Aortoesophageal perforation following ingestion of razorblades with massive haemothorax.

Aortoesophageal fistula is a rare complication of foreign body ingestion. Typically having ingested a fish or chicken bone, the patient complains of chest pain or discomfort and/or may present with massive gastrointestinal bleeding, which in all but rare cases is fatal. The pathological mechanism may involve perforation and direct communication of oesophagus and aorta usually at the level of the aortic arch; or more usually following oesophageal perforation, the subsequent mediastinal abscess leads to necrosis of the aortic wall. Torrential haemothorax as a result of such a process has not been previously described, though it has undoubtedly occurred. We present a case of massive haemothorax following deliberate ingestion of razorblades that highlights clinically and radiologically the natural course of such a tragic action.

Granular cell tumour developing in the background of a previous mandibular giant cell lesion: Case report.

INTRODUCTION: Granular cell tumours of the mandible are very rare. We present a unique case which has developed at the site of a previous giant cell lesion. PRESENTATION: 51 year old Caucasian lady had excision of a recurrent giant cell lesion of the anterior mandible. Follow up showed evidence of radiographic recurrence. However, further biopsies from the same site showed granular cell tumour with soft tissues extension. The patient remains well on long term follow up with no evidence of recurrence. DISCUSSION: This case is unique because the granular cell tumour has evolved from the site of a recurrent giant cell lesion. Conservative surgical excision was an adequate treatment option. CONCLUSION: Within the limitations of our case study, a correlation between granular cell tumour and giant cell lesion is possible. However, more research is needed to prove this.

Interphalangeal joint involvement of the big toe in gout: a rare presentation.

Atypical presentation of gout can cause diagnostic dilemmas. We report a case of gout that presented with an expansile lytic lesion involving the interphalangeal joint of the hallux, lack of a history of gout, and an associated solitary lung nodule. Magnetic resonance imaging showed an expansile destructive bony lesion with soft-tissue involvement suggestive of a possible bony metastasis. A needle biopsy was performed, and histopathologic features were diagnostic of chronic tophaceous gout.

Percutaneous medical liver core biopsies: correlation between tissue length and the number of portal tracts.

OBJECTIVE: Liver biopsy is an important tool for the diagnosis and assessment of liver disease. The authors aimed to establish the relationship between biopsy length and the number of total portal tracts. METHODS: The authors reviewed 163 16G percutaneous medical liver biopsies taken at a tertiary referral centre over a 14-month period. Haematoxylin and eosin sections were analysed using imaging software and portal tracts were counted. RESULTS: Liver biopsy length correlates with total portal tracts. The median biopsy length was 13.3 mm with a median of six portal tracts. Ninety-five per cent of biopsies measuring at least 15 mm contained six portal tracts or more with a significant difference between total portal tracts when compared with biopsies <15 mm (p<0.0001). CONCLUSION: To facilitate adequate histological assessment by examining at least six portal tracts, the authors suggest that 16G biopsies should be at least 15 mm long.