A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation.

Purpose: To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation.

Methods: A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and graft type used for repair were recorded.

Laryngeal granular cell tumour: a very rare diagnosis for a child presenting with hoarse voice in the UK.

We present a rare case of a paediatric laryngeal granular cell tumour (GCT) of the vocal cord. GCTs are rare clinical entities, thought to arise from Schwann cells. There are only a handful of paediatric laryngeal GCTs in the literature, and therefore, little is known regarding their natural history or preferred management strategies.

Acute presentation of an intraoral dermoid cyst causing airway compromise in a young child.

A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess.

DNAAF1 links heart laterality with the AAA+ ATPase RUVBL1 and ciliary intraflagellar transport.

DNAAF1 (LRRC50) is a cytoplasmic protein required for dynein heavy chain assembly and cilia motility, and DNAAF1 mutations cause primary ciliary dyskinesia (PCD; MIM 613193). We describe four families with DNAAF1 mutations and complex congenital heart disease (CHD). In three families, all affected individuals have typical PCD phenotypes.

High prevalence of p.His154Pro mutation causing primary ciliary dyskinesia disrupts protein oligomerisation and is associated with normal diagnostic investigations.

Rationale: Primary ciliary dyskinesia is a genetically heterogeneous inherited condition characterised by progressive lung disease arising from abnormal cilia function. Approximately half of patients have situs inversus. The estimated prevalence of primary ciliary dyskinesia in the UK South Asian population is 1:2265.

Primary gallbladder lymphoma presenting as a polyp.

We present an unusual case of a 75-year-old woman, with no significant medical history, presenting with ongoing weight loss and change in bowel habit. Her physical examination and initial blood tests were all normal, and, therefore, radiographic imaging was undertaken. Ultrasound and CT of the abdomen confirmed a gallbladder polyp and a laparoscopic cholecystectomy was subsequently performed.

Middle cranial fossa cystic schwannoma.

The authors present the unusual case of a 37-year-old man, with a history of hepatitis C, presenting with a 3 year history of progressive trigeminal, facial and vestibular nerve defects. Intracranial imaging demonstrated a cystic middle and posterior fossa lesion, that was ultimately diagnosed as a cystic trigeminal schwannoma. Due to the uncertainties of diagnosis he was managed in two stages with an open biopsy and then a subsequent partial resection.

Concurrent palmar lunate dislocation and posterior elbow dislocation: a case report.

We report a rare case of concurrent palmar lunate dislocation of the left wrist combined with a posterior dislocation of the left elbow joint in a 40-year-old man. He sustained both injuries after falling onto his outstretched left hand. The elbow was reduced by the closed method.

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.

Familial isolated congenital asplenia: case report and literature review.

Congenital asplenia is a rare life-threatening condition, often presenting with pneumococcal sepsis. It may arise as part of situs abnormalities or result from an unrelated specific defect of spleen development. The mode of inheritance is usually autosomal dominant, though sporadic cases are also reported.

Child sexual abuse and sexually transmitted infections: review of joint genitourinary medicine and paediatric examination practice.

Joint examination by doctors with complementary skills and screening for sexually transmitted infections (STIs) are recommended in children who may have been sexually abused or have been found to have an STI. Our study showed that criminal proceedings were more likely to be brought in cases with physical signs of sexual abuse. It could be difficult to prove whether sexual abuse had taken place or not with microbiological evidence alone, in the absence of other evidence.

Osteochondritis dissecans of the talus involving the subtalar joint: a case report.

Osteochondritis dissecans can affect any joint, although the ankle is the third most common location after the knee and elbow. When the ankle is involved, the lesion usually affects the talar dome. The authors report a case of osteochondritis of the subtalar joint affecting the talus in a 14-year-old girl without any history of trauma.

Localized amyloidosis of glans penis.

We describe a case of black Caribbean man who presented with penile rash for several months. The rash showed no improvement with topical steroid or anti-bacterial/fungal creams. A subsequent tissue biopsy and further investigations confirmed the diagnosis of localized amyloidosis.

Severe laryngitis following chronic anabolic steroid abuse.

The effects of anabolic steroids on the quality of voice have been well documented; however, no study has established significant structural changes in the larynx as a direct result of anabolic steroid use. We report a unique case of a 47-year-old male smoker and professional body builder who presented with progressive stridor and hoarseness following abuse of anabolic steroids over a period of two years. Conservative management failed to resolve his symptoms and a planned tracheostomy was performed to secure his airway.

Bitter sweet tympani.

During cholesteatoma surgery, the chorda tympani nerve must often be divided. We present an interesting case of a patient whose severe dysgeusia due to cholesteatoma resolved following section of the chorda tympani nerve.

The impact of Cardiovascular Autonomic Neuropathy in diabetes: is it associated with left ventricular dysfunction?

Cardiovascular Autonomic Neuropathy (CAN) is one of the least understood of all serious complications of diabetes. Besides increasing mortality, CAN may have various clinical sequelae including exercise intolerance, arrhythmias and painless myocardial infarction. But does it also cause left ventricular dysfunction? Patients with diabetes have a greater risk of developing congestive heart failure.

Endometrial ablation in England--coming of age? An examination of hospital episode statistics 1989/1990 to 2004/2005.

Objective: To observe numbers and trends in endometrial ablation performed for heavy menstrual bleeding (HMB) in England.

Design: Examination of National Health Service (NHS) Hospital Episode Statistics. Number of hysterectomies and endometrial ablation procedures performed each year from 1989/1990 to 2004/2005.

Prospective comparative switch study from timolol 0.5% and latanoprost 0.005% to bimatoprost 0.03%.

This prospective study compared intraocular pressure (IOP) control, cardiorespiratory function, and adverse effects in 50 patients with glaucoma and ocular hypertension. Patients on topical combination timolol-latanoprost therapy were recruited. After they had used this combination for at least 2 months, they were switched to bimatoprost monotherapy.

Improving the quality of outpatient clinic letters using the Sheffield Assessment Instrument for Letters (SAIL).

Aim: To improve the quality of outpatient letters used as communication between hospital and primary care doctors.

Methods: On 2 separate occasions, 15 unselected outpatient letters written by each of 7 hospital practitioners were rated by another hospital doctor and a general practitioner (GP) using the Sheffield Assessment Instrument for Letters (SAIL). Individualised feedback was provided to participants following the rating of the first set of letters.

Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic.

Objectives: To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic.

Method: Retrospective case notes review of 98 females aged 16 or less, who attended over a 5 year period (1996-2000).

Results: The overall prevalence of STIs was 26%.

Improving the effectiveness of the link system in an acute trust.

Link staff are a valuable asset to any ward area. They can disseminate information to their colleagues from the clinical nurse specialist, act as role models and identify strengths and weakness. However, many trusts are discovering that, although sound in theory, practice is quite different.

Using remifentanil in labour via patient-controlled analgesia.

Pain relief during labour is problematic. The expectations of the mother have to be balanced against compromising the baby. A new drug that has been used in labour is remifentanil.