We present three cases of late radiation enteritis, all admitted through the accident and emergency unit and managed in the surgical department. All presented with acute symptoms. Two had abdominal pain, nausea, and vomiting and in these two cases, plain radiology and computed tomography scans demonstrated small bowel obstruction. Exploratory laparotomies confirmed chronic radiation damage to the small bowel. The affected areas were resected and anastomoses were performed. The postoperative course was uneventful. The other patient presented with bleeding per rectum and a colonoscopy with biopsy of the rectum confirmed proctitis and radiation enteritis. This patient was treated conservatively and responded well. The key factor needed for successful diagnosis and management of chronic radiation enteritis is a high index of suspicion leading to appropriate use of imaging.

Congestive heart failure is a recognised complication of uncontrolled thyrotoxicosis but isolated right heart failure is rarely seen in association with thyrotoxicosis. Two cases of right heart failure associated with thyrotoxicosis are presented. In a 45-year-old man with right heart failure, investigations for all common secondary causes of right heart failure were negative. The only concurrent disease identified was thyrotoxicosis. The right heart failure subsided after treatment of the thyrotoxicosis. In a 36-year-old woman, the right heart failure had two underlying causes, thyrotoxicosis and an atrial septal defect. Treatment of thyrotoxicosis alone resulted in improvement of pulmonary hypertension and right heart failure. Thyrotoxicosis should be considered as a possible cause of pulmonary hypertension or isolated right heart failure.

We report a case of bacterial necrotising fasciitis complicated by the rare fungus Absidia corymbifera. Although this fungal infection is rare, the prognosis is poor and it therefore requires attention. Only 30 cases have been reported since 1874, and we are the first group to report this clinical scenario in our locality. Using a comprehensive journal review, we discuss the expected clinical course and optimal management.

Currently, when stroke patients are offered thrombolytic therapy, their ischaemic stroke subtypes are usually unknown. Given the risk of haemorrhage that accompanies thrombolytic therapy, unselective (or undiscriminating) use of recombinant tissue plasminogen activator in patients without large-artery thromboemboli is potentially hazardous. Advances in computed tomography techniques have enabled the stroke pathophysiology to be quickly delineated by multimodal computed tomography without compromise in time for recombinant tissue plasminogen activator administration. Through description of the investigation of a typical stroke patient, we report how this technique is feasible in a regional hospital and may guide judicious use of recombinant tissue plasminogen activator.

We report on two cases where breast magnetic resonance imaging examination changed clinical management. Breast magnetic resonance imaging is now recognised as an indispensable adjunctive examination to mammography and ultrasound. In each of the two cases described, breast magnetic resonance imaging revealed unsuspected, extensive, and mammographically and ultrasonologically occult, ductal carcinoma in situ. In each of these cases, planned breast conserving surgery was changed to mastectomy. The success of breast conservation treatment depends on removal of all tumour with clear margins at the time of surgery. Magnetic resonance imaging is now considered the most sensitive method for evaluating the extent of breast cancer. Breast magnetic resonance imaging has a very high sensitivity for invasive carcinoma (near 100%), and recent studies show its specificity in high-risk patients is between 93 and 99%. Magnetic resonance imaging may well be proven an important adjunctive examination in patients who have dense breasts or extensive fibrocystic change.