David Cummins

Visceral leishmaniasis after cardiac surgery.

An English child developed visceral leishmaniasis (kala-azar) after cardiac surgery. Neither he nor his mother had ever been out of the UK, and his disease was probably transmitted by blood transfusion. Kala-azar should be considered in patients with unexplained fever and hepatosplenomegaly, even if there is no history of foreign travel.

Management of an ABO-Incompatible Lung Transplant

A 24‐year‐old woman with cystic fibrosis underwent bilateral sequential lung transplantation and unintentionally received an ABO incompatible graft (blood type A1 graft into a type O recipient). The recipient had a high titer of IgG anti‐A antibody (256 by the indirect antiglobulin test). Emergency treatment included antibody removal by plasmapheresis and additional immunosuppression with mycophenolate, rabbit antithymocyte globulin and polyspecific intravenous immunoglobulin. Subsequently, immunoadsorption and the anti‐CD20 antibody rituximab were used to remove anti‐A antibody and inhibit its resynthesis. Early graft function was good; one episode of rejection at Day 46 responded promptly to treatment with methylprednisolone. Subsequently, graft function continued to improve and anti‐A antibody titers remained low. No infectious or other complications were encountered. The treatment regimen that we adopted may prove useful in other cases of unplanned ABO‐incompatible organ transplants. The successful outcome suggests that planned ABO‐incompatible lung transplants may be possible.

Medium-term outcome of an ABO incompatible lung transplant.

In 2004, our department reported on a 24-year-old woman with cystic fibrosis who underwent bilateral sequential single lung transplantation and unintentionally received an ABO incompatible graft (donor type A1, recipient type O) (1). Her initial anti-A IgG antibody titer had been high (256). Emergency treatment with plasmapharesis, mycophenolate, rabbit thymocyte globulin and polyspecific intravenous immunoglobulin, and subsequently with immunoadsorption and rituximab, resulted in a good short-term outcome.

The silent sentinels

The air outside was warm and sultry, with no wind. Dark clouds covered the mountains, and mist lay over the forest and nearby hills. The scattered wooden houses seemed empty and derelict; the dusty roads were deserted. “Take a look around,” he had said, “but be back by five.” The doctor visited the reservation once a fortnight. His patients were Gitksin Indians. Traditionally the Gitksin were hunters and skilled wood carvers, but those we had seen in the clinic were sad and smelt of whisky. The doctor said that when it all gets too much the Gitksin walk out on to the highway to join the Great Spirit. I strolled to the settlements northern edge, where the road to Alaska …

Presentational skills are taught in some hospitals.

Editor–Bernard Dixons comments on the poor presentational skills of young scientists are apposite but do not address a key issue.1 Given that presentations are so important in medicine and science, why is little teaching provided on how to give them? At a …

A memorable patient: Fascinating rhythm

A pianist in the Bill Evans style, he is a respected figure on the London jazz scene. His earliest icon was George Shearing, whom he heard as a teenager, but among his strongest influences were Horace Silver and Thelonius Monk. Like many of his idols, rhythm is what drives him, especially the challenging and the complex. It was this that made his medical history so intriguing.

Lassa fever: 10 years on

“We tell ourselves that pestilence is a mere bogey of the mind, a bad dream that will pass away. But it doesn’t always pass away and, from one bad dream to another, it is men who pass away”-Albert Camus, The Plague The fever came on gradually over a couple of days. Then one afternoon, in the hospital grounds, I had a rigor. My fever seemed out of place in the intense, tropical heat. Within hours I became seriously unwell. Segbwema lies in the rain forest of eastern Sierra Leone, an area of rolling hills, rutted roads, and diamond mines. I was researching Lassa fever, a disease highly endemic in the region and a leading cause of death. The natural host of Lassa virus is Mastomys natalensis , one of several types of rat that live in and around the village houses; most human infections are acquired through contamination of broken skin with the rodents urine. It has been estimated that in the whole of west Africa there may be up to 300 000 human Lassa virus infections each year. Many patients experience a mild, flu-like illness, but some deteriorate rapidly, developing facial oedema, encephalopathy, haemorrhage, and shock. Such patients usually die. I …

Government health warnings may encourage adolescents to smoke.

EDITOR,--Despite an intensive antismoking campaign aimed at young people and a decreasing prevalence of smoking among adults the prevalence of smoking in adolescents is increasing.1 2 I suggest that one possible contributor to this disturbing trend is …