A Case of Solitary Fibrous Tumour Arising From the Anterior Skull Base.

Solitary fibrous tumours (SFTs) are rare tumours of mesenchymal origin, most commonly found in adults with a median age of 45-50 years. Cases in the head and neck are uncommon, and definitive diagnosis relies on histomorphological features supported by immunohistochemical staining. Here we present a case of a 26-year-old gentleman with a one-year history of right-sided nasal obstruction and bloody discharge on a longstanding background of recreational cocaine use. A computed tomography scan of the paranasal sinuses demonstrated a mass arising from the anterior skull base extending into the right middle turbinate. Immunohistochemistry testing for tumour characterisation showed hematopoietic progenitor cell antigen (CD34) and signal transducer and activator of transcription 6 (STAT6) positivity in keeping with an SFT. The patient underwent definitive surgery via endoscopic piecemeal resection with no further reoccurrence at follow-up.

Oropharyngeal Bleeding Due to Cannabidiol Oil Vape Use.

Vaping has become an increasingly popular alternative to smoking in recent years. We present a rare and unusual case of upper airway bleeding caused by inhalation of a cannabidiol (CBD) oil-based vape due to a chemical burn. There are no case reports of this injury in the literature, and we discuss the clinical presentation, diagnosis and our management of this potentially life-threatening injury. A 27-year-old man presented to the accident and emergency department after using a CBD oil vape. After one inhalation of the CBD oil vape, the patient experienced immediate onset pain in the oropharynx, dyspnoea, expectoration of blood and hoarseness. The patient had used a CBD oil vape four hours earlier that evening for the first time, which was procured from an unregulated online source. The patient was referred to the Ear, Nose and Throat (ENT) team where the examination of oropharynx identified a posterior pharyngeal bleeding point. Flexible nasal endoscopy was undertaken showing profound erythema and inflammation throughout the oropharynx and posterior pharyngeal wall. The mucous membranes had been detached leaving an exposed bleeding submucosa. The patient was commenced on three cycles of back-to-back adrenaline nebulisers (1:1000 adrenaline in 5ml of 0.9% NaCl), 6.6mg dexamethasone intravenously and hydrogen peroxide gargles (5ml of 3% hydrogen peroxide in 10ml of water) three times a day. There were early involvement and review of the airway by the anaesthetic and intensive care teams, which was deemed safe at the time. A plan was made for a definitive airway if bleeding reoccurred. Upper airway bleeding can present as a rare form of vape-induced injury and should be considered part of the differential diagnosis particularly in those using CBD oil vapes. History taking is pertinent and patients should be questioned on the specific vape liquids used. Airway stabilisation is the priority with early involvement of the multi-disciplinary team including anaesthetists, intensive care specialists and ENT surgeons.

Low-cost simulation models in Urology: a systematic review of the literature.

INTRODUCTION: Simulation models have been found to be effective and valid for training in Urology. Due to increasing costs of surgical training, there is a need for low-cost simulation models to enable Urology trainees to improve their skills. MATERIAL AND METHODS: A literature review was performed using the PubMed and Embase databases until March 2020. A total of 157 abstracts were identified using the search criteria, of which 20 articles were identified describing simulation models for Urology training. Articles reviewed described simulation models created from materials costing less than $150. Data was extracted from the relevant articles in order to critically assess each paper for validity, ease of construct and educational impact. RESULTS: Models were found pertaining to suprapubic catheterization (6), cystoscopy (3), percutaneous nephrolithotomy (5), scrotal examination (1), circumcision (1), ureteroscopy (1), transurethral resection of the prostate and bladder (2), and open prostatectomy (1). 18/20 (90%) assessed for either face, content, or construct validity. None of the papers evaluated assessed for transferability of skills to performance in real patients. CONCLUSIONS: A plethora of low-cost simulation models for urological procedures are described in the literature, many of which can be easily constructed from cheap and accessible materials. However there is a need for further efforts to validate or assess for transferability of skills to clinical practice.

Failure to Return to Preinjury Activity Level after Hamstring Anterior Cruciate Ligament Reconstruction: Factors Involved and Considerations in Goal Setting.

BACKGROUND: Recent interest in the return to sports, following anterior cruciate ligament reconstruction, has focused on the influence of psychological factors. However, many factors contribute to this endpoint. This study aimed to investigate the ability of nonprofessional athletes to return alongside the reasons for failure. MATERIALS AND METHODS: We retrospectively studied 101 postreconstruction patients with followup in excess of 12 months. All patients underwent hamstring autograft anterior cruciate reconstruction. The Cincinnati Sports Activity Scale was used to define activity level preinjury, postinjury, and postreconstruction. Structured questionnaires were used to identify factors in those who did not return to the same level. RESULTS: Seventy percent of patients returned to their preinjury activity score. Of the 30% of patients who failed, age, reconstruction type, and associated pathology were unrelated. However, reconstruction within 6 months of injury resulted in increased return to preinjury score (P < 0.05). Failure was associated with continued knee symptoms (57%), lifestyle changes (27%), anxiety (27%), fear (23%), and other musculoskeletal problems (10%). Considerable interplay was found between these factors. Failure to return was associated with increased further surgery, but this was successful in only one-third of patients. CONCLUSION: Psychological factors are important (and may require targeted input), but return-to-sport is multifactorial. Ongoing symptoms may prompt further surgery, but this is frequently unsuccessful in achieving return. Patient-specific goals should be sought and revisited throughout the rehabilitation program. Acknowledging psychological barriers, in those aiming to return to the same level, may help achieve this goal. In other patients, success may be return to a desired lower level. Understanding the patient's expectations is important in goal setting.

Central Chest Pain - An Atypical First Presentation.

INTRODUCTION: The diagnosis of thoracic spondylodiscitis is challenging, given that it is a rare entity in itself and when unusual symptoms such as central chest pain predominate on presentation, it may pose a serious diagnostic challenge. CASE REPORT: A 54-year-old patient presented to accident and emergency with central chest pain and elevated inflammatory markers (C- reactive protein [CRP]: 21 mg/L). Following exclusion of life-threatening cardiac causes, he was discharged home with analgesia and no formal diagnosis. Over the course of the subsequent 6 weeks, he presented to his general practitioner on two different dates with worsening chest pain alongside a new symptom of back pain and progressively rising inflammatory markers. At 6 weeks, he presented back to the emergency department with clinical signs of sepsis, mid-thoracic tenderness with weakness and altered sensation to his legs. The CRP was raised at 297 mg/L. In view of these symptoms, a contrast magnetic resonance imaging scan was performed which revealed destruction of the sixth and seventh disc space with high signal intensity on T2 and short tau inversion recovery images in T6 and T7. Blood cultures were shown to have grown Staphylococcus aureus, and the patient was subsequently treated with combined intravenous antibiotics (flucloxacillin) and oral antibiotics (rifampicin) for 15 weeks resulting in complete resolution of his symptoms. CONCLUSION: Our case report highlights the need for a high index of suspicion of spondylodiscitis in patients presenting with central chest pain, unresolving back pain and elevated inflammatory markers especially in the absence of any other formal diagnosis.