Delftia acidovorans as an Unusual Causative Organism in Line-Related Sepsis.

The problem of line-related sepsis in patients undergoing chemotherapy for malignant disease remains a major problem in cancer-care even into the third millennium. We report a highly unusual pathogen which represented both a diagnostic and treatment challenge and highlights important issues around patient education as well as laboratory capability in the identification of causative organisms in line-related infections to facilitate clinical management.

Basal cell carcinoma of the penis.

Basal cell carcinoma (BCC) is the most common malignant tumour found in humans. It appears in the genital and perianal region in less than one percent of cases. Discovery of lesions around the genitalia may often be delayed due to neglect, hesitation of patients to visit the clinic or unawareness on the part of both the patients and physicians. We report a case of delayed presentation of BCC of the penis in a middle-aged man, which was successfully managed with wide local excision under the care of plastic surgeons.

Bilateral hip fractures associated with transient osteoporosis of pregnancy.

A case of transient osteoporosis of pregnancy complicated by bilateral neck of femur fractures is reported. We discuss the condition and review the literature, provide information to aid in the diagnostic dilemma clinicians may face when considering imaging techniques and the potential for foetal harm during radiation exposure. We discuss management strategies in such patients.

Rapidly evolving giant dermatofibroma.

Dermatofibroma, also known as "fibrous histiocytoma", is a benign dermal or subcutaneous poorly circumscribed proliferation of spindle-shaped fibroblasts and macrophages in the dermis. Although it is commonly present as a brownish nodule the legs of females, it may also arise on the upper extremities, trunk, and rarely on the head. The exact pathogenesis is unclear. However, it is widely believed that the originating insult to the dermis is a folliculitis, an arthropod bite, or an unspecified initial inflammatory condition. Giant dermatofibromas of greater than 5 cm in diameter are rare, with only 22 cases reported in the literature. We present a case of a rapidly evolving pedunculated mass in the groin of a male patient. Histological examination confirmed this to be a giant dermatofibroma. Though this specimen cannot is not confirmed as such, the cellular subtype is sometimes present as a larger lesion with anecdotal reports of local recurrence and distant metastases. The clinical and radiological features which were somewhat suspicious of malignancy are considered in the context of the definitive pathological diagnosis of a benign lesion.

Acute spinal epidural haematoma causing cord compression after chiropractic neck manipulation: an under-recognised serious hazard?

Spinal manipulative therapy performed by chiropractors is increasingly common in the United Kingdom. Spinal epidural haematoma is a rare complication of such physical therapy but when identified represents a neurological emergency. We describe the case of a 64 year-old man who presented with a dense hemiplegia due to a spinal epidural haematoma following cervical spine manipulation performed for acute neck pain. The clinical features and surgical management of the case are discussed and we stress the importance of recognition of chiropractic manipulation as a potential cause of neurological sequelae and discuss the potential pitfalls of such therapy as it becomes more widespread.

Equine endurance exercise alters serum branched-chain amino acid and alanine concentrations.

Six 2-year-old Arabian horses were used to determine whether 60 km prolonged endurance exercise (approximately 4 h) alters amino acid concentrations in serum and muscle, and the time required for serum amino acid concentrations to return to basal resting values. Blood and muscle samples were collected throughout exercise and during a 3 day recovery period. Isoleucine concentration in muscle tended to increase and leucine and valine did not change due to exercise. Serum alanine concentrations did not increase immediately after exercise, but increased at 24, 48 and 72 h postexercise. Serum isoleucine, leucine, and valine concentrations decreased after exercise and time required to reach pre-exercising concentrations was 48 h. In conclusion, endurance exercise in the horse decreases serum isoleucine, leucine, and valine concentrations, and increases serum alanine concentration. The decrease in serum branched-chain amino acid concentrations did not correspond to a measurable increase in total muscle branched-chain amino acid concentrations.

Supplemental silicon increases plasma and milk silicon concentrations in horses.

The primary objective of this research was to determine the effect of supplemental dietary silicon (Si) on plasma and milk Si concentrations of lactating mares and the subsequent effect on plasma Si concentrations in nursing foals. Additionally, the role of Si on altering biochemical markers of bone turnover was investigated, because supplemental Si may be advantageous in enhancing bone health. Twelve Arabian mare/foal units were pair-matched by foaling date and randomly assigned to two groups, Si-supplemented (Supplemented) or control (Control). Blood and milk samples were taken on d 0, 15, 30, and 45, d 0 being the 1st d after parturition. Plasma and milk (or colostrum) Si concentrations were determined and serum was analyzed for osteocalcin, carboxy-terminal pyridinoline cross-linked telopeptide region of type I collagen, and pyridinoline and deoxypyridinoline crosslinks. All Supplemented mares had higher (P < 0.01) plasma Si concentrations than Control by d 30, and Supplemented mares' milk had higher (P < 0.01) Si concentrations on d 45 than Control mares' milk. By d 45, foals of Supplemented mares had higher (P < 0.01) plasma Si concentrations than foals of Control mares. Supplemental Si did not influence (P > 0.36) bone metabolism in foals; however, trends (P < 0.10) for altered bone metabolism were observed in postpartum mares. Results indicate that supplemental Si increases plasma and milk Si concentrations. Further research is required to determine whether Si has a role in altering serum biochemical markers of bone and collagen activity.