features of a case of pelvic extraperitoneal solitary fibrous tumour in a young male are presented.
(p 92-97, General surgery; Oncology: 6 December 2011)
We present the case of a healthy seasoned marathon runner who sustained bilateral quadriceps tendon rupture following a low-energy fall. Radiographs demonstrated bilateral patellar spurs. Our case report serves to highlight the importance of maintaining a high index of clinical suspicion in patients of all ages. This is the first report of bilateral quadriceps rupture in...
(p 77-80, Orthopaedics; Radiology: 4 November 2011)
Liposarcoma is a mesenchymal neoplasm of uncertain pathogenesis. It is the second most common soft tissue sarcoma, found uncommonly in the breast, and constitutes less than 1% of all malignant breast tumors. We report a case of a 50-year-old woman with a pleomorphic type liposarcoma of the breast.
(p 87-91, Breast surgery; General surgery; Oncology; Pathology; Radiology: 17 October 2011)
This is the case of a 7-year-old girl with a history of migraine headaches who presented with a head tilt to the left and worsening headaches. Papilloedema was found on ophthlamoscopy. She had an intermittent history of migraine-type headaches for the past year. Oral naproxen 375 mg twice daily provided some relief of the headaches initially but they slowly worsened and...
(p 81-86, Radiology; Oncology; Paediatrics: 17 October 2011)
There are numerous reports of inadvertent injury to patients as a result of diathermy. This potential risk also applies to the surgical team. We report a case of a full thickness diathermy burn to the surgeon, occurring due to faulty diathermy forceps. Such incidents should be reported to minimize risk of injury.
(p 74-76, General Surgery: 16 September 2011)
Chilaiditi syndrome is rare, often challenging to diagnose and difficult to treat. In general, patients have a long history of symptoms from early childhood. Emergency surgery is usually performed in the case of volvulus or obstruction. Detorsion, colopexy or partial colonic resection have been proposed. However, these methods may lead to a recurrence of the disease. In...
(p 70-73, Colorectal Surgery: 16 September 2011)
A 4-year-old boy with beta-thalassemia major who underwent a successful bone marrow transplant (BMT), presented with a necrotic looking scalp lesion. Debridement was initially suggested but a punch biopsy showed Aspergillus fumigatus. Antifungal therapy was commenced and the lesion healed with minimal scarring. Invasive fungal infections are a major cause of morbidity and...
(p 66-69, Dermatology; Haematology; Paediatric Surgery: 12 August 2011)
The differential diagnosis between disorders of consciousness (DoC), on the one hand, and conditions of severe immobility with aphasia, on the other hand, is extremely difficult. A patient is described whose morphology of brain lesions permitted both kinds of disorder. A battery of functional magnetic resonance imaging (fMRI) examinations was applied indicating that...
(p 60-65, Clinical psychology: 18 July 2011)
Systemic amyloidosis secondary to myeloma is an uncommon condition that often has an insidious onset and poses as a diagnostic challenge due to the lack of typical presenting symptoms and signs. Prompt diagnosis of amyloidosis and appropriate referral have the potential to improve outcome for these patients. Here, we report the unusual case of a man whose primary...
(p 56-59, Haematology; Histopathology; Nephrology; Neurology; Pathology; Radiology: 18 July 2011)
Chronic hypokalaemia often remains a diagnostic challenge, especially in young women without hypertension. A concealed diuretic abuse should be suspected, especially in young women with eating disorders. This case describes a woman with chronic hypokalaemia in whom a thorough medical history and proper laboratory tests were essential to early and accurate diagnosis.
(p 53-55, Acute Medicine; Nephrology; Psychiatry: 18 July 2011)
We describe a case of very late stent thrombosis (ST) in a patient presenting with hematemesis while taking aspirin and oral anticoagulation therapy (OAC). This case shows that the management of patients with an indication for OAC who undergo percutaneous coronary intervention with drug-eluting stent (DES) implantation is challenging because of the need to balance the...
(p 48-52, Cardiology; Emergency Medicine; Gastroenterology; Haematology; Histopathology; Pathology: 18 July 2011)
Knee pain, stiffness and swelling are common complaints. Trauma and osteoarthritis are the most common diagnoses. However, benign and malignant tumours may also present around the knee. These tumours require characterization prior to definitive treatment. Here we describe a rare cause of knee stiffness with a popliteal mass.
(p 44-47, Orthopaedic Surgery; Rheumatology: 14 June 2011)
The case presented is a 21-year-old male conscript with vestiphobia and panic attacks triggered from donning his military vest. This case report highlights a common but largely under recognized anxiety disorder, and it is hoped to encourage improved diagnosis of patients suffering from such conditions in future.
(p 41-43, Occupational Health; Psychiatry: 14 June 2011)
Pure red cell aplasia (PRCA) is a rare complication of autoimmune rheumatic diseases such as systemic lupus erythematosus (SLE). Thymoma occurs in 5–13% of patients with PRCA and in 2% of patients with SLE. The simultaneous occurrence, however, of all 3 disorders is rare. We report a patient with lupus-like disease who developed PRCA in association with a...
(p 37-40, Haematology; Rheumatology: 14 June 2011)
Febrile illness has a broad differential diagnosis, particularly among persons infected with human immunodeficiency virus (HIV). Infectious complications of immunodeficiency must always be high on this differential, but clinicians must also consider HIV-associated malignancies as an explanation for fever in this population. We present the case of a 48-year-old man with...
(p 34-36, Critical Care; Infection and Immunity; Oncology; Virology: 6 April 2011)
Plantar fibromatosis is a complex problem encountered by many surgeons in different specialties. Understanding the complexity of this debilitating disease and awareness of the concept of the reconstructive toolbox is crucial in achieving best surgical outcome. We present a case where an instep defect following an excision of recurrent plantar fibromatosis was...
(p 28-33, Orthopaedics; Plastic Surgery: 6 April 2011)
A woman with known adnexal transposition for carcinoma of the cervix presented with abdominopelvic pain. The previously known complications of adnexal transposition are discussed and the first description of isolated torsion of the fallopian tube is presented.
(p 25-27, Gynaecology: 26 March 2011)
Pyelonephritis is a serious common complication of transplantation that can lead to either acute renal failure or graft loss. The occurrence of diverticulitis in a renal transplant recipient is a rare complication but may lead to major morbidity and mortality. The overall incidence of diverticular disease in patients over the age of 60 years is 30%. Intense...
(p 20-24, Nephrology; Transplantation: 26 March 2011)
An 80-year-old lady with abdominal pain had a perforated terminal ileum at laparotomy 2 weeks after treatment for Campylobacter jejuni infective colitis. Histology of the excised bowel revealed transmucosal inflammation but no dysplasia or malignancy. Cases of bowel perforation secondary to Campylobacter are more common in children and HIV-positive individuals.
(p 17-19, General Surgery; Infection and Immunity: 26 March 2011)
We report an unusual case of traumatic aortic rupture and lesion of the left main bronchus after blunt chest trauma in an 8-year-old otherwise healthy boy. The trauma mechanism was severe compression of the thoracic cavity underneath a heavy object without a deceleration component. The visceral lesions were disproportionally severe compared with the surface injury. This...
(p 1-4, Paediatric surgery; Trauma; Vascular Surgery: 25 February 2011)


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


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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