Caecal amoebic colitis mimicking a colorectal cancer.

Intestinal Entamoeba Histolytica infection in the UK is rare but it can lead to colitis, abscess formation, colonic perforation and rarely amoeboma. Although most patients are asymptomatic, it can present with a wide range of gastrointestinal symptoms depending on the phase of the infection. We present a case of amoebic colitis that caused diagnostic uncertainty by mimicking a colonic carcinoma.

Implementation of national diabetes retinal screening programme is associated with a lower proportion of patients referred to ophthalmology.

AIMS: To examine the impact of a new national retinal screening programme on screening attendance, technical quality of images, and referrals to the ophthalmology clinic. METHODS: Results from the previous ad hoc retinal screening service were compared with data from the first year of the new Scottish Diabetes Retinal Screening Programme in Dundee, which was administered according to criteria recommended by the Health Technology Board Scotland. RESULTS: Of 5150 patients invited for screening, 10.3% of patients did not attend. Overall, 4574 patients underwent single-field digital retinal photography and 25.4% required mydriasis for an adequate image. After screening, 1.9 and 90.5% were recalled for repeat photography at 6 months and 1 year, respectively, whilst 4.6% were ungradable and 3.0% were referred to the ophthalmology clinic. Compared with the last 18 months of the previous scheme, with the new programme a smaller proportion of patients were referred to ophthalmology (3.0 vs. 5.9%; P < 0.001, difference 2.9%: 95% confidence interval 2.1-3.7%). Moreover, the attendance was higher (89 vs. 82%; P < 0.01) and there were fewer ungradable images (4.6 vs. 7.1%; P < 0.001). CONCLUSIONS: Introduction of a systematic retinal screening programme can reduce the proportion of patients referred to the ophthalmology clinic, and use ophthalmology services more efficiently.

Hypokalaemic thyrotoxic periodic paralysis in an Asian man in the United Kingdom.

A large number of ethnic Chinese and other oriental populations are living in the West because of the modern day migration of people. Hypokalaemic periodic paralysis attributable to thyrotoxicosis is a common presentation in an Asian emergency department. It is uncommon in the white communities. There is a difference in the genetic type in the different racial groups. Thyrotoxic features are often masked or absent. Life may be threatened because of severe hypokalaemia and therefore a prompt diagnosis of this condition in the certain ethnic group presenting with weakness and hypokalaemia is essential. Thyroid function studies are mandatory in these cases.