Search

Gastric antral vascular ectasia (GAVE) syndrome is an uncommon but well-described cause of recurrent upper gastrointestinal bleeding or iron deficiency anaemia. Atiology is unknown but several associated diseases have been reported like connective tissue or autoimmune disorders or cirrhosis. Cases have been reported in systemic sclerosis, achlorhydia, atrophic gastritis and chronic renal failure. The most common cause is portal hypertension and portal hypertensive gastropathy. This is especially so after eradication of oesophageal varices by sclerotherapy or banding. Diabetic complications are characterised by microvascular diseases especially in the retina, glomerulus and vasa nervorum. It involves apoptosis and remodelling of endothelial cells. Hyperglycaemia is an essential cause of reactive oxygen species (ROS)-mediated oxidative stress in this complication. Angiopathy of gastric mucosa in diabetes mellitus has not been reported so far in the literature. We are presenting an interesting case of diabetes mellitus with gastric vascular ectasia without evidence of any other systemic illness.

A 78-year-old man presented with a huge abdominal swelling of 3 years duration. The swelling had progressively increased in size, especially over the last year. The patient also gave a history of dysuria and increased frequency of micturation of 8 years duration, which was attributed to prostatism. The patient had been receiving intermittent symptomatic treatment, and had been taking warfarin 3 mg for the last 6 years for paroxysmal atrial fibrillation. Examination revealed a large epigastric hernia (fig 1) with bowel loops as its content. Chest and cardiovascular examination including heart sounds was normal. Digital rectal examination was normal for prostrate, and blood counts, renal and liver function tests …

The majority of patients with primary mediastinal lymphoma are symptomatic at the time of diagnosis and commonly have fever, weight loss and/or night sweats. Symptoms due to compression of adjacent mediastinal structures are infrequent, but may include pain, dyspnoea, stridor, or superior vena cava syndrome. Local infiltration into the chest wall, pleura and pericardium is not uncommon. In the present report, two interesting cases of chest wall swellings that in fact were extensions of primary mediastinal lymphoma are given. Histopathology of the tumour was large B cell lymphoma (CD20+). The first case was in a 23-year-old woman, with dramatic onset but a good outcome. The second was in a 34-year-old Pakistani woman, with insidious onset and poor outcome due to extent and invasion by the tumour. Interesting CT images are presented showing chest wall and left supraclavicular swelling.

Delirium is a cognitive disorder. DSM-IV criteria for delirium must include both acute onset and fluctuating symptoms; disturbance of consciousness (including inattention); at least one of the following: disorganised thinking, disorientation, memory impairment or perceptual disturbance; and evidence of a putative causal medical condition. Traditionally, the course has been described as transient in which recovery is likely to be complete if the underlying aetiological factor is promptly corrected or is self-limited. The most common precipitating causes in elderly include sepsis, dehydration and drugs. Work-up for delirium is limited to septic screening, baseline investigations and imaging. Patients with delirium without focal signs and with either evidence for a medical aetiology of delirium or pre-diagnosed dementia are at a very low risk of having focal lesions in their contrast-enhanced CT or MRI. We are presenting an interesting case of delirium with urosepsis whose imaging revealed milliary brain tuberculomas on contrast-enhanced MRI.

The most common cause of upper gastrointestinal bleeding in patients with systemic rheumatic diseases is non-steroidal drug use; this is the case with COX-2 inhibitors, especially when used concomitantly with corticosteroids. Bleeding from varices is unusual in the absence of liver disease. We present an interesting case of a patient with systemic lupus erythematosus, rheumatoid arthritis and polymyositis overlap syndrome with recurrent upper gastrointestinal bleeds from isolated fundal gastric varices and a normal liver.

An 82-year-old woman presented with a 9-month history of progressive headache and swelling of the left side of head. The patient experienced deterioration in their consciousness level and was brought into hospital. Examination revealed a localised swelling of the left of the skull of bony consistency with a smooth surface. The patient was confused; vitals were stable and the patient had papilloedema. The rest of the systemic examination was normal other than a scar on the neck, which on further questioning was found to be due to …

We report a unique case of a 26-year-old female patient with systemic lupus erythematosus (SLE), who had been treated with hydroxychloroquine 400 mg/day from the age of 11 years, who presented with congestive cardiac failure. She was treated for heart failure with diuretics and angiotensin converting enzyme (ACE) inhibitors, but deteriorated and was readmitted, this time with the additional finding of pericardial effusion and painful left breast swelling. Echocardiography revealed dilated cardiac chambers with thin wall and septum and minimal pericardial effusion (figs 1 …