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Volume 7

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.
(p 70-74, Accident and emergency medicine and surgery (including trauma); Orthopaedic surgery: 20 November 2007)
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...
(p 67-69, General surgery; Laparoscopic surgery: 16 November 2007)
Allen Oldfather Whipple is a name that will be forever eponymously associated with pancreaticoduodenectomy for pancreatic cancer. This paper presents the history behind this procedure.
(p L1-L2, Landmark Case Report: 5 September 2007)
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.
(p 64-66, General surgery: 25 July 2007)
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.
(p 61-63, Accident and Emergency Medicine and Surgery (including Trauma); Neurology; Neuroradiology; Neurosurgery: 13 June 2007)
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.
(p 58-60, Ophthalmology, General practice, Surgery: 13 June 2007)
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...
(p 54-57, Thoracic Surgery, Trauma: 13 June 2007)
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...
(p 51-53, General Surgery: 13 June 2007)
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.
(p 48-50, General Surgery: 17 May 2007)
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.
(p 45-47, ENT/Head Neck Surgery, General Surgery, Endocrinology: 14 May 2007)
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.
(p 42-44, General Surgery: 14 May 2007)
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...
(p 39-41, Rheumatology: 14 May 2007)
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...
(p 36-38, General Surgery: 19 April 2007)
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,...
(p 29-35, Accident and Emergency Medicine, Surgery (including Trauma): 28 March 2007)
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/...
(p 26-28, Respiratory Medicine: 28 March 2007)
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...
(p 21-25, Rheumatology: 1 March 2007)
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...
(p 18-20, Respiratory Medicine, Thoracic Surgery: 1 March 2007)
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.
(p 16-17, Rheumatology, Radiology: 20 February 2007)
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...
(p 13-15, Orthopaedic surgery, Paediatrics: 20 February 2007)
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...
(p 9-12, Psychiatry, Urology: 20 February 2007)
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...
(p 5-8, General surgery: 20 February 2007)
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...
(p 1-4, HPB surgery: 2 February 2007)


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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