Variable expression in flecked (speckled) dystrophy of the cornea.

Five members of a three-generation pedigree had flecked corneal dystrophy. The number of flecks varied from patient to patient, and one individual was affected in only one eye. Visual acuity was normal in all family members. Homocystinuria also occurred in this family, but appeared to be coincidental. Central cloudy dystrophy of the cornea appears to be genotypically identical to flecked dystrophy of the cornea but is phenotypically distinct.     

Pyogenic liver abscess in patients with schistosomiasis mansoni

Schistosomiasis mansoni has been described as a predisposing factor for pyogenic liver abscess formation. Previous experimental studies have shown that acute schistosomiasis concurrent with Staphylococcus aureus bacteremia favors the colonization of the liver by the bacteria, and subsequent pyogenic liver abscess formation. In addition, clinical studies and case reports have demonstrated the association of schistosomiasis mansoni with pyogenic liver abscesses. We describe a Brazilian patient with chronic schistosomiasis mansoni who developed recurrent pyogenic liver abscesses due to Pseudomonas aeruginosa. The authors review the clinical, diagnostic and treatment aspects of patients with schistosomiasis and pyogenic liver abscess reported in the medical literature.     

Gastric wall necrosis owing to its incarceration through a rupture of the diaphragm into the left thoracic cavity

A 73 year-old female patient was admitted to the 3rd Medical Department of Semmelweis University with a painful haematoma in the left loin and respiratory disorders. Her general condition was getting progressively worse. Chest X-ray demonstrated a left sided hemopneumothorax caused by a fractured rib. Thoracic drainage was planned, but the tube introduced on the usual place into the left thoracic cavity perforated the stomach which was incarcerated in the chest. After this an urgent operation was carried out. We found an incarcerated, twisted stomach prolapsing through a rupture of the diaphragm. It was partially necrotic. Excision of the stomach wall with suturing the diaphragm, lavage and drainage of the thoracic and abdominal cavity was carried out. Despite the operation multi-organ failure developed as a result of sepsis, and the patient'died. We discuss the literature in connection with the presentation of this rare and interesting case. In the past 15 years we could not find similar case in the Hungarian surgical literature.     

Oral surgical aspects of child abuse and neglect

Oral trauma is a frequent manifestation of child abuse. Injuries to the oral hard and soft tissues are common in active children, but any oral injury in a young preambulatory infant should raise concern for abuse. Oral-facial trauma may be the primary presenting injury, or may accompany other severe inflicted injuries such as head injury, fractures, or abdominal trauma. Some congenital or acquired medical disorders may be mistaken for abuse or neglect. The oral surgeon is a critical participant in the collaborative management of child abuse cases.     

The development of a collaborative medical modelling service: organisational and technical considerations

We describe the steps, problems, pitfalls and modifications in the development of a collaborative medical modelling service for a general hospital in the United Kingdom. We emphasise the value of having as much control as possible in the hands of clinicians so that the maximum relevant information can be obtained at minimum cost. Three-dimensional imaging, modelling and planning are now essential parts of any reconstructive surgery unit and must be adapted to make them as user friendly as possible for clinicians.     

A form for referral of injured patients between maxillofacial and ophthalmology units

We have designed a form to facilitate referral of injured patients between maxillofacial and ophthalmology units. This form improves communication, gives a written record of referral, and can be used for audit.