IgG4-related disease confined to the laryngopharynx: a case report highlighting the complexities in diagnosis for this rare cause of stridor.

This case represents only the 15th reported incidence of IgG4-related disease (IgG4-RD) affecting the laryngopharynx, adding diagnostic and therapeutic data for this rare condition and helping to inform the future management of these patients. A 66-year-old man presented with airway symptoms, and investigations by otolaryngology, cardiology and respiratory teams did not provide a clear diagnosis. Repeat biopsies of the laryngopharynx eventually confirmed a clinicopathological diagnosis of IgG4-RD. Treatment with prednisolone and methotrexate was successful. When infective and malignant causes of adult stridor have been excluded, inflammatory causes should be considered. The diagnosis of IgG4-RD isolated to the laryngopharynx may be delayed when using the widely accepted American College of Rheumatology classification criteria because it excludes upper aerodigestive tract features. IgG4-RD isolated to the laryngopharynx is extremely rare. This means a multidisciplinary approach is vital in ensuring timely diagnosis and treatment. Better diagnostic criteria are also needed.

The palliative management of non-islet cell tumour hypoglycaemia with glucocorticoids and somatostatin analogues in an unresectable hepatocellular carcinoma.

Non-islet cell tumour hypoglycaemia (NICTH) results from paraneoplastic insulin-like growth factor-II (IGF-II) secretion and its potent insulin-like effect. It causes recurrent, often severe, hypoglycaemic episodes, which is detrimental to quality of life. There is limited evidence regarding best supportive care in unresectable tumours. A 76-year-old woman presented with hypoglycaemic collapse. A new diagnosis of unresectable hepatocellular carcinoma (HCC) was made. The IGF-II:IGF-I ratio was 11.0, which confirmed NICTH. The octreoscan showed avid disease. The main problem was symptomatic nocturnal hypoglycaemia. Curative treatment options were not possible in this case and treatment focused on preventing symptomatic hypoglycaemia. Inpatient treatment was with high carbohydrate nasogastric (NG) feeds, prednisolone and somatostatin analogue (octreotide) infusion. Once stabilised, the patient was discharged with NG feeds, prednisolone and a long-acting somatostatin analogue (sandostatin). The patient received successful end-of-life care with her family as per her wishes, without requiring readmission. The treatments were well-tolerated and effective in preventing symptomatic hypoglycaemic episodes. The combination of high carbohydrate NG feed with prednisolone and somatostatin analogues was effective in preventing symptomatic hypoglycaemia. Somatostatin analogues had a useful steroid sparing role. Larger case series are warranted to clarify the management of NICTH patients with placebo-controlled studies to determine the role of somatostatin analogues.

Trends and publication rates of abstracts presented at the British Association of Head and Neck Oncologists' (BAHNO) annual meetings: 2009 - 2015.

The British Association of Head and Neck Oncologists (BAHNO) hosts an annual meeting at which research from all specialties involved in the management of head and neck oncology is presented. We have analysed the rate of publication of the abstracts presented, and reviewed the finalised programmes from the meetings between 2009 and 2015. The 2014 meeting was excluded as it was a combined international meeting. Key terms were searched in PubMed and Google Scholar to identify publications in peer-reviewed journals. If none was identified, these platforms were searched for the authors' names. Published abstracts were excluded. Study and journal demographic data were extracted. A total of 363 abstracts were presented, including 75 oral, 271 poster, and 17 of unclear presentation method. The total publication rate was 31.1%, representing 46.7% of oral abstracts and 27.3% of poster presentations. The mean time to publication was 16.5 months. Research was published in 45 individual journals with a mean (range) impact factor of 2.559 (0.886-36.418). There was a trend towards an increasing number of presentations over time with a decreasing publication rate. However, there was no trend in mean impact factor by year. The publication rate of abstracts presented at the BAHNO annual meetings is comparable with that of other large otolaryngology and head and neck conferences. The mean impact factor has not previously been utilised within this field, but may prove a useful metric that enables monitoring of the quality of presented research and comparison of the impact of the conferences.