Grave's Eye disease developing following radioiodine treatment for toxic nodular goitre.

The development of Grave's ophthalmopathy (GO) following radioiodine (RI) treatment for Grave's thyrotoxicosis, though controversial, is well described. The development of ophthalmopathy following RI treatment for toxic nodular goitre is much less recognised. We report a 49 year-old female patient who developed thyrotoxicosis and GO after receiving RI treatment for toxic nodular goitre and we also review the relevant literature.

Diabetes care and the new GMS contract: the evidence for a whole county.

The aim of this study was to assess the impact of the Quality and Outcomes Framework (QOF) of the new GP contract on diabetes care in Shropshire, which has a total population of approximately 460 000. The mean percentage of patients achieving each of the quality indicators in each practice in Shropshire, before and after the implementation of the QOF was calculated. All 16 867 patients with diabetes from all 66 Shropshire practices were included.

The eosinophilic ulcer revisited.

This paper reviews the eosinophilic ulcer and presents a case of such an ulcer on the tongue of a young female patient. The stages involved in arriving at a differential diagnosis are discussed, along with management of the condition.

An unusual cause of severe hypoglycaemia in type 1 diabetes mellitus. Antepartum pituitary failure: a case report and literature review.

We describe an unusual cause of severe hypoglycaemia, secondary to hypopituitarism as a result of antepartum pituitary failure, in a pregnant patient with type 1 diabetes mellitus (T1DM). Antepartum pituitary failure is a very rare condition, which has been reported only in a very small number of pregnant patients with diabetes and presents with an acute onset headache and a sub-arachnoid haemorrhage-like picture. It is a potentially fatal condition to the mother and the child if not recognised and treated.

Evaluation of glargine group-start sessions in patients with type 2 diabetes as a strategy to deliver the service.

Improving glycaemic control in patients with type 2 diabetes reduces microvascular complications. The national service framework for diabetes and the new general medical service contract have been aiming to direct more focus on improving HbA1c. These measures have resulted in increasing number of patients being initiated on insulin therapy, which increases the workload of diabetes specialist nurses (DSNs).

Use of inferior vena cava filters in thromboembolic disease during labor: case report with a literature review.

Thromboembolic diseases during pregnancy are usually managed by conventional anticoagulation and patients are at high risk of pulmonary embolism. Inferior Vena Cava (IVC) filters can be used in cases of documented pulmonary embolism (PE) where anticoagulation is contraindicated or has failed. In our case the patient was diagnosed as having a deep vein thrombosis (DVT) and was started on anticoagulant therapy.

Spontaneous rupture of the hepatic artery in a patient with type 1 neurofibromatosis treated by embolization: a case report.

We report the case of a 48-year-old man with neurofibromatosis presenting with sudden-onset abdominal pain, profound hypotension, and a drop in hemoglobin. CT scan demonstrated a massive hematoma within the right lobe of the liver with rupture into the peritoneal cavity. Angiography demonstrated diffuse abnormalities of the hepatic circulation with fusifom, ectatic, and stenotic segments.

Relation of atrial shunts to migraine in patients with ischemic stroke and peripheral emboli.

This study investigated whether the increased incidence of stroke in young subjects with migraine is because they have an increased prevalence of atrial right-to-left shunts. The investigators report the prevalence of clinically relevant atrial shunts in those with stroke and migraine compared with those with stroke but without migraine and also in historic control groups of subjects who had migraine with aura but no stroke and in population controls. Of 60 consecutive stroke patients, 42 (70%) had large- or medium-sized atrial shunts.

Popliteal artery branching patterns -- an angiographic study.

Aim: To analyse the variations in branching patterns of the popliteal artery and infrapopliteal vessels using angiography.

Materials And Methods: Femoral angiograms of 1037 lower limbs in 568 patients were examined to assess the popliteal artery branching pattern. Variations of the infrapopliteal vessels supplying the foot were assessed in 662 limbs from the same cohort of patients.

Long-term results of endonasal laser dacryocystorhinostomy.

Objective: To determine the long-term success rate of endonasal laser dacryocystorhinostomy (DCR) in our unit.

Materials And Methods: This was a retrospective study including all the consecutive cases of endonasal laser DCR (ELDCR) between November 1996 and December 1999. Patients who underwent revision DCR were excluded.

The development of non-insulin-dependent diabetes after total body irradiation and bone marrow transplantation in adolescence: a case report and literature review.

A 6-yr-old-child received total body irradiation (TBI) and bone marrow transplantation (BMT) for relapsed acute lymphocytic leukemia. Nine years later, he developed diabetes mellitus (DM). He was started on basal bolus insulin therapy.

A prospective, randomized trial comparing conventional transurethral prostate resection with PlasmaKinetic vaporization of the prostate: physiological changes, early complications and long-term followup.

Purpose: We compared standard transurethral prostate resection with bipolar PlasmaKinetic prostate vaporization for bladder outflow obstruction using a Gyrus PlasmaKinetic Plasma V bar.

Materials And Methods: A total of 160 men were enrolled in a prospective, randomized trial. Those at higher risk for cancer were excluded by prostate specific antigen and digital rectal examination with or without transrectal ultrasound biopsy.

A diagnostic dilemma in diagnosing and managing an incidental phaeochromocytoma.

Incidental adrenal tumours are a common radiological finding. Phaeochromocytomas, though rare, are very important not to be missed, as the consequences could be fatal. Urinary catecholamines and metanephrines measurement is a commonly used method of screening for phaeochromocytomas.

Sequential metatarsal fatigue fractures secondary to abnormal foot biomechanics.

Sequential fatigue fractures of the fourth, second, and third metatarsals in the same foot are reported for a military aviator in the absence of abnormal stresses or underlying bone disease. The likely etiological factor is altered foot biomechanics, as identified in pedobarographic assessment. We have reviewed the literature regarding multiple metatarsal stress fractures.

The role of cardiac and pulmonary pathology in migraine: a hypothesis.

From observation of recent data linking migraine with right-to-left shunts and by analogy with the etiologies of decompression illness, we postulate that cardiac and pulmonary pathology can have an important effect on the cranial final common pathway that generates attacks of migraine. One possible mechanism is associated with a significant right-to-left shunt, which is usually through a persistent foramen ovale, but is sometime through a pulmonary shunt. This allows a venous agent, possibly 5-hydroxytryptamine, to bypass the lung filter.

An unusual cause of acute abdominal pain - a case presentation.

Background: In 1983, Graham Hughes described a condition of Antiphospholipid Syndrome in which there was a danger of thrombosis. The condition is readily detectable by blood tests and, once diagnosed; the risk of further thrombosis can be significantly reduced by anticoagulation treatments. Affected groups of patients can be distinguished by a specific blood test - the detection of antiphospholipid antibody (Ref-1).

Persistent epistaxis: what is the best practice?

Epistaxis is the commonest otolaryngological emergency, which is often managed by a nasal pack. A significant number of cases fail to respond to nasal packing and various surgical measures are available to control the nosebleed in these cases. However evidence is sparse regarding the best available surgical option for the management of persistent epistaxis.

Investigation of acute flank pain: how do practices of U.K.and Irish urologists compare with those of transatlantic and continental European colleagues?

Background And Purpose: Noncontrast-enhanced spiral CT (NESCT) is more accurate and reliable than intravenous urography (IVU) in diagnosing the cause of acute flank pain. This study aimed to determine the impact of current literature on the choice of imaging modality used to investigate acute flank pain within the UK and the Republic of Ireland.

Materials And Methods: A questionnaire regarding the preferred investigation for acute flank pain was sent to all consultant urologists registered as British Association of Urological Surgeons members.