Novel use of rituximab in a case of Riedel's thyroiditis refractory to glucocorticoids and tamoxifen.

A 42-year-old woman presented with a rapidly enlarging right-sided thyroid mass and underwent hemithyroidectomy. Riedel's thyroiditis was only diagnosed upon surgical decompression of the right carotid artery 2 years later. She became more symptomatic as Riedel's thyroiditis progressed, and mediastinal fibrosclerosis developed over the next 12 months.

WITHDRAWN: Services for helping acute stroke patients avoid hospital admission.

Background: Stroke patients are usually admitted to hospital for their acute care and rehabilitation. Services to help acute stroke patients avoid admission to hospital ('hospital-at-home') have now been developed.

Objectives: To establish the costs and effects of such services compared with conventional services.

Fracture through the apex of a delta tibia (minor tibial duplication) following minor injury.

Delta tibia (also known as minor tibial duplication) is a rare variant of congenital anterolateral tibial bowing. It is not associated with neurofibromatosis or pseudarthrosis in which there are characteristic changes on the lateral radiograph. This deformity is not thought to be prone to fracture.

Acute radiation enteritis causing small bowel obstruction.

Although much is known about the late intestinal side effects of radiation, comparatively little has been published about its acute complications. We present a case of a small bowel obstruction due to acute radiation enteritis. As radiotherapy continues to expand its role in the management of oncological disease, clinicians should remain alert to the resulting undesired effects.

An unusual case of obscure gastrointestinal bleeding in a patient with coeliac disease.

This paper describes the journey of a patient with coeliac disease who presented with overt obscure gastrointestinal bleeding. Upper and lower gastrointestinal endoscopy did not reveal a source of bleeding, but an abdominal CT scan detected abnormal lymphadenopathy and a wireless capsule endoscopy diagnosed a jejunal tumour, which was surgically removed. Gastrointestinal bleeding is rare in celiac disease.

CT myocardial perfusion imaging of myocardial blood flow reserve before and after coronary artery stenting.

A patient with crescendo angina underwent CTA, CTMPI and invasive angiography. Abnormal flow reserve was demonstrated in the RCA territory, which corresponded to a significant lesion demonstrated on CTA and invasive angiography. The defect was demonstrated prior to PCI, and resolved post PCI.

The use of omalizumab in the treatment of severe allergic asthma: A clinical experience update.

Severe persistent asthma causes a substantial morbidity and mortality burden and is frequently inadequately controlled despite intensive guideline-based therapy. Targeting allergic inflammatory processes that underlie the pathogenesis of severe persistent asthma improves asthma control in a significant proportion of patients. Omalizumab, a humanized monoclonal anti-immunoglobulin E (IgE) antibody, has been developed to target IgE, which is central to triggering and maintaining allergic airway inflammation.

Recognition of skin malignancy by general practitioners: observational study using data from a population-based randomised controlled trial.

Skin malignancy is an important cause of mortality in the United Kingdom and is rising in incidence every year. Most skin cancer presents in primary care, and an important determinant of outcome is initial recognition and management of the lesion. Here we present an observational study of interobserver agreement using data from a population-based randomised controlled trial of minor surgery.

Sudden loss of visual acuity following intra-articular steroid injection in to the knee joint: a case report.

Background: Exogenous and endogenous steroids have been implicated in the pathogenesis of central serous choroioretinopathy in the literature. Central serous choroioretinopathy presents as sudden reduction in visual acuity.

Case Presentation: Despite the fact that steroid injections are so commonly used in the Orthopaedics there is no information regarding central serous chorioretinopathy in Orthopaedic literature.

MicroRNAs: key players in carcinogenesis and novel therapeutic targets.

MicroRNAs (miRNAs) represent a recently uncovered class of small and endogenous non-coding RNAs. MiRNA function is critical to normal cellular processes such as differentiation and apoptosis, and recent studies have demonstrated that deregulated miRNA expression contributes to the malignant phenotype. The purpose of this review is to summarise these findings in relation to the most common human malignancies, and to analyse the clinical and therapeutic opportunities they provide.

Clinical pearl: a method of controlled movement of teeth using open and closed coil spring.

A method of controlled movement of teeth using open and closed coil spring. A 'clinical pearl' describing an original clinical technique to prevent uncontrolled tooth movement while using an active coil spring on the archwire.

Protein and the critically ill; do we know what to give?

The National Institute for Health and Clinical Excellence (NICE) has recommended that nutrition support in seriously-ill or injured patients should start at 50% of the estimated target energy and protein needs. This recommendation has caused some concern, since taking the NICE approach leads to these sick individuals receiving an initial N provision of only 0.12 g N/kg per d, as opposed to levels of approximately 0.

Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke.

Background: There are a number of different approaches to physiotherapy treatment following stroke that, broadly speaking, are based on neurophysiological, motor learning and orthopaedic principles. Some physiotherapists base their treatment on a single approach, while others use a mixture of components from a number of different approaches.

Objectives: To determine if there is a difference in the recovery of postural control and lower limb function in patients with stroke if physiotherapy treatment is based on orthopaedic or neurophysiological or motor learning principles, or on a mixture of these treatment principles.

A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease.

Objective: To evaluate the effectiveness of a personalised home programme of exercises and strategies for repeat fallers with Parkinson's disease (PD).

Method: Patients with a confirmed diagnosis of idiopathic PD, independently mobile, living at home in the community, experiencing more than one fall in the previous 12 months and with intact gross cognitive function were invited to participate in this randomised controlled trial. Usual care was compared with a personalised 6 week, home based exercise and strategy programme.

The mechanisms, diagnosis, and management of severe asthma in adults.

There has been a recent increase in the prevalence of asthma worldwide; however, the 5-10% of patients with severe disease account for a substantial proportion of the health costs. Although most asthma cases can be satisfactorily managed with a combination of anti-inflammatory drugs and bronchodilators, patients who remain symptomatic despite maximum combination treatment represent a heterogeneous group consisting of those who are under-treated or non-adherent with their prescribed medication. After excluding under-treatment and poor compliance, corticosteroid refractory asthma can be identified as a subphenotype characterised by a heightened neutrophilic airway inflammatory response in the presence or absence of eosinophils, with evidence of increased tissue injury and remodelling.

Recruitment to a clinical trial from the databases of specialists in Parkinson's disease.

Background: Many clinical trials involving elderly people living at home suffer from low recruitment. We report our experience of recruiting people with Parkinson's disease (PD) from specialist clinical databases, to a randomised controlled trial of personalized exercise.

Methods: We aimed to recruit 200 repeat fallers with PD.

Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome.

Background: A significant proportion of acute stroke patients suffer neurological deterioration during the first few days of recovery.

Aim: To explore the frequency, clinical characteristics, and consequences of early neurological deterioration during the acute recovery period.

Methods: We assessed all consecutive patients admitted to a University hospital with suspected stroke.

Non-esterified fatty acid concentrations are independently associated with hepatic steatosis in obese subjects.

Aims/hypothesis: We tested the hypothesis that NEFA concentrations are higher in obese subjects with fatty liver than in obese subjects without fatty liver.

Materials And Methods: We recruited 22 obese (BMI>30 kg/m(2)) men aged 42-64 years, in whom liver fat was assessed by ultrasound and classified into categories of no, mild to moderate and severe fatty liver by two independent radiologists. Regional and visceral abdominal fat were assessed by dual-energy X-ray absorptiometry and magnetic resonance imaging, and endogenous glucose production, whole-body glucose disposal during an insulin clamp, and NEFA concentrations were measured, along with NEFA suppression (percent (%) suppression and insulin sensitivity index for NEFA during an OGTT).

Flexible intramedullary nailing of displaced diaphyseal forearm fractures in children.

Introduction: This study analyses the results of 50 displaced diaphyseal forearm fractures in children treated with flexible intramedullary nailing.

Methods: Between 1999 and 2002 we treated 50 children aged between 5 and 15 years, with diaphyseal fractures of the forearm using Flexible intramedullary nailing (FIN). Both bones were fractures in 45 patients, radius only in 4 and ulna only in 1.

Epithelial-mesenchymal communication in the pathogenesis of chronic asthma.

Although Th-2-mediated inflammation is a key therapeutic target in asthma, its relationship to altered structure and functions of the airways is largely unknown. In addition to inflammation, asthma is a disorder involving the airway epithelium that is more vulnerable to environmental injury and responds to this by impaired healing. This establishes a chronic wound scenario that is capable of sustaining chronic inflammation as well as remodeling.

Is stroke unit care portable? A systematic review of the clinical trials.

Background: It is not known if mobile stroke teams can achieve the good results seen in trials of geographically discrete stroke wards (stroke units).

Objective: To establish the effectiveness of mobile stroke teams.

Design: Systematic review of controlled clinical trials that compared peripatetic systems of organised stroke care (stroke team care) with alternative hospital services.

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

Background: Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services.