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Volume 2

This report describes an uncommon condition, nonocclusive mesenteric ischemia (NOMI) in a patient with end-stage renal disease on continuous peritoneal dialysis therapy. The patient presented with nonspecific abdominal symptoms and leucocytosis which later progressed to an acute abdomen due to generalized peritonitis of unknown origin. She had been hospitalized with an...
(p 50-52, Nephrology: October 2002)
A number of paraneoplastic neurological syndromes have been described in association with small cell lung carcinoma and, less commonly, with other malignancies. We describe here the case of a 58-year-old woman with paraneoplastic limbic encephalitis (PLE) complicating squamous cell carcinoma of the lung.She presented with subacute cognitive decline, particularly memory...
(p 46-49, Neurology, Oncology: August 2002)
Relapse of squamous cell carcinomas usually occurs in a predictable pattern. We present two patients with rare metastases. The first developed peritoneal disease without evidence of intra-thoracic spread due to a laryngeal cancer. The second, a patient with a vulval squamous tumour was presented with distant disease following foot pain.
(p 43-45, Oncology: July 2002)
ACC is an unusual pulmonary neoplasm, accounting for 0.09%–0.2% of all lung cancers. It is a low-grade tumour with unusual histological features and rarely metastasises outside the lungs. We describe a case with bilateral renal metastases. We discuss the clinical and histological features, and the implications for its treatment.
(p 40-42, Respiratory Medicine; Oncology: July 2002)
We report a case of recurrent bacteraemia due to Staphylococcus aureus with associated pyomyositis and endophthalmitis in an insulin-dependent diabetic with chronic liver disease secondary to alcohol abuse.
(p 37-39, Vascular disease; Ophthalmology; Endocrinology: July 2002)
An ironic poem written at the time of a transient ischaemic attack is illustrated which demonstrates the expressive nature of dysphasic dysgraphia at the moment of the attack (Fig. 1).
(p 35-36, Neurology: July 2002)
The inguinal hernia sac can occasionally contain unusual intra and extra peritoneal structures. A case of acute presentation of ovulating ovary in indirect inguinal hernia is presented. This has not been described previously.
(p 32-34, General surgery: May 2002)
Total dislocation of the talus with dislocation of the talonavicular, subtalar and ankle joint is an extremely rare injury. Coltart in 1952 included no fracture total talar dislocation in his classification system [1]. Leitner considered subtalar dislocation to be the preliminary stage to total talar dislocation [2]. He stated that severe supination or inversion forces...
(p 29-31, Orthopaedics: May 2002)
We report a case of pulmonary Mycobacterium avium-intracellulare (MAI) in a previously fit 48-year-old man who subsequently developed Crohn's disease. We discuss the potential predisposing factors for pulmonary MAI; the diagnostic uncertainties in this particular case; the relationship between pulmonary MAI and Crohn's disease; and the difficulties in management that are...
(p 24-28, Respiratory Medicine; Gastroenterology; Infection: May 2002)
A 19-year-old boy presented with a 3-month duration of intermittent low back pain. SPECT imaging and CT scan confirmed the diagnosis of osteoid osteoma in the left pars inter-articularis of the L4 vertebra. Surgical enucleation of the tumour, curettage and bone grafting was performed through a posterior approach. The pars inter-articularis of L4 is an unusual location of...
(p 21-23, Orthopaedics: May 2002)
Hydatid disease, caused by the cestode Echinococcus, is common in Mediterranean regions. Depending on its size, an intact cyst may be ‘silent’ or may compress adjacent organs, causing symptoms. The cystic stage of Echinococcus granulosus is commonly located in the liver, which frequently results in a long symptom-free period [1]. Rupture of a hydatid cyst commonly gives...
(p 17-20, Emergency Medicine: April 2002)
Critical ischaemia of the lower limb secondary to occlusion of the puncture site vessel is an unusual but well-recognized complication of endovascular intervention. We present two patients who developed such a complication. In each case, the initial treatment plan was to perform an emergency thrombectomy. However, both cases were found to resolve dramatically with the...
(p 1-3, Vascular Radiology: April 2002)
A 78-year-old lady, with no history of trauma, was admitted with gradually increasing pain in the right groin and thigh; she had been unable to weight-bear for 24 h. The patient also complained of intermittent left shin pain. She had been treated for carcinoma of the breast 22 years earlier by total mastectomy with axillary clearance followed by local radiotherapy; she...
(p 13-16, Orthopaedics: March 2002)
The cardiovascular complications of sildenafil (ViagraTM) are well recognized, although non-cardiovascular complications are rare. We present the first recorded case of fractured penis associated with ViagraTM usage.
(p 11-12, Urology: January 2002)
An immunocompromised woman developed progressive respiratory symptoms followed by signs of embolism in the pulmonary artery and great vessels. MRI of the chest was able to demonstrate the lung cavitation, as well as demonstrating vascular invasion, suggesting a diagnosis of mucormycosis, an opportunistic fungal infection.
(p 8-10, Infection and Immunity: January 2002)
False aneurysms of the axillary artery are rare complications of blunt trauma and dislocation of the shoulder. We present a case of false aneurysm of the axillary artery secondary to traumatic fracture of the humeral neck, which resulted in brachial plexus damage and was initially diagnosed as a neoplasm.
(p 4-7, Vascular Radiology: January 2002)
A patient with HIV/AIDS presented with miliary TB, a cerebral lesion and a swollen optic nerve. On anti-TB therapy, the cerebral and optic nerve lesions initially worsened. Biopsy of the optic nerve was undertaken to exclude other disorders but only showed necrosis. Anti-TB therapy was continued and with time all lesions resolved.
(p 15-17, Ophthalmology: May 2001)


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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