This 75 year-old lady had six years previously undergone a mastectomy for a Grade 3, node positive breast carcinoma. She represented generally unwell with increasing back pain. Serological
investigation showed her to be hypercalcaemic. This plain pelvic x-ray shows multiple osteolytic bone metastases. Despite treatment with a bisphosphonate she died two months later.
This 82 year-old man presented to his general practitioner with increasing abdominal distension and vomiting of undigested. He had suffered with postprandial epigastric pain for a number of years
but had never sought medical advice. A barium meal was arranged. This showed the stomach to grossly distended with a large food residue. The appearances were those of pyloric stenosis which was confirmed with an upper GI
endoscopy. The underlying pathology was peptic ulcer disease. A partial gastrectomy with a Polya reconstruction was performed.
An 87 year-old man presented with regurgitation of undigested food that he noticed particularly when lying flat. This was associated with a nocturnal cough and several episodes of
'bronchitis'. Examination of his neck revealed an indistinct swelling arising from behind the sternomastoid muscle. Indirect laryngoscopy showed pooling of saliva within the pyriform fossa. A barium swallow confirmed the
swelling to be a pharyngeal pouch. He underwent a Dohlman's procedure - an endoscopic procedure during which the bar between the pouch and oesophagus was divided. He made an uncomplicated recovery from his surgery.
This 5-year old boy presented with a limp and right hip pain. Examination showed a reduction in abduction and internal rotation. This plain x-ray was obtained which showed the right femoral
head to be flattened and fragmented. A bone scan confirmed avascular necrosis of the capital femoral epiphysis. The appearances were those of Perthe's disease.