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Volume 14

In 1896, Robert Jones submitted the first publication reporting a radiograph of a bullet seen inside the human body. A 12-year-old boy shot himself in the left hand ‘‘just above the left palmar arch’’. The bullet, a lead pellet, could not be found on enlarging the wound and it was ‘‘thought injudicious to prolong the search’’ given the ‘‘important structures in the...
(p L3-L4, Landmark case report: 11 November 2014)
Ventilator-associated pneumonia is a severe complication among patients undergoing cardiac surgery. Although hospital-acquired bacterial pathogens, often multidrug resistant, are the most frequent cause, non-bacterial atypical and opportunistic agents traditionally associated with immunocompromise are increasingly recognized. We describe ventilator-associated pneumonia...
(p 24-28, Infection and Immunity: 17 September 2014)
It is uncommon in clinical practice to discover cancer as either a metastasis within soft tissue or containing heterotopic bone formation. These rarities are documented primarily through case reports in the literature. This report describes a patient with colon cancer whose painful wrist lesion was proven to exhibit both of these unusual features. It is important to...
(p 16-20, General Surgery; Orthopaedics; Pathology; Radiology: 3 September 2014)
A rare case of a huge mass in the thyroid gland that developed in a 45-year-old man who presented with a diffuse neck mass is discussed. Imaging showed a large mass in the neck, with no extra thyroid extension. A preoperative diagnosis was made by fine-needle aspiration as suspicious for tuberculosis or malignancy. Open surgical excision biopsy yielded a definitive...
(p 11-15, Head and neck surgery: 4 August 2014)
This report describes a pathologic fracture of the patella secondary to destruction by a giant cell tumour. Diagnosis was made after non-union of a patella fracture, with osteolysis and soft tissue invasion. Delayed union of any fracture should raise the possibility of an underlying pathologic process.
(p 6-10, Orthopaedics: 4 August 2014)
A 38-year-old woman was diagnosed as having hyperparathyroidism. Surgery to remove 3.5 parathyroid glands was scheduled along with intraoperative neuromonitoring of the recurrent laryngeal/superior laryngeal nerves. Even though the neuromonitoring during the surgery indicated intact recurrent laryngeal nerves, on removal of the endotracheal tube, the anesthesiologist...
(p 21-23, ENT; Head and Neck Surgery; General Surgery: 23 July 2014)
John Ormond is credited with the first description of idiopathic retroperitoneal fibrosis (RF) in the English literature. Seventeen years later, he speculated correctly that the disease was systemic and was in the same group of diseases as lupus, scleroderma and periarteritis. Presently, idiopathic RF is considered part of a recently defined group of diseases known as...
(p L1-L3, Landmark case report: 2 April 2014)
The case of a young man who presented in the emergency department complaining of sudden onset of cough, fever and haemoptysis is described. Chest ultrasonography rapidly diagnosed an acute respiratory distress syndrome picture, which was confirmed on computed tomography. This allowed prompt management of the patient. Blood cultures yielded Streptococcus pyogenes and...
(p 1-5, Critical care; Emergency medicine; Infection and immunity: 29 March 2014)


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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