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Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant condition characterised by benign tumours of the hair follicle, renal cancer, pulmonary cysts and spontaneous pneumothorax. We report the diagnosis of a BHD syndrome achieved after incidental radiological finding of a renal tumour in a 24-year old man. The patient also displayed recurrent pneumothoraces and showed to have cysts in the basis of both lungs. The association of recurrent pneumo - thoraces and renal neoplastic disease should alert for the possible presence of this syndrome.

A 40-year-old man was referred for evaluation of cough of a few weeks duration and a history of recurrent respiratory tract infections for several years. Clinical examination revealed no abnormalities. Routine hematologic and biochemical evaluation were normal. Contrast-enhanced computed tomography of the thorax showed a hypoplastic right lung, hyperinflation of the left lung with cardiomediastinal shift to the right. Absence of the right pulmonary artery was noted and replaced by an extensive collateral network of hypertrophied vessels originating from bronchial, intercostal and mammaria interna arteries, and right arteria subclavia (Fig. A, B). Discrete bronchiectasis with thickened bronchial walls in a hypoplastic right lung was noted (Fig. C). A normal bronchial tree and normal parenchyma in the left lung was seen.

The article presented is supportive of mandatory certification of forensic scientists and believes that such a mandate can help establish a threshold for competency in the profession, provide a universal standard for ethical professional conduct, and enhance the credibility of forensic science in users of the profession and the general societal public. After examining the history of professional certification in the United States across a spectrum of professions including forensic science, results of surveys sent to forensic science practitioners to gauge their views on mandatory certification is discussed. Seventy-three surveys were received with most surveyors being in support of mandatory certification related to their discipline. Reasons why many practitioners have chosen not to engage in voluntary certification were also provided on the surveys and discussed. Finally, the article discusses possible ways of implementing mandatory certification and concludes that the mechanisms to achieve this goal may already be in place., Competing Interests: None., (© 2019 The Authors.)

A 78-year-old man presented with diffuse abdominal pain, localized peritonitis and raised inflammatory markers. CT revealed an mesentery abcess with a linear high density structure in continuity with the adjacent small bowel lumen. Laparoscopy showed a perforation by a fish bone. Gastrointestinal tract perforation by foreign body ingestion is rare complication (1%). There are some risk factors and prefered locations of perforation. Time interval between ingestion and complication can vary extremely.

Carcinoid syndrome is often complicated by carcinoid heart disease. Deposition of carcinoid plaques on the endocardium of the tricuspid and pulmonary valves causes the typical echocardiographic iconography with thickening of the leaflets and valvular insufficiency and/or stenosis leading to right heart failure. Additionally, the fibrous plaques can be visualized with cardiac magnetic resonance using delayed enhancement sequences. Accurate assessment of the dimensions of the dilated right ventricle by magnetic resonance implicates therapeutic options and defines prognosis. We report the case of a patient with advanced right heart failure as the clue to the diagnosis of carcinoid syndrome. Echocardiography was suggestive. Advanced investigation with magnetic resonance confirmed carcinoid plaque deposition on the tricuspid and the pulmonary valves, and we also had evidence of plaque deposition in the right ventricle. Multimodality imaging is essential in the investigation of this rare disorder.

Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant condition characterised by benign tumours of the hair follicle, renal cancer, pulmonary cysts and spontaneous pneumothorax. We report the diagnosis of a BHD syndrome achieved after incidental radiological finding of a renal tumour in a 24-year old man. The patient also displayed recurrent pneumothoraces and showed to have cysts in the basis of both lungs. The association of recurrent pneumothoraces and renal neoplastic disease should alert for the possible presence of this syndrome.

A 47-year-old male patient with a dural craniocervical fistula is presented. One year after a car accident the man was admitted to the emergency department with severe nausea and progressive paralysis of the lower legs. MRI examination of the brain and cervical spine discovered cervical myelopathy and tortuous blood vessels anterior to the pons and cervical medulla. Angiography was performed to provide the final diagnosis of craniocervical fistula. An embolization of the fistula was performed, and all of the patient's complaints disappeared within three days.

We report a case of acute encephalopathy in a patient with Crohn's disease who had taken sulfasalazine for 1 month. The development of toxic hepatitis and dermatitis prompted interruption of the drug. Four days later, neurologic symptoms became evident. These included acute monoparesis of the left arm, the development of stupor and coma, with endorotation of both arms, and a left Babinski sign. CT and MR imaging revealed multiple lesions in the white and gray brain matter, suggesting diffuse cerebral microangiitis. All cerebrospinal fluid examinations were negative. Methylprednisolone was given intravenously. Complete clinical normalization followed. Neurotoxicity secondary to sulfasalazine has seldom been reported in the literature. We found certain similarities with two previous case reports suggesting a hypersensitivity reaction to sulfasalazine or one of its metabolites. For ethical reasons, no rechallenge was performed.

Computed tomography of the gastric wall after ingestion of 500-700 ml of pure tap water, followed by rapid intravenous injection of contrast medium, was performed on 24 patients with known gastric tumors. Computed tomography detected the wall abnormality in 22 of 24 cases (91%). Local gastric involvement was correctly predicted in 20 of these patients. Tumoral ulceration was only diagnosed in two of 13 proven ulcerated tumors. General acceptance and tolerance of tap water as a gastric contrast medium was good in all patients. No side effects occurred.