In-flight angina pectoris; an unusual presentation.

Background: An unusual case of typical angina which occurred on a long haul flight is presented. This case is notable as this was the index presentation, with no previous symptoms prior to this. Physiological changes at altitude can be marked, and include hypoxia, tachycardia and an increase in cardiac output.

4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): a randomised phase 3 non-inferiority trial.

Background: Follicular lymphoma has been shown to be highly radiosensitive with responses to doses as low as 4 Gy in two fractions. This trial was designed to explore the dose response for follicular lymphoma comparing 4 Gy in two fractions with 24 Gy in 12 fractions

Methods: FORT is a prospective randomised, unblinded, phase 3 non-inferiority study comparing radiotherapy given as 4 Gy in two fractions with a standard dose of 24 Gy in 12 fractions. Entry criteria included all patients aged over 18 years, having local radiotherapy for radical or palliative local control, with follicular lymphoma or marginal zone lymphoma, who had received no previous treatment for at least 1 month before.

Medium-term results of anal advancement flap compared with lateral sphincterotomy for the treatment of anal fissure.

Introduction: Anal fissure is associated with anal pain and bleeding. Lateral internal sphincterotomy (LIS) has been a common form of surgical management. This can however cause incontinence and hence an equally effective alternative without this risk would be ideal.

A life threatening uterine inversion and massive post partum hemorrhage caused by placenta accrete during Caesarean section in a primigravida: a case report.

Background: A 32-year-old Caucasian primigravida was admitted for elective Caesarean Section at 36 weeks and 6 days with the diagnosis of preeclampsia.

Case Presentation: Traction of the umbilical cord after delivery of a healthy baby resulted in uterine inversion. The placenta was found to be densely adherent to the posterior uterine wall.

Lunate migration following Darrach's procedure: a case report.

We report a case of a 28-year-old female patient who underwent Darrach's procedure to her dominant right wrist affected by rheumatoid disease. She developed severe pain in the wrist 4 weeks postoperatively. Collapse of the scaphoid and proximal migration of the lunate was noted.

IOLMaster biometry: refractive results of 100 consecutive cases.

Aims: To study the refractive outcome of cataract surgery employing IOLMaster biometry data and to compare it with that of applanation ultrasonography in a prospective study of 100 eyes that underwent phacoemulsification with intraocular lens implantation.

Methods: The Holladay formula using IOLMaster data was employed for the prediction of implanted intraocular lenses (IOLs). One month after cataract surgery the refractive outcome was determined.

Giant cell arteritis.

Giant cell arteritis is the most common vasculitis in Caucasians. The aetiology of this disease remains uncertain. This article reviews some of the recent work in epidemiology and pathology in this field, with particular regard to the immunohistochemical findings in temporal artery biopsy specimens.

Choriocarcinoma of the colon: report of a case and review of the literature.

Primary choriocarcinoma of the colon is a very rare tumor, with only six reported cases in the world literature, all but one of which was associated with an adjacent adenocarcinoma. This has led to the suggestion that colonic choriocarcinomas may arise from the more typical adenocarcinoma a process of further dedifferentiation. This article reviews the above cases and adds a further case from a 73-year-old male in whom no associated adenocarcinoma could be found despite careful postmortem examination.

Predictors of excessive blood loss during operative treatment of hip fractures.

Objectives: To determine the total blood loss and transfusion needs during operative treatments of hip fracture, and identify predictors of excessive blood loss.

Method: A prospective study of 242 consecutive patients operated for hip fractures over a 6 month period. The main outcome measure of blood loss was assessed by blood volume in the drainage system and swab weight.

Anorectal sepsis.

Anorectal sepsis is a common cause of hospital admission, presenting with abscess or fistula formation. This article discusses the aetiology of acute anorectal sepsis and its management.

Prophylactic carpal tunnel decompression during buttress plating of the distal radius--is it justified?

Our objective was to evaluate the role of carpal tunnel decompression in preventing median nerve dysfunction after buttress plating of the distal radius. We studied 69 consecutive patients with distal radial fractures managed by volar plating over a 4-year period. (1995-1998).

Synovial knee fistula: A cause of prolonged morbidity.

Postarthroscopy knee fistulae may lead to prolonged morbidity. A 62-year-old man presented with a synovial knee fistula 4 weeks after knee arthroscopy, which was confirmed by magnetic resonance imaging. He was treated with antibiotics and knee immobilization that resulted in closure of the fistula.

The sternoclavicular syndrome: experience from a district general hospital and results of a national postal survey.

Objective: To report our local experience of the sternoclavicular syndrome and sample the experience of other rheumatologists in the UK.

Methods: We studied case records of 23 patients referred to the Southend rheumatology clinic and data obtained from a postal questionnaire survey of British rheumatologists.

Results: We describe 58 cases (20 males and 38 females, mean age 47.

Survey of computed tomography scanning and endoscopic sinus surgery in a group of district general hospitals in south Essex.

The management of chronic sino-nasal disease has changed significantly in the last 15 years with the advent of topical nasal steroids and minimally invasive endoscopic surgery, but survey data from district hospitals in the UK have not been published to date. We examined the current management of 383 consecutively scanned patients with sino-nasal symptoms in three district hospitals. Survey standards were set, and were attained in 56 per cent for symptom recording, 60 per cent for pre-scan diagnosis, 62 per cent for endoscopic examination in out-patients, and 73 per cent for topical steroid use before scanning.

A unique parotid adenocarcinoma.

A large number of different types of benign and malignant tumours of the salivary glands are recognized, and rare and unusual variants arise from time to time that can be difficult to interpret. We report an apparently unique parotid neoplasm that does not fit any of the currently recognized diagnostic groups and can best be termed lymphadenocarcinoma. Clinical and pathological features are described, and its possible relationship to recognized tumour types is examined.

The effect of dexamethasone on growth, mineral balance and bone mineralisation in preterm infants with chronic lung disease.

Unlabelled: The aim of this prospective longitudinal study was to observe the effects of treatment with dexamethasone on somatic growth, mineral balance and bone mineralisation in very low birth weight (VLBW) preterm infants with chronic lung disease (CLD). Dexamethasone was started at a dose of 500 microg/kg body weight per day for 3 days followed by gradually decreasing doses for a total period of 3 weeks' treatment if the infant was still mechanically ventilated in the 3rd postnatal week and had signs of CLD on the chest radiograph. Eleven infants with CLD treated with dexamethasone were studied.

An unusual foreign body producing acute laryngeal obstruction.

This paper present an unusual case of acute upper respiratory obstruction due to an inhaled grape necessitating acute surgical measures. Study of the literature proves laryngeal foreign bodies to be a rare occurrence but infinitely more dramatic and life-threatening than either oesophageal or bronchial foreign bodies. Successful management entails prompt surgical intervention coupled with at times, surgical ingenuity.

Stabilization of an acute perilunate dislocation using the "TAG" suture anchor.

A case of acute perilunate dislocation associated with acute scapholunate dissociation and acute carpal tunnel syndrome is described in which the treatment was facilitated by the use of the TAG suture anchor.