Rectal pseudodiverticulum.

We present the case of a 77-year-old woman who initially presented 13 years ago to a colorectal clinic with a change in bowel habit and bleeding per rectum over 7 months. These symptoms were attributed to a tubulovillous rectal adenoma which was excised transanally, but recurred five times in 12 years. The most recent endoscopy showed recurrence of the rectal adenoma and a new rectal diverticulum.

Smartphone Applications for the Clinical Oncologist in UK Practice.

A number of medical smartphone applications have been developed to assist clinical oncology specialists. Concerns have arisen that the information provided may not be under sufficient scrutiny. This study aims to analyse the current applications available for clinical oncologists in the UK.

Spontaneous mesenteric hematoma complicating an exacerbation of Crohn's disease: report of a case.

Case Presentation: Spontaneous mesenteric haematoma is a rare condition that occurs due to localized bleeding in the mesenteric vascular tree of a bowel segment in the absence of an identifiable cause. Here we report a case of spontaneous mesenteric haematoma during an inflammatory exacerbation of Crohn's disease. The patient underwent surgical management for small bowel obstruction secondary to Crohn's disease, however the concurrent presence of a spontaneous mesenteric haematoma in the mid-jejunal mesentery was successfully managed conservatively.

Total knee arthroplasty with an oxidised zirconium femoral component: a 5-year follow-up study.

Purpose: To report the early results of the Oxinium Genesis II prosthesis with an oxidised zirconium femoral component in 55 patients.

Methods: 71 knees in 21 men and 34 women aged 32 to 75 (mean, 55) years were evaluated; 16 of the patients had bilateral staged total knee replacements with a mean interval of 9 (range, 6-16) months between surgeries. The indications for surgery included osteoarthritis (n=57), rheumatoid arthritis (n=13) and revision from a unicompartmental knee replacement for osteoarthritis (n=1).

Thyroid surgery as a 23-hour stay procedure.

Introduction: The main barriers to short stay thyroidectomy are haemorrhage, bilateral recurrent laryngeal nerve palsy causing respiratory compromise and hypocalcaemia. This study assessed the safety and effectiveness of thyroidectomy as a 23-hour stay procedure.

Methods: All patients undergoing total or completion thyroidectomy were prescribed calcium and vitamin D3 supplements following surgery.

Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance.

Background: Coronary artery calcium (CAC) imaging by unenhanced computed X-ray tomography (CT) is recommended as an initial diagnostic test for patients with stable chest pain symptoms but a low likelihood (10-29%) of underlying obstructive coronary artery disease (CAD) after clinical assessment. The recommendation has not previously been tested prospectively in a rapid access chest pain clinic (RACPC).

Methods: We recruited 300 consecutive patients presenting with stable chest pain to the RACPC of three hospitals.

Patient perspective on the management of atrial fibrillation in five European countries.

Background: Long-term management of chronic conditions, such as atrial fibrillation (AF), require frequent interactions with the healthcare systems. The multinational EUropean Patient Survey in Atrial Fibrillation (EUPS-AF) was conducted to investigate patient satisfaction with AF management in different of five European healthcare systems at a time of changing treatment paradigms for stroke prophylaxis, prior to the advent of newer oral anticoagulants.

Methods: Adults (>18 years) were recruited at random from the total populations of France, Germany, Italy, Spain and the UK using a randomized telephone dialling system.

Improving oral function and cosmesis in a case of Freeman-Sheldon syndrome.

Children born with the rare congenital condition Freeman-Sheldon syndrome (FSS) have a characteristic facial appearance: microstomia, a long philtrum, 'H-shaped' chin abnormality and 'pinched lips' in addition to extra-facial features such as kyphoscoliosis and hand deformities. Such children often have problems with oral continence and difficulties with speech leading to both nutritional and psychosocial concerns. Prompt correction through surgery is therefore important in effectively managing the condition.

Adolescent idiopathic scoliosis in Down's syndrome.

Adolescent idiopathic scoliosis in Down's syndrome individuals has previously been reported in the context of institutionalised individuals and is of an iatrogenic nature, resulting from previous thoracotomy for congenital heart defects. We report the case of a male, non-institutionalised Down's syndrome individual, with no history of previous thoracic surgery and we follow the natural history of the condition, with particular reference to height velocity and curve progression velocity throughout puberty and successful treatment with a Boston thoracolumbosacral orthosis.

The investigation of sudden arrhythmic death syndrome (SADS)-the current approach to family screening and the future role of genomics and stem cell technology.

SADS is defined as sudden death under the age of 40 years old in the absence of structural heart disease. Family screening studies are able to identify a cause in up to 50% of cases-most commonly long QT syndrome (LQTS), Brugada and early repolarization syndrome, and catecholaminergic polymorphic ventricular tachycardia (CPVT) using standard clinical screening investigations including pharmacological challenge testing. These diagnoses may be supported by genetic testing which can aid cascade screening and may help guide management.

Epiploic appendagitis with acute appendicitis.

A 28-year-old woman presented to accident and emergency department with a 1-day history of right-sided abdominal pain. She was afebrile, and haemodynamically stable, and the initial diagnosis was acute appendicitis. A transvaginal ultrasound scan was performed and was suggestive of appendicitis.

A systematic review of factors associated with the deferral of donors failing to meet low haemoglobin thresholds.

Background/objectives: Blood donors attending a donation session may be deemed ineligible to donate blood due to a failure to meet low haemoglobin (Hb) thresholds. Several studies have identified factors associated with a donor falling below these Hb thresholds. A review of these factors will inform future prospective studies and form the basis for predictive models of deferral due to low Hb.

Severe necrotic oesophageal and gastric ulceration associated with dabigatran.

A 69-year-old Caucasian man, who had been discharged 2 days previously, 5 days post-elective right total hip replacement, was re-admitted with a 16 h history of coffee-ground vomiting and epigastric pain. He had been discharged with 220 mg dabigatran, a novel oral anticoagulant. The coffee-ground vomiting started within minutes of taking the first dose.

Immunotherapy of malignant disease using chimeric antigen receptor engrafted T cells.

Chimeric antigen receptor- (CAR-) based immunotherapy has been under development for almost 25 years, over which period it has progressed from a new but cumbersome technology to an emerging therapeutic modality for malignant disease. The approach involves the genetic engineering of fusion receptors (CARs) that couple the HLA-independent binding of cell surface target molecules to the delivery of a tailored activating signal to host immune cells. Engineered CARs are delivered most commonly to peripheral blood T cells using a range of vector systems, most commonly integrating viral vectors.

Mechanical chest compressions.

The authors of this study state that there is a lack of evidence about the efficiency of mechanical devices in producing chest compressions as an adjunct to resuscitation during cardiorespiratory arrest.

Consent for gynaecological procedure: what do women understand and remember?

Purpose: To determine patients' understanding and recall of consent information and risks associated with their procedure following gynaecological surgery.

Method: Patients planned for routine gynaecological surgery were invited to participate in the study by completing a self-administered questionnaire 4-6 h after day-surgery and 24 h after in-patient surgery. Collated data were analysed using standard statistical methods.

Cluster of neurological manifestations of rotavirus infection in children.

Rotavirus infection in children in the resource-rich countries is usually benign but complications are reported rarely. Four children presented within 4 weeks with neurological symptoms and stool virology positive for rotavirus. All four made a quick recovery and were discharged home after a few days without medication.

Understanding and recollection of the risks associated with cesarean delivery during the consent process.

Objective: To investigate women's recall of information provided during the consent process for cesarean delivery, specifically the associated risks, 24 hours after the procedure.

Methods: A prospective questionnaire-based study was conducted at the Barnet and Chase Farm Hospitals NHS Trust between May 2009 and August 2010. Women who had undergone a cesarean delivery (planned or emergency) completed a self-administered questionnaire 24 hours after delivery.

Risk of ionising radiation to trainee orthopaedic surgeons.

We undertook this study to determine the amount of scattered radiation received by the primary surgeon, assistant and patient during dynamic hip screw fixation for proximal femoral fractures. Data was collected from fifty patients. Five registrars were included as operating surgeon and four senior house officers as assistant surgeon.

An unusual case of incomplete Kawasaki disease in an adolescent returning from holiday in Montana.

Here we present an unusual case of incomplete Kawasaki disease in a 15-year-old boy returning from a holiday with his family in Montana. His symptoms were initial diarrhoea and lethargy, with fever, rash, conjunctivitis, and arthralgia developing during the course of his illness. His condition worsened while he was at his local hospital, and he was transferred to the regional tertiary paediatric hospital.

How to do it: the difficult thyroid.

There is a paucity of publications detailing how to deal with the difficult thyroid cancer. When compared to other cancers, it is relatively rare with several histopathological subtypes which run differing clinical courses and respond to different therapies. It is a condition predominately treated by specifically trained General and now ENT surgeons who already have a thorough knowledge of vocal fold assessment and rehabilitation as well as emergency airways management both to avoid and treat common complications should they occur.

An unusual groin exploration: De Garengeot's hernia.

De Garengeot's hernia is a rare surgical phenomenon and describes the presence of the vermiform appendix within a femoral hernia. We describe a case of acute appendicitis mimicking an irreducible femoral hernia and reiterate key operative techniques necessary to prevent post-operative morbidity associated with this pathology.