Intravascular papillary endothelial hyperplasia of larynx: case report and literature review of all head and neck cases.

Intravascular papillary endothelial hyperplasia (IPEH) is a benign lesion of a vascular origin that is caused by excessive proliferation of endothelial cells in blood vessels or vascular malformations. It is a rare entity that can present in any region of the body, but with particular predilection to the head and neck region and the extremities. We also present the results of the English literature search, which to our knowledge are all the published cases of IPEH in the head and neck region (No=213). IPEH has not been reported to arise from the glottic region previously. We present a first case of IPEH arising from the vocal fold of a 48-year-old male. Histological differential diagnosis of IPEH includes several entities, most importantly angiosarcoma. Presentation and histology are discussed. The main treatment option is a complete surgical resection. Prognosis of IPEH is excellent, with the exception of some intracranial cases.

Open mini-incision parathyroidectomy for solitary parathyroid adenoma.

Parathyroid surgery is the acceptable definitive treatment for primary hyperparathyroidism (pHPT) due to parathyroid adenoma. Open mini-incision parathyroidectomy (O-MIP) has an excellent cure rate and minimal morbidity. We aim to demonstrate the safety, efficacy and subjective patient satisfaction of O-MIP and investigate the accuracy of pre-operative radiological localisation in relation to operative findings. A retrospective review of patients who underwent O-MIP for pHPT due to solitary parathyroid adenoma from April 2006 to August 2012 was performed. All patients were initially investigated by an endocrinologist to confirm pHPT with pre-operative localisation imaging using ultrasound scan (USS) and 99mTc-sestamibi (MIBI). One hundred and fifty consecutive patients were included with a median age of 62 years. Pre-operative USS and MIBI scans were concordant in 71 % of cases. In combined modality (USS and MIBI), localisation was 94.8 % accurate. There was 95.5 % identification of parathyroid tissue confirmed by intra-operative frozen section. Ninety-one percent of patients were treated as a day case. The median operative time was 60 min. The mean pre-operative calcium level was 2.98 mmol/l, and the short-to-medium term mean calcium level was 2.49 (Paired t test, p < 0.001). There was no significant complication. O-MIP confers significant advantages over the traditional gold standard treatment of bilateral neck exploration. Accurate localisation is the key to successful O-MIP. In experienced hands, ultrasound and MIBI may be the only pre-operative investigations required for accurate localisation.

The pH of commonly used topical ear drops in the treatment of otitis externa.

Healthy ear canal skin has an acidic pH. Evidence suggests that reacidification of the ear canal may lead to resolution of otitis externa. The pH of 15 commonly prescribed topical ear drop preparations used in the treatment of otitis externa was measured using a Jenway 3020 pH meter with temperature compensation at 37.5 °C. The pH values ranged from 2.89 to 7.83. Two-thirds of preparations tested were of acidic pH. The remaining one-third were alkaline. Reacidification of the ear canal may help in the treatment of otitis externa.

Vocal cord paralysis following central line insertion in a neonate: a review of the literature.

Acute onset stridor in a neonate following general anaesthesia is commonly attributed to laryngeal oedema secondary to anaesthetic airway trauma. The authors present a case of recurrent laryngeal nerve injury resulting in vocal cord paralysis causing stridor following central venous catheterisation under general anaesthesia in a neonate. This was managed expectantly and resolved spontaneously over a period of 6 months.

Management of Thyroid nodules in adult patients.

Thyroid nodule is a common presentation and requires a structured diagnostic approach to ascertain the risk of malignancy and determine appropriate management. This review article highlights the key points in the history and examination which can help with risk stratification. It also discussed the application of fine needle aspiration cytology findings and the British Thyroid Association Guidelines in clinical practice.

Management of recurrent epistaxis in an anticoagulated patient by temporarily closing the nares with sutures.

We describe an unusual case of recurrent, refractory anterior epistaxis in an 86-year-old man with two mechanical heart valves who was on permanent warfarin therapy. His numerous episodes of epistaxis were incited by chronic nose-picking and strong nose-blowing, practices that he continued to engage in despite repeated medical advice to stop. Stopping his anticoagulation therapy was not considered as a management option because of an unacceptably high risk that this would lead to a thromboembolic event. Eventually, we temporarily sutured his nares closed, and his nosebleeds ceased. The suturing was performed in the ward with local anesthesia. This procedure was simple to perform,fairly well tolerated, easily reversible, and highly effective.