An evidence-based approach to diagnosis and management of cellulitis.

Community nurses are involved in caring for people who are at risk of cellulitis. The community nurse may be involved in dressing leg ulcers and may refer a patient with suspected cellulitis for appropriate treatment. Community nurses are also increasingly involved in delivery of outpatient antibiotic therapy (OPAT).

The gumma and the gonad: syphilitic orchitis, a rare presentation of testicular swelling.

A 47-year-old man presented to his general practitioner (GP) with painful swelling of his right testis. He was diagnosed with epididymo-orchitis and a two-week course of erythromycin 500 mg four times daily was prescribed by his GP. Despite initial improvement, his symptoms persisted and he was referred to the local urology department.

Blunted increase in serum hepcidin as response to oral iron in HFE-hemochromatosis.

Background: HFE hemochromatosis (HFE-H) is the most common and well-defined inherited cause for iron-related morbidity and mortality. Majority of patients with HFE-H are homozygote for C282Y mutation. Recent studies suggest that iron accumulation in most types of hemochromatosis is due to deficiency of hepcidin, a central iron regulator.

Glucocorticoids as a novel approach to the treatment of disabling side effects of sodium stibogluconate.

What Is Known And Objective: Intravenous sodium stibogluconate (SbV) is the mainstay of treatment for mucocutaneous leishmaniasis. Incidence of this disease is increasing in the UK, partly because of returning military personnel. SbV has a side effect profile that requires treatment interruption in up to 28% of patients.

Endocrine and metabolic emergencies: hypoglycaemia.

Hypoglycaemia is rare in healthy individuals owing to the numerous elegant hormonal and neuronal mechanisms that maintain glucose homeostasis. Glucose is an obligate metabolic fuel for cerebral tissue and therefore hypoglycaemia, if uncorrected, can have disastrous consequences including death. Clinical hypoglycaemia is defined as a plasma (or serum) glucose concentration low enough to cause symptoms and/or signs, including impairment of brain function.

A kink is not always a perforation: assessing Essure hysteroscopic sterilization placement.

Objective: To highlight the fallacy of using a kink in the microinsert outline on plain abdominal x-ray as a marker for tubal perforation.

Design: Case report.

Setting: West London District general hospital.

Acral post-traumatic tumoral calcinosis in pregnancy: a case report.

Introduction: Tumoral calcinosis is an uncommon disorder characterized by the development of calcified masses within the peri-articular soft tissues of large joints, but rarely occurs within the hand.

Case Presentation: We present the case of a 31-year-old pregnant Indian woman with a three-month history of painful swelling within the tip of her right middle finger following a superficial laceration. She was otherwise well and had normal serum calcium and phosphate levels.

Case Report: Fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn's disease.

We present the case of a 28 year old lady with refractory Crohn's Disease treated with infliximab throughout her pregnancy. Her baby was born healthy and received a Bacillus Calmette-Guérin (BCG) vaccine aged 3 months. Soon after this the infant became unwell and died aged 4.

Screening for cardiovascular disease in patients with advanced chronic kidney disease.

Cardiovascular disease remains the major cause of mortality and morbidity in patients with advanced chronic kidney disease (CKD) and after renal transplantation. The mechanisms for cardiotoxicity are multiple. Identifying high-risk patients remains a challenge.

Managing vitamin D deficiency in children.

Vitamin D deficiency has been identified in many British children. This condition has many deleterious effects on their health. Taking vitamin D status into account needs to become a daily element of primary care practice, both in antenatal and postnatal situations.

The myositides: the role of imaging in diagnosis and treatment.

The entities encompassing the syndromes collectively known as myopathies and myositis are composed of numerous separate and distinct disorders with a vast spectrum of clinical signs, symptoms, immunopathology, genetic and environmental influences, as well as overall clinical outcome. Classification of the myositides (diseases of skeletal muscle) remains a rather controversial subject due to our lack of complete understanding of this divergent group of disorders. The mainstay of achieving diagnosis of a myopathy has until relatively recently been with a combination of clinical acumen, laboratory assessment, electromyography, and muscle biopsy.

Presence of hepcidin-25 in biological fluids: bile, ascitic and pleural fluids.

Aim: To examine body fluids such as ascitic fluid (AF), saliva, bile and pleural effusions for the presence of hepcidin using a novel radioimmunoassay (RIA).

Methods: Serum samples were collected from 25 healthy volunteers (mean age: 36 +/- 11.9 years, 11 males, 14 females).

Fever management: evaluating the use of ibuprofen and paracetamol.

Paracetamol and ibuprofen are safe and effective medications for reducing a fever in children and young people and they are often administered together with a view to reducing a temperature quickly. National Institute for Health and Clinical Excellence guidelines dictate that only one of these drugs should be given at a time because there is no evidence to suggest that simultaneous use is more effective. This article summarises a literature search of randomised controlled trials carried out to identify which, if either, of these drugs is faster at reducing a fever.

The diagnostic and prognostic value of tissue Doppler imaging during dobutamine stress echocardiography in end-stage renal disease.

Objective: To determine whether a quantitative measurement of peak systolic velocity (PSV) during dobutamine stress echocardiography (DSE) detects severe coronary artery disease (CAD) and predicts mortality in patients with end-stage renal disease.

Methods: One hundred and forty renal transplant candidates had DSE and coronary angiography. DSE analysis was performed using conventional visual wall motion assessment, longitudinal PSV, and combining the two modalities.

Hepcidin and inflammatory bowel disease: dual role in host defence and iron homoeostasis.

Objective: Hepcidin is an endogenous antimicrobial peptide with a key role in iron homoeostasis. Hepcidin is similar to defensin, the deficiency of which is associated with Crohn's disease. To date there has been no validated method to reliably assay serum hepcidin.

A novel laparoscopic approach to lesions related to the posterior aspect of the pancreatic head.

The posterior aspect of the pancreatic head has proven to be a technically demanding region to approach laparoscopically. Previously, this region was approached through the gastrocolic ligament with the patient in a left semilateral position. We believe that this makes the laparoscopic approach to the posterior pancreatic head extremely difficult.

A novel use for the rigid cystoscope: the removal of sacral tacks after a coloanal anastamosis dehiscence.

A 69-year-old female presented as an emergency with atrial fibrillation, which was treated with warfarin. She subsequently developed fresh rectal bleeding and after further investigations a Dukes B adenocarcinoma of the rectum was found. She subsequently underwent a low anterior resection, coloanal anastamosis and a defunctioning ileostomy.

Simple Liver Cyst as a Focus of Salmonella paratyphi Abscess: A Case Report.

Salmonellosis, endemic in various part of the world, is considered a differential diagnosis in a tropical traveller. Although it usually presents as gastroenteritis, its various clinical syndromes may vary from mild gastroenteritis to severe septicaemia including abscess formation, the later two being the most common cause of morbidity and mortality. Here we present a patient who returned to the UK after an overseas trip and was diagnosed with a pyogenic liver abscess with Salmonella paratyphi at a site of a pre-existing simple liver cyst.

Impact of marker density on the accuracy of association mapping.

We studied the impact of marker density on the accuracy of association mapping using Genetic Analysis Workshop 15 simulated dense single-nucleotide polymorphism (SNP) data on chromosome 6. A total of 1500 cases and 2000 unaffected controls genotyped for 17,820 SNPs were analyzed. We applied the approach that combines information from multiple SNPs under the framework of the Malecot model and composite likelihood to non-overlapping regions of the chromosome.