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A 67-year-old male with recently diagnosed type 2 diabetes mellitus presented with clinical features characteristic of Stevens–Johnson syndrome and died from a haemorrhagic bronchopneumonia. Autopsy revealed features of granulomatous arteritis and an interface cholestatic hepatitis. The cause of these features was felt to be due to a hypersensitivity reaction to glibenclamide. Although unusual, drug hypersensitivity with sulphonylureas may be fatal. Copyright © 2004 John Wiley & Sons, Ltd.

A 66-year-old insulin-requiring diabetic male with diabetes secondary to pancreatic damage from alcohol abuse, with well-established alcoholic liver disease and cirrhosis, developed obstructive jaundice from gall stones and later from a biliary stricture associated with gram-negative septicaemia. Death occurred from a haemorrhagic cholecystitis with ruptured gall bladder. At autopsy, a surprise finding was a non-functioning pancreatic islet cell tumour invading the ampulla of Vater. Cholestasis in this case was due to multiple factors. Copyright © 2002 John Wiley & Sons, Ltd.

A 53 year old male was diagnosed as having diabetes mellitus secondary to haemochromatosis. The patient died 27 months after presentation from a hepatoma. Haemochromatosis is reviewed with regard to its clinical presentation, diagnosis, treatment and prognosis. New information with regard to genotypic testing is discussed and screening for haemochromatosis in diabetic subjects and in relatives of patients with diagnosed haemochromatosis is reviewed. Copyright © 2002 John Wiley & Sons, Ltd.

A 52 year old diabetic female with obstructive jaundice due to cholangiocarcinoma developed recurrent deep venous thrombosis and venous gangrene (phlegmasia caerulia dolens). Carcinomatosis is the usual underlying cause of this rare form of gangrene and has a high mortality. It is important to remember that diabetic subjects can develop ‘non-diabetic’ gangrene, and other causes should be considered depending upon the clinical presentation. Copyright © 2002 John Wiley & Sons, Ltd.

Multidisciplinary team (MDT) meetings for decisions on cancer management are a cornerstone of UK cancer policy. We have proposed a comprehensive methodology to assess the clinical and economic effectiveness of telemedicine in this setting, which is being tested in a randomized breast cancer trial. Pre- and post-telemedicine assessment includes attitudes to and expectations of telemedicine, based on semistructured interviews. The communication content of videotapes of the MDT meeting is being scored using Borgatta's revised Interaction Process Analysis System. The technical performance of the telemedicine equipment is reported on a standardized pro forma. A short questionnaire captures key elements of professional satisfaction for each patient discussion (consensus on future management, confidence in and sharing of decision), added value of linkage, group atmosphere, overall conduct of the meeting and compliance with SIGN guidelines. A cost-minimization analysis will be used for economic assessment.

We report a case of pyoderma gangrenosum affecting both hands simultaneously. Pyoderma gangrenosum affecting the hands is an extremely rare condition which may result in considerable tissue destruction. Management includes immunosuppressant therapy, treatment of associated medical conditions and minimal surgical intervention. Despite a high maintenance dose of corticosteroid and adequate control of coexisting ulcerative colitis and rheumatoid arthritis, tissue destruction in the hands spread rapidly in our patient. The key to the patient’s dramatic improvement was the tissue biopsy suggesting pyoderma gangrenosum and the subsequent treatment with the cytotoxic immunosuppressant, azathioprine.