Impact of Otolaryngology in the diagnosis of early oesophageal malignancy.

INTRODUCTION: A large number of patients present in Otolaryngology clinics with vague upper gastro intestinal symptoms, some potentially originating from the oesophagus. In the United Kingdom there is no consensus for investigation protocols. The concern is that diagnosis of early oesophageal malignancy can be delayed with detrimental effects to the prognosis of the patient. The aim of this paper is to attempt to establish the impact of Ear Nose and Throat (ENT) work up in the diagnostic pathway of these patients. METHODS: Retrospective analysis of case notes of newly diagnosed oesophageal carcinoma over a 15 month period. RESULTS: Sixty five patients with a new diagnosis of oesophageal carcinoma were identified from the upper GI cancer network. A cohort of 7 patients was initially referred to ENT with related symptoms. Delays occurred at different stages during the course of their diagnostic pathways. Only 2 patients were diagnosed from ENT prior to referral to upper GI. CONCLUSION: We support the creation of one stop clinics incorporating the use of transnasal oesophagoscopy. The current literature is discussed.

The Rare Case of an Adult-Onset Xanthogranuloma of the Paranasal Sinuses: A Histological Dilemma.

Xanthogranuloma is a rare benign tumour, part of the non-Langerhans cell histiocytosis group, uncommon in adults and even less common in the paranasal sinuses. Despite its benign nature, it mimics neoplasm due to its local effects which can have serious functional consequences depending on the anatomical location. We present the rare case of a young lady who presented insidiously with a maxillary sinus xanthogranuloma and was treated with endoscopic resection. Tissue diagnosis is of paramount importance to guide correct further investigations and management, and we discuss the potential challenge in identifying such a rarely seen pathology.

Per-oral flexible laryngoscopy in awake neonates and infants: the 'pacifier' technique.

BACKGROUND: It is common for ENT specialists to be called to neonatal intensive care units to assess neonates with suspected laryngomalacia. At Addenbrooke's Hospital, Cambridge, UK, it is standard practice to initially try to assess the larynx whilst the patient is awake. This can cause the patient to cry and become irritable, and can induce worry in the parents. A literature search revealed that numerous procedures have been successfully performed on neonates and infants whilst they were being pacified. OBJECTIVES: This paper describes various procedures where pacification has been used effectively. Furthermore, it reports a pacification technique developed for per-oral flexible laryngoscopy in awake neonates and infants.

An elective combined caesarean section and small bowel GIST resection during the third trimester of pregnancy: Report of a case.

INTRODUCTION: Gastro-Intestinal Stromal Tumours (GISTs) are rare with an estimated incidence of only 11-15 per million. In pregnancy, GISTs are an extremely rare occurrence and are thus complex to manage from an ethical, surgical and oncological perspective. PRESENTATION OF CASE: We present the first reported case in the literature of a successful combined lower segment caesarean section (LSCS) and a tumour resection in a 31-year-old pregnant patient presenting with a small bowel GIST. DISCUSSION: We compare and contrast our case with other reported cases of GIST resection in pregnancy and discuss the challenges faced by both patients and clinicians. CONCLUSION: Our case demonstrates that a combined LSCS and GIST resection is feasible. In addition, our case highlights the importance of both the multidisciplinary setting and the consideration of patients' wishes in the successful management of this complex group of patients.

Systemic sclerosis as a model of chronic rejection in facial composite tissue transplantation.

INTRODUCTION: Chronic rejection remains a potential significant long-term problem of facial allograft transplantation. Scleroderma parallels chronic rejection in terms of its immunological pathophysiology and its histopathological processes. Through the analysis of facial changes in scleroderma we demonstrate how chronic facial allograft rejection may present and progress. METHODS: 129 consecutive patients with a clinical diagnosis of scleroderma were recruited into the study. Static facial disease assessment was carried out through the analysis of digital photographs. Facial motion dysfunction was assessed using a modified House-Brackmann Grading Scale and an established maximal static response assay. Psychological evaluation comprised the Derriford Appearance Scale short-form (DAS), the Noticeability and Worry score and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Static disease severity as measured using an observer-rated disfigurement scale revealed all grades of disease in the scleroderma cohort - from mild through to severe. Significant positive correlations were seen between observer rated disfigurement and DAS24, Noticeability and Worry scores. No significant relationship could be seen between the indices of facial motion impairment and psychological scores. CONCLUSIONS: Progressive facial deterioration seen over time in scleroderma provides a comprehensive spectrum of static and dynamic facial changes which may be encountered in chronic facial graft rejection. This study provides valuable insight into the potentially significant long-term sequelae of allogenic reconstructive transplantation.