A clue on the face..

A case of a 4-month-old girl with a subglottic haemangioma successfully treated with propranolol is reported.

An unusual case of dyspnoea in an elderly man.

Defective closure of the posterolateral pleuroperitoneal canal during embryogenesis gives rise to a congenital hernia (usually left sided) which was originally described by Bochdalek in 1948. It manifests primarily in children with respiratory symptoms and pulmonary hypoplasia. It is exceptionally rare for this defect to present in adulthood, with just over 50 symptomatic cases being described in the literature.

Genital verrucous carcinoma is associated with lichen sclerosus: a retrospective study and review of the literature.

Background: The association of lichen sclerosus (LS) with genital squamous cell carcinoma is well recognized. However, the relationship between LS and verrucous carcinoma remains unclear.

Objective: To evaluate the associations of genital and perianal verrucous carcinomas with LS.

Automated uro-oncology data collection: the Cancer Research Uro-Oncology Database.

Objective: To develop a relational database (Cancer Research Uro-Oncology Database, CRUD) to enable automatic data collection on all urological malignancies within our region, as there is increasing emphasis on good data collection for surgical patients with cancer, and numerous overlapping systems that are amassing data on the same patients.

Methods: Links have been established between pathological databases, multidisciplinary team data-collection systems and patient-survival monitoring facilities, providing accurate pathology, treatment and survival data on all of uro-oncology patients. We are also developing individual modules for the oncological surgeons within our unit that are compatible with the British Association of Urological Surgeons (Section of Oncology), and have plans to connect to the Medical and Clinical Oncology data systems in the future.

Biloma: an unusual complication in a patient with pancreatic cancer.

The term biloma describes an encapsulated collection of bile within the abdomen, usually secondary to bile duct disruption. The commonest causes reported in the literature are iatrogenic (secondary to hepatobiliary surgery), trauma or complications due to choledocholithiasis. A few cases have been reported as complications of cholangiocarcinoma or acute cholecystitis.

Seborrheic dermatitis among Oxford renal transplant recipients.

Background: Seborrheic dermatitis is an inflammatory dermatosis with a prevalence of 1-3% in the general population. It is recognized more commonly in those infected by human immunodeficiency virus (HIV). No studies have looked at Seborrheic dermatitis in the context of immunosuppression secondary to organ transplantation.

Safety, tolerability, pharmacokinetics and pharmacodynamics of the oral cyclin-dependent kinase inhibitor AZD5438 when administered at intermittent and continuous dosing schedules in patients with advanced solid tumours.

Background: AZD5438 is an orally bioavailable inhibitor of cyclin E-cdk2, cyclin A-cdk2 and cyclin B-cdk1 complexes. Three phase I studies assessed the clinical safety, tolerability, pharmacokinetics and pharmacodynamics of AZD5438 when administered in different dosing schedules.

Patients And Methods: AZD5438 was administered four times daily, once every 7 days (study 1), for 14 consecutive days followed by 7 days of rest (study 2), or continuously (study 3), to patients with advanced solid tumours.

Multiple sclerosis associated with Leber's Hereditary Optic Neuropathy.

The cause of multiple sclerosis is unknown although it is recognised to involve an inflammatory process associated with demyelinating plaques and more widespread neurodegeneration. It appears to have become progressively more common in females which is further discussed in this issue, and genetic factors, as identified to date, appear to play only a moderate role. One curious observation is that Leber's Hereditary Optic Neuropathy (LHON), a rare genetic syndrome, presents clinically overwhelmingly in males, but can be associated with an MS-like illness and when it does it occurs mainly in females.

Association of seborrhoeic warts with skin cancer in renal transplant recipients.

Background: Renal transplant recipients (RTR) have a well recognized increased risk of cutaneous malignancy. A clinical observation that RTR with skin cancer often had multiple seborrhoeic warts prompted an investigation in RTR into the relationship between seborrhoeic warts and skin cancer and an exploration into potential risk factors for seborrhoeic warts in this population, including infection with human papillomavirus (HPV).

Methods: This was a case control study involving 308 RTR.

Multiple sternotomies for repeated aortic root replacement--optimising the surgical approach.

A 44-year-old patient with fungal endocarditis required a total of five sternotomies over ten years. We present the course of his treatment, details of the surgical techniques employed as well as other interesting points encountered in the management of this patient.

Malakoplakia presenting as an enlarging neck mass: Case presentation and review of the literature.

Background: Malakoplakia is a very rare chronic inflammatory disorder, first described in 1902. In 75% of cases, the condition affects the genitourinary tract. Five cases of malakoplakia affecting the neck were previously reported in the literature.

Single dose oral flurbiprofen for acute postoperative pain in adults.

Background: Flurbiprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID), related to ibuprofen and naproxen, used to treat acute and chronic painful conditions. There is no systematic review of its use in acute postoperative pain.

Objectives: To assess efficacy, duration of action, and associated adverse events of single dose oral flurbiprofen in acute postoperative pain in adults.

Are routine pre-operative blood tests required in children undergoing primary cleft lip and/or palate repair?

Primary surgical repair of cleft lip and/or palate is performed before 9 months of age, often representing the first surgical intervention these children encounter. Obtaining pre-operative blood tests in young children often produces much anxiety for all involved. We reviewed the electronic data of 282 children over a five-year period undergoing primary cleft repairs to determine the value of pre-operative full blood count, and transfusion requirements.

Incidence of haemoglobinopathies in various populations - the impact of immigration.

Objectives: The aim of this study was to update the incidence data of beta thalassaemia mutations in various populations and compare it to the spectrum of mutations in the United Kingdom (UK) population in order to determine the impact of immigration.

Design And Methods: Published data for the beta-thalassaemia mutation spectrum and allele frequencies for 60 other countries was updated and collated into regional tables. The beta-thalassaemia mutations in the UK population have been characterised in 1712 unrelated carriers referred for antenatal screening.

An alternative to gamma histograms for ROI-based quantitative dose comparisons.

An alternative to gamma (gamma) histograms for ROI-based quantitative comparisons of dose distributions using the gamma concept is proposed. The method provides minimum values of dose difference and distance-to-agreement such that a pre-set fraction of the region of interest passes the gamma test. Compared to standard gamma histograms, the method provides more information in terms of pass rate per gamma calculation.

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The guidance is welcome and was needed to provide clarity, particularly in determining the appropriate level of NHS involvement when patients are faced with decisions about treatments that are not available at taxpayers' expense.

A novel mutation in a patient with a deficiency of the eighth component of complement associated with recurrent meningococcal meningitis.

Introduction: Complement component C8 is one of the five terminal complement components required for the formation of the membrane attack complex. Complete absence of C8 results in increased susceptibility to gram-negative bacteria such as Neisseria species.

Materials And Methods: Two functionally distinct C8 deficiency states have been described: C8 alpha-gamma deficiency has been predominantly reported amongst Afro-Caribbeans, Hispanics, and Japanese and C8beta mainly in Caucasians.

Evaluation of point-of-care activated partial thromboplastin time testing by comparison to laboratory-based assay for control of intravenous heparin.

Introduction: Patients on intravenous heparin require regular activated partial thromboplastin time monitoring. Laboratory-based activated partial thromboplastin time assays necessitate a delay between blood sampling and dose adjustment. Point-of-care testing could permit immediate dose adjustments, potentially enabling tighter control of anticoagulation.

Update in understanding common variable immunodeficiency disorders (CVIDs) and the management of patients with these conditions.

The common variable immunodeficiency disorders are a mixed group of heterogeneous conditions linked by lack of immunoglobulin production and primary antibody failure. This variability results in difficulty in making coherent sense of either immunopathogenesis or the role of various genetic abnormalities reported in the literature. The recent attempt to collate the varied complications in these conditions and to define particular clinical phenotypes has improved our understanding of these diseases.

Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up.

Background: Our aim was to assess the long-term risks of death, disability, and rebleeding in patients randomly assigned to clipping or endovascular coiling after rupture of an intracranial aneurysm in the follow-up of the International Subarachnoid Aneurysm Trial (ISAT).

Methods: 2143 patients with ruptured intracranial aneurysms were enrolled between 1994 and 2002 at 43 neurosurgical centres and randomly assigned to clipping or coiling. Clinical outcomes at 1 year have been previously reported.

Dissecting and refining the staging of chronic kidney disease.

The current Kidney Disease Outcomes Quality Initiative (KDOQI) staging system of chronic kidney disease (CKD) is simple but too rigid to accommodate variations in renal function observed in the general population. The formula most commonly used to estimate renal function is not validated in subjects without a priori evidence of renal disease. Their combined use results in inappropriate diagnosis of CKD and improbable estimates of prevalence rates.