The truth is in the water: metastatic prostate cancer presenting as an intermittent facial nerve palsy.

An elderly man presented to the acute ear, nose and throat (ENT) services with a history of intermittent, self-limiting facial nerve palsy. Full ENT examination was normal, with all cranial nerves and peripheral neurology intact. Multiple imaging modalities suggested an aggressive bony lesion, secondary to locally advanced prostate malignancy with extensive metastatic infiltration. Prostate cancer is known to preferentially metastasise to bone and has been known to cause multiple cranial nerve palsies and ophthalmoplegia. This is the first case described in the literature of metastatic prostate cancer presenting with intermittent facial nerve palsy.

Changing trends in HIV diagnosis in an inner city London teaching hospital 2007-2011.

In 2008, guidelines aimed at reducing undiagnosed HIV infection were published, recommending normalization of testing. Local initiatives were carried out in south-west London including an extensive primary care education programme. This study aimed to establish the impact of these initiatives on HIV diagnoses. Data on all new diagnoses referred to our centre were collected and analysed from patient records. A total of 394 patients were newly diagnosed with HIV from 2007 to 2011. Diagnosis in primary care and other non-sexual health (SH) settings increased by 184% during this period. There was an increase of 37% in the median CD4 count at diagnosis, taking the figure to 372 cells/mm³ in 2011. The proportion of patients presenting with a CD4 count of <200cells/mm³ decreased by 24%. The evidence suggests that these local initiatives were successful in increasing HIV diagnoses outside SH settings, particularly in very late presenters.