Delayed ventricular septal rupture complicating anterior wall myocardial infarction.

A 59-year-old woman was admitted to our hospital with acute pulmonary oedema and cardiogenic shock 35 days after anterior ST elevation myocardial infarction. She developed a new loud pan systolic murmur. Echocardiography revealed a ventricular septal rupture with a significant left to right shunt. She was immediately transferred to the local cardiothoracic unit where she underwent a successful ventricular septal defect (VSD) repair. Ventricular septal rupture often presents within the first 24 hours of acute myocardial infarction and is rare thereafter. It carries a poor mortality (41-80%) even when recognised. Timely recognition of this life-threatening complication can help reduce the resultant morbidity and mortality. Doctors should be aware that this well-recognised complication may present unusually late as in this case.

Anything rare is possible here: Brucellosis in London in 2012.

Brucellosis is a rare zoonotic disease in the UK but endemic in parts of the world, including the Mediterranean region, South and Central America, Caribbean, Africa and Persian Gulf. Therefore, the most common routes of transmission to the UK are either through emigration or by vacationing in such endemic regions. This provides us the challenge even today, especially in the extensive multi-ethnic area of East London, in recognising the signs and symptoms of the rare disease of Brucellosis. Here, we report such a patient case of Brucellosis.

The clinical experience of the challenges of oncology in South East Asia.

An unforgettable summer elective in the heart of Pakistan, discovering the specialities of internal medicine at the state-of-the-art cancer centre-Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCHRC). Cancer incidence and mortality are rising across the world, forcing medical research to find new and better treatments, all the time. The SKMCHRC is the only charity-funded cancer centre providing free treatment for anyone diagnosed with cancer in Pakistan. It is definitely the beginning of a new future for cancer patients in Pakistan, giving them a chance for a better quality of life, even those in poverty. Just like this, there are many appreciations and memories from my uplifting clinical experience at SKMCHRC.

An instant rare complication: a fractured metallic pyloric stent.

Metallic pyloric stenting (also termed as metallic enteral stenting) performed endoscopically, stands as first-line treatment for malignant gastric outlet obstruction. With reported evidence, these self-expandable metallic stents (SEMS) re-enable oral food intake, preventing patients having to face invasive techniques such as surgical gastroenterostomy. We report a patient having received a covered pyloric SEMS insertion following a tumour growth causing stenosis in the gastric antropyloric region. After 3 weeks, the patient presented with a fracture of the pyloric SEMS, a rare complication, resulting in a second pyloric SEMS insertion.