'A problematic plum pit in the piping': a case of traumatic oesophageal perforation.

A 75-year-old man presented to accident and emergency having swallowed a plum pit. He initially experienced sharp neck pain, which was mild at presentation. He was otherwise haemodynamically stable and was able to subsequently eat a sandwich without consequence. He was referred to the ear, nose and throat senior house office (SHO), who reviewed the soft tissue radiograph, which appeared normal. The patient displayed no concerning clinical signs and was well; however, his pain persisted. Examination revealed a localised area of surgical emphysema on the left side of the neck. Retrospective review of the soft tissue radiograph showed a small region of subcutaneous free air. An urgent CT scan confirmed a pneumomediastinum indicative of an oesophageal perforation. The patient was admitted for observation, and was managed conservatively without surgical intervention. He was weaned onto sterile fluid and progressed to a solid diet. He was discharged from hospital with no long-term sequelae.

Gastroesophageal and extraesophageal reflux symptoms: similarities and differences.

OBJECTIVES/HYPOTHESIS: The association between extraesophageal reflux (EER) and symptoms of gastroesophageal reflux disease (GERD) is inadequately understood. We used the Comprehensive Reflux Symptom Scale (CReSS) to evaluate EER and reflux-symptom prevalence in gastroenterology and otolaryngology outpatients and symptom awareness among UK gastroenterologists. STUDY DESIGN: Cross-sectional cohort survey. METHODS: Six hundred thirty-nine participants were surveyed: 103 controls, 359 patients undergoing esophagogastroduodenoscopy (EGD), and 177 otolaryngology clinic patients with throat symptoms. Participants completed the CReSS questionnaire. The study was undertaken in the Endoscopy Unit and the Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom. Registered members of the British Gastroenterology Society were asked to rate how frequently reflux patients might complain of each CReSS item. RESULTS: The median CReSS total in volunteers (4) was significantly lower (P < .002) than in ear, nose, and throat (ENT) patients (26) or EGD patients with (42) or without (32) esophageal inflammation. All items were scored as ≥1 by >15% of ENT patients and 28% of EGD patients. Three major, robust CReSS factors: esophageal, pharyngeal, and upper airway emerged. Of 259 gastroenterologists, >20% scored 8 of the 34 symptoms as never being reported by reflux patients. CONCLUSIONS: Endorsement of each EER CReSS item by 28% to 58% of patients with endoscopic evidence of GERD supports the Montreal consensus on an EER-GERD continuum. Gastroenterologists vary considerably in their appreciation of EER symptom relevance. The advantages of CReSS include standardized, comprehensive capture of patient experience; discriminant validity of ENT and GERD patients from volunteers; and discrete esophageal, pharyngeal, and upper airway subscales. LEVEL OF EVIDENCE: 4.

Extracurricular participation in research and audit by medical students: opportunities, obstacles, motivation and outcomes.

BACKGROUND: Medical students should learn to critically evaluate research to inform future evidence-based practice. Participation in research and audit at medical school can help develop these skills whilst prompting interest in academic pursuits. AIMS: We investigate medical student attitudes and participation in extracurricular research and audit focusing on their opportunities, obstacles, motivation and outcomes. METHOD: A 60-item questionnaire was distributed to final-year medical students graduating from the University of Nottingham Medical School in the United Kingdom. RESULTS: A total of 238 questionnaires were returned (response rate 75%). Of these, 86% felt research or audit experience was useful for medical students. The main driver for involvement was curriculum vitae (CV) improvement (51%). Male students and those involved in extracurricular research were more likely to agree that this experience should influence selection into training programmes (p = 0.017, p = 0.0036). Overall, 91 respondents (38%) had been involved in such activity with a mean number of projects undertaken of two (range one to four). Those interested in a surgical career were most likely to have undertaken projects (58%). Frequently cited obstacles to involvement were time constraints (74%) and a perceived lack of interest from potential supervisors (63%). CONCLUSIONS: Despite significant CV motivation, many are enthusiastic regarding extracurricular research opportunities but frustrated by obstacles faced. Our study suggests there is scope for providing further opportunities to participate in such activities at medical school.

The role of extracellular-signal regulate kinase (ERK) in the regulation of airway tone in porcine isolated peripheral bronchioles.

Extracellular signal regulated kinase (ERK) is known to regulate vascular smooth muscle contraction. However, a role for ERK in airway smooth muscle contraction has yet to be demonstrated conclusively, although contractile agents increase ERK activity in airway smooth muscle. Rather than initiating contraction, ERK could regulate airway tone by interfering with relaxation. Therefore, the aim of this study was to determine whether ERK regulates contraction or relaxation of airway smooth muscle. Segments of porcine peripheral bronchioles were mounted in an isolated tissue bath in Krebs-Henseleit buffer and maintained at 37°C. Cumulative concentration-response curves to histamine, endothelin-1, or the muscarinic agonist carbachol were then carried out in the absence or presence of the MEK inhibitor PD98059. In separate experiments, cumulative concentration response curves to the ß-adrenoceptor agonist isoprenaline or the adenylyl cyclase activator forskolin were carried out in the absence or presence of the MEK inhibitors PD98059 or U0126. ERK activity was measured by Western blotting. All three contractile agents increased ERK activity, but the contractile responses were unaffected by PD98059. On the other hand, both PD98059 and U0126 enhanced the relaxations to isoprenaline but not relaxations to the adenylyl cyclase activator forskolin. The enhancement of isoprenaline-induced relaxations with PD98059 was prevented by the K(+) channel blocker tetraethylammonium. These data suggest that ERK regulates airway smooth muscle tone by inhibiting ß-adrenoceptor-mediated relaxations, rather than an initiation of contraction. The effect on ß-adrenoceptor-mediated responses appears to be through a cAMP-independent mechanism, possibly through an interaction with K(+) channels.