0:00:01this is an interesting case with thirty seven year old male or people in those
0:00:05and on the type one diabetes minutes as
0:00:07presented in writing on my quality for
0:00:10and how the left ventricle and this
0:00:12was able to six months was customer the time many years later than for the
0:00:17and eighty percent to thank you indicated you know function
0:00:21optimal imaging at the time cross court and shrivelled native kidney is compared to previous
0:00:27imaging shown very smooth outline
0:00:30listen i'm sort of the prosodic state is a time in a small the cortex
0:00:34all found
0:00:36it was empirically decided to restock
0:00:39then data he had a kidney transplant
0:00:42and i'm not an effect a few years of the that will stand to one
0:00:47decided not to be restored
0:00:49but then some with scheme like you get into the allegra
0:00:54and imaging at the time
0:00:57showed in fort in the current time are infinitely fits in the lottery
0:01:01mccullough imaging children and recent
0:01:04calcification the apex
0:01:06and i don't collected from bus
0:01:09and we'll frame was we stopped at this time from video screens two thousand ten
0:01:13like in your cousin well they'll say finally diagonals and possibly adaptable syndrome
0:01:20many potential
0:01:21discussion points in the management this case
0:01:24his talk goals might think it or something
0:01:27so this case raises some quite interesting manager said discussion points and the first of
0:01:32that it would be around one o'clock actually formed in the first pass and that's
0:01:36pretty simple i think actually in the end of f indicator and the reason for
0:01:39the nineteen ninety and in that area of the myocardial the wasn't problem blood flow
0:01:44the space
0:01:45i don't that situation with and a serial injury you can get information from possible
0:01:50that from this is normally result i goes away quite quickly which is why the
0:01:53anti calculation was only done for short time now why the three refill will be
0:01:58harming you can see the river thames and sixteen eighty three there was a huge
0:02:03frost that held on a frozen real attends one would rather free so it's the
0:02:08same reason but because of anti forcefully that antibodies ever that and but because of
0:02:13a copula perfect state
0:02:14and in the patient's case there was a sticky plots and she didn't realise that
0:02:18are
0:02:19so that's the first aspect of not only became obvious after recurrent from policies were
0:02:24a problem
0:02:26the second aspect discusses why detected so very long to make diagnoses about the possible
0:02:30of adaptivity syndrome well that's because the diagnostic techniques change as time went by he
0:02:35was will for nice and a model for a nice purely incorrectly warfare has a
0:02:39risk this man was a diabetic question opposite you also has one people in that
0:02:43the rich you miss you could have a complete voice
0:02:46you could fall over to have a so you're and of course we know there
0:02:49is a little for an associated the prophecy without and also degraded and three and
0:02:52that could damage is precious allegra so is not a straightforward thing is to put
0:02:56model
0:02:57and then the next aspect really is what's happened over the years with the diagnosis
0:03:01of anti possible to the antibodies and that's become a little easier because some of
0:03:04the but as we can now do in the parse tree had greater specificity a
0:03:08greater sensitivity many markedly patients do have these antibodies don't have proposed to make a
0:03:14proper diagnosis you have the hapless from both together and
0:03:17the correct antibodies present in the serum and therefore upgraded and three month period in
0:03:22that context you've got you darkness