Search

We report the rare case of a 15-year-old boy who sustained sequential bilateral lesser trochanter avulsion fractures over a 6-month period while playing football. No malignancy or associated metabolic bone disease was found. He subsequently made a full recovery with non-operative treatment.

The management of patients with acute stroke regarding treatment of thromboembolism is supported by a limited evidence base. We present the case of a 55-year-old female patient who initially presented with an ischaemic cerebral infarct with haemorrhagic transformation. Her clinical recovery was complicated by cardiac arrest secondary to massive pulmonary embolism. This was successfully treated with cardiopulmonary resuscitation and thrombolysis using Alteplase, which led to a full recovery to the pre-arrest state with no evidence of haemorrhagic complication. The patient was successfully discharged to a specialist centre for on-going stroke rehabilitation with no additional neurological impact. Despite the limited evidence base we believe this case highlights that thrombolysis can be used in select patients with haemorrhagic transformation of stroke and serious thromboembolic complications to achieve a positive outcome.

A patient diagnosed with extensive abdominal wall necrotising fasciitis from a perianal abscess was managed with a novel aeration technique using adapted 36-French tubes. A total of 14 drains were placed in the plane of the transversalis fascia after surgical debridement. The drains were left open to allow drainage of liquefactive contents and aeration of the abdominal wall tissues. An extended course of intravenous antibiotics were administered and the patient was ventilated in the intensive therapy unit. The patient was reoperated after 2 weeks, at which time the drains were removed. The patient made a full recovery, and was discharged with follow-up.

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity, associated with a vast array of medical conditions and a variety of presenting symptoms. There is a characteristic pattern of radiographic features alongside suggestive clinical manifestations, which lead to a diagnosis of PRES. This report describes the case of a 39 years old, previously normotensive woman, who presented on day 7 postpartum with generalised tonic clonic seizures, reduced conscious level and a history of blurred vision and headache. She was treated immediately as eclamptic and transferred to the intensive care unit for stabilisation. Following an inconclusive CT result, an MRI was performed 2 days after presentation, which demonstrated white matter changes consistent with those found in PRES. She made a full recovery and a repeat MRI scan 7 weeks later showed no progression of the lesions noted on the original scan.

The needs of children and adolescents severely affected by chronic fatigue syndrome, myalgic encephalomyelitis (CFS/ME) are currently inadequately addressed in the UK. Sadly, there are few specialists addressing the needs of these patients who are primarily bed-bound, wheelchair users or who can only leave home on an infrequent basis. Uncertainty about what to offer as well of a lack of funding may play a part. Action for Young people with ME (AYME) suggests that at least 350 severely affected children/adolescents are receiving little or inadequate care to help them overcome this debilitating illness. This case report illustrates how recovery can occur with pragmatic rehabilitation combined with a committed compassionate family based approach.

Opportunistic mycobacterial infections are rare in immunocompetent patients. The authors describe a case of disseminated Mycobacterium avium complex disease in a previously healthy patient presenting with hepatosplenomegaly and non-specific symptoms which initially led to a diagnosis of metastatic carcinoma. After correct treatment she made a full recovery, with resolution of symptoms and the radiological findings.

Acute mesenteric ischaemia is a severe surgical condition with significant mortality, and it requires prompt recognition and surgical intervention. This report describes a case of a middle-aged gentleman with no previous risk factors who presented with an acute abdomen secondary to mesenteric ischaemia and made a full recovery. This case illustrates that mesenteric ischaemia can occur without the presence of any obvious risk factors and if treated early can result in successful outcomes.

Myeloproliferative disorders predispose individuals to bleeding and thrombosis, often with devastating consequences. We report a 41-year-old man who presented with headache, amnesia and dysphagia due to cerebral haemorrhage. Extensive investigation revealed the cause of the neurological syndrome as an underlying essential thrombocytosis. The patient made a full recovery following extensive inpatient and community rehabilitation, returning to work after 6 months. We discuss the diagnosis and management of stroke due to myeloproliferative conditions. This case report illustrates the importance of multidisciplinary teamwork in fully investigating and treating all patients with acute onset of stroke.

Bioabsorbable interference screws have been effective for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of these screws is low but some unique problems have been reported in the literature. We present a case of unusual tissue reaction to a bioabsorbable interference screw following ACL reconstruction. A young male underwent ACL reconstruction, during which a bioabsorbable interference screw was used for graft fixation at the tibial end. The patient presented with a pretibial swelling at 30 months after the operation. Exploration revealed chalky white remnants of the bioabsorbable screw with no evidence of infection. Histological studies confirmed a foreign body reaction against screw remnants with the presence of multinucleated giant cells. The patient had a full recovery with no compromise to graft stability. Bioabsorbable interference screws are usually inert but can initiate a tissue reaction. The presentation can be as late as 2–3 years postoperatively and may mimic an infection. Satisfactory results can be achieved by proper exploration and debridement.