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Implantable cardiac defibrillators are a key component in preventing sudden cardiac death for patients with life-threatening arrhythmias. Through ageing, frailty and the progression of cardiac and non-cardiac morbidity, many will develop a 'life-limiting' condition. This raises the challenge of how to approach making decisions to deactivate the defibrillator function. This article discusses the background to deactivation of implantable cardioverter defibrillators and the practical considerations for different circumstances. [ABSTRACT FROM AUTHOR]

The article describes a case study that shows the importance of recognition of Wellens syndrome as an electrocardiographic pattern suggestive of a critical intracoronary lesion requiring urgent invasive intervention, with topics mentioned such as angina, xanthelasma palpebrum, and myocardial infarction.

The article presents a case of a 79-year-old female with isolated pericardial effusion and a new diagnosis of rheumatoid arthritis to discuss an unusual symptom of dysphagia.

The article explores the pathophysiology of clubbing or the swelling of the soft tissue of the terminal phalanx of a digit with loss of the normal angle between the nail and the nail bed. Topics covered include the presence of clubbing in patients diagnosed with pachydermoperiostitis, the elevated levels of circulating vascular endothelial growth factor (VEGF) in patients with clubbing and the neurological mechanisms associated with clubbing.

The article discusses the pathophysiology and epidemiology of carbon monoxide poisoning. It claims that some sources of carbon monoxide are internal combustion engines, household appliances, and portable barbecue. Also cited are the symptoms of carbon monoxide intoxication like headache, drowsiness, and dizziness, the cases of deliberate and accidental poisoning in Great Britain, and possible treatments like erythropoietin.

The article focuses on the benefits, process, and cautions associated with hospital-based work experience programmes. It highlights the reasons and process for taking work experience students within a hospital setting. The benefits of participating in the programme for the students are highlighted, including providing an impression of how the National Health Service works as an overall structure. An overview of examples of activities for work experience students is also provided.

The article discusses heart involvement from Lyme disease, and mentions that the spirochaete infection is not widespread in Great Britain. It discusses the stages and clinical features of Lyme carditis, and explains its diagnosis, prevention and treatment, which involves oral doxycycline or amoxicillin. The article concludes that recognized clinical features of erythema migrans and a history of exposure are necessary in making a diagnosis.

The article discusses the Department of Health regulations governing entitlement to National Health Service (NHS) care in Great Britain. It highlights the complex eligibility criteria for entitlement, and explores the rules for emergency treatment, cases of planned resettlement of British citizens, and overseas visitors. The article concludes that Great Britain's reciprocal agreements with other countries and complex regulations lend eligibility to a larger patient base than the NHS can manage.

The article presents the case of an Asian male who was presented due to atypical chest pain at 14 years of age and was diagnosed with likely idiopathic congenital clubbing.

The article focuses on the case of a 91-year-old man, who had a pacemaker fitted, was presented with chest pain and was diagnosed of having intra-cardiac pacemaker.

The article describes a case study which reported that hypoxia was a risk factor for a flight attendant suffering thiazide-induced acute hyponatraemia.

The article describes the case of a 21-year-old primiparous woman with spontaneous pneumomediastinum after uncomplicated vaginal delivery.

The article discusses voltage-gated potassium channel antibody syndrome. Topics covered include voltage-gated potassium channel antibody syndrome as an unusual cause of autoimmune encephalitis and peripheral nervous system effects and how management of voltage-gated potassium channel antibody syndrome involves immunosupression with cortiscosteroids or steroid-sparing agents.

The article describes the case of a 34-year-old professional bodybuilder who was admitted with a two-week history of progressive breathlessness. Echocardiography showed severely impaired left ventricular function. The patient admitted that he took anabolic steroids for a bodybuilding competition. It is noted that anabolic steroids cause impaired left ventricular function in a high proportion of users.

The article describes the case of a 64-year-old man diagnosed with light chain (AL) amyloidosis due to non-Hodgkin's lymphoma. The patient presented with an 18-month history of easy bruising and excessive bleeding after undergoing a tooth extraction. His renal function deteriorated over the following 18 months. He underwent chemotherapy using a combination of rituximab, bortezomib and dexamethasone. The role of serum amyloid A protein in light chain (AL) amyloidosis is mentioned.

The article describes the case of transient global amnesia in a 92-year-old woman. Topics covered include medical background of the patient, loss of immediate memory of about five hours' duration, diagnostic criteria for transient global amnesia and key differentials in the diagnosis of transient global amnesia.

The article describes the case of a 35-year-old woman with anaplastic large cell lymphoma with axial skeletal lesions, deemed an uncommon form of lymphoma with a particularly poor prognosis. Magnetic resonance scans confirmed multiple destructive lesions of the spine, while further subtyping confirmed an anaplastic lymphoma kinase (ALK) positive anaplastic large cell lymphoma. It also presents a discussion on anaplastic large cell lymphoma including presentation, treatment and survival rate.

The article discusses whether the case of an active young man who has occlusive coronary and aortic disease but without episodes of inflammation and risk factors can be diagnosed as premature accelerated atherosclerosis or burnt-out Takayasu's arteritis. An overview of Takayasu's arteritis is also presented. Factors to consider are the autoimmune process and presence of angina. Immunosuppression as the core treatment for Takayasus's arteritis is also discussed.

The article describes the case of an active young man who was diagnosed with Takayasu's arteritis. Topics covered include the symptoms of Takayasu's arteritis, the imaging modalities that can detect pre-stenotic disease such as computed tomographic angiography and the use of immunosuppresion in treating the disease. Also mentioned are the results of the patient's echocardiography, computed tomography and invasive angiography.

The article explores the case of a 69-year-old female patient diagnosed with Budd-Chiari syndrome after being admitted due to severe hyperkalemia and urinary sepsis. Topics discussed include the nature of the Budd-Chiari syndrome including aetiological factors commonly associated with primary Budd-Chiari syndrome, complications associated with central venous catheters and recommendation treatment for the disease.

The article discusses the case of managing an 80-year-old male patient with renal cell carcinoma. Topics covered include the absence of metastases in some patients with vena caval extension, the need to consider surgery in highly selected patients with metastases and the results of the echocardiography and computed tomography done on the patient. Also mentioned are the unusual features of the disease like the potential for regression of metastases.

The article presents a case of a bronchoscopic approach to lung reduction surgery in emphysema.

The article describes the case of a 55-year-old man who was admitted with heart failure and whose electrocardiogram showed two independent morphologies for the QRS complex, including one from the native heart and second from the donor heterotopic heart transplant.

The article presents a case study of a 51-year-old man who was referred to a paediatric dermatologist due to suffering from erythropoietic protoporphyria. As per the case, in childhood the patient experienced blistering and scabbing in sun-exposed areas of hands, nose, neck and ears. The case also highlights that the patient has been advised to have an annual review for checking blood porphyrin levels, blood count and tests for liver function. INSET: Case Report.

The article describes the case of an African form of hereditary amyloid cardiomyopathy in a 66-year-old Caucasian man. Topics covered medical background of the patient, shortness of breath for 12 months, numbness and paraesthesiae in both hands, diagnosis, treatment and management of the disease and the possibility of amyloidosis in patients presenting thick-walled restrictive cardiomyopathy.

The article describes the case of a 57-year-old woman who presented with a one-week history of severe lethargy. The patient had a history of hypertension and asthma and an electrocardiogram showed deep T-wave inversion laterally. She underwent thallium myocardial perfusion scintigraphy and was fully recovered following a sepsis episode and an apparent major cardiac event.

The article presents a case study of a 48-year-old African American man of Nigerian heritage who was presented with a 24-hour history of frontal headache of gradual onset. He was diagnosed with Behçet's disease 10 years ago as of October 2013, with an initial presentation of oral and genital ulceration. He was diagnosed with neurological Behçet's disease.

The article presents a case study of an 18-year-old man, diagnosed with Friedreich's ataxia at the age of 8, presented with a fast irregular pulse. Blood tests were normal, electrocardiogram showed rapid atrial fibrillation, echocardiogram revealed concentric left ventricular hypertrophy and diastolic dysfunction. This cardiomyopathy in Friedreich's ataxia; he was treated with oral sotalol, digoxin, and aspirin for rate control and potentially chemical cardioversion.

The article discusses a case study of a 47-year-old man with intractable pain from trigeminal neuralgia. Treatment with analgesics and subcutaneous infusion of ketamine made no significant improvement in his condition. He was re-referred for surgical microvascular decompression and underwent root section as no vascular loop was found at surgery. The case highlights the medical and psychological issues resulting from the extreme pain caused by trigeminal neuralgia. INSET: Case Report.

The article presents a case study of a young man, accidently poisoned by carbon monoxide (CO) from a barbecue placed in his camper van. He was moved to hospital and was diagnosed with high creatinine levels. The man responded to rehydration and was referred for hyperbaric oxygen therapy. The article discusses that carbon monoxide poisoning is the usual cause of fatal poisoning worldwide and delayed neurological sequelae is a known feature of recovery from carbon monoxide poisoning. INSET: Case Report.

Temporal lobe epilepsy may comprise simple partial seizures without loss of awareness or complex partial seizures with a loss of awareness. Complex partial seizures may evolve into a generalized tonic-clonic seizure. Aura is a feature of the majority of temporal lobe seizures. Most auras and automatisms last a very short period, from a few seconds to 1-2 minutes. This article reports a young woman who experienced a generalized grand mal seizure after 20 years of approximately fortnightly déjà vu phenomena, and describes the association of temporal lobe epilepsy with childhood febrile convulsions. [ABSTRACT FROM AUTHOR]

Temporal lobe epilepsy may comprise simple partial seizures without loss of awareness or complex partial seizures with a loss of awareness. Complex partial seizures may evolve into a generalized tonic-clonic seizure. Aura is a feature of the majority of temporal lobe seizures. Most auras and automatisms last a very short period, from a few seconds to 1-2 minutes. This article reports a young woman who experienced a generalized grand mal seizure after 20 years of approximately fortnightly déjà vu phenomena, and describes the association of temporal lobe epilepsy with childhood febrile convulsions. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 62-year-old man with a background of atrial fibrillation, aorto-femoral bypass surgery, type 2 diabetes and hypothyroidism. Results of his physical examination, electrocardiogram, echocardiography, and chest radiograph are revealed. It discusses the diagnosis and treatment of hypothyroidism. INSET: Case Report.

The article presents a case study on the size, friability, location and histological type of primary cardiac tumours. Cardiac angiosarcomas are frequently first noticed by two-dimensional echocardiography and approximately 80% are located in the right atrium. Histologically, cardiac angiosarcomas usually show evidence of endothelial differentiation, having vascular channels formation. INSET: Case Report.

A letter to the editor is presented concerning the use of nitrous oxide gas as a recreational drug in Great Britain.

The article presents a case study of a 78-year-old Caucasian woman with Sweet's syndrome who was admitted to hospital because of suffering anorexia. After six months treatment of the skin disease, she remained systematically cure from the oral prednisolone. It states that she was also prescribed to take long-term warfarin and antibiotics to treat pneumonia and repeated urinary tract infections.

The article presents a report on cocaine body packers and transportation of illicit drugs by internal concealment in Great Britain. It is stated that these body packers are usually asymptomatic but symptoms arise due to leakage or rupture of packets. It is also recommended that patients with no evidence of drug toxicity can be left to pass packets whole bowel irrigation with polyethylene glycol.

A case study of a 29-year-old woman diagnosed with multiple myeloma is presented. This is generally considered to be a disease of those in their late middle age or latter years. In this context, the author described the epidemiology, diagnosis and management of this condition. The diagnosis is multiple myeloma which is B-cell malignancy characterized by clonal proliferation of abnormal plasma cells.

The article discusses the case of a 58-year-old man with Charcot-Marie-Tooth syndrome and Mobitz II heart block. Topics covered include the result of his blood tests and electrocardiogram, the prevalence of peroneal muscle atrophy and the association between Charcot-Marie-Tooth syndrome and conduction disease.