Designer orthopaedic surgery in a patient with anti-Vel antibodies.

The authors present a rare case of anti-Vel antibodies in a patient who underwent a shoulder replacement with a custom designed procedure which involved combination of autologous blood pre-deposit, pre-operative haemodilution and resurfacing arthroplasty.

Plain abdomen radiographs: the right view?

Background: Plain abdomen radiographs (PAR) have limited use in the setting of the emergency department. We conducted this study to look at the appropriateness of requests and its utilization in our emergency department.

Methodology: We conducted a retrospective analysis of scanned emergency department notes between the period of December 2005 and February 2006 (3 months).

Current concepts in research related to oncogenes implicated in salivary gland tumourigenesis: a review of the literature.

Background: Salivary gland tumours are relatively uncommon and there exists considerable difficulty in decisions regarding prognosis and management, as well as diagnostic uncertainty that has implications for treatment.

Method: Literature pertaining to individual oncogenes has been reviewed and commented upon, specifically looking at the role of these as diagnostic and prognostic markers and as potential targets for treatments.

Results: kit, PLAG1, Mect1-Maml2, HMGIC, HER2/neu, ras, c-fos and Sox-4 all have seminal small-scale studies in the literature with potential for further research and eventual clinical applications.

Spontaneous atraumatic Achilles tendon rupture in healthy individuals: biomechanical aspect.

Achilles tendon rupture bilaterally secondary to predisposing factors such as steroid, fluoroquinolones, SLE, RA etc. Other factors are well-described in the literature but this is an extremely rare phenomenon in the absence of risk factors. Available reports in healthy athletes, all had history of severe trauma.

Prospective audit of the effectiveness of hydrocortisone premedication on drug delivery reactions following amphotericin B lipid complex *.

Objective: Amphotericin B lipid complex (ABLC), a lipid-based formulation of amphotericin B, is an effective treatment for fungal infections, but is associated with mild to moderate drug delivery reactions (DDRs), such as fever, rigors and chills, in some patients. Although clinical studies have indicated that premedication with hydrocortisone may reduce the incidence of DDRs, there are currently limited confirmatory data from clinical practice. The aim of the audit was to assess prospectively a hydrocortisone premedication strategy with ABLC to reduce the rate of DDRs.

Hepatic artery aneurysm repair: a case report.

Introduction: Hepatic artery aneurysms remain a clinically significant entity. Their incidence continues to rise slowly and mortality from spontaneous rupture is high. Repair is recommended in those aneurysms greater than 2 cm in diameter.

Do babies with isolated single umbilical artery need routine postnatal renal ultrasonography?

Background: The presence of isolated single umbilical artery (SUA) in infants has been associated with an increased risk of occult renal malformations. However, the need for routine postnatal renal imaging of such infants, especially in an era of now routine antenatal fetal sonography, is controversial.

Aim: To determine the prevalence of significant renal anomalies and the need for routine postnatal renal imaging in infants with isolated SUA.

Severe hypomagnesaemia due to lansoprazole.

A 71-year-old woman, who had been taking lansoprazole for 18 months for dyspepsia, presented with vomiting, thought to be due to gallstones, and was found to have severe hypomagnesaemia. She was treated with intravenous and then oral magnesium, and discharged, but was soon readmitted with symptoms due to hypomagnesaemia, and again treated with magnesium supplementation. No other recognised cause for hypomagnesaemia was found.

Development of a scrotal vasocutaneous fistula producing viable spermatozoa 9 years after vasectomy.

Objective: To describe a case of scrotal vasocutaneous fistula discharging viable sperm.

Design: Case report.

Setting: A hospital-based assisted conception center.

Daptomycin in endocarditis and bacteraemia: a British perspective.

Assessment of the place of daptomycin in the treatment of endocarditis and bacteraemia requires assimilation of data from one open-label randomized comparative clinical trial sized for equivalence, from registry data and from case reports. Selected relevant animal models and in vitro data are also considered in an effort to produce an integrated assessment of the current place of daptomycin in treatment. The evidence for the use of daptomycin is best in Staphylococcus aureus bacteraemia and endocarditis, but also includes some data on infections due to Enterococcus spp.

Endobronchial obstruction from an intubation stylet sheath.

Many clinicians intubate newborns using a stylet, but how many always check if the device is intact after use? We describe a case of endobronchial obstruction by a plastic sheath coating the metal stylet, and suggest ways to reduce the incidence of this serious iatrogenic complication.

Treatment of scaphoid nonunion with combined vascularized distal radius graft and iliac crest bone graft.

The optimal treatment of scaphoid nonunion is a controversial and challenging task in hand surgery. Although advances in internal fixation techniques have resulted in improved union rates, fractures with impaired vascularity have less than satisfactory results with conventional grafting techniques. We describe the technique of using a tricortical iliac crest graft and a vascularized distal radius graft in cases of nonunion with avascular necrosis.

Late recurrence of large peri-stomal metastasis following abdomino-perineal resection of rectal cancer.

Background: Cutaneous metastasis from colorectal cancer after excision of the primary is a rare occurrence and presents as cutaneous or subcutaneous nodules or as a rash commonly on the anterior abdominal wall.

Case Presentation: This is a case description of the management of a large fungating peristomal cutaneous metastasis occurring 14 years after abdomino-perineal excision of the primary cancer. The gross appearance initially suggested possibility of a true metachronous cancer with peristomal spread.

The nature and severity of voice disorders in lung cancer patients.

This study examines the nature and severity of voice disorders in a set of lung cancer patients. Patients' concern for their voice, relative to other lung cancer symptoms, will also be examined. Voice assessment included both the patients' view (Voice Handicap Index) and expert clinicians' perceptual rating of voice quality (GRBAS).

The role of capillary density, macrophage infiltration and interstitial scarring in the pathogenesis of human chronic kidney disease.

To assess the relationship between interstitial capillary density and interstitial macrophages we prospectively measured these factors in situ in 110 patients with chronic kidney disease. Macrophage numbers and urinary MCP-1/CCL2 levels significantly correlated inversely with capillary density which itself significantly correlated inversely with chronic damage and predicted disease progression. In 54 patients with less than 20% chronic damage, there was a significant correlation between the urinary albumin to creatinine ratio and MCP-1/CCL2, and MCP-1/CCL2 and macrophages but not between MCP-1/CCL2 and capillary density.

A patient with worsening mobility: a diagnostic challenge.

Worsening mobility and "off legs" are common reasons to seek a medical opinion. A 62-year-old gentleman, previously fit and healthy, was referred to a district general hospital in the UK with worsening mobility. The initial clinical features were suggestive of Miller Fisher syndrome (MFS).

Spleno-renal bypass facilitating endovascular stenting of a juxta-renal aortic aneurysm in a high risk patient.

The management of juxta-renal abdominal aortic aneurysms (AAA) is challenging. Open surgical repair is associated with significant morbidity (predominantly renal) and the absence of an adequate length of normal infra-renal aorta precludes the placement of a standard endograft. In high-risk patients who are unsuitable for standard open repair the endovascular options include fenestrated or branched stent grafts, which are complex, expensive and not widely available, especially in the acute setting.

Control of infections due to extended-spectrum beta-lactamase-producing organisms in hospitals and the community.

Control of infection classically involves hand and healthcare hygiene, reduction of selective and ineffective chemotherapy, reduction of invasive procedures and achlorhydria and adequate staffing, along with appropriate containment and concentration of patients. Investigation and control of any continuing sources of infection in food and water supplies is important also, as is recognition of individuals carrying high-risk strains and species. The onset of infection may be distant from the time of acquisition and may critically affect epidemiological assessment of control points.

Case report: herpes meningitis complicating genital herpes presenting as anal fissure.

A 33-year-old woman presented with stabbing perianal pain and intermittent headache and photophobia. Examination revealed atypical multiple perianal fissures with non-specific neurological findings. Polymerase chain reaction of the perianal swab and cerebrospinal fluid examination confirmed the diagnosis of perianal herpes simplex type 2 ulcer with herpes meningitis.

Once weekly thyroxine treatment as a strategy to treat non-compliance.

Hypothyroidism is a common disorder, which is mainly treated in primary rather than secondary care. Once daily thyroxine replacement restores euthyroidism in most patients; some patients, however, remain hypothyroid despite adequate thyroxine replacement. Non-compliance is the most common cause of lack of response to thyroxine treatment.