Venous thromboembolism in ENT surgery: a review of the literature and completed audit cycle of adherence to national guidance.

Venous thromboembolism (VTE) risk assessment of elective ENT patients is essential to minimize the risk of mortality and morbidity. The study is standard-based audit of VTE risk assessment against the ENT UK guidelines and intervention includes instructional poster and departmental presentation. 23 patients on eight operating lists were audited in the first cycle (C1).

The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness.

Purpose: The aim of this meta-analysis was to compare the risk of stiffness between early and delayed anterior cruciate ligament (ACL) surgery in studies that use a modern accelerated rehabilitation protocol.

Methods: Medline, Embase, and the Cochrane library were searched for studies that compared outcomes for early and delayed ACL reconstruction with a modern accelerated rehabilitation protocol. Risk ratios for stiffness were pooled using random effects meta-analysis.

Pasireotide therapy in a rare and unusual case of plurihormonal pituitary macroadenoma.

Unlabelled: We report the use of pasireotide in a rare and unusual case of pituitary macroadenoma co-secreting GH, prolactin and ACTH. A 62-year-old Caucasian man presented with impotence. Clinically, he appeared acromegalic and subsequent investigations confirmed GH excess and hyperprolactinaemia.

Paediatric choroidal osteoma treated with ranibizumab.

An 11-year-old patient presented with blurred vision in both eyes resulting from bilateral choroidal osteoma. The patient was treated with a course of monthly intravitreal injections of ranibizumab for 3 months and this led to improvement of visual acuity. This effect was sustained without the need for further injections over a 2-year period of follow-up.

Validation of the modified LDIFlare technique: a simple and quick method to assess C-fiber function.

Introduction: In this study we validated a modified laser Doppler imager method (mLDIf) for assessing C-fiber function and compared it to the original (oLDIf). Both measure flare size in foot skin after heating, but the mLDIf uses 47°C (vs. 44°C), making it quicker and better suited for clinical use.

Atypical central serous retinopathy in a patient with latent tuberculosis.

A 32-year-old Afro-Caribbean male presented with a 4 month history of blurred vision and distortion in his right eye. Fundus examination showed multiple pigment epithelial detachments which progressed over 2 months of observation to a large serous detachment of the macula. Fundus fluorescein angiography (FFA) showed multi-focal hyperfluorescence in the early phase which increased in the later stages.

Initial assessment of young people in the emergency department.

One of the most important aspects of care for children in emergency departments (EDs) is the initial assessment of their conditions and circumstances. Paediatric nurses, or other nurses who have had adequate training and skills in the care of children and younger people, should use the appropriate tools to undertake these assessments so that they can identify and manage children's physical, mental or social problems. This article discusses the use of such tools in the initial assessments of children at Ipswich Hospital NHS Trust ED, and how this use has improved practice while raising the profile of paediatric emergency care.

Successful two-stage revision of a KineSpring® joint unloading implant: a case study.

Few nonsurgical treatment options are available to the patient with debilitating knee osteoarthritis (OA) that is refractory to conservative care. The KineSpring® System joint unloading implant is a unique device that reduces the load carried by the medial compartment of the knee joint by up to 13 kilograms during the stance phase of gait. We report a case of a male patient who underwent implant with the KineSpring System for symptomatic knee OA but subsequently required revision due to local infection.

Small fibre dysfunction, microvascular complications and glycaemic control in type 1 diabetes: a case-control study.

Aims/hypothesis: The aim of this study was to determine the influence of microvascular disease on C-fibre function in patients with type 1 diabetes of moderate duration.

Methods: The axon-reflex flare area induced on the dorsum of the foot by local skin heating to 47 °C was measured with a laser Doppler imager (LDI) in sex-, age- and height-matched groups with type 1 diabetes, with and without microvascular disease (MV+ and MV-, respectively) and in healthy controls (HC). Each group consisted of 24 individuals and all were free from clinical neuropathy (neuropathy disability score <3 and Toronto clinical neuropathy score <5).

The role of biologics in treatment of ANCA-associated vasculitis.

The vast majority of patients with anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) who receive conventional treatment with glucocorticoids and cyclophosphamide experience frequent relapses and treatment-related side-effects. Increasing knowledge of the pathogenesis of AAV has permitted the development of targeted therapies against tumour necrosis factor (TNF)-α and T and B lymphocytes. Therapy with TNF-α blocking drugs has so far proved disappointing, and this approach is not recommended.

Synchronous bilateral squamous cell carcinoma of the lung successfully treated using intensity-modulated radiotherapy.

We present a case of synchronous bilateral inoperable lung cancer which required treatment with external beam radiotherapy to a radical dose. Intensity-modulated radiotherapy (IMRT) was used. More conformal dose distribution within the planning target volume was obtained using IMRT than the conventional technique.

Lingual orthodontics: an overview.

Unlabelled: As adults increasingly seek orthodontic treatment, a growth has been witnessed in the demand for aesthetic orthodontics, the ultimate of which are appliances bonded to the lingual surfaces of the teeth. Development has spanned 30 years and many of the initial challenges faced with this approach have now been overcome. An overview is provided on the development of lingual appliances from conception through to the current systems available.

Churg-Strauss syndrome in a patient previously diagnosed with multiple sclerosis.

A lady in her 70s with a background of multiple sclerosis (MS) and late-onset asthma was admitted with a 2-week history of cough and shortness of breath, progressive right-sided weakness and functional decline. Investigation revealed eosinophilia, elevated myeloperoxidase antineutrophil cytoplasmic antibody, CT sinuses showed long-standing inflammatory changes consistent with sinonasal polyposis and MRI head showed lesions consistent with vasculitis. She then developed left-sided weakness and increased wheeze.

Nonischemic central retinal vein occlusion in an adolescent patient with ulcerative colitis.

Inflammatory bowel disease (IBD) can present with extraintestinal manifestations occasionally involving the eye. Retinal vein occlusions are rarely seen and have never been reported in the pediatric population though vascular thrombosis can be associated with IBD. Here, we present a case of what we believe is the youngest reported patient with nonischemic central retinal vein occlusion (CRVO).

Surgical management of troublesome mastoid cavities.

Objective: To examine the reasons for discharging mastoid cavities, the operative findings during revision surgery, and the medium-term outcome.

Patients: One hundred and forty revision mastoidectomies in 131 patients were studied. Post-operatively, patients were followed up at three, six and 12 months and then yearly.

A problem in diagnostic imaging.

Many pathological processes can present as a swelling in the groin. We present a case of complex, ruptured pyonephrosis causing a psoas collection, which in turn presented clinically as an apparent right "incarcerated inguinal hernia." The patient was successfully treated with antibiotics and ultrasound-guided drainage of the abscess.

Intensity modulated radiotherapy (IMRT) in the management of locally advanced oropharyngeal squamous cell carcinomata (SCC): disease control and functional outcome using the therapy outcome measure (TOM) score--report from a single U.K. institution.

Introduction: This paper evaluates tumour control and toxicity especially in relation to swallowing dysfunction in those patients with locally advanced oropharyngeal squamous cell carcinoma who have undergone either primary chemo-radiation or post-operative parotid sparing IMRT. The TOM scoring system was used to assess dysphagia.

Methods: All patients with locally advanced (stage 3/4) squamous cell oropharyngeal cancer and who required either primary or post-operative RT were identified.

Update on the management of T1 renal cortical tumours.

There are a range of treatment strategies for the management of patients with small incidental renal cortical tumours including active surveillance, radiofrequency ablation, cryotherapy, radical nephrectomy and partial nephrectomy. A large number of such tumours are benign and might therefore be over-treated with radical nephrectomy. There are emergent short-term oncological and clinical outcomes for cryotherapy and radiofrequency ablation, and recent studies have illustrated the benefits of partial nephrectomy for minimizing the risk of progression to chronic kidney disease.

Lobular neoplasia of the breast.

Lobular neoplasia is increasingly being detected, probably due to the widespread screening for breast malignancies. The understanding of lobular neoplasia is undergoing a paradigm shift, from being considered a predictor of recurrence to being considered a pre-invasive lesion, based on molecular studies suggesting a clonal link with invasive lobular cancer. The management of patients diagnosed to have lobular neoplasia is in evolution, with the increasing need for risk stratification and hence the necessity to identify this entity separately as either lobular carcinoma in-situ and atypical lobular hyperplasia.

Epidemiology of ANCA-associated vasculitis.

The epidemiology of the antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV), comprising Wegener's granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome, poses considerable challenges to epidemiologists. These challenges include the difficulty of defining a case with a lack of clear distinction between the different disorders, case capture, and case ascertainment. The AAV are rare and therefore a large population is required to determine the incidence and prevalence, and this poses questions of feasibility.

Topical vaginal estrogen therapy in managing postmenopausal urinary symptoms: a reality or a gimmick?

Postmenopausal estrogen deprivation has been suggested as a risk factor for lower urinary tract dysfunction including stress incontinence, overactive bladder and recurrent urinary tract infection. These symptoms could have enormous effects on individuals and health-care providers in terms of impact on quality of life and cost. Recent randomized, controlled trials suggested that systemic hormone replacement therapy does have a negative effect on female lower urinary tract function, probably because of the progestogen component.

Irreducible posterior subtalar dislocation with incarceration of a fracture of the anterior process of the calcaneum.

Subtalar dislocation is a significant injury characterised by late complications, including subtalar arthritis. We describe a rare case of irreducible posterior subtalar dislocation due to incarceration of a fracture of the anterior process of the calcaneum in the subtalar joint, and discuss appropriate management.