Vanishing White Matter (VWM) Disease Presenting As Neuro-Ovarian Failure.

A 19-year girl was admitted with a one-month history of worsening spastic paraparesis, cerbellar ataxia, visual decline and worsening headaches on a background of walking difficulty, progressive quadriparesis and migraine since the age of 10 years. She had no sensory loss, and cranial nerves examination was notable for optic atrophy with crescent formation only. She had primary amenorrhea and underdeveloped secondary sexual characteristics.

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years.

To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015. A total of 9499 mandibular defects were reconstructed with 6178 fibular, 1380 iliac crest, 1127 composite radial, 709 scapular, 63 serratus anterior and rib, 32 metatarsal, and 10 lateral arm flaps including humerus. The failure rate was higher for the iliac crest (6.

Fissurectomy Combined with High-Dose Botulinum Toxin Is a Safe and Effective Treatment for Chronic Anal Fissure and a Promising Alternative to Surgical Sphincterotomy.

Background: There is paucity of data on the long-term outcome of the combination of fissurectomy and botulinum toxin A injection for the management of chronic anal fissure.

Objectives: The aim of this study is to assess the safety, efficacy, and long-term outcome of the combination of fissurectomy and botulinum toxin A injection.

Design: This is a nonrandomized prospective cohort study.

Kingella kingae Causing Septic Arthritis of the Knee in an Immunocompetent Adult.

The bacterium Kingella kingae is a species of Gram-negative coccobacillus usually found in the oropharynx. This is an emerging pathogen reported to cause bacteraemia, endocarditis, and osteoarticular infections in children and endocarditis in the immunocompromised adult. However, there are few cases of isolated joint infections reported in the immunocompetent adult.

Does the level of socioeconomic deprivation at the location of cardiac arrest in an English region influence the likelihood of receiving bystander-initiated cardiopulmonary resuscitation?

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Administration of cardiopulmonary resuscitation (CPR) by a bystander witnessing a cardiac arrest has been shown to increase the likelihood of return of spontaneous circulation and survival. This study analyses the association between the socioeconomic status of the location where a person suffers a cardiac arrest and the proportion of victims with OHCA receiving bystander CPR.

Management of Posterior Malleolar Fractures: A Systematic Review.

Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. Although treatment of associated lateral and medial structures is well established, several controversies exist in the management of posterior malleolus fractures. We performed a systematic review of the current published data with regard to the diagnosis, management, and prognosis of posterior malleolus fractures.

Adult nasal gliomas.

Background: Nasal gliomas are congenital neurogenic tumours that are mostly diagnosed in the perinatal period. They occur in 1 in 20 000-40 000 live births. Cases reported in adulthood are rare and the management in adults is controversial.

Hyponatraemic encephalopathy: an unusual stroke mimic.

We present a case of a 74-year-old man who was admitted to our stroke unit with symptoms and signs suggestive of a left total anterior circulation stroke. Subsequent MRI failed to support this diagnosis and, furthermore, correction of an incidental finding of hyponatraemia due to syndrome of inappropriate antidiuretic hormone secretion led to a complete recovery of symptoms. Investigation and subsequent exclusion of other potential differential diagnoses confirmed the diagnosis of hyponatraemia mimicking acute stroke.

Metastatic breast cancer presenting as sequential cranial nerve palsy: a case report.

Introduction: Cranial nerve palsy is a common presentation in the neuro-ophthalmology clinic and investigations are directed towards the cause. Metastatic breast cancer presenting as carcinomatous meningitis leading to sequential fourth, third and sixth nerve palsy is very rare. This is the first case to be reported to the best of our knowledge.

Pancreatic panniculitis.

We present the case of a 55-year-old Caucasian man presenting with polyarthritis, weight loss and multiple tender cutaneous nodules. Abnormal liver function tests prompted imaging of the liver which demonstrated liver metastases. Biopsy of the liver lesions confirmed the diagnosis of metastatic pancreatic neuroendocrine carcinoma.

Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique.

Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System.

Lemierre's disease: a case with bilateral iliopsoas abscesses and a literature review.

Lemierre's disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701-3, 1936. Clin Microbiol Rev 20(4):622-59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain.

Limbic encephalitis.

We present a case of paraneoplastic limbic encephalitis, describing the presenting features, diagnosis and management plan. Limbic encephalitis is one differential of rapidly progressive dementia. We describe a rational approach to the diagnosis of the patient with rapid cognitive decline.

Delayed pneumothorax following an isolated clavicle injury.

Isolated fractures of the clavicle have been rarely reported to be complicated by a pneumothorax. However, a delayed pneumothorax following this injury has not yet been reported in the literature. This case report describes a 19-year-old man who developed a left-sided apical pneumothorax from an ipsilateral fractured clavicle 5 days after his initial motorbike accident.

The Ntcheu derotation splint for lower limb traction.

The Ntcheu derotation splint is recommended as a tool to improve the care of patients in lower limb traction. It avoids the various problems associated with the traditional plaster boot that is routinely used (stiffness, pressure sores, cost and time). It is easy to make, is relatively low cost and uses widely available materials.

The patient presenting with acute hemiparesis.

Acute hemiparesis is a common cause of presentation to hospital. In the majority of cases the cause is acute stroke, which is ischaemic in 80% of cases. This article aims to provide the reader with a practical approach to the initial management of suspected stroke.

Results of total knee replacement with/without resurfacing of the patella.

Objective: To study the difference of post-op patellofemoral pain, clunk and crepitus in patients with/without resurfacing at 5 years who had pre-op patellofemoral pain. To study the incidence of post-operative patellofemoral pain, clunk and crepitus following patelloplasty in both the groups.

Methods: Retrospective review of 765 patients who had total knee replacement with/without resurfacing.

Idiopathic spontaneous haemoperitoneum due to a ruptured middle colic artery aneurysm.

Introduction: Idiopathic spontaneous intra-abdominal haemorrhage is a rare, but challenging condition, associated with high mortality if not managed appropriately. The preoperative diagnosis is difficult, despite the recent advances in imaging. We present the clinical manifestations of this condition, as well as the available diagnostic and therapeutic modalities.

Duodenal rupture following trauma in a child.

We present a case of delayed presentation of a traumatic duodenal rupture in a 15-year-old boy. He presented 12 hours after falling six feet and sustaining blunt trauma to his anterior abdominal wall. On arrival in the Emergency Department he was shocked and peritonitic.

Availability of services for subjects of sexual assault in genitourinary medicine clinics.

The aim of this study is to gain an understanding of the services available to subjects of sexual assault at genitourinary medicine (GU medicine) clinics throughout the United Kingdom, and to determine whether these services are adequate. By means of a questionnaire, consultants in 106 clinics provided information on the number of patients who reported sexual assault and the services available to them. The study found a marked regional variation in attendances by subjects of sexual assault.