Unprecedented Haemorrhagic Stroke: A Rare Manifestation of Atypical Haemolytic Syndrome.

Atypical haemolytic uraemic syndrome (aHUS) is a rare and complex condition characterized by systemic thrombotic microangiopathy resulting from complement dysregulation. While primarily affecting renal microvasculature, aHUS can present with multi-organ involvement, posing significant diagnostic and therapeutic challenges. We report the case of a 22-year-old female with a history of aHUS who developed a catastrophic haemorrhagic stroke.

Immunotherapy-Induced Overlap Syndrome: Myositis, Myasthenia Gravis, and Myocarditis-A Case Series.

Immune checkpoint inhibitors (ICI) are monoclonal antibodies that target immune checkpoint inhibitory receptors. They have revolutionised cancer treatment but can be associated with a wide range of adverse side effects. Rarely, they can be associated with the triad of myositis, myasthenia gravis, and myocarditis or overlap syndrome.

Clinical and Echocardiographic Correlates of Iron Status in Chronic Heart Failure Patients: A Cross-Sectional Descriptive Study.

Background:  Chronic heart failure (HF) is one of the conditions commonly seen in the medical outpatient departments, and iron deficiency (ID) has been reported as the commonest nutritional deficiency in these patients. The presence of ID may interfere with the clinical parameters of chronic HF. The relationship between iron status and chronic HF needs more attention and should be given more consideration in the evaluation of patients with chronic HF.

Epidermolysis bullosa aquisita following immune-checkpoint inhibitor treatment for metastatic melanoma.

A case of epidermolysis bullosa aquisita following immunotherapy for melanoma. This adds to the repertoire of subepidermal blistering disorders documented following immune checkpoint therapy.

Cancer-associated fibroblasts in renal cell carcinoma: implication in prognosis and resistance to anti-angiogenic therapy.

Objectives: To investigate the role of cancer-associated fibroblasts (CAFs) in clear cell renal cell carcinoma (ccRCC) with respect to tumour aggressiveness, metastasis development, and resistance to anti-angiogenic therapy (vascular endothelial growth factor receptor-tyrosine kinase inhibitors [VEGFR-TKI]).

Patients And Methods: Our study involved tissue samples from three distinct and independent cohorts of patients with ccRCC. The presence of CAFs and tumour lymphangiogenesis was investigated, respectively, by transcriptional signatures and then correlated with tumour development and prognosis.

Adult Granulosa Cell Tumor With High-grade Transformation: Report of a Series With FOXL2 Mutation Analysis.

Adult granulosa cell tumor (AGCT) is a low-grade malignant neoplasm with a significant propensity for late recurrence and metastasis. Almost all AGCTs are composed of cells with bland nuclear features and even when these tumors recur or metastasize, the nuclear features are almost always low-grade. We report 5 cases of AGCT in patients aged 37 to 88 years composed of areas of typical AGCT with low-grade morphology admixed with areas of high-grade morphology, with marked nuclear atypia, often with bizarre multinucleate cells and high mitotic activity; this is the first reported series of high-grade transformation in AGCTs.

A diagnostic dilemma of cryptogenic organising pneumonia.

Cryptogenic Organising Pneumonia is a rare lung condition, which has incidence of 6-9 cases per 1,000,000 people with onset at age group between 50-60. The pathogenesis of this condition remains unknown. It mimics like pneumonia but has a good outcome with steroid treatment.

Thrombolysis beyond 3 hours for acute ischaemic stroke.

Intravenous thrombolysis is an accepted form of treatment for acute ischaemic stroke when administered within 3 h of symptom onset. However, evidence for its benefit when given beyond this time continues to strengthen. The case history of a young woman is presented with an ischaemic stroke who was successfully thrombolysed with recombinant tissue-type plasminogen activator more than 3 h after presentation.

Outcome and complications of treatment of ankle diastasis with tightrope fixation.

Fixation of ankle syndesmosis injury with a fibre-wire tightrope has previously been reported. Early clinical results indicate that it can remain in situ indefinitely without complications. We are the first to report complications with the use of this device.

Avulsion fracture of inferior pole of patella and tibial spine--a case report of rare combination of knee injury.

A rare sport injury having patellar fracture and anterior cruciate ligament avulsion fracture is being reported. This case was noteworthy as it involved rare combination of two separate injuries often seen in sportsmen. Our experience with operative intervention and postoperative rehabilitation with a supervised physiotherapy regimen has yielded good results.

Permanent left atrial pacing: a 2-year follow-up of coronary sinus leads.

Left atrial pacing is feasible via the coronary sinus. However, long-term characteristics of coronary sinus pacing parameters are largely undefined as yet. This study assessed the feasibility and long-term pacing parameters of coronary sinus pacing.

Biatrial pacing for paroxysmal atrial fibrillation: a randomized prospective study into the suppression of paroxysmal atrial fibrillation using biatrial pacing.

Objectives: The purpose of this study was twofold: to assess whether biatrial pacing is superior to single-site pacing and capable of reducing the frequency of episodes of paroxysmal atrial fibrillation (PAF); and to compare pacing of the proximal coronary sinus (PCS) with the distal coronary sinus (DCS) and the effects of sequential or simultaneous biatrial pacing.

Background: Interatrial conduction abnormalities have a role in the initiation of PAF. Biatrial pacing alters the site and timing of atrial depolarization and may benefit those with drug-resistant PAF.

Single-agent mitomycin for advanced non-small cell lung cancer.

In the treatment of patients with advanced non-small cell lung cancer with chemotherapy, there is no consensus concerning the optimum regimen. Survival is poor and the activity of drugs has to be balanced against toxicity. There is therefore continued interest in the use of single-agent chemotherapy for this condition.

Operative mortality rates among surgeons: comparison of POSSUM and p-POSSUM scoring systems in gastrointestinal surgery.

Purpose: The original Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity and the more recent Portsmouth predictor equation for mortality scoring systems were developed to provide risk-adjusted mortality rates in general surgery. The aim of this study was to compare crude and risk-adjusted operative mortality rates among four surgeons using the above scoring systems and assess their applicability for patients scored retrospectively.

Methods: A total of 505 consecutive patients undergoing major gastrointestinal surgery were analyzed; 65 percent underwent colorectal, 27.

Initial experience of intramammary prostheses in breast conservation surgery.

Aims: We assessed the cosmetic and psychological effects of prosthetic intramammary breast reconstruction on women undergoing complete local excision for breast cancer.

Methods: Twenty-two women (mean age 54) underwent insertion of a Nagor silicone prosthesis into the breast cavity immediately following complete local excision. Following surgery, patients were assessed (range: 6 weeks to 1 year) by a postal questionnaire and independent photographs.

Genital herpes masquerading as anal fissures.

Sexually transmitted genital infections in women may affect the vulva, vagina, cervix and urethra, or more rarely the rectum. Proctitis, a common finding in surgical clinics, can be caused by sexually transmitted infections including gonococcal and chlamydial. This possibility should be considered by coloproctologists and general surgeons when sexually active young women present to them with relevant anorectal symptoms, particularly if the symptoms are of a relapsing nature.

Recurrent bacterial vaginosis--an old approach to a new problem.

Bacterial vaginosis (BV) is a common cause of abnormal malodorous vaginal discharge and can be frustrating to manage in its recurrent form. Metronidazole is the standard treatment, but is unacceptable to many women when given repeatedly. Results of treating recurrent BV using a single vaginal washout with 3% hydrogen peroxide are analysed.

Electrophysiology in a district general hospital.

Objective: To investigate the feasibility of performing electrophysiological studies at a district general hospital and to evaluate the importance of such studies in the management of patients with suspected arrhythmias.

Design: Retrospective study of patients having had electrophysiological studies during a three year period.

Setting: District general hospital.

Correction of myocardial ischaemia after transcatheter embolisation of a small left coronary artery venous fistula.

A 50 year old woman presented with a history of angina and palpitation. She had a positive exercise test and thallium scintigraphy showed reversible ischaemia in the territory of the left anterior descending coronary artery. Coronary angiography showed a small coronary arteriovenous fistula arising from the bifurcation of the left main stem--that is, the origin of the left anterior descending and circumflex coronary arteries--with no evidence of coronary stenosis.