Cytological follow-up after hysterectomy: is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach.

Objectives: Vaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged.

Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: is it common?

Asymptomatic spontaneous coronary artery spasm is rare and there are no case reports in literature presenting with acute ST elevation on routine ECG. We present the case of a 68-year-old Caucasian man who presented to a primary care physician for a routine ECG as part of hypertension follow-up. ECG revealed ST elevation in inferior leads II, III and aVF with reciprocal ST depression in leads I, aVL and also ST depression in anterior leads V1, V2 and V3 suggesting ongoing inferoposterior ST elevation myocardial infarction.

Olecranon bursitis: a systematic overview.

Background: Olecranon bursitis is a common condition where the bursal cavity, superficial to the olecranon, becomes inflamed. This can occur either with or without infection and has been given pseudonyms relating to the repeated minor trauma from external pressure that often predisposes. As a result of the multiple aetiologies, olecranon bursitis can present to any medical specialty with reasonable frequency and, although many therapies are described, a single, evidence-based and standardized treatment pathway is not well described.

Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial.

Background: Evidence is scarce for the effectiveness of therapies for oesophageal cancer progressing after chemotherapy, and no randomised trials have been reported. We aimed to compare gefitinib with placebo in previously treated advanced oesophageal cancer.

Methods: For this phase 3, parallel, randomised, placebo-controlled trial, eligible patients were adults with advanced oesophageal cancer or type I/II Siewert junctional tumours, histologically confirmed squamous-cell carcinoma or adenocarcinoma, who had progressed after chemotherapy, with WHO performance status 0-2, and with measurable or evaluable disease on CT scan.

Primary uterine osteosarcoma presenting synchronously with bilateral breast carcinomas.

Primary uterine sarcomas are infrequent neoplasms and most commonly leiomyosarcomas or endometrial stromal sarcomas. We report a rare case of primary uterine osteosarcoma discovered in a woman in her 60s following staging CT imaging for bilateral breast carcinomas. Examination of the subsequent hysterectomy specimen showed a tumour composed of malignant spindle cells and osteoclast-like giant cells associated with osteoid and neoplastic bone, in keeping with primary uterine osteosarcoma.

Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries.

Achilles tendon ruptures tend to occur more commonly in healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. The injury is usually due to sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot and violent dorsiflexion of a plantar flexed foot, all of which occur during high impact activities. We present the first reported case of interactive activity with Nintendo Wii games that have resulted in Achilles tendon rupture in a 46-year-old man.

A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy.

Uterine torsion is rare in pregnancy and the cause in most cases is unknown. It is associated with fetal compromise, with perinatal mortality reported to be around 12%. Our case describes an acute torsion, presenting in pregnancy with severe abdominal pain and vomiting with a viable 32-week gestation.

UK temporomandibular joint replacement database: report on baseline data.

Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually.

Enterobius vermicularis infection of the ovary.

Enterobius vermicularis is an intestinal parasite, which may occasionally involve extraintestinal sites including the female genital tract. We report a rare case of ovarian involvement, which presented with chronic right iliac fossa pain in a 31-year-old woman. A transvaginal ultrasound scan was suggestive of a right adnexal dermoid cyst; however, histological examination of the subsequent salpingo-oophorectomy specimen showed an abscess containing viable E.

Haemorrhage control in extremity stab injury.

The Foley catheter is described in the emergency treatment of penetrating cardiac injuries, and its intra-operative use to control bleeding while definitive measures for intravascular embolization are being made. We present the first reported case of the use of a urinary catheter to control haemorrhage in an extremity stab injury to obtain haemodynamic stability while awaiting definitive surgical treatment. This quick, easy and useful technique can be used for junctional vascular injuries and wounds with a narrow neck, and can be easily removed once in the operating theatre.

Internal iliac aneurysm presenting with lower back pain, sciatica and foot drop.

Internal iliac aneurysms are usually silent and are identified as an incidental finding on a radiological investigation for an unrelated condition, unless catastrophic bleeding occurs. We present the first case of a middle-aged man with a large internal iliac aneurysm presenting with a foot drop and sciatic nerve pain. The endovascular management is discussed.

Role of exclusive breastfeeding in energy balance and weight loss during the first six months postpartum.

Purpose: To investigate the energy intake (EI), energy expenditure (EE), and body weight changes of solely breastfeeding women during the first six months postpartum.

Materials And Methods: This is a prospective observational study of lactating women (n = 64). Three-day dietary records were filled in to assess EI.

Effect of hyperventilation on rate corrected QT interval of children.

Background: Hyperventilation is known to cause ST segment changes and QT variability in adults, but this has not been systematically studied in children.

Aim: To investigate the effect of hyperventilation on rate corrected QT interval (QTc) in children.

Methods And Results: 25 children (male=10) with a median age of 14 (range 8.

Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies.

Background: There is a risk that people who have invasive urodynamic studies (cystometry) will develop urinary tract infections or bacteria in the urine or blood. However, the use of prophylactic antibiotics before or immediately after invasive cystometry or urodynamic studies is not without risks of adverse effects and emergence of resistant microbes.

Objectives: To assess the effectiveness and safety of administering prophylactic antibiotics in reducing the risk of urinary tract infections after urodynamic studies.

Speech in noise testing before and after grommet insertion.

Objectives: To assess the feasibility of designing and implementing a speech in noise test in children before and after grommet insertion, and to analyse the results of such a test in a small group of children.

Methods: Twelve children aged six to nine years who were scheduled to undergo grommet insertion were identified. They underwent speech in noise testing before and after grommet insertion.

An incidental peri-adrenal cystic lesion.

A 50-year-old man was found to have an incidental peri-adrenal cystic lesion on CT imaging which was removed laparoscopically. Histological examination showed a cystic structure composed of respiratory and cuboidal-type epithelium with underlying smooth muscle, cartilage and seromucinous glands. The differential diagnosis for such a lesion includes bronchogenic cyst or teratoma differentiated.

Seizures in the early post-partum period: A diagnostic dilemma.

We discuss the differential diagnosis and management of early post-partum seizures and headache following a presumed dural puncture in a 20-year-old female. She initially presented with generalised tonic-clonic seizures preceded by nausea and headache on the fourth post-partum day along with a decreased Glasgow Coma Scale (8/15). Although clinical and laboratory examination including lumbar puncture, computerized tomography and magnetic resonance imaging were normal, a persistent headache was the only symptom.

Outcomes of endoscopic sphenopalatine artery ligation for epistaxis: a five-year series from a single institution.

Epistaxis is a common emergency seen by the otolaryngologist. A minority of cases require surgical intervention. Multiple surgical procedures have been tried in the past, including endoscopic ligation of the sphenopalatine artery (ELSPA), which is considered an effective surgical modality in the management of epistaxis.

Caecum herniation through the Foramen of Winslow.

Foramen of Winslow herniation is a rare occurrence with a high mortality; it presents a diagnostic challenge with subtle clinical and radiological features. We present a case of caecal herniation through the foramen of Winslow creating a closed loop obstruction which remained undiagnosed until laparotomy. Reduction was achieved with gentle traction after first decompressing the caecum whilst still within the lesser sac.