Article type : Our Experience Clinical case series describes a contraindication for SerenoCem Granules TM in mastoid obliteration: Our experience in sixty-four patients.

histopathology units, and 33 consultant urological surgeons contributed. RESULTSIn all, 210 biopsies from 205 men aged ≥ 80 years were identified, of whom 163 (79%) had biopsy-confirmed prostate cancer. All 29 men with a PSA level of ≥ 100 ng/mL, 98% of 47 with ≥ 50 ng/mL, 97% of 76 with ≥ 30 ng/mL and 92% of 101 with ≥ 20 ng/mL had biopsy cores containing cancer; 63% of men with a PSA level of < 20 ng/mL had cancer on biopsy. In men with cancer and a PSA level of ≥ 30 ng/mL, 92% had Gleason grade ≥ 7 and 93% were treated with hormonal withdrawal alone. In all men with cancer the DRE was abnormal in 91%, the mean number of positive cores was 59% and the bone scan was positive in 18%. The DRE was abnormal in 77% of men with benign biopsies. CONCLUSIONSIn men aged ≥ 80 years with a PSA level of ≥ 30 ng/mL, at least 97% had prostate cancer, > 90% of whom had high-grade disease, and nearly all with cancer received active pharmacological treatment. In the vast majority of these men prostate biopsies did not alter their cancer management. The value of prostatic biopsy in this age group, with a PSA level of ≥ 30 ng/mL, is questionable.

SummaryThis case report reviews the rare condition of Riedel’s thyroiditis via a patient case. The report highlights the difficulties that one may encounter when managing such a case in regards to patient symptoms, side effects of medications and the relapsing nature of the condition. The case report also highlights novel treatment in the treatment of Riedel’s thyroiditis, rituximab, how this works and the resolution of symptoms that we have achieved with our patient on this treatment.Learning points:Riedel’s thyroiditis is characterised by chronic inflammation, which causes dense fibrosis in the thyroid gland.Riedel’s thyroiditis can present with neck pain, dysphagia and dyspnoea with a firm, non-tender mass found on examination.Riedel’s thyroiditis is part of the IgG4-related systemic disorders.Rituximab is a monoclonal antibody that works against the protein CD20.

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ABSTRACT.A 69-year-old male was referred from the renal unit to radiology for investigation of bleeding per rectum. A CT mesenteric angiogram was performed. However, it was noted on the pre-contrast images that the large bowel contained positive oral contrast media. The procedure was abandoned as it would have been difficult to see extravasation of intravenous contrast from a bleeding point in the large bowel. The initial belief was that either the patient had been given oral contrast by ward staff on the assumption that it would be needed, or had had a recent radiological study requiring contrast, which was still present. Neither was the case; it emerged that the patient was taking Fosrenol (Shire Pharmaceuticals, Wayne, PA), a lanthanum carbonate medication used in the treatment of hyperphosphataemia. Lanthanum is densely radio-opaque and appears as positive bowel contrast on CT and plain radiography studies. When considering radiological studies specifically requiring the absence of oral contrast, it is important to be aware of the patient's drug history to avoid non-diagnostic scans with the associated radiation exposure. CT mesenteric angiography is an established technique for the localisation of intestinal bleeding. The standard protocol specifically precludes the use of oral contrast agents in order to allow for the visualisation of intraluminal contrast in the bowel from active bleeding. We present a case of a 69-year-old male who developed bleeding per rectum while in the renal unit and undergoing treatment for chronic renal failure. A CT mesenteric angiogram was requested to locate the source of the bleeding. However, initial pre-contrast images showed that the colon contained what was thought to be oral contrast media, which prompted the scan to be terminated prior to the administration of intravenous contrast. The patient and ward staff all denied that contrast had been given. It was later discovered that the patient was taking regular lanthanum carbonate (Fosrenol; Shire Pharmaceuticals, Wayne, PA) for the treatment of hyperphosphataemia, which can act as a positive oral contrast. We report the details of the case and discuss the radiological properties of lanthanum. Case reportA 69-year-old male with longstanding end-stage renal failure of unknown aetiology was admitted to hospital with a lower respiratory tract infection. The patient had previously been on haemodialysis and had undergone two renal transplants, one having been removed and one still in situ but not functioning. Automated peritoneal dialysis had been established as renal replacement therapy since the failure of the second transplant 3 years earlier.During the patient's time in hospital, fresh bleeding per rectum developed. This was investigated with an inpatient flexible sigmoidoscopy, which was normal. The bleeding subsequently stopped. A second large bleed reduced the patient's haemoglobin level to 6.1 g dl 21 and prompted a blood transfusion. After discussion with the radiology department, an urgent CT mesenteric angiogram was ar...