the doctor is in ... feb 08

(I am back from a well-deserved doctor’s respite at … well, nowhere. Just been busy with my day job. We have a new case – Red and Swollen Eye in a 61-Year-Old Man. Not sure what to make of it. Let’s start with the pic.)


(Oh, my! Somebody done poked that dude in the eye with a stick or something! Must’ve hurt. What’dya think it could be? Something about this guy looks dirty to me. Let’s get some data …)

BACKGROUND
A 61-year-old man presents to the emergency department (ED) with a 5-day history of pain with associated redness and swelling in his right eye. (“Five days,” you say. Uhunh … scribble scribble … ok.)

The patient had been diagnosed with herpes zoster (is that like Herpes Complex Z? Z?!? Z is like towards the end of the alphabet. That can’t be good) a few days before this presentation; he was discharged to home with a prescription for acyclovir and hydrocodone. (AAH—AAK—PSYCH—AAHPSYCH—LOVER. Acyclovir … got it here somewhere. OK, “first-time or repeat outbreaks of genital herpes.” This boy got sexed in his eyeball. That’s disgusting.)

Since he started taking acyclovir, the pain and swelling in his eye has increased. (Good. Done go have sex involving your eyeball it oughta hurt. At least now we know it weren’t no stick that got stuck there. Damn boy, whatchu thinking? You on the other side of some sleazebag glory hole?) He also reports binocular diplopia and decreased visual acuity. (BI-nocular? He got one eye shut from a getting a dick jammed in it. The only “bi” thing around here is his sexual orientation.)

On the day of presentation, he is nauseous and vomiting (yeah, after you woke up, saw the glory hole, the line of satisfied customers … I am quite sure you were puking), and he cannot open the affected eye (stick, stick, stick, poke, poke, poke. Of course he can’t open it! Hell, he probably passed out from getting clubbed by somebody’s ankle spanker), which demonstrates ptosis (p-p-pu-TOE-s-s-s-sis) of the upper eyelid, generalized proptosis, and mild periorbital erythema with associated edema.

The right pupil is 8 mm in diameter and nonreactive to direct and indirect light. (Still trying to get the license plate off that man club that hit him.) Intraocular pressure in both eyes is normal at 12 mm Hg.

What is the diagnosis? (He got a little excited about his first gay experience, went to a bar, and became a bit too intrigued about what was on the other side of those holes in the wall. Poor guy. Still puking his guts out. He got love clubbed …)

DIAGNOSIS: (See above.) Cerebro-rhino-orbital phycomycosis (CROP)/mucormycosis. (Yeah, the only “crop” he saw was the riding kind when he had the bit in mouth up on stage. Poor dude – the first time can be so humiliating.)

(Alright, alright, we’ll let the fake docs have their say … fine. Be that way. I know how it is with people like you. You know, just a side note – I kinda HAVE to leave this other stuff in. You should see my page rankings for just god-awful diseases. I do have some fraction of a conscious, somewhere, I am sure I do. Well, maybe not, but I read a lot and I know what one looks like. So read on – just remember – they are WRONG. The guy just had a very rough first outing at the club. That’s all.) CROP is an aggressive, invasive infection that is caused by broad, nonseptate fungi with irregularly shaped hyphae from the class Phycomycetes. The genera that typically cause infection are Rhizopus, Rhizomucor, Absidia, and Basidiobolus. The spores of these fungi are ubiquitous and gain entrance to the human body through the mouth and the nose. Individuals who are immunocompetent will phagocytize these spores; therefore, they do not develop the disease.

Infection is most common in immunosuppressed persons, specifically in patients with poorly controlled diabetes mellitus (often in the setting of metabolic acidosis), and in patients receiving the iron-chelating drug deferoxamine. Unlike immunocompetent individuals, whose bodies phagocytize the spores, immunocompromised patients have massive spore proliferation. Mucormycosis is described almost exclusively in patients with compromised immune systems or metabolic abnormalities. The spores attach to the nasal or oral mucosa, where massive germination and hyphae formation occur, allowing the fungus to directly invade the blood vessels. Areas of ischemic infarction and necrosis are seen in the infected tissue. The fungi invade the blood vessel lumina and cause thrombosis through inflammatory occlusion. Infection usually begins in the nasal cavity and the maxillary sinuses, followed by direct invasion of contiguous structures, such as the palate, the orbits, the ethmoid sinuses, and the brain. Orbital involvement occurs when the ethmoid sinuses are affected. Intracranial spread can occur through the ophthalmic artery, superior fissure, or cribriform plate.

Rhinocerebral infections are usually fulminant and have high morbidity and mortality rates, despite improved diagnostic and therapeutic interventions. Mortality rates of 30-70% are quoted in the literature, with higher mortality rates seen in older series. The mortality rate in diabetic patients appears to be lower than it is in nondiabetic patients and in patients with intracerebral involvement. Death may occur within 2 weeks if CROP is left untreated or is unsuccessfully treated. Additionally, until the 1950s, this disease was almost always fatal. Even with recovery, permanent residual effects, such as blindness and cranial nerve defects, occur in up to 70% of cases.

The clinical manifestations of CROP may include orbital and facial pain, fever, periorbital and orbital cellulitis, proptosis, purulent nasal discharge, and mucosal necrosis that appears as black eschars in the nasopharynx, the oropharynx, and the tissues surrounding the orbits and sinuses. These clinical features are not universally seen; therefore, a high index of suspicion is required. Ocular involvement leads to afferent papillary defects and loss of visual acuity. Progressive extension of necrosis into the brain can lead to cavernous sinus thrombosis and abscess formation. The patient may demonstrate an altered mental status, convulsions, aphasia, or hemiplegia.

Patients with diabetic ketoacidosis are most often affected, but opportunistic infections may also develop in association with renal deferoxamine therapy (eg, in patients with chronic renal disease) or with immunosuppression (particularly in patients with neutropenia or those receiving high-dose corticosteroid therapy).

The diagnostic study of choice is computed tomography (CT) scanning of the orbits and sinuses. In affected patients, CT scans demonstrate soft-tissue swelling, sinus mucosal thickening, and bone erosion. Intracranial and cavernous sinus involvement may also be present. Magnetic resonance imaging (MRI), if available, can show extension of the infection into the surrounding blood vessels, orbital fat, and intracranial areas. Urgent biopsy is usually indicated. Necrotic and edematous tissue with neutrophilic infiltrate is frequently seen with fungal elements (which are broad, nonseptate hyphae with branching at 90°).

The cornerstone of medical treatment for CROP is the administration of systemic amphotericin B at the highest patient-tolerable dose. Local packing of the involved mucosal membranes with an amphotericin B solution is effective for minimizing local disfigurement. When on the medication, the patient should be assessed for nephrotoxicity, as well as other systemic symptoms of toxicity, including fever, nausea and vomiting, phlebitis, anemia, and electrolyte abnormalities. Liposomal amphotericin B may be more efficacious; it is less toxic, thus allowing higher doses of the medication to be given. Additionally, local irrigation and packing of the areas to aid delivery of amphotericin to necrotic and poorly perfused tissues is recommended, because poor vascular supply may prevent systemic therapy from reaching the fungus and because local irrigation of infected tissue has been reported to be an important adjunct to treatment that may even help prevent disfiguring surgery. Treatment of the underlying disease (eg, hypoxia, acidosis, hyperglycemia, electrolyte abnormalities) and discontinuation of any immunosuppressants are also important. The physician should evaluate any steroid medication, antimetabolites, or immunosuppressants that the patient is taking, and such agents should be discontinued if appropriate. It is encouraged that the advice of an infectious disease specialist be obtained.

Aggressive, emergency surgical debridement of all necrotic tissue is necessary; sometimes, multiple procedures are needed to clear all necrotic tissue. The vaso-occlusive effect of mucormycosis leads to infrequent bleeding of the involved tissue; therefore, debridement of affected tissue until normal, well-perfused, bleeding tissue is encountered is ideal. Intraorbital irrigation of amphotericin B may be considered as an adjunct treatment. Surgery may often be disfiguring. Orbital exenteration, as well as removal of the sinuses, may be necessary. Some authors have suggested hyperbaric oxygen as an adjunctive treatment. Reconstructive surgery after complete resolution of infection should be considered.

Indeed, a multidisciplinary approach is best for the treatment of this condition. An ophthalmologist is required to evaluate for ophthalmoplegia and optic neuropathy. An oculoplastic surgeon can provide an orbital evaluation, as well as perform debridement and reconstruction. An otolaryngologist is required for biopsy or debridement of the nasal and sinus cavities. An infectious disease specialist can provide guidance for appropriate medical treatment with antifungal agents. Internal medicine specialists and endocrinologists are useful for the medical management of underlying systemic etiologies. Neurosurgery may be necessary if intracranial involvement is present. Finally, a pharmacotherapy specialist can assist with dosing of amphotericin B.

The complications of CROP include intracranial invasion, cavernous sinus thrombosis, blindness, occlusion of the central retinal artery, and airway obstruction caused by infections of the head and neck (with spread to the carotid sheath or the mediastinum through the fascial planes). The prognosis of CROP is guarded, with reported mortality rates of 30-70% (as stated earlier).

In this patient, treatment with amphotericin B was promptly initiated. CT scans of the orbits and sinuses demonstrated an air-fluid level in the right maxillary sinus, mucosal thickening of the right anterior ethmoid sinus, and preseptal cellulitis. An MRI of the head showed enhancement of the intraconal fat and rectus muscles of the right eye. The patient received emergency sinus debridement, and a biopsy was performed. Pathology demonstrated fungal angiitis and orbital inflammation that was consistent with mucormycosis. The patient underwent 3 additional operations, including exenteration of the right eye, and received hyperbaric oxygen treatments. After hospitalization for 3 weeks, he was discharged to home in good condition.

the doctor is in 5

just learned something about odiogo audio - i need to use different titles. it associated this post with an older one. so i am deleting and reposting. will use doctor is in 5 ... then 6 ...

Today we are presented with a 68 year-old. We’ll get to his story in a few. First, the pics …


Oh my! Looks like the dude swallowed somebody’s scrotum! That’s gross. I mean, nuts still wrapped up like a couple mini-pillows just-for-to-sleep-on-honey-oh-no-thank-you! seem to be lodged in this guy’s throat. Wanna have some fun? Take your browser slider and move it up and down a bit – the old chin strap seems to move around as if it were riding free in a pair of Levi’s and we are frolicking in a meadow feeling free and pretty like those girls that wear panti-liners. Hey, wait a sec … look at that kinda sorta line of white under the scrotal package. Odd. Wonder what it is. Better look at the next pic.


AAHH!! AAAHHHH!!!! AAHHH!!! NO!!! SAY IT ISN’T SO!!! AAAHHHHH!!!! IT IS!!! The dude SWALLOWED somebody’s DICK!! AHHH!! AAAAHHHHH!!! NNOOOOO!!!!! AND IT WAS STILL PUMPING THE LOVE JUICE!!! IT’S RIGHT THERE! LJ’S STILL DRIPPING!! IT’S IN HIM. NOO!!! AAAHHHH!!!!!

This boy better have a good story. Ain’t never no reason no-how to go chomping down on the spanker, and in particular … AAHH!! AAAHHHH!!!! THE DUDE HAD HIS LOVE PUMP LOVING IN SOME OTHER DUDE’S MOUTH AND GOT BIT BIG TIME! AAHH!! AAAHHHH!!!! And then this low-down geriatric sexual purveyor of “Dick: The Other White Meat” couldn’t stop there – he had to take the lil buddies, too? Damn, man, what is you thinking?

You better have a DAMN fine story, or I am going toss HIPAA right out that window, track down your sorry ass, and perform a stomach stapling without anesthesia. You won’t eat another thing, son, for the rest of your days. You done had your last meal!

Alright – cough, I want the story. I’m listening.

BACKGROUND

A 68-year-old (sixty-eight, 68! You should know better, son! Ain’t your dick still attached? You like it there? You tinkle on a regular basis? What is wrong with you?), previously healthy white man (I knew he was white, just by viewing the crime scene – I knew it. Yeah, “previously healthy” until you started chomping. I oughta kick your ass right through this cyber-diagnosis) presents to his primary care physician’s office with a complaint of 2 years of progressive dysphagia (Two years, my ass! That dick still dripping momma’s milk! You lie so bad). He reports that he has lost about 15-20 lb and that he is not following any diet or regimen to lose weight (unsafe sexual practices can lead to weight lose, too, grampaw. I don’t see no rubber on that rascal. You surfing bareback. Why you surprised you losing weight? Probably fit into a size 9 cocktail dress now, don’t you?). Although he can drink liquids without difficulty, he has lately felt a “sticky sensation” in the middle of his throat (it’s still dripping – can’t you people see that? Of course it’s sticky! It’s gots to stick to the egg – it’s designed that way! HEY – THE DUDE BIT OFF AND SWALLOWED SOMEBODY’S DICK THEN WENT AFTER THE MUD FLAP! YEAH – STICKY – SURPRISED? You want to know what is even more sticky? When the now-flapless-and-dickless partner goes home to his WIFE and has to EXPLAIN where his DICK went – and STILL is!) when he eats any solid food (I think our friend has had enough solid food for one lifetime). He also regurgitates food particles from a particular meal for up to 2 days after he has eaten it (I am positive this is true. Yes, whatever he eats comes back up. Yes. I have no problem believing this).

On physical examination, the patient’s vital signs are within the normal range. The examination of the oropharynx yields unremarkable findings. The patient has no neck mass or other abnormality. Examination of the thorax and the abdomen also yield unremarkable results. (Blah, blah blah. The formerly attached dick lost its erection. You would, too, with a good bite-down. So of course you don’t feel anything in there. It’s sticky – but soft.)

HINT
Observe the saclike structure in the esophagus. (Scrotal fun buns, dick. Saw them. Thanks.)

ANSWER
Zenker (so that’s his name. Better write that down. I can find him. No problem. I’ll do the Whistle Test. Little known fact: Dicks lodged in throats prevent whistling. Something about the way air moves in the diaphragm. I’ll find every 68 year-old Zenker in America and make them whistle. When one can’t – I’ll have my man!) (pharyngoesophageal) diverticulum: The frontal (see Image 1) and lateral (see Image 2) barium-swallow images of the upper esophagus demonstrate a large outpouching (what a great medical term, “outpouching.” I prefer “lodged spanker.”) at the posterior aspect of the pharyngoesophageal junction that retains barium (arrows) (I think “barium” is code for “seminal fluid”). This finding is consistent with a Zenker diverticulum (Latin for “pervert.” Zenker, Pervert. Now I have a complete name. This dude is so toast).

A Zenker diverticulum, also called a pharyngoesophageal diverticulum, is a pseudodiverticulum (note, “pseudo” – this answer is full of code only us internet docs can read) consisting of esophageal mucosa and submucosa (read, “seminal fluid”) that herniate (“the buddies”) posteriorly between the cricopharyngeus and the inferior pharyngeal constrictor muscles (like a pirate map to show you where to find your nuts if your wife said, “go back and get them! And don’t return until you do!”) and through an area of potential weakness referred to as the Killian dehiscence (the first clue as to the victim’s identity – a Mr. Killian). The pathogenesis of this condition is not well known (this means that they don’t have much information on Mr. Killian – must have been a chance encounter in a bar, mayeb a glory hole). Patients with a Zenker diverticulum are thought to have a discoordination of the swallowing mechanism that increases pressure on the mucosa of the pharynx (this “discoordination” means that he didn’t want to bite the guy’s dick off – but got the “mucosa” thing happening, which means he did bite the guy’s dick off). Over time, this pressure leads to herniation of the esophageal mucosa through the Killian dehiscence (“Over time … herniation” – Mr. P. Zenker bite off the dick of one Mr. Killian, and then bit off and removed the remainder of the male package).

The condition occurs most commonly in elderly women (this should come as no surprise), with peak incidence in the seventh to ninth decades of life (OK, good information. No wonder older men tend to be so quiet – fear of being Zenkered). The most common presenting feature in a Zenker diverticulum is upper-esophageal dysphagia, which occurs in as many as 98% of patients (this means that the dick get lodged pretty high up). Other common symptoms are halitosis (you’ve got a dick in your throat, probably been there for days – of course your breath stinks), regurgitation of undigested food, aspiration, noisy deglutition, and changes in voice (eg, hoarseness) (yeah, what about the change in voice in the bitee?). Weight loss, possibly resulting from limited caloric intake (tough to get calories around that thing in your throat, eh, grammaw?) and recurrent pulmonary infection from aspiration, occurs in approximately one third of patients.

(Blah, blah, blah. Read the rest of the pseudo-answer if you like. Here’s the bottom line. Diagnosis: Dick and Scotty lodged in throat. Recommended treatment: Shoot him right between the legs, then between the eyes. Put his crime on prune juice containers for all prospective criminals to see – face, facts, final disposition – under the caption, “Don’t be a Zenker!”)

In patients with a Zenker diverticulum, the physical findings are usually normal. Fluoroscopic barium-swallow studies are the mainstay of diagnosis and demonstrate the characteristic outpouching that arises from the midline of the posterior wall of the distal pharynx near the pharyngoesophageal junction. This finding is best identified during swallowing, and it is typically seen on lateral images, on which the diverticulum is observed at the C5-C6 vertebral level. If the diverticulum is large, it may protrude laterally, most often to the left side. After the bolus of contrast agent passes the upper esophagus, the diverticulum is typically seen extending posterior to the cricopharyngeus muscle, and the contrast material that was retained in the diverticulum may be regurgitated into the hypopharynx. The lumen of the diverticulum should be carefully observed for irregularities or filling defects because squamous cell carcinoma can develop in a small percentage of cases.

When incidentally imaged on computed tomography (CT) scans or magnetic resonance imaging (MRI) scans, a Zenker diverticulum appears as a structure that arises posteriorly from the hypopharynx and is filled with air, fluid, or oral contrast material. Zenker diverticula may also be found on endoscopy. Care must be taken during endoscopic procedures, because passage of the endoscope into the diverticulum may result in perforation.

Small, asymptomatic diverticula may be followed up by monitoring the progression of symptoms. Surgical management should be considered in patients with clinically significant dysphagia, weight loss, pulmonary aspiration with recurrent lung infections, and complications related to bleeding. Surgical options for treatment include myotomy of the cricopharyngeus muscle, with or without diverticulopexy, and endoscopic division of diverticular wall with stapling. The success rate (ie, the relief of symptoms as measured in most studies) is approximately 93%.

shatterproof vaginal doors

I was 12, I think, when I realized that shatterproof didn’t mean the same thing as breakproof. I was at my friend’s house (Artie). His dad had a new tool thing on the workbench with a grinder wheel. This shatterproof glass flipped over the wheel to block flying debris. I read the little sticker, “Shatterproof Glass.” “Neat,” I thought, and then picked up a pair of pliers and whacked it! It fractured in place. “Oh,” I thought, “shatterproof. Shatter. Got it. Fuck me.” I put the pliers down and walked away. Knowing Artie’s dad, I am sure he got his ass kicked for that broken-but-not-shattered glass. The good news is that I learned the importance of words in a very concrete setting.

Still into my webcams. Well, not really. Regardless of the G rating for the ones I would look at, I only peruse the lists when I am blogging, and only view the Watering Hole linked before when I am not blogging. Webcams still suggest to me Bambi touching herself live just for you as she works her way through college, who then becomes Bambi working her way down bobo for $45 a pop when her full-time job doesn’t quite make enough for her.

This webcam ”Switzerland Live Webcam on authentic steamer cruise, Interlaken, Bernese Upper Country,” is not live, but takes a pic every 60 seconds. The neat part is that the database goes back a few months. When you go to the site, it takes you the last pic of the last day. Move yourself to the first pic of the day, then you can use your arrow keys to move from pic to pic through the day. It takes just a moment for each image to load. Beautiful country.

Last one. Since the Cubbies won the NL Central yesterday, here is the exterior of Wrigley Field. OK, I’m bored, too.

Put in an address and get satellite pics. It’s free but the database is old.

You want to know how well read I am? I thought Ezra Pound was a chick. Turns out he’s a dude! Go figure. He read and recorded a lot of own works. Here’s a comprehensive set of direct links. Guess I better start listening.

I’m watching the Nationals-Phillies game. I love finding out who I am by noting the commercials chosen to present during the things I like to view. I have an enlarged prostate. My dick don’t work. My grey hair is holding my back from banging complete strangers in bars. I eat crap fast food (no wonder my dick doesn’t work). I need a new razor, cell phone, and tv (“it’s the mirrors”). I’m a wreck with out-dated tools.

So I went to the Flomax site and pull the full prescribing information.

You know the line about telling your eye doc you’re taking Flomax if you are going to have cataract surgery? “Intraoperative Floppy Iris Syndrome (IFIS) has been observed during cataract surgery in some patients treated with alpha-1 blockers, including FLOMAX capsules.” Floppy Iris Syndrome? I don’t know what the hell that is, but anything followed by syndrome can’t be good.

It gets better: “The patient's ophthalmologist should be prepared for possible modifications to their surgical technique, such as the utilization of iris hooks, iris dilator rings, or viscoelastic substances.” A HOOK? Wait a minute. Help me understand. I got something inside my ass that somehow changes my urine stream, you give me medicine, and now I have a hook in my eye? WTF?

Oh, great. As I write, Avodart is advertising and some clown is squeezing a ball of clay to show how my ass obstruction will get smaller. He claims to be a modeler who makes detailed city scenes. He’s a liar. Know how I know? This highly detailed model of a series of city blocks – just beautiful – is shown. Looks real, full scale. Then his face comes into view and you learn it is a model. Then – wait for it – then this ass-obstructionist put a cup of coffee down right in the middle of the street! A ring on the bottom, a bump and spill – and a-o is explaining to the client why he is $15K over budget and one week delayed. People get fired for stupid stuff like that. Must be a urine back-up clouding his thinking.

Where was I? Flomax, OK. The bit about sperm counts? “Studies in rats revealed significantly reduced fertility in males dosed with single or multiple daily doses of 300 mg/kg/day of tamsulosin hydrochloride (AUC exposure in rats about 50 times the human exposure with the maximum therapeutic dose). The mechanism of decreased fertility in male rats is considered to be an effect of the compound on the vaginal plug formation possibly due to changes of semen content or impairment of ejaculation.”

Well, “significantly reduced” is soft language – just means they can measure it and attribute it to the drug. Big enough so it isn’t a false positive. The second part is what I like – a “vaginal plug.” What a great concept. The reduction is so significant that a biological function arises inside the woman that says, “You must be kidding? Is that the best you got?”

So how many vaginal doors get slammed? They label the observation, “Abnormal Ejaculation.” The placebo group abnormally ejaculated 0.2% of the time. For the first dosage level of the anti-ass-obstruction-but-hook-in-your-eye “medical solution” AE’d 8.4%, and the next dosage level 18.1%.

Ouch! One out of five guys gets a hook in his eye, and the door slammed on the one-eyed guy – but he can piss up a Cat 2 Hurricane! I want some!

My heart isn’t strong enough to read the pharm data on the dick medicine that tells us that if your erection lasts longer than four hours you need to see a doctor. Four hours? That’s normal, ain’t it? But I am sure if I read it I would find that I am at risk of inner ear prolapse – but not slamming vaginas. So I guess it’s a balance.

I need to walk around. My privates are not relaxed with all this talk. You should be ashamed of yourself for reading this smut. Go find a webcam.

I’m impotent!

I was visiting with my twin the other day and was feeling useless for various reasons. She held my right hand, lifted my face with her other hand so that I our eyes met, and said so tenderly, “You’re impotent.”

So now I have pledged to myself that every time I visit her, I will get a shave and haircut, and will wear a suit. If I’m impotent, I gotsta look impotent!

And I am impotent for another reason. I am a big-time Beatles fan. Lots of links on the right side under the Apple logo (all rights reserved!). My twin was looking at some art on-line and sent to me a link showing a limited ed. litho of a Stuart Sutcliffe painting.

The gallery link is here, and the litho link is (or was) here. A good picture of the original painting is here.

The Beatles Store has packaged the litho with some letter and wants about US$500 for it. Yuk! So I did some research and found the Stuart Sutcliffe site which is where the painting is available (and the good pic link above is found).

I wrote to the estate using their on-site cgi, so I don’t have a copy of it. I wrote something like: I love what you have done with this site and the memory of Stuart Sutcliffe. You have done very well. Thank you. / I could never afford anything original, just a different economic class than me. However, I noticed that The Beatles Store is selling a limited edition lithograph of this painting. They have packaged it with some letter and the pricing is therefore too much for me. / I am wondering, since you have licensed the image for reproduction, if you would kindly direct me to a source so that I could buy just the litho. / Thank you, Clyde.

Whoops! Talk about opening a can of worms! “Objection, your honor, assuming a fact not in evidence!”

I did not get a direct response. It was instead directed to The Beatles Store and the attorney for the Estate of Stuart Sutcliffe. The e is reproduced below exactly as I received it. I am laughing my ass off! Seems that both the litho and the letter are violating the copyrights of The Estate of Stuart Sutcliffe and the National Museums and Galleries of Liverpool, respectively. I be’s impotent!

Dear Sirs,

It has been brought to our attention that you have for sale the following:

“The Art of Stuart Sutcliffe.
Limited edition 96/1000.

Reproduction of one of Stuart's last paintings with letter from his tutor Edward Paolozzi
W71 x H54cm”

You need to know that there are two separate breaches of copyright;

1) The Stuart Sutcliffe Art image is the property of the Stuart Sutcliffe Estate along with the copyright.

No authorization has been given to reproduce this image or to sell it as a limited edition and therefore this is a serious breach of copyright.

2) The letter from Eduardo Paolozzi was purchased with copyright from the Stuart Sutcliffe Estate by the National Museums and Galleries of Liverpool. You are therefore in breach of their copyright as well.

Where do they come from?
Who authorized them?
How many were sold?
How many are left? Etc.

We expect to hear from you straight away - before we put this in the hands of our solicitors and before we inform the National Museum and Galleries of Liverpool.

Yours sincerely,
Diane Vitale
Director
The Stuart Sutcliffe Estate

PS: Who ever boot legged this should have at least ensured that Eduardo Paolozzi’s name was spelt correctly.

I wrote back and thanked them for contacting me, and wished them luck in resolving their issue.

I received this e in return:

Dear Clyde,

Thank you Clyde for bringing this very serious matter to our attention.

There is an official limited edition Stuart Sutcliffe print (entitled, The Beatals) available through the Rock Art Show and Celebrity Art.

Here is the link: www.rockartshow.com

Best wishes,

Diane Vitale for Pauline Sutcliffe

I am now a small yet official part of Beatles history, as is my twin. Impotency is cool!