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Volume 9

A woman with known adenocarcinoma of the right parotid gland presented with bony metastasis in her left proximal femur. This was histologically confirmed and the patient underwent prophylactic intramedullary nail and hip screw fixation of her left proximal femur. This represents the first report of adenocarcinoma of parotid origin metastasising to a long bone in an adult.
(p 59-62, Oncology, Orthopaedic surgery: 22 July 2010)
A case of Epstein–Barr virus (EBV) meningoencephalitis in a 74-year-old white man with rheumatoid arthritis is reported. The potential predisposing factors for EBV meningoencephalitis, the diagnostic approach and the management highlighted by this case are discussed.
(p 49-53, Infection and immunity; Neurology; Rheumatology: 31 December 2009)
A case of cutaneo-cutaneous fistula superior to the external auditory canal extending from the mastoid skin to the skin over the zygoma is reported. The adult patient presented with recurrent discharge and swelling of the skin over the zygoma and mastoid bones. Definitive treatment was in the form of complete excision of the fistula tract.
(p 54-57, ENT/head and neck surgery; Microbiology: 24 December 2009)
We report the diagnostic challenges raised by the uncommon synchronous finding of a lung sequestration and foregut cyst in a 76-year-old male scheduled for radical treatment of his colonic cancer. Following a computed tomography (CT) scan of the chest and a combined positron emission tomography (PET)-CT scan these lesions initially suggested a primary lung cancer with...
(p 45-48, Radiology, Thoracic surgery: 7 December 2009)
A case is described involving a 71-year-old hirsute woman with a growing adrenal tumor and a high serum testosterone level, which did not normalize after adrenalectomy. Following this she was found to have a testosterone-producing ovarian Leydig cell tumor. This case provides key features that can help distinguish adrenal and ovarian causes of hirsutism.
(p 42-44, Oncology: 17 November 2009)
Supraventricular tachycardias are the most commonly encountered arrhythmias during and shortly after pregnancy. This case report describes several ECG-based diagnostic considerations and briefly reviews the current standards of care.
(p 38-41, Cardiology: 17 November 2009)
Lateral abdominal wall haematoma following blunt trauma can be a life-threatening condition and requires prompt diagnosis and treatment. We present the imaging findings and treatment modalities used for a young man presenting to the emergency department with abdominal pain and bruising.
(p 33-37, Accident and Emergency Medicine and Surgery (including Trauma), Radiology, Vascular Surgery: 17 November 2009)
Intramuscular supraspinatous cysts are rare and usually related to partial supraspinatous tendon tears. Conventional magnetic resonance imaging (MRI) and MRI arthrography are the most commonly used modalities for imaging such rotator cuff pathology. Treatment and follow-up of such cysts is not well documented in the literature. We report the successful conservative...
(p 29-32, Orthopaedic surgery, Radiology: 17 November 2009)
Spontaneous spinal epidural haematoma is a rare condition that may lead to spinal cord or cauda equina compression resulting in severe neurologic impairment. Predisposing factors include anticoagulation, vascular malformation, disc herniation. Both surgical and more recently conservative modes of treatment have been described in the literature. This is the first reported...
(p 24-28, Neurosurgery, Orthopaedic surgery: 17 November 2009)
The inception of spinal anaesthesia can be traced to James Leonard Corning, a New York neurologist who inadvertently administered cocaine spinal anaesthesia in 1885. In 1898 August Karl Gustav Bier, a German surgeon, pioneered the successful use of operative spinal anaesthesia in lower limb surgery. Early spinal anaesthesia was fraught with complications but through...
(p L1-L4, Landmark Case report: 15 September 2009)
Strangulation, secondary to reduced blood flow, is a well-known complication of herniae. Signs of bowel activity do not rule out the possibility of vascular compromise. Raised inflammatory markers and a positive computed tomography scan can lead to a preoperative diagnosis, but the mortality rate remains high.
(p 20-23, General Surgery: 13 July 2009)
(p 18-19, Rheumatology: 1 July 2009)
We report the case of 58-year-old gentleman with pancreatic masses, possibly of neuroendocrine origin, with the history of renal carcinoma, primary hyperparathyroidism and pituitary cyst. Histological analysis after pancreatectomy revealed metastases from renal cancer. This unusual case illustrates the challenging differential diagnosis between multiple endocrine...
(p 14-17, Endocrinology, Oncology: 28 May 2009)
Intestinal obstruction secondary to displacement of a stone from the gall bladder into the intestinal tract is relatively uncommon. The commonest site of calculus impaction is at the ilio-caecal valve. Occasionally, however, the gall stone may either pass through the valve into the colon or perforate directly into the transverse colon and impact in the distal colon. The...
(p 9-13, Radiology: 29 April 2009)
Although splenomegaly is found in approximately two thirds of patients with infectious mononucleosis (IM), splenic rupture is uncommon. However, it constitutes the single largest cause of mortality in this group. True atraumatic splenic rupture is very rare and is seen in only 0.5% of all cases of IM. We present a case of a 22-year-old man with atraumatic...
(p 6-8, Critical care, General surgery: 16 March 2009)
‘Plug and patch’ hernia repair techniques have been developed to minimise tissue dissection and suturing, minimise post-operative pain, to return the patient to ‘normal’ levels of activity promptly, as well as to help decrease recurrence rates. As an extension to this concept of repair, a new collagen-based bioabsorbable plug has been developed in an attempt to eliminate...
(p 1-5, General surgery: 16 March 2009)

Editor-in-Chief

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

Editors

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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