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The case of ectopic central incisor

13 Aug, 14 | by Kristy Ebanks

Aggressive dentigerous cyst

We have some very interesting images for you but, can you answer the questions below?

figure_4-Intraoral_Perioperative_view figure_3-Occlusal_view figure_2-IOPA_view figure_1-Intraoral_Preoperative_view

1. What would be your diagnosis upon presentation?
2. What ancillary examinations would you request and what my be your differential diagnosis based on the imagiological findings?
3. How would you manage this condition?

If you don’t know the answers or want to know more read ’Aggressive dentigerous cyst with ectopic central incisor

The case of brachial artery pseudoaneurysm

13 Aug, 14 | by Kristy Ebanks

Brachial artery pseudoaneurysm

We have some very interesting images for you but, can you answer the questions below?

Figure_1 Figure_2 Figure_3 Figure_4 Figure_5

1. What is the difference between an aneurysm and pseudoaneurysm?
2. What are the usual causes of pseudoaneurysm?
3. How might a fracture result in vascular injury?

If you don’t know the answers or want to know more read ’Brachial artery pseudoaneurysm

Complex composite odontoma and World Record teeth

24 Jul, 14 | by Dr Dean Jenkins

The case of Ashik Gavai from India has been widely reported in the press.

India doctors remove 232 teeth from boy’s mouth (BBC News)

The Indian boy who had a ‘world record’ 232 teeth (Washington Post)

Chew on that. 232 teeth removed from boy’s mouth (Mumbai Mirror)

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Image of Odontoma from BMJ Case Reports 2012

He presented with a rare condition called complex composite odontoma and the photographs accompanying the news reports highlight the surgical findings and the bloody result of the marathon extraction of multiple ‘teeth’.

The usual presentation is by the odontoma being picked up on a routine X-ray but on this occasion the young Indian boy presented with gross swelling of the jaw.

Learn more about them at BMJ Case Reports

Astekar M, Manjunatha BS, Kaur P, Singh J. Histopathological insight of complex odontoma associated with a dentigerous cyst. BMJ Case Rep. 2014 Jan 31;2014. pii: bcr2013200316. doi: 10.1136/bcr-2013-200316.

Agrawal B, Gharote H, Nair P, Shrivastav S. Infected complex odontoma: an unusual presentation. BMJ Case Rep. 2012 Aug 24;2012. pii: bcr2012006493. doi: 10.1136/bcr-2012-006493.

Gupta A, Vij H, Vij R, Malhotra R. An erupted compound odontoma. BMJ Case Rep. 2014 Apr 12;2014. pii: bcr2013201820. doi: 10.1136/bcr-2013-201820.

The case of the brachial plexus injury

18 Jul, 14 | by Kristy Ebanks

Acromioclavicular joint dislocation with associated brachial plexus injury

We have some very interesting images for you but, can you answer the questions below?

Case_Study_Figure_4 Case_Study_Figure_3 Case_Study_Figure_2 Case_Study_Figure_1

1. How is the diagnosis of AC joint dislocation made?
2. What are the features shown in Figures 1 and 2?
3. What are the principles of effective surgical management?

If you don’t know the answers or want to know more read ’Acromioclavicular joint dislocation with associated brachial plexus injury

The case of the resistant temporomandibular joint pain

10 Jul, 14 | by Kristy Ebanks

Successful use of stellate ganglion block and a new centrally acting analgesic with dual mode of action

We have a very interesting case for you but, can you answer the questions below?

1. What are the options for managing neuropathic pain?
2. What combination therapies are available?
3. What are the indications for stellate ganglion block?

If you don’t know the answers or want to know more read ’Successful use of stellate ganglion block and a new centrally acting analgesic with dual mode of action in a resistant temporomandibular joint pain

The case of endometrioma

4 Jul, 14 | by Kristy Ebanks

Endometrioma within the broad ligament

We have some very interesting images for you but, can you answer the questions below?

Figure_4 (3) Figure_3 (1) Figure_2 (6) Figure_1 (20)

1. How common is endometriosis?
2. How is the diagnosis made?
3. What exactly is an endometrioma?

If you don’t know the answers or want to know more read ’Endometrioma contained within the broad ligament

The case of foregut, midgut and hindgut atresia

27 Jun, 14 | by Kristy Ebanks

Trilogy of foregut, midgut and hindgut atresias presenting in reverse order

We have some very interesting images for you but, can you answer the questions below?

Fig_1_Radiographs Fig_2_Contrast_radiographs

1. How do gut atresias arise?
2. How might these abnormalities present?
3. What is the role of antenatal screening?
4. What are the limitations of antenatal screening in detecting gut atresias?

If you don’t know the answers or want to know more read ’Trilogy of foregut, midgut and hindgut atresias presenting in reverse order

The case of an incidental talonavicular coalition

23 Jun, 14 | by Kristy Ebanks

A Podiatric Perspective

We have some very interesting images for you but, can you answer the questions below?

Figure_1C

Figure_1B Figure_1A

1. What exactly is a tarsal coalition?
2. Under what circumstances may this develop?
3. How common is this?

If you don’t know the answers or want to know more read ’An Incidental Talonavicular Coalition in a Diabetic Patient: A Podiatric Perspective’

The case of the Maxilla reconstruction

2 Jun, 14 | by Kristy Ebanks

Reconstruction using a Fibula graft and virtual planning techniques We have some very interesting images for you but, can you answer the questions below? blog4 blog3 blog2 blog

1. How would you manage a maxillofacial defect such as this?
2. Would you consider using a graft?
3. How could you enhance the outcome?

If you don’t know the answers or want to know more read ’Reconstruction of the Maxilla Using a Fibula Graft and Virtual Planning Techniques

Too young for cancer. Case in the media highlights challenge of diagnosis

28 May, 14 | by Dr Dean Jenkins

The case of a 29 year old scientist who died of bowel cancer has been highlighted in the press because her brother is planning to raise funds for the World Cancer Research Fund.

A doctor who was told she was too young to get bowel cancer died after being sent home and misdiagnosed with bowel disease.” Doctor, 29, died of cancer after being told she was too young to have disease. Daily Telegraph, May 27th 2014

After suffering from stomach pains so severe she was forced to miss part of her brother’s wedding day, Suzanne was initially told by doctors she could not be suffering from bowel cancer as she was so young. She was instead diagnosed with an inflammatory bowel condition.” Tragic former Chatham pupil Dr Suzanne Gould died of bowel cancer after being told she was too young to have disease. Kent Online May 27th 2014

Tragic Suzanne Gould badgered family doctors for six months because of severe stomach pain but was told she had Crohn’s disease. In fact, she had terminal bowel cancer and died 18 months later.”  Brother of tragic doctor ‘too young for cancer at 29′ to raise money in her memory. Daily Express, May 28th 2014.

In 2012, my sister Suzanne, started to have bad stomach pains and other ailments. The doctors refused to believe she had bowel cancer because she was too young, however in November 2012 she was rushed to A&E where a cancerous tumor was removed, and her fight to get better began.” Rob Newton’s JustGiving page.

PhD, married, with kitten called Poppy, fighting bowel cancer previously misdiagnosed as Crohns disease. Hoping to raise awareness in the relatively young” @Dr_SooziG Twitter profile.

These types of cases – and others reported in BMJ Case Reports(1,2,3) – of younger patients presenting with symptoms where the underlying cause is malignancy are a challenge for diagnosis and there is no simple way of addressing it. Clinical examination may be normal which may lead the practitioner to be less likely to investigate. “Raising awareness” is often a phrase that is mentioned when these cases are presented at medical meetings. It helps, but by itself it doesn’t seem sufficient. Fine-tuning your “Index of suspicion” is something that can be achieved by reading more case reports … and seeing more, listening to and learning from patients in your clinical practice.

1. Raghunath Prabhu, Neha Kumar, Sunil Krishna, Rajgopal Shenoy. Primary colonic signet ring cell carcinoma in a young patient. BMJ Case Reports 2014:published online 20 March 2014, doi:10.1136/bcr-2013-200587

2. Syed Tausif Ahmed, Sudipto Kumar Singh, Tanmoy Mukherjee, Manju Banerjee. Breast carcinoma in a prepubertal girl. BMJ Case Reports 2014:published online 15 April 2014, doi:10.1136/bcr-2013-203251

3. Anna Freeman, David Weeden, Jane Wilkinson, Ramesh J Kurukulaaratchy. An unusual bronchial obstruction in a fit young man. BMJ Case Reports 2013:published online 9 January 2013, doi:10.1136/bcr-2012-007766

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