Glottic Obstruction from Fibroepithelial Polyp.

BACKGROUND Fibroepithelial polyps are benign lesions of mesodermal origin, which have been reported in the head and neck area. The aim of this study is to describe the management of an oropharyngeal fibroepithelial polyp causing stridor. CASE REPORT A 39-year-old male presented with 24 hours of stridor and dysphagia. Flexible laryngoscopy revealed a pedunculated sessile polyp on the posterior oropharynx. The mass was excised using bipolar diathermy and histopathology revealed a fibroepithelial polyp. The differential diagnoses for stridor are extensive. Although uncommon, a fibroepithelial polyp should be considered. CONCLUSIONS We present a rare case of a fibroepithelial polyp causing stridor and imminent airway obstruction. We recommend the use of SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) for general anaesthesia and resection of pharyngeal polyps.

The effect of thin, thick, and normal corneas on Goldmann intraocular pressure measurements and correction formulae in individual eyes.

OBJECTIVE: To evaluate the usefulness of the central corneal thickness (CCT)-based correction formulae for stratified CCT groups, with intraocular pressure (IOP) from the Pascal dynamic contour tonometer (PDCT) as the reference standard. DESIGN: Retrospective case series. PARTICIPANTS: Two hundred eighty-nine patients attending a specialist glaucoma practice and a mixture of normal subjects and subjects with confirmed glaucomatous optic neuropathy. METHODS: Intraocular pressure was measured using PDCT, Goldmann applanation tonometry (GAT), and the Ocular Response Analyzer (ORA; Reichert Corp, Buffalo, NY). The GAT readings were obtained before automated readings and were adjusted for CCT using 4 different correction formulae. Discrepancies between GAT and CCT-corrected GAT readings were evaluated after stratification into thin, intermediate, and thick CCT groups. The IOP measurements from GAT, the ORA, and CCT-adjusted IOP were compared against PDCT IOP measurements using Bland-Altman analysis. MAIN OUTCOME MEASURES: Mean, 95% limits of agreement, and proportion of patients with IOP difference of 20% or more between PDCT IOP and each of GAT IOP, Goldmann-correlated IOP (IOPg), corneal-compensated IOP (IOPcc), and adjusted IOP using CCT-based correction formulae. RESULTS: Average PDCT IOP values were higher than GAT, IOPg, IOPcc, and CCT-adjusted IOP. The GAT IOP readings demonstrated poor agreement with PDCT IOP (95% limits of agreement, ± 4.7 mmHg); however, IOPg, IOPcc, and adjustment of GAT IOP with CCT-based formulae resulted in even poorer agreement (range of 95% limits of agreement, ± 5.1 to 6.7 mmHg). If PDCT was used as the reference standard, there was a 26% to 39% risk of making an erroneous IOP adjustment of magnitude of 20% or more at all levels of CCT. This risk was greatest in the patients with thicker corneas (CCT, ≥568 µm). CONCLUSIONS: Adjusting IOP using CCT-based formulae resulted in poorer agreement with PDCT IOP when compared with unadjusted G AT IOP. If PDCT is the closest measure we have to intracameral IOP, there is a risk of creating clinically significant error after adjustment of GAT IOP with CCT-based correction formulae, especially in thicker corneas. This study suggests that although CCT may be useful in population analyses, CCT-based correction formulae should not be applied to individuals.

Completing an intercalated research degree during medical undergraduate training: barriers, benefits and postgraduate career profiles.

AIM: To undertake a comprehensive evaluation of the intercalated research degree at the School of Medicine, University of Auckland, New Zealand and to ascertain the career profiles of Auckland medical graduates who completed the intercalated degree programme. METHOD: A questionnaire was devised and mailed to all Auckland MBChB graduates (1972-2005) who completed an intercalated research degree during the undergraduate medical course. RESULTS: Among 50 graduates who met the inclusion criteria (mean of 1.5 per annum), 30 (60%) completed the questionnaire. An interest in a career in research and academic medicine was the most commonly cited reason for undertaking an intercalated degree. Eighty percent of respondents encountered some problems during the intercalated year, with the most common reported being loss of contact with friends in the medical course. The satisfaction associated with an intercalated degree was generally high, with 90% giving an affirmative response to the statement that 'it was a worthwhile endeavour.' However, a majority of respondents were reluctant to do the intercalated degree again if given time over as a medical student in the current environment (33% affirmative versus 43% negative). Only one respondent was in general practice, whereas 73% of the respondents were either consultants or trainees in other specialties. Ninety percent of the respondents had been involved with research since graduation and 33% already possessed a higher research degree, such as MD or PhD. CONCLUSIONS: Despite the extremely low uptake rate of the intercalated degree option, the graduates who took the intercalated degree option were generally satisfied with their experience. However, although the majority of respondents reported that the intercalated degree was worthwhile and 90% had also completed further research since graduation, 43% would be reluctant to pursue an intercalated degree in the current environment.

Medical students' attitudes towards research and a career in research: an Auckland, New Zealand study.

AIM: To determine the attitudes towards research and research careers among students at a New Zealand medical school. METHODS: A questionnaire was devised and distributed during compulsory lecture sessions to all medical students enrolled at the School of Medicine, University of Auckland during the 2007 academic year. RESULTS: Among the 756 students enrolled for the 2007 academic year, 558 responded, with an overall response rate of 74%. Twenty-five percent of students had participated in some form of research activity during medical school, with summer studentships being the most common type of research experience. Seventy percent of all students surveyed expressed interest in participating in research during medical school. Although 68% of respondents were aware of the intercalated research degree option at the School of Medicine, only 8.6% expressed interest in undertaking this option. The most common reasons for not pursuing an intercalated degree option were lack of interest in this format of research experience (46%), social reasons (29%), and financial reasons (27%). There was no widespread support from the students for having research training as a compulsory part of medical school curriculum. With respect to long-term career plan, 35% of respondents planned to be involved in research throughout their medical career, and 22% were interested in pursuing higher degrees (MD or PhD) following graduation. However, more students rated lifestyle (84% affirmative) and earning potential (43% affirmative) as more important factors than opportunity for research (23% affirmative) when choosing a career specialty. CONCLUSIONS: The New Zealand medical students sampled reported a significant interest in research, with a majority of the students planning to participate in extracurricular research activities during medical school, and many hoping to be involved in research throughout their medical careers. However, only a small number of students were interested in pursuing research through an intercalated undergraduate degree option. Ultimately, the opportunity for research was deemed to be a less important consideration when choosing a specialty, compared to lifestyle and earning potential.

Evaluating the use of a scanning laser-derived oedema index to grade diabetic retinopathy and maculopathy.

PURPOSE: To evaluate the Heidelburg Retina Tomograph II (HRTII) retinal module as a tool for grading severity of retinopathy in a diabetic retinal screening and treatment service. METHODS: Seventy-seven consecutive patients with type 2 diabetes underwent scanning laser tomography using the HRTII. Scan data were analysed using the proprietary macular module software and oedema indices calculated for each of nine topographic macular zones. Two consultant ophthalmologists, masked to the result of the HRTII scans, graded each subject for severity of retinopathy and presence of macular oedema. The oedema indices were analysed statistically to determine whether these correlated with severity of retinopathy and presence of macular oedema. RESULTS: There is an increased oedema index in severe non-proliferative diabetic retinopathy in the outer temporal zone compared with lesser grades of diabetic retinopathy (P = 0.001). In patients with clinically detectable macular oedema, the oedema index from the 500-microm-diameter central zone was significantly higher than those without (P = 0.03). CONCLUSION: The scanning laser-derived oedema index differentiated between moderate and severe non-proliferative diabetic retinopathy in this series and detected diabetic macular oedema. Further development of this technology may provide an important tool to supplement retinal photographic surveillance in eye clinics overwhelmed by an increasing prevalence of type 2 diabetes.