Emergency management of neck stoma patients during the coronavirus pandemic: a national nurse survey.

BACKGROUND: Neck stoma patient care involves significant clinical complexity. Inadequate staff training, equipment provision and infrastructure have all been highlighted as causes for avoidable patient harm. AIMS: To establish the perception of knowledge and confidence levels relating to the emergency management of neck stomas among UK nurses during the COVID-19 pandemic. METHOD: A nationwide prospective electronic survey of both primary and secondary care nurses via the Royal College of Nursing and social media. FINDINGS: 402 responses were collated: 81 primary care and 321 secondary care; the majority (n=130) were band 5. Forty-nine per cent could differentiate between a laryngectomy and a tracheostomy; ENT nurses scored highest (1.56; range 0-2) on knowledge. Fifty-seven per cent could oxygenate a tracheostomy stoma correctly and 54% could oxygenate a laryngectomy stoma correctly. Sixty-five per cent cited inadequate neck stoma training and 91% felt inclusion of neck stoma training was essential within the nursing curriculum. CONCLUSION: Clinical deficiencies of management identified by nurses can be attributed to a lack of confidence secondary to reduced clinical exposure and education.

Benign thyroid swelling presenting as Horner's syndrome.

Horner's syndrome is a rare neurological condition seen in association with the disruption in the sympathetic nerve supply. Thyroid swelling is a common condition but rarely causes cervical sympathetic chain compression. We describe a case of a 54-year-old man who presented with Horner's syndrome secondary to a benign thyroid nodule with pressure effect on the sympathetic chain. An association between thyroid pathologies and Horner's syndrome has been mentioned previously, however, to our knowledge, this is the first case of Horner's syndrome being the initial presentation for an underlying benign thyroid swelling.

Kikuchi-Fujimoto Disease and Prognostic Implications.

Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenitis seen mostly in Asian populations (Kikuchi in Nippon Ketsueki Gakkai Zasshi 35:379-80, 1972). First described in 1972, KFD is a benign and self-limiting disease characterised by lymphadenopathy, mild fever, fatigue, and leukopenia (Fujimoto in Naika 30:920-7, 1972; Lin et al. in Otolaryngol Head Neck Surg 128(5): 650-3, 2003). We present a case of a 38-year-old woman with a 6-week history of cervical lymphadenopathy. Her ultrasound scan and fine needle aspiration cytology results were inconclusive. Excisional biopsy of the lymph node confirmed presence of KFD. The aetiology of KFD is unknown; however, there is strong association with systemic lupus erythematosus (SLE). Kucukardali reported 9% of European KFD patients and 28% of East Asian patients had concomitant SLE (Kucukardali et al. in Clin Rheumatol 26(1):50-4, 2007). We describe a follow-up algorithm for newly diagnosed KFD cases, based on the current literature. KFD is a rare cause of cervical lymphadenopathy. It is associated with increased risk of developing SLE, therefore early diagnosis and long-term follow-up are recommended.

Eccrine Porocarcinoma: A Case Report of a Rare and Aggressive Cutaneous Tumour.

Eccrine porocarcinoma (EPC) is an extremely rare, adnexal carcinoma that represents less than 0.01% of all cutaneous malignancies. An aggressive tumour with a high recurrence rate, it has a tendency to metastasise to regional lymph nodes. Once metastasis has occurred, mortality rate increases to 75%-80% and thus survival is dependent on adequate and timely resection of the lesion. EPCs are frequently missed as a differential diagnosis due to their rarity and non-specific appearance, which can lead to serious consequences for patients. Consequently, EPCs are an important diagnosis for clinicians to be aware of and consider when evaluating cutaneous lesions.  We present a case of EPC of the knee, which was initially misdiagnosed as a benign lesion on magnetic resonance imaging (MRI). We discuss the use of MRI in aiding assessment of EPCs.