An 88-year-old woman presented with thrombo-embolic disease of the left upper extremity manifested by the classical signs of pain, paresthesias, pallor, pulselessness, and poikilothermia. She was found to have a thrombo-embolus in the left distal brachial artery as well as two large thrombi in the aortic arch and proximal descending aorta. Initial surgical intervention...
(p 52-56, Vascular medicine; Vascular surgery: 3 December 2008)
We describe a case of Prinzmetal's angina that is refractory to medical therapy but responded fully after percutaneous coronary intervention. This case shows that there is a role for percutaneous coronary intervention in refractory variant angina as long as a culprit lesion within the vasospastic segment can be identified.
(p 49-51, Cardiology: 3 December 2008)
Total parenteral nutrition (TPN) is an essential means of maintaining nutrition in those who are unable to do so via an enteral route. However, long term TPN can pose potentially serious complications, in particular liver related damage. This article describes a case of abnormal liver function following total parenteral nutrition and discusses the methods of potentially...
(p 46-48, Gastroenterology: 26 November 2008)
Foreign bodies within the para-nasal sinuses are a reported cause of chronic unilateral rhinosinusitis. The most commonly cited cause is of dental origin. One previously reported case cited a foreign body from the repair of an orbital blow-out fracture. Suspicion of a sinugenic foreign body cause may only be aroused by a thorough history and examination, usually confirmed...
(p 43-45, ENT; Head and neck surgery: 18 November 2008)
We report the case of a 53-year-old lady who underwent laparoscopic cholecystectomy and was found to have an accessory cystic duct close to the fundus. Careful dissection of the liver bed was done and the duct clipped preventing a bile leak. The presence of such ducts though rare should be identified during surgery to prevent potential complications.
(p 40-42, Colorectal surgery: 10 November 2008)
The occurrence of cutaneous metastases from colon cancer to cutaneous scars is being increasingly recognized and reported in the literature. Although the most common scenario involves scars resulting from prior resection of the cancer, rare instances represent distant involvement of scars from unrelated procedures. As well as being of interest as an intriguing biological...
(p 38-39, : 1 October 2008)
We report the case of a 62-year-old man who presented with puckering and tethering of his appendicectomy scar; he was found to have an underlying caecal carcinoma. We review the literature regarding this uncommon presentation of caecal cancer.
(p 35-37, General Surgery; Colorectal Surgery: 1 October 2008)
Compartment syndrome is a potentially limb- and life-threatening clinical entity resulting from elevated intra-compartmental pressures. A high clinical suspicion is paramount in diagnosis since full recovery is time-sensitive. We present a unique case of chronic myelomonocytic leukemia-induced (CMML) compartment syndrome which illustrates the importance of quick diagnosis...
(p 31-34, Accident and Emergency Medicine and Surgery (including Trauma); Orthopaedic Surgery; Vascular Surgery: 1 October 2008)
We report on an 81-year-old male with bilateral septic arthritis of the knee joints, who was treated with multiple joint washouts and intravenous antibiotics. As far as we know, there has been no case report in the English literature, on bilateral septic arthritis of the knee secondary to group G β-haemolytic streptococcal endocarditis.
(p 28-30, Cardiology; Microbiology; Orthopaedic Surgery; Infection and Immunity: 29 September 2008)
A 20-year-old woman was admitted with a short history of high fever, rash, gastrointestinal symptoms, vaginal discharge and hypotension. Whilst toxic shock syndrome was considered, no gynaecological source of infection was found. Subsequent isolation of Staphylococcus aureus from a cutaneous blister led to confirmation of the diagnosis.
(p 25-27, Infection and Immunity: 29 September 2008)
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. The development of metabolic syndrome is widely recognised with the use of atypical antipsychotic agents, and not infrequently DKA has been described with some of these drugs. We describe a complex patient with HIV who presented with severe DKA and prolonged hyperchloraemic acidosis, which we...
(p 22-24, Endocrinology: 26 June 2008)
Postpartum cardiomyopathy (PPCM) is the development of heart failure in the last month of pregnancy or within 5 months after delivery without an identifiable cause in a previously healthy female. It is a rare condition, which carries a high maternal mortality. We describe the case of a 35-year-old South Asian woman who presented with dyspnoea, fatiguability, peripheral...
(p 19-21, Cardiac Imaging; Cardiology: 26 June 2008)
A 73-year-old Asian gentleman was admitted via the Accident and Emergency Department with upper abdominal pain, jaundice, fever and rigors. Past history included non-insulin dependant diabetes, asthma, psoriasis and alcoholism. His drug history included methotrexate. A diagnosis of acute cholecystitis was made and ultrasound findings were consistent with this. The patient...
(p 14-18, General Surgery: 8 June 2008)
Hartmann's procedure, first described by the French surgeon Henri Albert Hartmann in 1921, is one of the most commonly performed operations. This paper examines the history behind this operation and assesses its significance in modern surgical practice.
(p L1-L3, Landmark Case Report: 13 May 2008)
We report the case of a 91-year-old lady who presented with a gastrocutaneous fistula in the absence of any recent surgery. We review the literature and discuss this uncommon surgical problem.
(p 10-13, Breast Surgery, gastroenterology; General Surgery: 28 February 2008)
We report on a boy who presented with acute renal failure and bilateral ureteral obstruction 5 days after an uneventful appendectomy. In contrast to the few cases described in the literature, bilateral ureterothiasis was the pathogenesis of ureteric obstruction. The clinical signs and diagnostic findings, and an overview of the literature are presented. The severity of...
(p 6-9, General surgery; Paediatric surgery: 28 February 2008)
Subcutaneous nodules are a common clinical finding. Common causes include rheumatoid nodules, gouty tophi, neurofibromatosis type 1, Madelung's disease (benign symmetric lipomatosis), Dercum's disease (adiposis dolorosa) and tuberous xanthomas. Other causes include: hibernoma, lipoblastoma, angiolipoma, liposarcoma, glomus tumour, leiomyoma, eccrine spiradenoma...
(p 4-5, Rheumatology: 29 January 2008)
Varicose vein surgery is one of the commonest surgeries performed in the Western world. Utilisation of a plastic stripper and olive or a perforation/inversion metallic stripper has been used to remove the great saphenous vein in the thigh. We describe a non-traumatic technique for removal of the great saphenous vein that has minimal complications.
(p 1-3, Vascular surgery: 24 January 2008)