To the Editor—With regard to the

Hughes-Stovin syndrome is a scarce entity associating pulmonary artery aneurysms and deep ven-ous thrombosis. It was considered to be a form of Behcet’s syndrome at its initial feature. We present a case of a 27-year-old man having a Hughes-Stovin syndrome. The patient had a history of left ilio

A 23-year-old man was referred for pain in his left foot of 2 weeks duration following a sprain. Examination revealed vague tenderness over the medial aspect of the left mid-foot. An anteroposterior radiograph of both feet was obtained. Q1 What are the radiological findings? In the left foot

of diagnosis of DISH in 43-year-old male and the importance of an early diagnosis and relief of symptoms. Case report: A young man presented with a history of pain at lumbar and right rump the last 5 years, mainly at walking and prolonged standing. From his medical history, extensive clinical examination

TIAs secondary to carotid stenoses are unusual in young patients with no obvious cardiovascular risk factors, and may be missed. Case history A 30-year-old, left-handed man presented to the

with angina pectoris

erythematosus

Asthma and male infertility are common diseases that can occur in the same patient. In some cases they could have patho-physiological changes common to both diseases. Our patient was seen as a result of having an irritating cough with wheezing, mainly at night, for more than a month. Asthma was diagnosed, and he responded favourably to the treatment given. Upon being informed that he had been examined for infertility for 5 years, alpha-1 antitrypsin (AAT) levels were requested. These confirmed that he had a phenotype SZ AAT deficiency. These findings, together with some evidence published recently, suggested that there is a need to rule out AAT deficiency in males with asthma and infertility.

A 20 year old male university student presented with a one year history of a stiff painful swollen left ankle. He described morning stiffness of one hour and also night pain which occa-sionally kept him awake. He was unable to take part in sport-ing activities. There was no history of trauma. No other joints were painful. There was no history of back or heel pain, psoriasis, iritis, urethritis, or inflammatory bowel disease. There was no history of preceding gastrointestinal or genitourinary infection. He had had an episode of Stevens-Johnson syndrome at the age of 12 (but no recent skin or mouth lesions) and occasional migraine headaches.His health was otherwise good. There was no history of weight loss. Non-steroidal anti-inflammatory drugs provided more sympto-matic relief than simple analgesics. His grandmother had rheumatoid arthritis. There was no other significant family

Hyperparathyroidism (HPT) has long been a com-mon reason for referrals to endocrinologists andgeneral surgeons. Although patients often have no symptoms, clinicians should be familiar with the signs, symp-toms, laboratory findings, and other disease processes that might indicate HPT. Usually the diagnosis is straightforward, but in the case discussed in this article, HPT manifested in a most unusual way. CASE A 20-year-old African-American male presented as an outpa-tient for surgical consultation with a 3-day history of nausea, vomiting, and epigastric abdominal pain. The patient had a history of hypertension and gastroesophageal reflux disease for which he took atenolol and a proton pump inhibitor. He was allergic to penicillin, strawberries, and seafood. There was no surgical history, and the patient denied use of alcohol and illicit drugs. A review of systems was noncontributory, and the results of a physical examination were entirely nor-mal except for moderate obesity and epigastric tenderness to light and deep palpation. The results of laboratory tests were normal, except numbers were elevated for serum calcium at 13.9 mg/dL (normal [n], 8.4-10.2 mg/dL), amylase at 1,163 U/L (n, 25-125 U/L), and lipase at 783 U/L (n, 10-140 U/L). Abdominal CT showed fluid collection around the pancreas compatible with pancreatitis (see Figure 1). Initially, the pancreatitis was treated with IV normal saline solution, analgesics, and complete bowel rest. The abdominal pain resolved, and the serum amylase and lipase levels were brought within normal range. Nevertheless, the patient’s serum calcium levels remained elevated. Further workup revealed that the parathyroid hormone (PTH) level was 781 pg/mL (n, 12-65 pg/mL) and that the