Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined,a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis.Therefore,pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams.With the ongoing accumulation of evidence,it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients.

Hospital admissions from alcohol-related acute pancreatitis during the COVID-19 pandemic:A single-centre study

BACKGROUND The United Kingdom government introduced lockdown restrictions for the first time on 23 March 2020 due to coronavirus disease 2019(COVID-19)pandemic.These were partially lifted on 15 June and further eased on 4 July.Changes in social behaviour,including increased alcohol consumption were described at the time.However,there were no data available to consider the impact of these changes on the number of alcohol-related disease admissions,specifically alcoholrelated acute pancreatitis(AP).This study evaluated the trend of alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown.AIM To evaluate the trend in alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown in the United Kingdom.METHODS All patients admitted with alcohol-related AP from March to September 2016 to 2020 were considered in this study.Patient demographics,their initial presentation with AP,any recurrent admissions,disease severity and length of stay,were evaluated using ANOVA andχ^(2)and Kruskal–Wallis tests.RESULTS One hundred and thirty-six patients were included in the study.The highest total number of AP admissions was seen in March–September 2019 and the highest single-month period was in March–May 2020.Admissions for first-time presentations of AP were highest in 2020 compared to other year groups and were significantly higher compared to previous years,for example,2016(P<0.05).Furthermore,the rate of admissions decreased by 38.89%between March–May 2020 and June–September 2020(P<0.05),coinciding with the easing of lockdown restrictions.This significant decrease was not observed in the previous year groups during those same time periods.Admissions for recurrent AP were highest in 2019.The median length of hospital stay did not differ between patients from each of the year groups.CONCLUSION An increased number of admissions for alcohol-related AP were observed during months when lockdown restrictions were enforced;a fall in figures was noted when restrictions were eased.

Hepatocellular carcinoma,human immunodeficiency virus and viral hepatitis in the HAART era

The incidence of hepatocellular carcinoma(HCC)in patients with human immunodeficiency virus(HIV) is rising.HCC in HIV almost invariably occurs in the context of hepatitis C virus(HCV)or hepatitis B virus (HBV)co-infection and,on account of shared modes of transmission,this occurs in more than 33% and 10% of patients with HIV worldwide respectively.It has yet to be clearly established whether HIV directly accelerates HCC pathogenesis or whether the rising incidence is an epiphenomenon of the highly active antiretroviral therapy(HAART)era,wherein the increased longevity of patients with HIV allows long-term complications of viral hepatitis and cirrhosis to develop.Answering this question will have implications for HCC surveillance and the timing of HCV/HBV therapy,which in HIV co-infection presents unique challenges.Once HCC develops,there is growing evidence that HIV co-infection should not preclude conventional therapeutic strategies,including liver transplantation.

Hepatic ischemia-reperfusion injury in liver transplant setting:mechanisms and protective strategies

Hepatic ischemia-reperfusion injury is a major cause of liver transplant failure,and is of increasing significance due to increased use of expanded criteria livers for transplantation.This review summarizes the mechanisms and protective strategies for hepatic ischemia-reperfusion injury in the context of liver transplantation.Pharmacological therapies,the use of pre-and post-conditioning and machine perfusion are discussed as protective strategies.The use of machine perfusion offers significant potential in the reconditioning of liver grafts and the prevention of hepatic ischemia-reperfusion injury,and is an exciting and active area of research,which needs more study clinically.

Postoperative sleep disorders and their potential impacts on surgical outcomes

Postoperative sleep disturbance is a common occurrence with significant adverse effects on patients including delayed recovery,impairment of cognitive function,pain sensitivity and cardiovascular events.The development of postoperative sleep disturbance is multifactorial and involves the surgical inflammatory response,the severity of surgical trauma,pain,anxiety,the use of anesthetics and environmental factors such as nocturnal noise and light levels.Many of these factors can be managed perioperatively to minimize the deleterious impact on sleep.Pharmacological and non-pharmacological treatment strategies for postoperative sleep disturbance include dexmedetomidine,zolpidem,melatonin,enhanced recovery after surgery(ERAS) protocol and controlling of environmental noise and light levels.It is likely that a combination of pharmacological and non-pharmacological therapies will have the greatest impact;however,further research is required before their use can be routinely recommended.

New insights into the immunology and evolution of HIV

Fewer than one million HIV infected individuals are currently receiving anti-retroviral therapy. Thelimitations of such treatment have underscored the need to develop more effective strategies to control thespread and pathogenesis of HIV. Typically, naturally occurring protective immune responses provide theparadigm for such development. It is now clear however that HIV can utilise the millieu of an activatedimmune system to its own replicative advantage. Mobilisation of the immune response, intended to thwartof HIV contributes to lack of immune control and the development of progressive disease in the majority ofinfected, untreated individuals. Further delineation of the intimate interactions between the HIV and theimmune system will be critical and recent advances in this direction are discussed.

Football injuries of the ankle: A review of injury mechanisms, diagnosis and management

Football is the most popular sport worldwide and is associated with a high injury rate, most of which are the result of trauma from player contact. Ankle injuries are among the most commonly diagnosed injuries in the game. The result is reduced physical activity and endurance levels, lost game time, and considerable medical cost. Sports medicine professionals must employ the correct diagnostic tools and effective treatments and rehabilitation protocols to minimize the impact of these injuries on the player. This review examines the diagnosis, treatment, and postoperative rehabilitation for common football injuries of the ankle based on the clinical evidence provided in the current literature.

Current and future role of three-dimensional modelling technology in rectal cancer surgery:A systematic review

BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.

Antibiotic stewardship programmes in intensive care units:Why,how,and where are they leading us

Antibiotic usage and increasing antimicrobial resistance(AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units(ICU). Antibiotic stewardship programmes(ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies"through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial(RCT), 22 observational and 11 case series], 29(85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin(PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop(de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

Near-fatal Panton-Valentine leukocidin-positive Staphylococcus aureus pneumonia,shock and complicated extracorporeal membrane oxygenation cannulation:A case report

BACKGROUND Panton-Valentine leukocidin(PVL)is an exotoxin secreted by Staphylococcus aureus(S.aureus),responsible for skin and soft tissue infections.As a cause of severe necrotising pneumonia,it is associated with a high mortality rate.A rare entity,the epidemiology of PVL S.aureus(PVL-SA)pneumonia as a complication of influenza coinfection,particularly in young adults,is incompletely understood.CASE SUMMARY An adolescent girl presented with haemoptysis and respiratory distress,deteriorated rapidly,with acute respiratory distress syndrome(ARDS)and profound shock requiring extensive,prolonged resuscitation,emergency critical care and venovenous extracorporeal membrane oxygenation(ECMO).Cardiac arrest and a rare complication of ECMO cannulation necessitated intra-procedure extracorporeal cardiopulmonary resuscitation,i.e.,venoarterial ECMO.Coordinated infectious disease,microbiology and Public Health England engagement identified causative agents as PVL-SA and influenza A/H3N2 from bronchial aspirates within hours.Despite further complications of critical illness,the patient made an excellent recovery with normal cognitive function.The coordinated approach of numerous multidisciplinary specialists,nursing staff,infection control,specialist cardiorespiratory support,hospital services,both adult and paediatric and Public Health are testimony to what can be achieved to save life against expectation,against the odds.The case serves as a reminder of the deadly nature of PVL-SA when associated with influenza and describes a rare complication of ECMO cannulation.CONCLUSION PVL-SA can cause severe ARDS and profound shock,with influenza infection.A timely coordinated multispecialty approach can be lifesaving.

Danish cohort of monozygotic inflammatory bowel disease twins: Clinical characteristics and inflammatory activity

AIM: To describe the establishment of a Danish inflammatory bowel diseases (IBD) twin cohort with focus on concordance of treatment and inflammatory markers.METHODS: We identified MZ twins, likely to be discordant or concordant for IBD, by merging information from the Danish Twin Register and the National Patient Register. The twins were asked to provide biological samples, questionnaires, and data access to patient files and public registries. Biological samples were collected via a mobile laboratory, which allowed for immediate centrifugation, fractionation, and storage of samples. The mean time from collection of samples to storage in the -80&#x02005;&#x000b0;C mobile freezer was less than one hour. The diagnoses where validated using the Copenhagen diagnostic criteria.RESULTS: We identified 159 MZ IBD twin pairs, in a total of 62 (39%) pairs both twins agreed to participate. Of the supposed 62 IBD pairs, the IBD diagnosis could be confirmed in 54 pairs. The cohort included 10 concordant pairs, whereof some were discordant for either treatment or surgery. The 10 concordant pairs, where both pairs suffered from IBD, included eight CD/CD pairs, one UC/UC pair and one UC/IBDU pair. The discordant pairs comprised 31 UC, 5 IBDU (IBD unclassified), and 8 CD discordant pairs. In the co-twins not affected by IBD, calprotectin was above 100 &#x003bc;g/g in 2 participants, and above 50 &#x003bc;g/g in a further 5 participants.CONCLUSION: The presented IBD twin cohorts are an excellent resource for bioinformatics studies with proper adjustment for disease-associated exposures including medication and inflammatory activity in the co-twins.

Histopathology and immunophenotyping of late onset cutaneous manifestations of COVID-19 in elderly patients: Three case reports

BACKGROUND Several cutaneous manifestations such as urticarial rash,erythematous patches and chilblain-like lesions have been described in young adults with coronavirus disease 2019(COVID-19)and are present in up to 20%patients,but few reports exist describing histopathological and immunophenotypic characteristics of dermatological lesions in older patients.Our aim was to characterize skin lesions in elderly patients during late stages of COVID-19 from clinical,histological and immunophenotypic perspectives.CASE SUMMARY Three patients,admitted for COVID-19,and who developed cutaneous manifestations underwent skin biopsies.Immunophenotypic analysis for CD20,CD3,CD4 and CD8 was performed on skin biopsies to assess immune cell infiltrates.CD1a was used as a marker of Langerhans cells,and CD31 as a marker of endothelial cells.In the three study patients,cutaneous manifestations were evident in the late-stage of COVID-19(mean time from the first positive severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)swab to rash onset was 35 d).Skin biopsies showed a similar pattern of T lymphocyte infiltration in all patients.Indeed,a chronic dermatitis with perivascular lymphocytic infiltrate was observed with predominance of CD3+T-cell(CD3+).CONCLUSION Our study confirms previous reports.Histological and immunophenotypic patterns in our patients confirm results described in the two previous reported experiences.This pattern is similar to what is found in some lympho-proliferative disorders.Therefore,since these findings are non-specific,SARS-CoV-2 infection should be suspected.

On COVID-19 and Membrane Lipids and Public Health

Coronavirus has a lipid membrane.Whist replication requires hijacking the RNA tools of the host to synthesize virion protein,that then has to be wrapped in a lipid membrane to enable the budding off which extends the infection.Recent studies implicate certain essential fatty acids with replication suppression properties.The lipid membrane is commonly thought of as a fatty barrier to water solubles.It is however highly ordered and compositionally specific to cellular and sub cellular functions.There will likely also be an optimum specificity for the viral coat.Whist DNA,RNA and protein compositions are not affected by diet,the lipid membrane is.Moreover,the greater sensitivity of males over females to inadequacy of these essential fatty acids and membrane integrity has been known since the 1960 s.With evidence that arachidonic and docosahexaenoic acids exhibiting anti-viral,immune,anti-inflammatory,blood pressure control and resolvin activity,their status needs to be urgently examined in relation to the prevention and therapy for Covid-19.It would also be advisable to re-assess food policy.The lipid requirements for the membrane rich systems as in the brain,nervous,vascular and immune systems have not been considered.There is little doubt these were significant in shaping the human genome over several million years.Departure from such conditions would be predicted to put populations at risk to disorder and infection,with males being more at risk than females.

Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis

Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis.In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis,the implications for the neonate,as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment.Finally,we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.

剖宫产再孕的妇女孕期B超监测下剖宫产瘢痕形态学改变

目的:通过B超监测评价剖宫产再孕的孕妇在整个妊娠过程中剖宫产瘢痕处的形态改变,并评价最后的分娩结局。方法:应用阴道超声观察320例有剖宫产史并再次妊娠的妇女怀孕11～13周、19～21周以及32～34周时剖宫产瘢痕的变化,主要测量剖宫产瘢痕处子宫肌层的厚度变化。结果:在320例孕妇中,284例发现剖宫产瘢痕的宽度、长度及厚度均发生改变,比例达到88.7%,瘢痕的长度和宽度明显增大,瘢痕的厚度明显变薄。2例孕妇因剖宫产瘢痕处子宫肌层发生破裂而终止妊娠,这2例病例,B超监测瘢痕处子宫肌层厚度为0.5mm,整个孕期减少了2.7mm、2.5mm。结论:通过观察,建立了相关的B超参考数据,并证明了剖宫产瘢痕在下一次妊娠中会发生形态学上的改变。菲薄的瘢痕处肌层厚度以及该处厚度的快速减少是剖宫产瘢痕破裂的先兆,在剖宫产再孕产妇的孕期监测过程中,瘢痕处肌层厚度的快速改变是提示剖宫产瘢痕破裂的潜在预警信号。这对防止剖宫产再孕的孕妇发生子宫破裂具有重要的意义。

Management of achilles tendon injury: A current concepts systematic review

Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmB ase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.

Use of ketamine sedation for the management of displaced paediatric forearm fractures

AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna(moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and postmanipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also undertaken.RESULTS During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate(3), fractures of both radius and ulna(6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthesia, each case performed under ketamine sedation was associated with a saving of ￡1470, the overall study saving being ￡14700. CONCLUSION Ketamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced fractures of the radius and ulna, with high parent satisfaction rates.

Studies on the allostimulatory function of dendritic cells from HCV-HIV-1 co-infected patients

There is increasing recognition of the potential morbidity and mortality associated with HIV-1 and hepatitis C (HCV)co-infection. HIV appears to adversely affect HCV disease while the reciprocal effect of HCV on HIV remains controversial.We therefore studied the effect of co-infection on dendritic cell function versus HIV infection alone, as previous work has shown that HCV impairs dendritic cell (DC) function. HIV-1 positive individuals with HCV were matched for CD4count, HIV- 1 RNA viral load and therapy, to HIV- 1 positive patients without HCV. Monocyte-derived DC were generated and mixed leukocyte reactions were performed. We assessed allostimulatory capacity with and without administration of exogenous Thl cytokines, using thymidine uptake and cell division analyses with the vital dye CFSE. We found that monocyte-derived DC from co-infected individuals showed no significant differences in allostimulatory capacity to ex vivo generated DC from HIV-1 infected individuals without HCV. Unlike the situation with HCV infection alone, this impairment was not reversed by increasing concentrations of either interleukin-2 or -12. Monocyte-derived DC from HIV-1 and HCV co-infected individuals have a similar allostimulatory capacity to DC from matched patients with HIV-1alone. These findings are compatible with results of prior clinical studies that found no evidence that HCV co-infection altered HIV disease progression and has implications for immunotherapeutic approaches in co-infected individuals.

米索前列醇经口、直肠和阴道给药的药代动力学

OBJECTIVE: To compare the pharmacokinetic profiles of orally, rectally, and vaginally administered misoprostol tablets in pregnant women. METHODS: Women between 7 and 14 completed weeks of gestation were recruited and randomly assigned to be given 400 μmisoprostol orally, rectally, or vaginally 3 hours before surgical termination of pregnancy. Blood samples were obtained at 0, 7.5, 15, 30, 45, 60, 60, 120, and 240 minutes and later analyzed for plasma concentrations of misoprostol free acid (the principle metabolite). RESULTS: Vaginal misoprostol was present in the circulation longer than oral misoprostol and had a greater area under curve at 240 minutes (P < .001). Rectal misoprostol had a similar pattern but a much lower area under curve at 240 minutes. Oral misoprostol had a significantly greater peak plasma concentration and a shorter duration to maximum concentration than either rectal or vaginal misoprostol (both P < .001). CONCLUSION: Oral misoprostol tablet is also absorbed by the rectal and vaginal routes. Misoprostol administered in early pregnancy has route-dependent pharmacokimetics and is absorbed best when administered vaginally.

Classical seminoma in a 92-year-old patient

Seminoma is a germ cell tumour which primarily affects the testes. Seminomas are treated by orchidectomy with usually excellent outcomes. We report the occurrence of a classical seminoma in a 92-year-old man,who is currently the oldest patient with this histology reported in literature. He presented with a painful,swollen testis. Scrotal ultrasound scan revealed a testicular mass. A left inguinal orchidectomy was carried out and histological examination confirmed the diagnosis of a classical seminoma. Further staging by computerised tomography revealed pulmonary lesions suspicious of metastases. The patient declined further treatment in view of his age and co-morbidities.