Achalasia secondary to carcinoma of prostate

Summary Esophageal achalasia secondary to malignancy has been described in gastric and pancreatic adenocarcinoma as well as bronchogenic carcinoma and lymphoma. This report describes a man with achalasia due to metastatic prostatic adenocarcinoma. The distinguishing features from idiopathic achalasia and the pathogenesis of tumor-induced achalasia are reviewed.     

Values‐based medicine and modest foundationalism

Philosophically, values refer to the basic commitments that justify judgements, beliefs and practices, both at the community and personal levels. The study of these kinds of values is axiology. We suggest that all people subscribe to three foundational values – survival, security and flourishing – and that these foundational values are expressed by way of concepts, systems, principles and practices that may differ substantially from culture to culture. Values can stand on their own as foundational justifications for health care and medicine. Many ethical quandaries can be better understood, even though they may remain unsolved, by reference to the foundational values that people can agree upon. This version of values‐based health care has strong claims to prior logical status as a justification for the whole enterprise of health care, and values‐based medicine is a part of this larger domain.     

Kimura disease of the eyelid in an Indian man

Kimura disease is a rare idiopathic chronic inflammatory disease, characterized by subcutaneous nodular lesions in the head and neck area. Ophthalmic manifestation of Kimura disease involves orbital and eyelid lesions mostly in Asian patients, but it has been described in White patients and Black Caribbean patients. Kimura disease is usually associated with eosinophilia and occasionally with renal disease. Here, we report a case of Kimura disease of the eyelid in a 50-year-old Indian man with eosinophilia. The main differential diagnosis was angiolymphoid hyperplasia with eosinophilia. Histology is crucial to separate these two entities, and our case was shown to be Kimura disease by histology. To our knowledge, this is the first report of a person of Indian origin to develop Kimura disease involving the eyelid.     

Bilateral internuclear ophthalmoplegia—an unusual initial presenting sign of giant cell arteritis

A 63-year-old man presented six days after the sudden onset of horizontal double vision. His left eye became divergent two days later. On initial examination he had bilateral internuclear ophthalmoplegia with weakness of adduction and abducting nystagmus. Convergence was weak but there were no other neuro-ophthalmic signs. Constitutional signs included confusion and unsteadiness on his feet. A provisional diagnosis of arteritis was made. His ESR was 92 mm/h and a superficial temporal artery biopsy confirmed the diagnosis of giant cell arteritis. After two weeks or oral prednisolone his eye movements returned to normal. There have been no further relapses.
This would appear to be a unique presentation of giant cell arteritis. The causes of internuclear ophthalmoplegia are discussed along with a review of the ocular and neuro-ophthalmic signs of giant cell arteritis.     

The Sodoeconomic Status of Women Attending a New Zealand Colposcopy Clinic

Summary: An analysis of a group of predominantly Caucasian women with cervical intraepithelial neoplasia grade 3 lesions seen at the Dunedin Hospital Colposcopy Clinic during a period when it was the only colposcopic service in the region, showed that patients in the lowest socioeconomic class, as judged by two parameters unique in New Zealand were overrepresented. This finding is in agreement with the social class gradient for cervical cancer and precursor lesions observed in other countries. Poverty, more liberal sexual activity and smoking may be factors in the genesis of cervical neoplasia amongst the women studied. In providing cervical smear facilities for at-risk women, special provision should be made for women in the lowest social stratum.