Severe hypo-osmotic hyponatraemia due to chylous leak following radical neck dissection.

Chylous leak is a documented complication of radical neck dissection with well recognised morbidities, including wound breakdown, hypovolaemia and hypoalbuminaemia. Other less well-documented electrolyte imbalances can also ensue. We aim to raise awareness about hypo-osmotic hyponatraemia as a potentially fatal, commonly overlooked complication of high-output chylous leaks.

Evidence for context-dependent complementarity of non-Shine-Dalgarno ribosome binding sites to Escherichia coli rRNA.

While the ribosome has evolved to function in complex intracellular environments, these contexts do not easily allow for the study of its inherent capabilities. We have used a synthetic, well-defined Escherichia coli (E. coli)-based translation system in conjunction with ribosome display, a powerful in vitro selection method, to identify ribosome binding sites (RBSs) that can promote the efficient translation of messenger RNAs (mRNAs) with a leader length representative of natural E.

Success of cricopharyngeal myotomy for specific and non-specific cervical dysphagia.

Objective: The present study aimed to compare outcomes of cricopharyngeal myotomy (CPM) in patients with documented cricopharyngeal dysfunction (CPD) and those in whom the diagnosis is complex or in doubt.

Materials And Methods: Retrospective comparative study of all patients undergoing CPM between 2001 and 2010 at a single UK centre. Patients were classified as having either CPD (n = 15) or non-specific cervical dysphagia (NSCD) (n = 12) based on contrast swallow results.

Bilateral pharyngeal apparatus (branchial) sinuses in a set of identical twins--a case report.

Defective closure of the pharyngeal apparatus during the second week of gestation results in pharyngeal arch anomalies. Although pharyngeal apparatus (branchial) anomalies are frequently seen, bilateral cases are rare (only 2% to 3%). Bilaterality has a familial predisposition.

Extramedullary plasmacytoma of the true vocal fold.

We report a rare case of extramedullary plasmacytoma (EMP) of the true vocal fold. Our patient, a 62-year-old woman, presented with dysphonia. On workup, fiberoptic laryngoscopy detected a lesion arising from the anterior half of her left true vocal fold.

Study of clinical and aetiological profile of 100 patients of pancytopenia at a tertiary care centre in India.

Pancytopenia is not a disease but an important clinico-haematological entity encountered in our day-to-day clinical practice with findings that may result from a number of disease processes. A total of 100 patients of pancytopenia admitted in medicine wards of Civil Hospital, Ahmedabad, Gujuarat, India, were studied. The most common cause of pancytopenia was megaloblastic anaemia (45%) followed by infections (20%) and hypersplenism (15%).

Post meningocele repair urinary ascites in a neonate--a rare presentation.

A full-term female neonate with a large lumbosacral meningocele developed sudden abdominal distension and urinary retention after meningocele repair. An erect abdominal radiograph showed homogeneously opacified areas with a paucity of intestinal gas. Abdominal ultrasound revealed ascites with multiple internal echoes.

Follow-up in head and neck cancer: patients' perspective.

Purpose: The purpose of this paper is to determine head and neck cancer patients' perspective of their follow-up regime and to suggest ways in which these perspectives can be incorporated into current practice.

Design/methodology/approach: This is a prospective survey-based study. A total of 263 patients consecutively attending a head and neck cancer clinic completed a survey about their experience of the follow-up process in the post-treatment period between January 2009 and October 2009.

Single-stage Modified Duhamel procedure for Hirschsprung's disease : our experience.

Introduction: Primary single-stage pull-through for Hirschsprung's disease (HD) has been reported to give comparable surgical outcomes to staged operations with less morbidity. Herein, we present our experience with single-stage Modified Duhamel procedure for management of HD.

Patients And Methods: This was a review of 48 cases of HD who underwent single-stage Modified Duhamel procedure without a protective colostomy.

Matrix metalloproteinase-dependent microsomal prostaglandin E synthase-1 expression in macrophages: role of TNF-α and the EP4 prostanoid receptor.

Matrix metalloproteinase (MMP)-9 contributes to the pathogenesis of chronic inflammatory diseases and cancer. Thus, identifying targetable components of signaling pathways that regulate MMP-9 expression may have broad therapeutic implications. Our previous studies revealed a nexus between metalloproteinases and prostanoids whereby MMP-1 and MMP-3, commonly found in inflammatory and neoplastic foci, stimulate macrophage MMP-9 expression via the release of TNF-α and subsequent induction of cyclooxygenase-2 and PGE(2) engagement of EP4 receptor.

Medial approach for hindfoot arthrodesis with a valgus deformity.

Background: Surgical correction of valgus deformity of the hindfoot has traditionally been via a lateral incision, often complicated by wound healing problems and sural nerve damage. Potential advantages of a medial approach especially for a valgus deformity include excellent wound healing, no risk of damage to the sural nerve and extensibility of the approach to include additional procedures such as navicular fusion or tendon transfer if indicated.

Materials And Methods: We present a retrospective review of 18 consecutive patients with valgus deformity of the hindfoot, all undergoing arthrodesis via a medial approach.

Visual loss following head and neck surgery.

Introduction: Non-arteritic ischaemic optic neuritis is a known post-operative complication of ophthalmological and maxillofacial surgery, but has not been widely described as a potential consequence of head and neck surgery.

Aim: To highlight non-arteritic ischaemic optic neuritis as a potential risk in patients undergoing head and neck surgery.

Subject And Method: Case report of a 60-year-old man undergoing total laryngectomy and bilateral neck dissection for laryngeal squamous cell carcinoma.

Internet and e-mail use in ENT: a survey of patient usage and satisfaction.

Nowadays, internet and e-mail are important modes of communication and information. This paper seeks to determine internet usage as a source of health information amongst ENT patients and to investigate whether patients prefer to communicate primarily with the hospital via e-mail. The method used is a questionnaire study and 201 patients attending an ENT clinic completed questionnaires over 2 weeks in December 2010.

Soft, fortified ice-cream for head and neck cancer patients: a useful first step in nutritional and swallowing difficulties associated with multi-modal management.

Patients with head and neck cancer have complex swallowing and nutritional concerns. Most patients are malnourished, and treatment modalities within the aerodigestive tract have profound effects on future swallowing and nutrition. The objective of this study is to investigate whether the introduction of fortified soft ice-cream to post-operative head and neck cancer patients would increase compliance with oral-feeding regimes.

Strategies for safety reporting in substance abuse trials.

Background: Reporting all adverse events (AEs) and serious adverse events (SAEs) in substance use disorder (SUD) clinical trials has yielded limited relevant safety information and has been burdensome to research sites.

Objective: This article describes a new strategy utilizing standard data elements for AE and SAEs that defines a threshold to reduce unnecessary safety reporting burden in SUD clinical trials and describes retrospective review and prospective preliminary data on the strategy's safety reporting impact.

Methods: We developed a new strategy to standardize safety reporting and tailor reporting to the trial intervention risk.

Relation of study design to recruitment and retention in CTN trials.

Background: Recruitment and retention in randomized clinical trials are difficult in general and particularly so in trials of substance abuse treatments. Understanding trial design characteristics that could affect recruitment and retention rates would help in the design of future trials.

Objective: To test whether any of the following factors are associated with recruitment or retention: type of intervention, type of therapy, duration of treatment, total duration of trial, number of treatment sessions, number of follow-up visits, number of primary assessments, timing of primary assessments, number of case report form (CRF) pages at baseline, and number of CRF pages for the entire trial.

Bleomycin: A worthy alternative.

Context: Lymphangiomas are developmental anomalies presenting mainly in the first two years of life. Surgical excision has been the mainstay of treatment; however a potentially disfiguring surgery along with presence of important structures in the vicinity and infiltration into surrounding structures makes the dissection difficult.

Aims: To study the safety and efficacy of Bleomycin as a sclerosing agent for lymphatic malformations in children.

Patient-centered medical home cyberinfrastructure current and future landscape.

The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit.

Evaluation of the TREX1 gene in a large multi-ancestral lupus cohort.

Systemic lupus erythematosus (SLE) is a prototypic autoimmune disorder with a complex pathogenesis in which genetic, hormonal and environmental factors have a role. Rare mutations in the TREX1 gene, the major mammalian 3'-5' exonuclease, have been reported in sporadic SLE cases. Some of these mutations have also been identified in a rare pediatric neurological condition featuring an inflammatory encephalopathy known as Aicardi-Goutières syndrome (AGS).

Spontaneous bowel perforation in a neonate with anorectal malformation.

Gastrointestinal perforation in neonates with anorectal malformations is extremely uncommon. Delayed patient presentation is an important factor that demands special attention. We present a neonate with anorectal malformation and meconium peritonitis following spontaneous bowel perforation.

The follow-up of patients with head and neck cancer: an analysis of 1,039 patients.

In all cancer specialities, there has been much debate about the best follow-up regime. The provision of a service that meets high standards whilst being cost-effective is increasingly pertinent. The objectives of the study were to examine: whether routine follow-up facilitates early diagnosis and recurrence; whether there is a cohort of patients who require a more intensive follow-up regime; whether follow-up should be customised to individual patients.

Acute acalculous cholecystitis causing gall bladder perforation in children.

We report two cases of children who presented with acute abdomen due to gall bladder perforation and biliary peritonitis. Cholecystectomy with peritoneal lavage proved curative.

Persistent otorrhoea with an abnormal tympanic membrane secondary to squamous cell carcinoma of the tympanic membrane.

Objective: The authors present an extremely rare case of carcinoma of the tympanic membrane.

Method: A case report and review of the literature concerning carcinoma of the tympanic membrane and temporal bone are presented and discussed.

Results: The authors present a patient with recurrent otorrhoea and an abnormal tympanic membrane.