Results-During follow up 13 patients died of unrelated causes. Of the remainder 33% discontinued fludrocortisone at a mean of five months. Reasons for discontinuing treatment were hypertension, five; cardiac failure, four; depression, three; oedema, three; and unspecified, two. In those who continued treatment supine systolic and diastolic blood pressure did not differ significantly from baseline (follow up two to 21 months). Hypokalaemia developed in 24% at a mean of eight months; in no case was treatment withdrawn because of hypokalaemia. Conclusion-Fludrocortisone, even in low doses, is poorly tolerated in the long term in older patients with hypotensive disorders. (Heart 1996;76:507-509)
IntroductionGangrenous cholecystitis is a severe complication of acute cholecystitis. We present an unusual case of gangrenous cholecystitis which was totally asymptomatic, with normal pre-operative parameters, and was discovered incidentally during a laparoscopic cholecystectomy. We have not found any similar cases in the published literature.Case presentationA 79-year-old British Caucasian man presented initially with acute cholecystitis which responded to conservative management. After six weeks he was asymptomatic and had normal blood parameters. An elective laparoscopic cholecystectomy was performed and our patient was found to have a totally gangrenous gall bladder.ConclusionIt is important to keep a high index of suspicion for the diagnosis of gangrenous cholecystitis in order to avoid potentially serious complications.
Glomus tumors are rare, soft-tissue neoplasms arising from the thermoregulatory neuromyoarterial glomus bodies. They are commonly observed in the extremities and typically present with symptoms of cold hypersensitivity, pain and localized tenderness. Intraneural glomus tumors (INGTs) are even rarer. Here we review the literature on INGT and present an unusual case of an asymptomatic INGT, found incidentally within the excision specimen of a spiradenocarcinoma that arose near the natal cleft. Interestingly, this had not been identified on magnetic resonance imaging (MRI) used to investigate the spiradenocarcinoma. Although glomus tumors are usually considered benign, malignant transformation has been reported, highlighting the need for reporting pathologists and treating clinicians to be aware of this entity.
Introduction: Lenadogene nolparvovec is a promising novel gene therapy for patients with Leber hereditary optic neuropathy (LHON) carrying the m.11778G[A ND4 mutation (MT-ND4). A previous pooled analysis of phase 3 studies showed an improvement in visual acuity of patients injected with lenadogene nolparvovec compared to natural history. Here, we report updated results by incorporating data from the latest phase 3 trial REFLECT in the pool, increasing the number of treated patients from 76 to 174. Methods: The visual acuity of 174 MT-ND4carrying patients with LHON injected in one or both eyes with lenadogene nolparvovec fromThe members of the LHON Study Group are listed in the Acknowledgments section.
Difficult access to care during the COVID-19 pandemic has led to a delay in some disease diagnoses. The pandemic has exacerbated pre-existing health inequalities, and the most deprived population has often been the most disproportionately affected. In this study, we investigated the impact of COVID-19 on the volume and pattern of melanoma diagnosis, to evaluate whether there is an association with the socioeconomic status of the population. Cases with newly diagnosed cutaneous melanoma from January 2019 to December 2021 were identified in a specialist multidisciplinary team-held database. Breslow thickness, pathological disease stage, patient demographics and postcodes were reviewed. In the 3-year study period, there was a total of 1910 cases. Compared with 2019 prepandemic data, there was a 31% reduction (P = 0.03) in melanoma cases diagnosed in 2020 and a 10% reduction (P = 0.09) in 2021. In 2020, stage 4 cases had a 46% increase (P = 0.031). In 2019, 7% of the most deprived population had stage 4 disease at diagnosis, which increased to 21% in 2020 (P = 0.02). COVID-19 has caused a dramatic reduction in the volume of melanoma diagnoses and an accompanying upstage of disease. Among the most deprived population in our region, they are three times more likely to receive a stage 4 diagnosis vs. before the pandemic. This suggests that the barrier to health care secondary to the pandemic is most apparent to the deprived population and probably caused a delay in cancer diagnosis among this group of patients. Health policy needs to be put in place urgently to address this health inequality, to minimize the prognostic impact on the population.
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