Lacrimal sac compression by an anterior ethmoidal mucocele presenting as a late complication of dacryocystorhinostomy.

This was an unusual case of lacrimal sac compression by an anterior ethmoidal mucocele presenting as a late complication of a dacryocystorhinostomy (DCR) that was jointly managed by ophthalmic and ENT surgeons via an endoscopic approach. A 22-year-old lady presented with a 12-month history of a painless lump in her left medial canthus area and a 6-month history of left intermittent epiphora. She had a DCR when she was 15 years old with initial symptom control until recent recurrence.

The articular surface replacement implant recall: a United Kingdom district hospital experience.

We present our experience of the articular surface replacement (ASR) hip and the implant recall process. One hundred and twenty-one ASR components were implanted (21 resurfacing hip arthroplasty (RHA) and 100 ASR/XL modular total hip replacements). At the time of the implant recall in August 2010 there were 111 surviving hips (92%) with a mean follow-up of 44 months.

Comparing virtual with conventional microscopy for the consensus diagnosis of Barrett's neoplasia in the AspECT Barrett's chemoprevention trial pathology audit.

Aims: To compare the diagnostic accuracy of conventional versus virtual microscopy for the diagnosis of Barrett's neoplasia.

Methods And Results: Sixty-one biopsies from 35 ASPirin Esomeprazole ChemopreventionTrial (AspECT) trial patients were given a Barrett's neoplasia score (1-5) by a panel of five pathologists using conventional microscopy. Thirty-three biopsies positive for neoplasia were digitized and rescored blindly by virtual microscopy.

The clinical biochemistry of anorexia nervosa.

In anorexia nervosa, under-nutrition and weight regulatory behaviours such as vomiting and laxative abuse can lead to a range of biochemical problems. Hypokalaemia is the most common electrolyte abnormality. Metabolic alkalosis occurs in patients who vomit or abuse diuretics and acidosis in those misusing laxatives.

Subsidence of the Corail femoral component in the elderly. A retrospective radiological review.

206 patients age 70 years or older who underwent uncemented total hip arthroplasty (THA) using the Corail stem were studied. Radiographs taken post operatively and at one year were measured for subsidence of the stem. 13 patients had subsidence of the femoral stem of more than 2 mm.

The theory and implications of the biaxial model of corneal birefringence.

Purpose: A theoretical model of biaxial optical anisotropy is derived and its structural, biomechanical and developmental implications are discussed with reference to known corneal anatomy. METHODS A concise review of the theory of optical crystallography is followed by the derivation of a theoretical model of the optical anisotropic properties of a dome of biaxial birefringent crystalline material. The model is then applied to parameters relevant to the biaxial model of human corneal birefringence.

Splenic artery aneurysm presenting with clinical features of a bleeding gastric gastrointestinal stromal tumour.

Gastrointestinal stromal tumours often present with insidious upper gastrointestinal symptoms. Initial definitive diagnosis can be difficult and therefore misdiagnosis is not infrequent. Here we report a case of upper GI bleeding caused by a splenic artery aneurysm that was misdiagnosed as a gastric GIST.

Spontaneously ruptured splenic aneurysm in a young patient with Ehlers-Danlos syndrome.

The authors describe a young patient with a history of type IV vascular Ehlers-Danlos syndrome (EDS) who underwent successful treatment for a spontaneous haemorrhage from a splenic artery aneurysm, and the authors would like to remind clinicians of the mortality and morbidity associated with vascular-type EDS.

Seat-belt trauma of the breast in a pregnant woman causing milk-duct injury: a case report and review of the literature.

Injury to the milk-duct following a road traffic accident has not been reported in the literature. This case report describes a 25-year-old postpartum lady with massive swelling of the breast due to milk-duct injury and collection of milk within the breast. We describe the possible mechanism of milk-duct injury, its presentation and management, and also review the literature on seat-belt injury to the breast.

Two cases of pustular toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a life-threatening, immune-mediated reaction, characterized by severe cutaneous and mucosal blisters and erosions. It often presents with flu-like symptoms, followed by a maculopapular, urticarial, purpuric or erythema multiforme-like eruption, which then evolves into blisters and sheet-like erosions. Presentation with pustules, however, is not well described in the English literature, and may lead to delayed diagnosis.

Factors predictive of distress in people awaiting a lower gastro-intestinal endoscopy.

Lower gastro-intestinal endoscopy is a common investigative procedure which can be distressing. The extent of this distress is not known, nor have the predictive factors been identified. The aim of the present study was to identify to what extent it is distressing, what factors might predict distress in this population and to identify coping strategies that may mediate such distress.

Two-year comparison of tension-free vaginal tape and transobturator tape for female urinary stress incontinence.

Tension-free vaginal tape (TVT) and transobturator tape (TOT) are relatively new, minimally invasive procedures for the management of stress incontinence. All patients with urodynamic stress incontinence who underwent a TVT procedure from April 2003 to March 2005 (n = 76) were compared with all patients who had TOT from September 2004 to August 2006 (n = 73). The overall success rate for TVT was 97.

Riedel's thyroiditis masquerading as anaplastic thyroid carcinoma: a case report.

Introduction: Riedel's thyroiditis is a rare thyroid disease characterized by dense fibrous tissues that replace the thyroid gland and invade the adjacent structures that can mimic thyroid malignancy. We discuss the presentation, investigation and management of this very rare condition.

Case Presentation: We present a case of a 59-year-old African-Caribbean man who presented with a rapidly growing hard neck mass, a hoarse voice, dysphagia and breathing difficulty that clinically suggested thyroid malignancy.

An aromatic mystery.

A case of antiepileptic hypersensitivity syndrome presenting as an acute septic illness is reported. A 67-year-old man, with a history of essential hypertension (treated with amlodipine) and recently diagnosed nocturnal epilepsy (treated with phenytoin), presented initially with an acute pneumonic illness with periorbital oedema. This was treated successfully with antibiotics and his phenytoin was changed to carbamazepine due to concerns regarding the periorbital oedema.

Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics.

Venous thromboembolism (VTE) is a clinically important complication for both hospitalised and ambulatory cancer patients. In the current study, the frequency, demographics and risk (according to tumour site) of VTE were examined among patients seen at outpatient DVT (deep-vein thrombosis) clinics. Of 10,015 VTE cases, 1,361 were diagnosed with cancer, for an overall rate of cancer-associated VTE of 13.

Probable trigeminal autonomic cephalgia in a 3-month-old male infant.

To my knowledge trigeminal autonomic cephalgias (TACs) have not previously been reported in infancy. The diagnosis is dependent on an accurate history, including parents noting any physical signs at the time of the episode. Obtaining a clear history can be challenging when such symptoms occur in preverbal children.

Intraoperative assessment of sentinel node using imprint cytology.

Background: Sentinel lymph node (SLN) biopsy has replaced axillary sampling as the axillary staging procedure of choice in patients with breast cancer. Accurate intraoperative evaluation of the SLN would allow axillary lymph node clearance to be performed during the initial operation when the SLN is positive for metastatic disease. The aim of the present study was to assess the accuracy of intraoperative imprint cytology (IC) of the SLN in two different institutions in the United Kingdom.

Difficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type.

There have been several reports of resistance to local anaesthetic agents in women with Ehlers-Danlos syndrome, hypermobility type, also known as Ehlers-Danlos syndrome Type III. General anaesthesia with rapid sequence induction was performed for caesarean section due to prolonged second stage of labour, but intubation proved to be difficult. We propose that intubation difficulty probably arose from collapse of fibro-elastic tissues and adjoining C-shaped cartilages of the trachea with appropriately applied cricoid pressure.

Eruptive disseminated superficial porokeratosis with rapid resolution: a drug-induced phenomenon?

We report a case of eruptive disseminated superficial porokeratosis occurring in a 63-year-old man with no history of excessive sun exposure. Unlike disseminated superficial actinic porokeratosis, this condition resolved rapidly with minimal topical treatment. This is most likely to have represented a drug-induced phenomenon, which is very rarely reported in the dermatological literature.

Parotidectomy: the timing of post-operative complications.

We evaluated the timing of complications following parotidectomy. We performed a 119-patient retrospective case series analysis over a 12-year period (1994-2006) and investigated timing of post-operative complications. 38% of temporary facial nerve palsies resolved within 1 month, 78% within 3 months and all recorded resolved within 7 months.