No abstract

Coeliac disease was considered to be a rare childhood affliction causing malabsorption and weight loss. It is now recognized to occur at any age with a range of non-specific manifestations including anaemia, recurrent miscarriages, neuropsychiatric disorders and osteopenia. This article summarizes advances in diagnosis and innovations in therapy.

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 361;23 nejm.org december 3, 2009 e53 A n 83-year-old man was admitted to the acute medical ward after having fallen down in his home. On admission he was confused and agitated. Physical examination revealed a swelling with bruising over his right sternoclavicular joint (Panel A) and periorbital bruising. He had a white-cell count of 14×10 3 per cubic millimeter, a C-reactive protein level of 56 mg per liter, and a urinalysis that was positive for a urinary tract infection. A social history was taken and revealed no suggestion of abuse. Radiography of the chest (Panel B) showed a right sternoclavicular dislocation, which was clinically confirmed to be anterior. Anterior sternoclavicular dislocations often result from an indirect force to the shoulder, rotating the shoulder posteriorly. The physician must always consider the possibility of abuse having caused this type of injury. The patient was treated for his urinary tract infection. His anterior sternoclavicular dislocation was treated conservatively. The confusion resolved, and after a short period of rehabilitation, he regained good function of his right upper limb.

No abstract