Fatigue and breathlessness in pregnancy: a rare and sinister cause.

We describe a rare but sinister presentation of fatigue and dyspnoea in a 39-year-old woman at 16 weeks gestation. Blood tests and bone marrow aspirate confirmed the diagnosis of multiple myeloma. The patient was managed expectantly during pregnancy with plasma exchange and blood transfusion. The pregnancy continued without event; labour was induced at 35 weeks gestation and a healthy female infant weighing 3100 g was delivered vaginally following a 2 h, 5 min labour. The patient subsequently underwent six cycles of cyclophosphamide, thalidomide and dexamethasone (CTD) chemotherapy followed by an autologous stem cell transplant (SCT) and reduced intensity conditioning matched unrelated donor (RIC MUD) transplant.

The alleged poisoning of Joseph Stalin: proof beyond reasonable doubt?

The name "Ioseb Besarionis dze Dzhugashvili" is as unassuming as it is unknown. It is the birth name of the brutal dictator who changed the face of Europe and whose actions still influence our lives today. Stalin, the man responsible for the slaughter of over twenty million of his own Soviet citizens and yet, the man who transformed the USSR from the feudalistic society of the Tsar's to a twentieth century military powerhouse that was instrumental in the defeat of Nazi Germany. Known as "Koba" to his friends, he cultivated a cult of personality where he was, and to a certain extent still is, admired in Russia and the former Soviet states. This paper will look at the following questions: why when he fell gravely ill did his comrades wait so long before seeking medical assistance? why were there omissions in the final post mortem report?, and why did one his closest lieutenants boast so openly about having murdered him.

Obstructive jaundice induced by biliary ascariasis.

Ascaris lumbricoides is one of the most prevalent parasitic infections, especially in developing countries. Its presence can lead to a multitude of presentations, one of the rarer ones being obstructive jaundice due to migration of the worm in to the biliary tree. We describe a case of a man who presented as an emergency to the general surgeons complaining of abdominal pain, fever, jaundice and vomiting. Ultrasound was used and the diagnosis of biliary ascariasis was made. The patient underwent surgery consisting of a cholecystectomy, common bile duct exploration and T-tube choledochostomy. Our report highlights the varied aetiology of obstructive jaundice and the importance of including biliary ascariasis in the differential diagnosis of the jaundiced patient, especially from endemic areas.