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Unusual foreign bodies

25 Jul, 13 | by Dr Dean Jenkins

Interesting case of a bronchial obstruction from a germinating pea has resurfaced.

Only in America: Pea plant grows inside man’s lung (Hospital Doctor)

… but the case is an old one from 2010.

Pea plant grows inside man’s lung (BBC Health)

Doctor finds plant growing inside man’s lung (WHDH News)

Pea sprout plucked from Cape man’s lung (boston.com)

However, it is always good to be reminded of clinical lessons especially where the cause is as clearly identified as here. There are reversible causes of bronchial obstruction in the older person and lung cancer should not be assumed without further evaluation.

Vulvar adenocarcinoma: the visual resemblance with a vulvar abscess

1 Jul, 13 | by jhudson

Though vulvar cancer is not very common, the misdiagnosis of malignancy as an abscess by practising gynaecologists is a mistake, which can prove costly to the patient. This article focuses attention on this aspect.

Reviewer
Ranganath Ratnagiri
Yashoda Cancer Institute

Vulvar adenocarcinoma: the visual resemblance with a vulvar abscess

A very unique cyclist

18 Jun, 13 | by Dr Dean Jenkins

Cyclist Tom Staniford from Exeter has a particularly rare form of Type 2 diabetes associated with absent subcutaneous fat and hearing loss.

“Although he was born a normal weight, he lost all the fat around his face and limbs during his childhood, and yet his body still thinks he is obese, meaning he has type 2 diabetes. His hearing also deteriorated when he was 10 and he has worn hearing aids since.

Staniford’s condition had never been identified – until recently, when a research team set about mapping and analysing his DNA to pinpoint the precise gene mutation responsible.

Finally, Staniford has discovered he is one of just eight people in the world with MDP syndrome.”

http://www.bbc.co.uk/news/health-22903537

Lucky then that he lives in a city with one of the world’s leading research centres for genetic forms of diabetes as his case was investigated by Andrew Hattersley’s team at Exeter University [1]. Hopefully with recognition of his condition suitable arrangements can be made for his paracycling competitions.

Tom Staniford Paracyclist

1. Weedon MN, Ellard S, Prindle MJ, Caswell R, Allen HL, Oram R, Godbole K, Yajnik CS, Sbraccia P, Novelli G, Turnpenny P, McCann E, Goh KJ, Wang Y, Fulford J, McCulloch LJ, Savage DB, O’Rahilly S, Kos K, Loeb LA, Semple RK, Hattersley AT. An in-frame deletion at the polymerase active site of POLD1 causes a multisystem disorder with lipodystrophy. Nat Genet 2013 Jun;advance online publication Available from: http://www.nature.com/ng/journal/vaop/ncurrent/full/ng.2670.html

Case report of Fibrous Dysplasia 120,000 years post mortem

6 Jun, 13 | by Dr Dean Jenkins

PLoS One has published archeological evidence of a possible primary rib cancer in a Neanderthal era human from over 120,000 years ago. (1)

This, clearly, is a very long time to wait for the publication of a case report!

The authors provide photographic and radiographic evidence of the tumour and presume it to be a primary bone tumour – fibrous dysplasia, “a benign disease of bone with rare potential for malignant transformation” (2). They go on to discuss the possible environmental factors associated with this type of abnormal growth / malignancy and that tumours can occur in the unpolluted environment of our ancient human ancestors.

 

1. Monge J, Kricun M, Radovčić J, Radovčić D, Mann A, Frayer DW. Fibrous Dysplasia in a 120,000+ Year Old Neandertal from Krapina, Croatia. PLoS ONE 2013 Jun;8(6):e64539. Available from: http://dx.doi.org/10.1371/journal.pone.0064539

2. Riddle ND, Bui MM. Fibrous dysplasia. Arch. Pathol. Lab. Med. 2013 Jan;137(1):134–138. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23276185

Variable ECG findings associated with pulmonary embolism

10 May, 13 | by jhudson

Very interesting case and well written.
One could postulate that the hypoxia associated with massive PE might have caused ischaemic changes without infarction or that the death was too soon for changes of infarction to be visible at post mortem examination.
Either way, a good learning point, though clearly thrombolysis for either PE or MI would not have been feasible due to the recent GI bleed and therefore the outcome was inevitable.

Reviewer
Dr Noeleen Foley
Royal United Hospital

Variable ECG findings associated with pulmonary embolism

 

Perioperative risk stratification for a patient with severe obstructive sleep apnoea undergoing laparoscopic banding surgery

13 Mar, 13 | by Emma

Surgery on patients with OSA can be problematic, and a preoperative assessment is useful as a predictor of complications and as a means of planning best clinical practice. This proposed assessment takes into account the 3 major areas of concern, namely the severity of OSA, the planned procedure, and the need for perioperative sedation and analgesia.

I would encourage others to have such an approach to preoperative assessment and management of surgical patients with OSA.

Reviewer
Dr David Barnes
Associate Professor
Royal Prince Alfred Hospital

Perioperative risk stratification for a patient with severe obstructive sleep apnoea undergoing laparoscopic banding surgery

A not very NICE case of endocarditis

6 Mar, 13 | by Emma

The recommendations of the American Heart Association and European Society for Cardiology on the use of antibiotic prophylaxis for patients considered to be high risk is very relevant in dental practice. The NICE guidelines as described by the author, at times need not be too nice for a high risk patient.

Reviewer
Dr Peter George MD
Associate Professor
Father Muller Medical College

A not very NICE case of endocarditis

Primary prophylaxis of pulmonary embolus with retrievable IVC filter

4 Mar, 13 | by Dr Dean Jenkins

Announced in the news today was the case of Doreen Carter who had an inferior vena cava filter inserted as an alternative for prophylaxis against thromboembolism.

http://www.bbc.co.uk/news/uk-england-berkshire-21655038

She was due to have bowel surgery and, presumably, was deemed too high risk for anticoagulation. The titanium device was also designed to be easily removed.

“Dr Carl Waldmann, a consultant at the hospital, said giving post-operative patients anti-clotting drugs can be risky, and existing measures to catch clots also carry risks because they are difficult to insert and remove.”

As the IVC filter devices and deployment skills have improved, especially of retrievable devices [1], there has been debate over when they should be used. [2]

 

1. Johnson MS, Nemcek AA Jr, Benenati JF, Baumann DS, Dolmatch BL, Kaufman JA, Garcia MJ, Stecker MS, Venbrux AC, Haskal ZJ, Avelar RL. The safety and effectiveness of the retrievable option inferior vena cava filter: a United States prospective multicenter clinical study. J Vasc Interv Radiol 2010 Aug;21(8):1173–1184.Available from: http://www.ncbi.nlm.nih.gov/pubmed/20598570

2. Wehrenberg-Klee E, Stavropoulos SW. Inferior vena cava filters for primary prophylaxis: when are they indicated? Semin Intervent Radiol 2012 Mar;29(1):29–35.Available from: http://www.ncbi.nlm.nih.gov/pubmed/23450194

 

All tied up in knots

28 Feb, 13 | by Emma

Anything that is linear and remotely flexible may get knotted up. This is well demonstrated in the images accompanying the present case. Murphy’s law applies, and the advice given by the authors is very sound.

Reviewer
Kirsten Moller

All tied up in knots

Adenocarcinoma: not all that wheezes is asthma

6 Feb, 13 | by Emma

This is well written case report of a rare presentation of a rare condition. It provides a important reminder to consider a differential diagnosis in patients with asthma.

Large airway tumours are rare (0.2%) amongst patients with lung cancer, and amongst tracheal tumours it is thought that adenocarcinomas represent 4-10%.1-5 The majority of tracheal adenocaricinomas are diagnosed in smokers.3-4 In one case series of tracheal tumours 21% had symptoms of progressive bronchial asthma.5

Reviewer
Dr Ian Clifton
St James’s University

References

1. Li W, Ellerbroek NA, Libshitz HI. Primary malignant tumors of the trachea. A radiologic and clinical study. Cancer 1990;66:894–9.
2. Hajdu SI, Huvos AG, Goodner JT, et al. Carcinoma of the trachea. Clinicopathologic study of 41 cases. Cancer 1970;25:1448–56.
3. Gelder CM, Hetzel MR. Primary tracheal tumours: a national survey. Thorax 1993;48:688–92.
4. Licht PB, Friis S, Pettersson G. Tracheal cancer in Denmark: a nationwide study. Eur J Cardiothorac Surg 2001;19:339–45.
5. Houston HE, Payne WS, Harrison EG Jr, et al. Primary cancers of the trachea. Arch Surg 1969;99:132–40.

Adenocarcinoma: not all that wheezes is asthma

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