Bezoars are concretions of undigested material in the gastrointestinal tract and are most commonly found in the stomach. Antroduodenal localization of bezoars is exceptional; therefore, we report a case of a 40-year-old man who experienced recurrent epigastric pain following laparoscopic sleeve gastrectomy. An upper gastrointestinal endoscopy revealed a phytobezoar in the antroduodenal area, which was removed in its entirety via endoscopic fragmentation and piecemeal retrieval.

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Breast cancer was the most frequently diagnosed cancer among United Arab Emirate (UAE) nationals in 2002, accounting for 23% of all cancers in women. However, few studies have examined the immunohistochemical profile and subtyping of breast cancer in UAE and their correlation with the established prognostic factors. The aim of this study is to evaluate the immunohistochemical expression of oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)/neu, B-cell lymphoma 2 (Bcl-2), E-cadherin and p53 in primary breast carcinomas in Ras Al Khaimah (RAK) and analyse their expression in comparison with the established prognostic factors of breast cancer. We also attempt to classify breast cancer in the present cohort using immunohistochemical marker panels consisting of ER, PR and HER2, and to study the correlation with the other clinicopathological characteristics. The study included 28 patients with primary breast carcinomas diagnosed at the Department of Surgery, Saqr Hospital, RAK, during the period 2001–10. Immunohistochemical staining for ER, PR, HER2/neu, Bcl-2, E-cadherin and p53 was carried out and the tumours were categorized into four subtypes: luminal A, luminal B, HER2 enriched and triple-negative breast cancer (TNBC). Expression of ER, PR, HER 2, Bcl-2, E-cadherin and p53 was observed in 12 (42.85%), 7 (25%), 6 (21.4%), 14 (50%), 12 (42.8%) and 5 (17.8%) tumours, respectively. Lobular carcinoma showed significantly higher expression of ER (80%, P = 0.05) and loss of E-cadherin expression in all cases (100%, P = 0.006); HER2 and p53 overexpression was more frequently found in invasive ductal carcinoma (66.6% and 80%, respectively), and poorly differentiated tumours exhibited loss of ER and PR (84.6%, P = 0.02, and 92.3%, P = 0.01, respectively), loss of E-cadherin expression and showed predominant expression of p53 (P = 0.029). There was a strong positive correlation between ER and PR expression and Bcl-2 expression (P = 0.002 and P = 0.03, respectively). A total of 40% of p53-expressing tumours showed HER2 overexpression compared with 82.61% displaying loss of both markers (P = 0.0001). The majority of p53-positive tumours were ER, PR and Bcl-2 negative (80%, 100% and 80%, respectively). The luminal A, luminal B, HER2-enriched and TNBC subtypes accounted for 39.29%, 10.71%, 10.71% and 39.29%, respectively. The immunohistochemical subtypes were significantly associated with histological grade (P = 0.03), in situ component (P = 0.04), American Joint Committee on Cancer (AJCC) stage (P = 0.02) and Bcl-2 expression (P = 0.001). Steroid hormone receptors and p53 expression were relatively lower than other series, whereas the expression of HER2, Bcl-2 and E-cadherin were consistent with the range reported in the literature. The molecular subtypes showed significant associations with tumour grade and stage, two of the well-established prognostic factors.

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Although medical advances in the treatment of thalassaemia major have led to increased survival, some patients still suffer from disease complications. These complications, along with chronic treatment via transfusions and chelation, can adversely impact patients' quality of life (QoL). A cross-sectional study was carried out in children and adolescents suffering from thalassaemia who received treatment at Saqr and Saif Bin Ghabash Hospitals from January to March 2012. QoL was assessed using the QoL Short Form questionnaire-36 items (SF-36) in 25 patients; 25 participants who did not have thalassaemia formed a control group. There was a significant reduction in the QoL of patients with thalassaemia when compared with the control group. Patients in the age group 17–24 years had better QoL than other age groups, and women had a higher QoL score than men. Patients with a higher level of education had better QoL than those with a lower level of education and patients who had undergone fewer blood transfusions (< 12 per year) had better QoL than those who had undergone more blood transfusions. Patients who regularly received iron chelation (≥ 30 per month) showed better QoL than all other groups.

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The prevalence of acute pancreatitis (AP) is increasing and is paralleled by an increased prevalence of obesity. High levels of adipocytokines, including adiponectin, can indicate a large amount of visceral fat surrounding the pancreas. Our aim is to study the ability of serum adiponectin to predict the clinical severity of acute biliary pancreatitis and its potential use as a marker of body mass index (BMI). Data were collected from 102 patients in this prospective study who were diagnosed with initial acute biliary pancreatitis between January 2010 and April 2013. Waist circumference and BMI were measured and serum adiponectin levels were analysed at the time of admission using enzyme-linked immunosorbent assay (ELISA). In addition, plasma samples of adiponectin were taken from an age-, sex- and BMI-matched control group. Our results showed that BMI was significantly correlated with pancreatitis severity (P = 0.007) and there was a negative relationship between BMI and adiponectin levels with a Pearson correlation coefficient of < 0.45 (P = 0.001). Serum adiponectin did not correlate with weight or waist circumference and, furthermore, serum adiponectin was significantly lower in patients with AP than in the control subjects (P < 0.0001). Obesity is a risk factor for developing severe AP and we demonstrate that measuring the serum adiponectin level can be used as a new marker for BMI at the time of hospital admission; however, adiponectin failed to serve as predictive marker of clinical severity.

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The aim of the study was to determine the indications for surgical correction of aphakia and stability and complications following the combination of multiple procedures with retrofixation of Artisan® (Ophtec, Groningen, Netherlands). Seven patients who underwent retropupillary fixation of the intraocular lens (IOL) in the Cataract and Refractive Surgery Unit of Dubai Hospital from January 2012 to December 2012 were selected for the study. The study included one patient with aphakia following penetrating injury with pupillary abnormality, two patients with opaque hydrogel posterior chamber IOL (PCIOL) (with pseudophakic bullous keratopathy in one of these patients) and one patient each wth previous failed keratoplasty with anterior chamber IOL (ACIOL) and pupillary abnormality, aphakia following complicated cataract surgery, subluxated PCIOL with sunset syndrome and pseudophakic bullous keratopathy with ACIOL. All the patients underwent detailed eye examination and IOL calculation. Artisan insertion was combined with other surgical procedures in all of the patients and the patients were followed up postoperatively for a minimum of 6 months. There was improvement in vision in all patients. There was no significant increase in intraocular pressure (IOP) or postoperative inflammation, but one patient showed disenclavation of the haptic after 6 months. Retrofixation of IOL is one of the novel methods of correcting secondary aphakia of various causes. It is well tolerated in any age group and presents few complications. In addition, this procedure can be easily combined with other procedures such as penetrating keratoplasty, vitrectomy and anterior chamber reconstruction.

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This is an account of contemporary asthma diagnosis and management, with a look to the future. It summarizes current UK, US and international guidelines regarding asthma diagnosis and management and outlines a plan for asthma monitoring to optimize control, as well as an account of contemporary anti-asthma therapy. It is stressed that poor compliance, poor inhaler technique and inattention to comorbidities and exacerbating factors are common causes of poor asthma control and that these aspects should be addressed before modifying therapy. There is a final note on future possibilities for asthma care.

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Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of mortality worldwide and is predicted to become more of a problem over the next 20 years. The predominant cause of COPD in high-income countries is cigarette smoking, whereas the major cause in low-income countries remains the use of biomass fuel for cooking and heating. A great deal of COPD remains undiagnosed and the greater use of spirometry in screening would identify patients who could be helped by treatment. The aim of treatment is to reduce further problems by stopping exposure to harmful agents and by reducing exacerbations. Many treatments are available to improve symptoms and to treat exacerbations and a simple classification based on lung function and symptoms can be used to guide the general approach to treatment.

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Synovial cell sarcomas of the kidney are rare tumours that most urologists and pathologists throughout the world have not encountered. Because of this, most practitioners may not be aware of the presentation, diagnostic features or biological behaviour of such tumours. This article reviews the literature on synovial cell sarcomas of the kidney in order to document the presentation, investigation, management as well as outcome following treatment of these tumours. Synovial sarcoma of the kidney is a rare tumour that was first reported in 1999 and, since then, 64 cases have been reported in the literature. Synovial sarcomas of the kidney tend to be found in patients who are aged between 17 and 61 years, and the clinical presentation and radiography findings are similar to those of other renal tumours. There are three main types of primary synovial sarcomas of the kidney: the biphasic, the monophasic and the poorly differentiated varieties. Primary biphasic synovial sarcomas contain both glandular elements and spindle epithelial cells, whereas primary monophasic synovial sarcomas are composed of spindle cells only and poorly differentiated synovial sarcomas (PDSSs) exhibit three histological variants: large cell, small cell and high-grade spindle cell variant. PDSSs are composed of sheets of undifferentiated round cells with hyperchromatic nuclei and frequent mitoses, and such tumours are often associated with a rich vascular pattern with dilated and thin-walled vascular spaces that resemble haemangiopericytoma. The differential diagnoses include adult Wilms' tumour, transitional cell carcinoma, renal cell carcinoma, haemangiopericytoma, congenital ectoblastic nephroma and primitive neuroectodermal tumour (PNET).Diagnosis of renal synovial sarcoma is based on microscopic findings of (a) spindle cells (monophasic) or (b) glandular cells and spindle cells (biphasic) supported by immunohistochemical staining characteristics [positivity for CD99, CD56, Bcl-2, epithelial membrane antigen (EMA) and cytokeratin (CK)] and molecular genetic studies of the tumour showing characteristic chromosomal translocation t(X;18)(p11.2;q11.2), which is seen in cases of synovial sarcoma. There is no consensus regarding the treatment of synovial sarcoma of the kidney; however, surgical excision including a portion of surrounding normal tissue (radical nephrectomy) has so far been the main treatment. In addition, response to ifosfamide and doxorubicin (adriamycin) chemotherapy has been reported. Recurrence following treatment for non-metastatic synovial sarcoma is approximately 36% and prognosis for advanced disease is poor. Diagnosis of synovial sarcoma of the kidney is based upon characteristic microscopic findings that must be supported by specific diagnostic immunohistochemistry characteristics and molecular genetic evidence of chromosomal translocation. Because of the rarity of synovial sarcomas of the kidney, urologists and oncologists need to report all cases they encounter, together with reports of long periods of follow-up, to enable practitioners to fully understand the biological behaviour of such tumours.

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The micropapillary variant of urothelial carcinoma is one of the variants of urothelial carcinoma that was added to the World Health Organization (WHO) classification in 2004. This variant of urothelial carcinoma is uncommon and, therefore, a number of practitioners have not yet encountered the tumour in their clinical practice. In view of this, the diagnostic features and the biological behaviour of this tumour are not well known by practitioners. This review documents the diagnostic features, management and outcome of the micropapillary variant of urothelial carcinoma. Various internet search engines were used to identify literature on the micropapillary variant of urothelial carcinoma, including case reports and case series, which formed the basis of the literature review. At least 500 cases of the micropapillary variant of urothelial carcinoma have been reported since it was first described in 1994. The gross morphology is variable and there are no special features to differentiate this variant from other variants or from conventional urothelial carcinoma. The micropapillary variant may be sessile, papillary, ulcerative or polypoid or may manifest as an infiltrative mass of variable size, ranging from microscopic to > 10 cm. The microscopic features of this variant of urothelial carcinoma exhibit an architecture that is reminiscent of the papillary configuration of ovarian papillary serous tumours. The nuclei of the micropapillary variant cells are commonly of high grade and show reverse polarity to the external surface of the tumour nests. A minority of the tumour-containing spaces represent actual lymphovascular invasion, which is supported by their characteristic immunohistochemical staining with endothelial markers. Lymphovascular invasion can be found in most cases of the invasive micropapillary variant of urothelial carcinoma if the specimens are adequately sampled, but a majority of the tumour-containing lacunae do not have endothelial lining and, therefore, do not represent true lymphovascular invasion. Psammoma bodies, which are common in ovarian papillary serous tumours, are rare in the micropapillary variant of urothelial carcinoma, and most of these tumours exhibit deep muscle invasion. Urine cytology exhibits papillary/spheroid clusters of tumour cells that have a high nuclear grade. The micropapillary variant of urothelial carcinoma is a rare and aggressive variant and may be under-reported as some pathologists may not be aware of its diagnostic features. Reports so far would indicate that this variant is associated with poor prognosis and adjuvant chemotherapy may have a questionable efficacy. Because of the rarity of this variant of urothelial carcinoma, there is no consensus opinion regarding the optimal treatment. Therefore, there is a need for urologists and oncologists throughout the world to report cases of the micropapillary variant of urothelial carcinoma so that the biological behaviour of the tumour can be ascertained. There is also a need for multicentre trials of treatment of this variant of urothelial carcinoma so that lessons can be learnt regarding the biological behaviour of the tumour and a consensus opinion can be established regarding the best treatment modality for such an apparently aggressive tumour.

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A 42-year-old man presented with complaints of recurrent blisters over his chest and abdomen that he had been experiencing for 1 year. The blisters were painful and black and, although they were healing, scars remained. Examination revealed a few bullae filled with haemorrhagic fluid on the anterior aspect of the chest and abdomen and atrophic scars from previously healed lesions were seen. The lesions were typically found on the easily accessible areas of the chest and abdomen with normal skin over the rest of the body areas. Systemic examination findings were normal and the clinical diagnosis of dermatitis artefacta was given. These self-inflicted skin lesions are often induced by foreign objects and typically found on areas that are easily accessible by the patient's own hands. Owing to the frequent lack of honest disclosure and cooperation from the patient, this disorder is often difficult to diagnose and treat.

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Cough is the most common reason why patients consult their doctor. An acute cough due to viral upper respiratory tract infection is disruptive to the individual and can lead to a reduction in productivity. Dextromethorphan is one of the most widely used antitussives; however, there is a paucity of evidence to support the use of antitussive medications. In some patients, the cough persists and impacts on health-related quality of life. Cough hypersensitivity syndrome (CHS) is an emerging term for patients with a chronic cough and it recognizes cough reflex hypersensitivity as a key feature. Most patients describe a laryngeal irritation, such as a tickle sensation, also known as laryngeal paraesthesia. The initial management of CHS is to minimize common aggravators, such as airway inflammation, gastro-oesophageal reflux and rhinitis, which may exacerbate a cough. In cases of refractory cough, speech- or physiotherapy-led cough suppression therapies and gabapentin are recommended. There is a pressing need to develop effective antitussive medications that target peripheral and central cough neural pathways.

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