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Archive for May, 2009

When a nephrectomy cures hypoglycaemia

22 May, 09 | by Emilia Demetriou

Episodes of hypoglycaemia can be caused by solid tumours and this case is an example involving a renal sarcoma causing non-islet cell tumour hypoglycaemia via excess IGF-II secretion. The authors discuss the likely mechanisms.

When a nephrectomy cures hypoglycaemia

A 14-year-old girl with a sudden arm swelling after axillary depilatory wax

14 May, 09 | by Emilia Demetriou

“Some presentations are not what they seem especially when there is a coincidental relationship with some event in the history. This case describes the challenge of diagnosing the unusual in the younger person and the authors identify some useful learning points.”

A 14-year-old girl with a sudden arm swelling after axillary depilatory wax

Earliest case report in BMJ archive?

11 May, 09 | by Dr Dean Jenkins

Although there are some cases described by Mr Greenhow of the practical use of his fracture bed1 (traction device for the treatment of leg and thigh fractures) in the very earliest issue of the Provincial Medical and Surgical Journal it is in the form of a letter.

I needed to go to the second issue, a week later, to find what appears to be the earliest case report available in the recently released BMJ Archive. In this article Mr Banner, Surgeon to the Liverpool North Hospital, describes the clinical presentation, operative findings and successful outcome of a lady with strangulated femoral hernia2. It is not until the very last line of the report does Mr Banner reveal that she was 5 months pregnant with her 15th child at the time! He goes on to describe another case of osteosarcoma in a teenage girl.

The cases are well described but no attempt is made to generalise the findings or make learning points explicit. The style is more of a factual report presented in a way that a knowledgeable colleague could use for reference. This has the advantage of not over-interpreting the outcome or findings of a single case which is a common mistake in poorly written case reports and, clearly historically, part of the etiquette of publishing written case reports. Cautious conclusions are good but there is however, no patient confidentiality as the names of the two patients are published in the reports.

These early cases show the potential of well written case reports to communicate medical knowledge. Modern case reports are not greatly different. Of course there is more formality about the peer-review, citations to the literature and there is patient confidentiality. The educational or scientific value in modern case reports is also made more obvious to the reader but, in a good case report, not over generalised.

I’d be interested to know if anyone has found an earlier case report in the archive or any other worthy cases in the last 169 years.

1) Greenhow TW. Mr Greenhow’s Fracture Apparatus. Prov Med Surg J 1840;s1-1:8, doi: 10.1136/bmj.s1-1.1.8.
2) Banner. Case of Strangulated Femoral Hernia, &c. Prov Med Surg J 1840;s1-1:27, doi: 10.1136/bmj.s1-1.2.27

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