An interesting collection of paraneoplastic syndromes in a patient with a malignant thymoma.

Paraneoplastic neurological syndromes are conditions that manifest as the remote effects of cancer. These are very rare, occurring in 1/10000 patients with a malignancy, and include Lambert-Eaton myasthenic syndrome, limbic encephalitis, subacute cerebellar ataxia, opsoclonus-myoclonus, Stiff-Person Syndrome, retinopathies, chronic gastrointestinal pseudo-obstruction and sensory neuropathy. This report describes a case of 41-year-old man who presented with elements of multiple paraneoplastic syndromes, including chronic gastrointestinal pseudo-obstruction, myasthenia gravis-Lambert-Eaton overlap syndrome and polymyositis, and who was subsequently found to have a malignant thymoma. There are only three reported cases in the literature describing cases of Lambert-Eaton myasthenic syndrome in association with a thymoma, and only one case of a myasthenia gravis-Lambert-Eaton overlap syndrome in a patient with thymoma. However, there are no documented cases in the literature of this constellation of syndromes in a patient with a malignant thymoma.

A rare case of suture material obstructing the closure mechanism of a prosthetic aortic valve: a case report.

Prosthetic aortic valve dysfunction presenting as aortic regurgitation is a complication of mechanical valve replacement. We describe a case of late valve dysfunction caused by an annular suture of excessive length obstructing the closure mechanism of a bileaflet prosthetic valve.We present this rare cause of valve dysfunction in an 80-year-old male patient who presented with haemolysis and dyspnoea. At the time of operation it was found that a long vertically positioned annular valve suture was interfering with the normal closure mechanism of one of the prosthetic leaflets causing eccentric regurgitation jets. These findings were misdiagnosed as paravalvular leaks on the preoperative transoesophageal echo. No paravalvular leak was identified intraoperatively. After removal of the responsible suture normal prosthetic valve function was restored.Whilst early aortic valve dysfunction caused by suture material has previously been reported, this is the first report of suture material causing late dysfunction.