Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

feature of vagotomy and pyloroplasty relative to the other operations considered is a lesser degree of bile reflux. Laboratory studies in animals'-3 have shown an increased incidence of stomach cancer after gastroenterostomy and a decreased incidence after addition of mucin. These results imply that the decreased integrity of the mucosal barrier caused by bile reflux is an important factor in the aetiology of stomach cancer. In reviewing the papers which Mr Farrands and others cite as evidence that the type of operation does not affect the subsequent late development of cancer4-8 I note that the only operations considered in these papers are those ofBillroth I or II or vagotomy and gastroenterostomy. Vagotomy and pyloroplasty is not mentioned. I therefore interpret their paper as an important piece of evidence to suggest that when hypochlorhydria is combined with bile reflux the risk of malignancy is enhanced. Consequently all operations associated with bile reflux should be abandoned in favour of of vagotomy and pyloroplasty or the more fashionable highly selective vagotomy. The proposed mechanism of development of malignancy would be the familiar hypothesis of prolonged hypochlorhydria resulting in an increased concentration of carcinogenic nitrosamines, which are more capable of affecting the gastric mucosa if its integrity is impaired by the presence of bile. G W L PHILLIPS

https://www.bmj.com/content/bmj/286/6381/1900.2.full.pdf

Evaluation of syncope.

A patient with bilateral granulomatous uveitis also had the simultaneous manifestation of granulomatous inflammation under red dye areas of a 10-year-old multicolored tattoo. The patient manifested secondary cystoid macular edema and uveitic glaucoma due to the chronic uveitis. Punch biopsy of the inflamed area of the tattooed dermis displayed a dense lichenoid granulomatous inflammation. Thoracic imaging revealed lymphadenopathy and pulmonary biopsy confirmed a diagnosis of sarcoidosis. This case and review of literature demonstrates that tattoo inflammation, whether generalized or localized to a particular color, should be considered a potential sign of systemic sarcoidosis and patients should be carefully evaluated for systemic granulomatous inflammation.

https://www.tandfonline.com/doi/pdf/10.3109/09273948.2014.891041

Systemic sarcoidosis and red dye granulomatous tattoo inflammation after influenza vaccination: a case report and review of literature.

The presentation of a MALT lymphoma in the bladder is exceedingly rare. Furthermore, the optimal treatment of primary MALT confined to the bladder remains to be defined. Here, we report a case of a 65-year-old female with primary MALT lymphoma treated with definitive radiation therapy. The patient received a total dose of 30 Gy in 20 equal daily fractions to the bladder and tolerated the treatment well. In addition, we have extensively reviewed the relevant literature to better define the optimal management of this rare disease. In conclusion, primary MALT lymphoma of the bladder represents a rare malignancy with excellent prognosis if detected at an early stage. For early stage disease, definitive radiation represents an excellent treatment modality with a minimal side-effect profile.

/pdf/malt-lymphoma-of-the-bladder-a-case-report-and-review-of-the-1qtc81ziko.pdf

MALT Lymphoma of the Bladder: A Case Report and Review of the Literature

Primary bladder mucosa-associated lymphoid tissue lymphoma: A case report and literature review.

A 62-year-old man presented to our family practice office with a skin lesion that developed over 8–10 months. Over the past 2–3 months the lesion grew more quickly. A 2–3 cm, hard brown projection was noted on the dorsal aspect of his hand. A decision was made to excise the lesion and send it for pathological evaluation. The lesion was found to be a cutaneous horn with invasive squamous cell carcinoma at the base. The margins of the sample were free of cancer cells. Cutaneous horns are raised skin lesions made of dead keratin derived from base keratinocytes. They are frequently found in areas of the body that have had solar exposure. There are a wide variety of histopathological findings at the base of these lesions. They range from benign to premalignant to malignant. Cutaneous horns should be completely excised and sent for pathological evaluation.

/pdf/cutaneous-horn-get-to-the-bottom-of-it-44j6zds2ys.pdf

Cutaneous horn: get to the bottom of it.

This case report describes a 54-year-old man who presented to his primary care physician with low back pain. During his workup, an incidental finding of a bladder mass was diagnosed. He underwent transurethral resection of the bladder tumour and the resulting pathology was consistent with extra nodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Presentation of MALT lymphoma in the urinary bladder is rare. This malignancy is more commonly found in the stomach. The prognosis for this rare tumour is excellent. Our patient showed no sign of recurrence with transurethral excision and radiation alone.

https://casereports.bmj.com/content/casereports/2014/bcr-2013-202994.full.pdf

A rare urinary bladder tumour.

Volume 86, Number 7 www.aafp.org/afp American Family Physician 669 A 39-year-old man presented with small nodules that had developed in his tattoos over the previous eight weeks. The nodules were not painful or pruritic. They were present only in the blue portions of the tattoo, but appeared in different tattoos on his arms and upper back (Figures 1 and 2). The tattoos were professionally applied about 12 to 13 years prior at the same tattoo parlor. The patient had diabetes mellitus, hypertension, and gout, which were all well controlled. He was also a smoker. He was taking metformin (Glucophage), glipizide (Glucotrol), allopurinol (Zyloprim), lisinopril (Zestril), and meloxicam (Mobic). The nodules continued to develop over the next six weeks, after which no significant changes were noted. A biopsy was performed.

Delayed complication from a tattoo.

This case report describes a 58-year-old man who is otherwise healthy but has periodic episodes of syncope which only happen when he laughs vigorously. This occurs suddenly with no prodrome, so the patient has no time to react and is unable to brace himself when he falls. The case is one of the very few described in the medical literature, most of which have similar presentations and findings on subsequent investigation. Recognition of the typical presentation, in the absence of more serious causes of syncope, may avoid extensive and expensive evaluation.

https://casereports.bmj.com/content/casereports/2013/bcr-2013-010169.full.pdf

Laughter-induced syncope.

Background: One of the key factors of the patient-centered medical home (PCMH) transformation require shifting mental models at the individual level and culture change at the practice level on how ...

https://journals.sagepub.com/doi/pdf/10.1177/2150132718817952

Charles Haddad

Papers

Cutaneous horn: get to the bottom of it.

A rare urinary bladder tumour.

Delayed complication from a tattoo.

Laughter-induced syncope.

Practice Transformation: Using Team-Based Care Training to Improve Diabetes Outcomes: