The angiopoietin:Tie 2 interaction: a potential target for future therapies in human vascular disease.

Angiopoietin-1 and -2 are endogenous ligands for the vascular endothelial receptor tyrosine kinase Tie2. Signalling by angiopoietin-1 promotes vascular endothelial cell survival and the sprouting and reorganisation of blood vessels, as well as inhibiting activation of the vascular endothelial barrier to reduce leakage and leucocyte migration into tissues. Angiopoietin-2 generally has an opposing action, and is released naturally at times of vascular growth and inflammation.

A rare case of polyorchidism.

A 28-year-old offshore worker attended accident and emergency department with a tender benign-feeling lump inferior to the left testis. He was previously investigated abroad with an ultrasound scan showing a homogenous mass posterior to the left testis. Subsequent CT was unremarkable.

If at first you do not succeed, think again!

The authors describe a case of platypnoea orthodeoxia syndrome in an 83-year-old man with a fenestrated atrial septal defect and severe coronary artery disease. The patient had been admitted to hospital six times in the previous year with acute breathlessness, attributed to paroxysmal atrial fibrillation. The patient's symptoms resolved completely following surgical repair of the defect and coronary artery bypass grafting.

Skull base oncocytoma presenting as epistaxis: an unusual presentation of a rare tumour successfully managed with active surveillance.

Oncocytomas are rare tumours, usually occurring in the salivary glands, but may very occasionally occur in other sites. The authors present a skull base oncocytoma as a rare cause of spontaneous epistaxis. Following diagnosis through imaging and intranasal biopsy, the patient opted for annual surveillance instead of active treatment and made a full recovery nonetheless.

Hyperemesis gravidarum and fetal gender: a retrospective study.

This retrospective study of 9,980 women who delivered at the James Paget Hospital, Norfolk, UK, over 5 years, aimed to primarily determine whether the incidence of hyperemesis gravidarum (HG) is higher in the presence of a female fetus. The results showed that more women with HG had a female fetus compared with women without HG. Also found was that heavy ketonuria was more prevalent in women with a female fetus compared with women with a male fetus, and the mean number of admissions per woman was also higher in women with a female fetus compared with women with a male fetus.

The use of cerclage wires as a suture passer in the repair of quadriceps tendon ruptures.

We describe a novel, simple and cost-effective method of passing sutures through the patella, without the need for expensive or specialised equipment.

Ehlers Danlos Syndrome Type IV and pregnancy.

Introduction: A case report is presented of a 23-year-old patient who was diagnosed with Ehlers Danlos syndrome (EDS) Type IV (vascular type) in the 23rd week of her second pregnancy. EDS Type IV has one of the highest mortality rates for pregnant women of any condition with significant morbidity if the mother survives.

Discussion: Current literature is presented and supports the necessity for close monitoring of mother and child in a specialist unit with involvement of a multi-disciplinary team.

Congenital isolated absence of the inferior oblique muscle and compensatory aberrant insertion of the inferior and lateral recti.

Absence of various extra-ocular muscles has previously been described. However isolated absence of the inferior oblique has not yet been described. Our patient was found to have a small right esotropia and limitation of right eye abduction with an abnormal head posture.

Choosing the optimum swab for canal drying in cemented total hip replacement.

During total hip replacement, the reamed medullary canal of the femur should represent a clean, dry surface. We compared the effectiveness of 4 different cotton swabs in a synthetic femur that had been reamed to receive a size 1 Exeter trial prosthesis. Swab sizes included a 2.

Accidental delivery of a baby during a caesarean section through a vaginal incision (a laparoelytrotomy).

A 27-year-old woman was admitted at 39 weeks' gestation for induction of labour for gestational diabetes. During artificial rupture of her membranes, cord prolapse occurred necessitating an emergency caesarean section. At closure, the incision, instead of being in the lower uterine segment, was found to be in the vagina about 1.

Intraorbital organic foreign body--a diagnostic challenge.

Intraorbital organic foreign bodies pose a diagnostic and management challenge to ophthalmologists. A high degree of suspicion of an orbital foreign body is needed when patients present with injuries to the eyelids and orbit. We present a case of retained intraorbital wooden foreign body which was initially undetected.

Eosinophilic colitis.

Eosinophilic colitis is a rare chronic inflammatory bowel condition of unknown etiology. We report a case of cecal volvulus causing obstruction in a patient with eosinophilic colitis. A 48-year-old lady presented with abdominal pain, constipation, and abdominal distension.

Current management strategies for testicular microlithiasis.

The association of testicular microlithiasis with testicular tumor and the management of incidentally detected testicular microlithiasis have generated a great deal of interest. We review the current literature on testicular microlithiasis with regard to its association with testicular tumor. This association seems complex.

To "EE" or not to "EE".

Objective: To assess whether /i:/ ("ee") is the best sound to use during indirect laryngoscopy to produce the optimal view of the larynx.

Design: Prospective study.

Setting: District general hospital otolaryngology outpatient clinic.

Neurological deterioration in diabetic ketoacidosis is it cerebral edema or something else?

Cerebral edema (CE) is the commonest cause of morbidity and mortality during the first day of treatment for (DKA) in pediatric patients, but if neurological deterioration occurs during treatment of diabetic ketoacidosis, other possibilities must also be considered. We present a 13 month old girl with DKA and meningococcal meningitis.

Intranasal myopericytoma. A tumour with perivascular myoid differentiation: the changing nomenclature for haemangiopericytoma.

We present a case report of a patient who developed a sinonasal myopericytoma treated by surgical excision through a lateral rhinotomy. Some aggressive features on pre-operative computed tomography scanning and the complexity of recent changes in the histological nomenclature for these tumours led to consideration of adjuvant therapy. The close histological relationship between myopericytoma, myofibromatosis, solitary myofibroma and infantile haemangiopericytoma is discussed.

Randomized clinical trial comparing two mastectomy techniques.

Background: The unit was considering the routine use of diathermy scissors for standard mastectomy surgery. We therefore aimed to assess scientifically the outcome of patients following the use of this instrument in their operation before accepting it as a routine procedure.

Methods: A single blind randomized control trial compared the outcome of patients undergoing simple mastectomy using either the standard scalpel blade technique or the bipolar cutting scissors technique.

The European working time directive.

A British perspective