Eosinophilic Gastroenteritis Presenting As Unexplained Chronic Abdominal Pain.

A 27-year-old Caucasian female was hospitalized three times over a four-month period for recurrent, intermittent abdominal pain associated with nausea and diarrhea. No signs or symptoms of gastrointestinal (GI) bleeding were present. A stool occult blood test and stool enteric pathogen tests were negative. A complete blood count (CBC) revealed a peripheral blood eosinophil count of 1080 cells /µL without any inflammatory reaction. An upper endoscopy showed grossly normal-appearing esophageal and duodenal mucosa; however, a gastric mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/high power field (HPF). Based on these findings, she was diagnosed with eosinophilic gastroenteritis (EGE). A definitive diagnosis of EGE should be confirmed with both an analysis of gastrointestinal mucosal biopsy and an elevated peripheral blood eosinophil count. Specifically, histological evaluation of the mucosal tissue must show an eosinophilic infiltration rate of 20 eosinophils/HPF. The diagnosis should be followed by an extensive review of the patient's allergic disease history.

The Dislocated Hip Hemiarthroplasty: Current Concepts of Etiological factors and Management.

BACKGROUND: Hip hemiarthroplasty (HA) following an intracapsular neck of femur fracture is an increasingly common procedure as a result of an ageing population. Patients are often frail and so morbidity and mortality figures are significant. As a result the National Institute for Health and Clinical Excellence (NICE) has formulated guidelines and a Best Practice Tariff (BPT) in an attempt to improve the care of such patients. Dislocation following HA is a potentially devastating complication with a reported incidence ranging from 1 to 15%. Multiple causative factors have been cited and studied in an effort to reduce the incidence of this complication which has a high rate of recurrence following the first episode and is associated with a high mortality rate and significant financial burden on the health economy. This paper reviews the available literature in an effort to identify the most pertinent factors affecting dislocation rates and thus reduce the incidence of this serious complication. METHODS: A comprehensive review of the literature was performed using the search engine PubMed with the keywords 'hip', 'hemiarthroplasty' and 'dislocation'. Two hundred and forty three articles were identified and assessed by the 3 authors independently. Data from fifty-two articles pertinent to the review on hemiarthroplasty dislocation epidemiology, risk factors and management were extracted in a standardised fashion. RESULTS: Following review of the papers multiple causative factors relating to HA dislocation were identified and grouped into 4 broad categories for analysis. The factors with the strongest correlation with dislocation included patient cognition, previous failed surgery, delay to surgery, surgical approach and femoral offset. CONCLUSION: Hip hemiarthroplasty remains the gold standard for elderly patients with intracapsular neck of femur fractures. In each individual case the factors most strongly associated with postoperative dislocation should be recognised. Delays to surgery should be minimised and the posterior approach avoided. In addition to good surgical technique, particular attention should be paid to restoring the patient's native femoral offset and post operatively those with cognitive impairment should be closely monitored.

A novel technique for identification of fractured ceramic acetabular liner in total hip arthroplasty: a case report.

In total hip arthroplasty ceramic bearings are liable to fracture. We present the case of an 82-year-old male with groin pain and an audible squeak 6 months post ceramic on ceramic hip arthroplasty. Initial plain radiography and examination under anaesthetic (EUA) were normal. Fluoroscopy with normal image exposure was also unremarkable. Over penetration of the image intensifier film demonstrated a fracture of the ceramic acetabular liner. The patient subsequently underwent a revision of both acetabular and femoral bearing surfaces.Displaced ceramic liner fractures are easy to identify with plain radiographs. We recommend the use of over penetration using image intensification as a technique to help identify subtle ceramic liner fractures. To our knowledge this has not been previously reported in the literature.

Anterior tibial spine fracture - an easy fracture to miss.

Fractures of the intercondylar tibial spine are uncommon injuries that occur more frequently in the growing skeleton. They are easy to miss in the triage setting often being diagnosed as 'sprains' after sporting injuries. We report three cases that occurred in adolescents attending the same sporting event. We seek to highlight the importance of recognising these injuries so that the appropriate immediate treatment can be given.