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Maybe just one comment. As someone who has had a close family member treated for endometrial cancer recently (similar, but not identical to the treatment for cervical cancer which has spread to the uterus), can I just say how well Jade looks in this video clip. She must be wearing false eyelashes and pencilled-in eyebrows, because they fall out at the same time your hair does when you are having chemotherapy.

As far as this writer is aware, there are never any post mortem signs of epilepsy itself. It is after all electrical discharge in the brain - not something you can see after the event! Perhaps what the pathologist (medical examiner) means is that no other pathology was found, leaving a seizure as the only other conclusion. The sixteen-year-old’s body has now apparently been cremated.

The web has been alive with speculation surrounding this family tragedy. Not least because of the reports of autism, and the fact that Scientologists do not believe in autism. It has also been reported that Jett Travolta suffered from Kawasaki syndrome. This quite rare condition usually occurs in very young children, and is hardly ever life-threatening. It can occasionally lead to heart problems (particularly aneurysms of the coronary arteries) but is not associated with epilepsy later in life.

Apple CEO Steve Jobs

The boss of Apple has had a particularly nasty, and very rare condition called a neuroendocrine tumour. They often crop up in the pancreas, but can also grow inside other organs.

‘Pancreatic cancer’ is something different altogether, and usually taken to mean a cancer of the pancreatic tissue itself - an adenocarcinoma. Unfortunately your outlook if you have this condition is bleak indeed. The cancer is aggressive, and it usually ‘presents late’ - that is that by the time you notice anything wrong (the first thing is usually that you are going yellow - jaundiced - but with no other symptoms except perhaps weight loss) the cancer is well advanced.

Neuroendocrine tumours produce various hormones, and the exact symptoms will depend on what particular type of tumour is growing. They only usually spread locally - so after an operation to remove the tumour there is no need for other treatment like radiotherapy or chemotherapy. In fact a relative of mine had his pancreas removed for a neuroendocrine tumour a few months ago. His was secreting steroid-like hormones, and he was initially diagnosed with Cushing’s syndrome.

This will be why Mr. Jobs is reportedly having problems with a hormone imbalance. We wish him well, and a speedy return to good health. As a huge fan of everything ‘Apple’, I want him releasing pretty new gadgets for many years to come.

If you are a fan of medical dramas like St. Elsewhere or ER, or even Britain’s Casualty or Holby City, you might have heard a normal heart rhythm referred to as ‘sinus rhythm’, or ‘normal sinus rhythm’. What, I hear you yell in frustration, has my heart got to do with sinuses? They’re in my head, aren’t they?
The term ‘sinus’ is used to describe many areas of the body - the thing they have in common is that they are usually holes or hollowed-out bits. Like the sinuses on your head and face, and like a small area on your heart in which the ‘natural pacemaker’ resides. This area of specialised neuro-muscular tissue kicks off at around 70-80 times per minute under normal circumstances, and keeps you heart beating regularly. It can be upset by all sorts of things. One of the commonest reasons for an oddly-beating heart among the general population who attend emergency departments is use of artificial stimulants.

Paul Gascoigne

On the recent documentary aired on the Channel 4 - ‘Saving Gazza’, Paul Gascoigne’s 12 year old son was asked what he thought was wrong with his dad. “Everything” was the reply. The lad should definitely consider clinical psychology as a career. This link to a previous documentary - ‘Surviving Gazza‘ - has some video clips. These were filmed prior to the documentary ‘Saving Gazza.’
Whether or not Paul Gascoigne (the former England footballer) has a formal psychiatric diagnosis is an arguable point, but probably not one worth arguing. However you label the poor guy, he appears to be very ill indeed and possibly beyond recovery.
According to some sources he has suffered at various times from ‘manic depression’ (also known as bipolar disorder), paranoia, bulimia, obsessive-compulsive disorder (OCD), attention deficit and hyperactivity disorder (ADHD) and a mild form of Tourette’s syndrome.

Certainly on his wedding video there were facial twitches and grimaces suggestive of Tourette’s. His need to count things and only be comfortable with certain combinations of numbers is indicative of OCD. He seemed to have a distorted body image in keeping with someone who may have an eating disorder. And he displayed some frankly paranoid delusions about persecution and being followed. Maybe he does have a bit of everything. Tragically, it seems that he is self-medicating primarily with alcohol as a way of coping with his many demons. Not at all what the doctor ordered.

When I were a lad, we’d get one or two ruptured AAAs (triple As, Abdominal Aoritc Aneurysms) into the resus room every month. Most of them died. The aorta is the large blood vessel that leads from the top of the heart, and curves down toward the rest of the body, throwing off smaller branches on the way.

In the abdomen, it should be no more than about 4-5mm in diameter in an adult. An aneurysm is a weakening in the wall of a blood vessel - in the case of the aorta, it means that the vessel bulges. This bulge can be measured using ultrasound. Once it has got to a certain critical size, planned surgery can be undertaken to repair the defect. Before this sort of ultrasound screening, the first thing most people knew about their AAA was when it ruptured.

Mortality from planned surgery is a lot lower then from emergency repair, but it’s still a risky operation. Risk factors include ‘co-morbidity’ (other diseases the patient - usually elderly - may suffer from), and also the exact level at which the aneurysm lies, and how extensive it is. Some aortic aneurysms extend into the thoracic aorta (within the chest) and these are particularly deadly.

I’m not of course privy to the exact details of Mr. Lyttleton’s case, but it would seem that the combination of age and surgical risk were simply too much. A loss to us all.

The film director and screenwriter Anthony Minghella has died unexpectedly, a week after undergoing surgery for what sounds like tonsillar cancer.

Ever since I found out about its existence, tonsillar cancer has been top of my list of things-I-don’t-want-to-get. It’s a horrible disease, just like other forms of cancer. But this one is particularly nasty as it tends to present late, and the treatment is particularly aggressive and often disfiguring.

By ‘present late’ we doctors mean that a disease is quite well advanced by the time it is spotted. If you take skin cancer on the face as an opposite example, this is usually picked up early because the patient, or an acquaintance, notices that strange spreading mole on the cheek. But when the cancer is tucked away at the very back of your throat, there can be nothing in the way of symptoms for a long time. In fact a secondary deposit of the cancer in another part of the body, or in a lymph node in the neck or head area, may be the first sign of tonsillar cancer.

The disfiguring treatment is also related to the anatomical site of the cancer. Many of the organs in the head and neck share lymphatic drainage, and this needs to be taken into account when planning surgery. As well as the actual tumour (which can be difficult to locate exactly) portions of the jaw, neck, tongue and even face may have to be operated on. This experience was detailed by John Diamond, the journalist husband of Nigella Lawson, who died of oral cancer in 2001.

But from all accounts, the initial operation appears to have gone well for Anthony Minghella. He suffered a fatal haemorrhage several days after the operation.

Bleeding several days ‘post-op’ is usually caused by infection. Many wounds get infected after surgery - modern so-called ’superbugs’ usually have nothing to do with it. Most of the time the body shrugs off the infection and the surgical tampering heals. But if you’re unlucky, the infection will become established. And if you’re really unlucky, the infection will involve a large blood vessel (of which there are plenty around the head and neck). If a small abscess erodes through the wall of even a fairly small artery, the bleeding can be catastrophic. And once again, the position of the operation site is a factor here. Bleeding from any artery can usually be stopped very efficiently simply by pressing on the bleeding point. But if the bleeding is coming from somewhere deep in the neck or throat, pressing on it is simply impossible.

The ‘bleeding post-op tonsil’ is a classic exam scenario for both surgeons and anaesthetists. It doesn’t just happen in cancer treatments - in fact the vast majority of postoperative tonsillar haemorrhages occur in young people having ‘routine’ tonsillectomies (a far rarer operation nowadays than in the past - for a brief glimpse of the operation’s shady history, click here.) About 7-10 days after the apparently successful operation, a child can present with copious bleeding from the mouth, enough to require intravenous fluid and/or blood replacement. They also need to be anaesthetised for an operation to stop the bleeding. But their blood pressure is low (because of the bleeding) which limits the anaesthetic techniques which can be used. And the back of their throat is full of blood, so it is difficult to ‘maintain an airway’ (ensure an unobstructed passage for air to get into the lungs.) Bleeding post-op tonsils are a nightmare, and can be a challenge for even the most experienced physicians.

In Mr. Minghella’s case it would seem that he has succumbed to just that event, albeit one complicated by the presence of a tumour of some kind - so his surgery will have been more extensive than that for a simple tonsillectomy.

It has been a strange week for celebrity deaths caused by bleeding from major neck vessels. There’s another one here.

It only works with intra-muscular (IM) injections. I’ve never practised it myself, or indeed seen it done, but I am quite certain it exists.

Most IM injections are drawn up into the syringe out of the phial they come in, using the same needle that you inject into the patient. The needles are actually little miracles of engineering, with an angled, sharpened point at the end. If that point is tapped firmly on the bottom of the glass phial while the drug is being drawn up, the point bends round very slightly at the tip. You now have a barbed implement. It goes in alright, but on withdrawal it catches on muscle fibres and tears them, causing unnecessary pain and a very nasty bruise afterwards.

As I say, I’ve never done this or seen it done. But the very fact such a phenomenon is even talked about is one very good reason to be nice to your nurse and your doctor. If you need one.

So here’s the first of what will probably turn out to be occasional brief rants about such people.

The woman who booked in because her false fingernail had come off and she wanted us to stick it back in place.

The woman who actually called ‘999′ (the emergency services number) for an ambulance because she had chewing gum stuck in her hair. In fact the trick to get chewing gum off clothes is to put the clothing in a freezer for a couple of hours so the gum goes hard and can be cracked off. So I advised the patient to go home and stick her head in the freezer for a couple of hours.

Of course I didn’t actually. The General Medical Council frown on that sort of thing. But it’s what I wanted to tell her.

The weird thing is that a lot of medical soaps cover exactly this sort of thing these days - inappropriate use of resources, ambulances tied up with trivia while the elderly man quietly dies form his heart attack - that sort of thing. But the eejits who pitch up with their gummed hair and broken nails either don’t watch popular TV shows as they are too busy attending museums and art galleries (unlikely), or they are just so stupid that they can’t see the comparison.