Chronic gastritis is a common manifestation of Helicobacter pylori infection. Clinical presentations can range from epigastric discomfort to gastrointestinal bleeding. The clinical course and gross endoscopic findings can mimic alternative diagnoses such as gastric adenocarcinoma and gastrointestinal stromal tumors (GISTs). We report a case of H. pylori-associated chronic gastritis that initially presented with frank melena. Subsequent blood tests demonstrated a drop in hemoglobin and a rise in serum urea. The case was managed according to the hospital's upper gastrointestinal bleed protocols. The next day, endoscopy demonstrated a large polypoidal mass in the gastric antrum suspicious for GIST. However, subsequent biopsy and histological examination showed lymphoid aggregates and active inflammation with comma-shaped bacilli consistent with H. pylori infection. The case was subsequently managed with triple eradication therapy. This case underscores the value of prompt management of upper gastrointestinal bleeding and the need to validate diagnoses with definitive modalities to optimize long-term management.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a multisystem autoimmune disease that may present diagnostic challenges, particularly in patients with coexisting autoimmune conditions. Although the coexistence of rheumatoid arthritis and ANCA-associated vasculitis is recognised, vasculitis more commonly develops several years after rheumatoid arthritis onset. We describe a 68-year-old man who developed rapidly progressive glomerulonephritis due to myeloperoxidase (MPO)-ANCA-associated microscopic polyangiitis within 6 months of a diagnosis of seropositive rheumatoid arthritis. The diagnosis was established following an acute deterioration in renal function, positive MPO-ANCA serology and renal biopsy demonstrating pauci-immune necrotising crescentic glomerulonephritis. This case emphasises the importance of considering ANCA-associated vasculitis in patients with rheumatoid arthritis who develop acute kidney injury, even early in the disease course.
Abstract Background and aims Minimally invasive surgery may be an effective treatment for intracerebral hemorrhage (ICH), but benefit may depend on haematoma location. Our aim was to test whether corticospinal tract (CST) injury explains location dependence and modifies the effect of surgery on outcome after ICH in a secondary analysis of the MISTIE-III trial. Methods CST location was estimated on stability CT scans (n = 499) using our previously described automated model, whilst haematoma and oedema were defined using semi-automated manual segmentation. Risk of CST injury was categorized as: no risk, oedema infiltration, haematoma infiltration or complete CST interruption (Figure 1). Primary outcome was motor NIHSS at day 180 and secondary outcome was mRS at day 365. The association between CST injury and clinical outcomes was tested using multivariable regression models, introducing an interaction term to test for heterogeneity for treatment by CST injury. Results Day 180 motor NIHSS was significantly lower with less CST risk (no risk, β = −3.77 [−5.8 to −1.70], P = 0.0003; oedema infiltration, β = −2.3 [−3.5 to −1.1], P = 0.0002; vs. tract interruption). A significant interaction was noted between surgery and hematoma infiltration (β = −2.07 [−3.8 to −0.4], P = 0.016) (Figure 2). CST risk was also associated with day 365 mRS (no risk, β = −1.98 [−3.1 to −0.9], P < 0.0001) but no significant interaction was noted. Conclusions CST injury risk is a significant modifier of the MISTIE-III surgical intervention, with surgery reducing day 180 motor NIHSS scores by two points more in participants with hematoma infiltration (vs. tract interruption). Patients with partial CST infiltration may be a subgroup that benefits from haematoma evacuation. Conflict of interest ONM is funded by a Natalie Kate Moss Trust research fellowship; DJ has nothing to disclose; NW has nothing to disclose; HCP has nothing to disclose; TFC serves as a consultant to Aviagen Ltd; WZ is supported by the NIH and serves as an Associate Editor of Neurocritical Care; CK has nothing to disclose; DH serves as a consultant to Synaptogenix/Neurotrope and Medicolegal Consulting; UH has nothing to disclose; APJ is supported by a Margaret Giffen Stroke Association Reader Award (Ref: SA L-RC 19\100000). Figure 1 - belongs to Methods Figure 2 - belongs to Results
Background Isthmic spondylolisthesis is commonly associated with back pain and neurological symptoms. The primary localised kyphotic deformity at the level of the spondylolisthesis is counterbalanced by increased lordosis across the lumbar spine. Spondylolisthesis reduction and fusion corrects the initial deformity and may also restore lumbar lordosis and sacral slope. In this study, we aimed to investigate how lumbar lordosis normalises following short-segment transforaminal lumbar interbody fusion (TLIF) for isthmic spondylolisthesis. Methodology In total, 54 consecutive patients from a single surgeon series of isthmic spondylolisthesis undergoing reduction and TLIF performed between 2013 and 2023 underwent retrospective radiological analysis by two independent observers. Measurements of the lumbar lordosis, sagittal cobb angle across the lumbar spine as a whole, and individual motion segments were taken using pre and postoperative standing radiographs. Results A total of 39 fusions were performed at L5/S1, 12 at L4/5, two on both levels L5/S1 and L4/5, and one at L3/4. Normalisation of lordosis was noted at all spinal levels, including those distant from the surgical site. Global lumbar lordosis decreased from a median of 66° to 50° (p < 0.001). All segmental levels showed significant reductions in lordotic angle (p < 0.05), with the greatest proportional change at L1/2 and the largest angular correction at L5/S1. Conclusions This study is the first to demonstrate that surgical reduction of isthmic spondylolisthesis can restore global sagittal harmony by correcting the compensatory hyperlordosis across all lumbar segments.
Femoral head fractures, though rare, represent a significant challenge in orthopaedic practice due to their anatomical complexity, association with high-energy trauma, and potential for severe complications. These fractures often result from mechanisms such as motor vehicle accidents or falls from heights and are frequently accompanied by posterior hip dislocations. The primary aim of this systematic review was to evaluate the effectiveness of various management strategies for femoral head fractures, identify factors influencing outcomes, and highlight gaps in the current literature. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of databases, including PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, identified 16 studies involving 1,234 patients. Data extraction focused on fracture classification, treatment approaches, functional outcomes, complications, and long-term prognosis. The findings emphasised that non-operative management is effective only in select cases of minimally displaced fractures. Open reduction and internal fixation emerged as the gold standard for displaced fractures, with superior functional outcomes when anatomical reduction is achieved. Emerging techniques, such as surgical hip dislocation and hip arthroscopy, have shown promise as alternatives in specific scenarios, offering improved exposure or minimally invasive options. However, complications such as avascular necrosis and post-traumatic arthritis remain prevalent, particularly in cases with delayed intervention or suboptimal surgical outcomes. The review concludes that individualised, evidence-based approaches are essential for optimising treatment outcomes. Future research should focus on high-quality randomised controlled trials, the development of standardised outcome measures, and long-term studies to evaluate the durability of interventions. Innovations such as minimally invasive techniques warrant further exploration to improve patient care and recovery.
