Leprosy in a patient infected with HIV.

A 60-year-old Nigerian man, who had lived in Europe for 30 years but had returned home frequently, presented with right frontalis muscle weakness and right ulnar nerve palsy, without skin lesions. Neurophysiology showed a generalised neuropathy with demyelinating features. Blood tests were positive for HIV, with a normal CD4 count. There was nerve thickening both clinically and on MRI. Nerve biopsy showed chronic endoneuritis and perineuritis (indicating leprosy) without visible mycobacteria. His neuropathy continued to deteriorate (lepra reaction) before starting treatment with WHO multidrug therapy, highly active antiretroviral therapy and corticosteroids. There are 10 new cases of leprosy diagnosed annually in the UK. Coinfection with HIV is rare but paradoxically does not usually adversely affect the outcome of leprosy or change treatment. However, permanent nerve damage in leprosy is common despite optimal therapy. Leprosy should be considered in patients from endemic areas who present with mononeuritis multiplex

Median nerve injury: an underrecognised complication of brachial artery cardiac catheterisation?

This is an uncommon, but probably underrecognised complication. Those performing cardiac catheterisation via the right brachial artery should be aware of the potential risks of damage to the median nerve. They should evaluate hand function after the procedure and take prompt action if median nerve dysfunction is noted. Damage to the median nerve results in appreciable long term disability, which may have medicolegal relevance

Reflecting on the process : actors' documentation of comic performance (and the case of Bull fighting Beckett)

This article considers actors' documentation of their process and suggest how performers' ‘reflection-on action’ might become more formalised in the study and recording of performance. While ‘autobiographical’ material is generally regarded as being unreliable in providing source material for the documentation of performance, validated documented contributions on what the central producer – the actor – brings to theatre, film or television productions tend to be hard to find. Actors' memoirs provide, at best, fleeting glimpses into the performer's process within the overall play or film. Nonetheless, where documentary examples of performer's input do exist, these can offer valuable insights into the nature of the part that the performer plays in the creation of the artefact. The case for making more formal documentation of process (particularly for performers-in-training) is presented here. The article draws on one brief case study to indicate how, even the most informal documentary evidence that is available (appearing in both published and unpublished forms), it can be useful in illuminating the actor's process. This illustrative case study element features the writing of the character actor Peter Bull (1912--1984) and charts, specifically, his experiences of playing Pozzo in the first British production of Samuel Beckett's seminal, absurdist tragicomedy Waiting for Godot in 1955–1956. Bull's reflections are mined in order to propose the value that such reflective documentation of process can bring to the whole picture of the making of a piece of comic theatre