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1.
BMJ Case Rep ; 12(12)2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31811108

RESUMO

Goltz syndrome or focal dermal hypoplasia (FDH), is an X-linked dominant condition which predominantly involves the skin, limbs and eyes. In otolaryngology, FDH has been poorly described, but can result in increased symptoms of obstructive sleep apnoea requiring surgery. There have also been documented cases of mixed severe hearing loss secondary to congenital ossicular anomalies. More frequently, patients present to the ear-nose-throat clinic with symptoms of dysphagia, secondary to papillomatosis. A 36-year-old woman presented with pain, irritation and dysphagia with a known diagnosis of FDH. She was subsequently investigated with an oesophago-gastro-duodenoscopy, Barium Swallow and an MRI neck scan with contrast. Lymphoid hyperplasia was found on investigation and the patient underwent a panendoscopy with CO2 laser to the lesion with good clinical outcome. This case report highlights the need for multidisciplinary team involvement to ensure full consideration of management options.


Assuntos
Hipoplasia Dérmica Focal/diagnóstico , Adulto , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Endoscopia do Sistema Digestório , Feminino , Hipoplasia Dérmica Focal/complicações , Hipoplasia Dérmica Focal/diagnóstico por imagem , Hipoplasia Dérmica Focal/cirurgia , Humanos , Terapia a Laser , Imagem por Ressonância Magnética
2.
Adv Med Educ Pract ; 10: 877-884, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695550

RESUMO

Objective: We hypothesize that poor consideration of specialist surgery is due to a lack of exposure to information about careers and practice itself. Ear, Nose, and Throat (ENT) surgery is given little weight in medical school curricula, despite ENT problems being extremely common. Our objective is to assess whether a specialty showcase day was sufficient to boost informed consideration of this career. Design: We designed a half-day course involving an interactive careers workshop exploring ENT as a specialty choice, alongside simulation stations of commonly presenting ENT problems led by ENT doctors. We used pre- and post-course evaluation sheets to explore factors that encourage and discourage students from surgical careers and perceptions of ENT. Setting: A large proportion of UK medical schools do not offer ENT placements, and of those that do, nearly half are not compulsory. This leaves students unaware of ENT as a career option and unclear about what an ENT career comprises. Our half-day course took place in the simulation suite at St Mary's Hospital, London. Participants: Medical students were mainly in their third year of study and had aspirations towards a variety of surgical and non-surgical careers, with a minority aspiring towards ENT before the course. Results: Our results demonstrate that all students found the session useful and had a much better understanding of ENT practice, with almost all students leaving more likely to consider a career in ENT. Conclusion: We would like to repeat this session in different student year groups and compare their perceptions with our results. We find our results a good case for including informative careers workshops as part of medical school teaching. We pose that interactive workshops exploring specialist surgical careers are a valid way to enable students in making informed career decisions - particularly in specialties that are under-represented at medical school.

3.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451469

RESUMO

We present a rare and unusual case of a 16-year-old girl, with no significant medical history, presenting with right nasal obstruction and suspected sinusitis with occasional epistaxis and haemoptysis. On examination, she had a mass lesion in the right nasal cavity, with no evidence of other pathology on assessment of the ears, nose, throat or head and neck. A CT scan revealed an opacified right maxillary sinus with polypoidal mucosa, extending and passing through the accessory ostium into the right nasal cavity. Examination under anaesthesia with functional endoscopic sinus surgery and excision of the lesion was subsequently undertaken. Histological analysis confirmed the mass lesion as a haemangioma. This case report is the first to present a maxillary haemangioma presenting as nasal obstruction with intermittent sinusitis symptoms in a child. The authors discuss the incidence, presentation and management of maxillary haemangiomas in the paediatric population.


Assuntos
Hemangioma , Neoplasias do Seio Maxilar , Sinusite Maxilar , Obstrução Nasal/diagnóstico , Cirurgia Endoscópica por Orifício Natural/métodos , Adolescente , Diagnóstico Diferencial , Feminino , Hemangioma/patologia , Hemangioma/fisiopatologia , Hemangioma/cirurgia , Humanos , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/patologia , Neoplasias do Seio Maxilar/patologia , Neoplasias do Seio Maxilar/fisiopatologia , Sinusite Maxilar/diagnóstico , Sinusite Maxilar/etiologia , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Obstrução Nasal/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
BMJ Case Rep ; 12(4)2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31023732

RESUMO

A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess. He had an excision of the cyst and drainage of the superimposed abscess and made a good recovery. The histology report revealed a dermoid cyst which is a rare diagnosis in a child, particularly within the oral cavity. Early treatment is required to remove these lesions especially when they cause airway compromise or swallowing difficulties. This is the first case to our knowledge which suggests tongue tie release procedures causes a predisposition to the development of dermoid cysts in the oral cavity.


Assuntos
Abscesso/microbiologia , Transtornos de Deglutição/etiologia , Cisto Dermoide/patologia , Drenagem/métodos , Abscesso/patologia , Doença Aguda , Anquiloglossia/complicações , Anquiloglossia/patologia , Cisto Dermoide/complicações , Cisto Dermoide/diagnóstico por imagem , Cisto Dermoide/cirurgia , Humanos , Lactente , Masculino , Soalho Bucal/patologia , Soalho Bucal/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
Adv Med Educ Pract ; 9: 827-835, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30532610

RESUMO

Background: Ear, nose, and throat (ENT) surgery is a niche and unique specialty that has been recognized as being poorly taught throughout medical school and postgraduate training. Junior doctors who rotate into this specialty often find it hard and struggle to manage patients. Aims: The aim of this study was to devise a junior doctor-focused induction program with specific emphasis on shadowing and partnered working to improve confidence and competence. Methods: Feedback from previous trainees was used to identify valuable training opportunities within the 4-month rotation. Trainers identified clinical areas where supported learning could be delivered. Trainees were allocated to rotate between theater, ward, on-call shifts, and acute clinics. The degree of time spent in each area was analyzed in order to balance service provision vs learning needs. Furthermore, novel strategies were introduced in each session to maximize learning experiences. Junior doctors were aware of the opportunities that would be available to them at the start of the rotation. In order to assess whether the aims were met, a questionnaire survey was used to assess exposure to core ENT practical skills and junior doctors' confidence levels in carrying them out unsupervised. Results: Junior doctors spent 40% of their time assessing new acute admissions. Twenty percent of time was spent in ENT clinic, but novel practical methods of induction were introduced such as 1 week of directly supervised shadowing, followed by a transition period with regular debrief. A three-stage model was used to offer training in practical procedures in the clinical setting. Over half of the trainees felt confident in undertaking 50% of the core ENT procedures unsupervised. Conclusion: Our study reveals that giving junior doctors a relevant, focused and appropriate induction helps orientate them, give them the opportunity to ask questions, and also find their grounding in order to begin working. Having dedicated time to shadow and be with a colleague to assess and treat patients initially, with ongoing telephone and in person support, ensured that their confidence and competence improved very quickly. It also improved workplace satisfaction and motivated doctors to undertake self-directed learning and improve and enhance their skills beyond the minimum.

6.
Adv Med Educ Pract ; 9: 335-343, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29780265

RESUMO

Background: General practitioners (GPs) are key members of the health care profession who are required to have a considerable breadth of knowledge to manage and treat patients effectively in the community. Their skills and experience varies depending on the medical school they attended and their foundation training and specialist GP training schemes. Exposure to ear, nose, and throat (ENT)-specific pathology is often insufficient due to the lack of formal otolaryngology rotations, minimal relevant teaching opportunities, and inconsistencies in curricula, despite ENT-related pathology presentations being one of the commonest consultations in primary care. Methods: We undertook a learning needs assessment among Watford general practice vocational training scheme trainees to assess whether they lacked confidence in managing typical ENT pathology, as well as to ascertain whether they felt a formal and focused ENT teaching session would be beneficial to them. Results: The results suggested they were interested in such a session, and therefore we organized a formal program on the assessment and management of acute and common ENT pathologies with a postteaching questionnaire to evaluate participant confidence in these domains. The results showed an improvement in participant knowledge and confidence regarding the assessment and management of ENT pathologies following the teaching session intervention. In addition, most attendees were overall very satisfied with the session. Conclusion: This study highlights the need for teaching specifically tailored to the learning needs of general practice vocational training scheme trainees, particularly in niche specialties, in order to prepare them adequately for clinical practice in the community setting.

7.
BMJ Case Rep ; 20172017 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-28264806

RESUMO

We present a case of a Caucasian woman aged 67 years referred with a 4-day history of sore throat, dysphagia, fever and nasal blockage. Examination revealed a swollen neck and pharyngeal pseudomembrane. A throat swab was positive on culture for Corynebacterium ulcerans, with toxin expression confirmed on PCR and Elek testing. A diagnosis of classical respiratory diphtheria was made, with subsequent confirmation of the patient's domesticated dog as the source of infection. The dog had recently been attacked by a wild badger and was being treated for an ear infection. The patient made a good recovery with intravenous antimicrobial and supportive therapy; however, she subsequently developed a diphtheritic polyneuropathy in the form of a severe bulbar palsy with frank aspiration necessitating percutaneous endoscopic gastrostomy feeding. A mild sensorimotor peripheral neuropathy was also diagnosed. The patient eventually made an almost complete recovery.


Assuntos
Anti-Infecciosos/uso terapêutico , Corynebacterium/isolamento & purificação , Difteria/microbiologia , Difteria/terapia , Pneumopatias/microbiologia , Pneumopatias/terapia , Idoso , Animais , Corynebacterium/genética , Difteria/transmissão , Gerenciamento Clínico , Doenças do Cão/microbiologia , Cães , Nutrição Enteral , Feminino , Gastrostomia , Humanos , Zoonoses/microbiologia
8.
Int J Surg Case Rep ; 28: 196-199, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27718440

RESUMO

INTRODUCTION: The authors present an interesting case of a 19-year-old male who presented as a polytrauma patient following a fall from a height. PRESENTATION OF CASE: He was initially managed on the intensive care unit with intracranial pressure bolt monitoring after being intubated and sedated and having his other traumatic injuries stabilized. Upon attempting to wean sedation and extubation a repeat CT scan of the head was undertaken and showed a new area suggested of cerebral infarction, this was a new finding. Further imaging found that he had a cervical vertebral artery dissection following this polytrauma mode of injury. DISCUSSION: The incidence of vertebral artery dissection following generalized or local trauma is rising but routine imaging/screening in these patients is not undertaken. CONCLUSION: Our report displays select images related to this case report and emphasizes the consideration of routine imaging in head and neck traumatic injuries to diagnose internal carotid and/or vertebral artery dissections much earlier.

9.
Adv Med Educ Pract ; 7: 211-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27099543

RESUMO

Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification) in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies - this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in other specialties and departments.

10.
Adv Med Educ Pract ; 6: 591-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26527905

RESUMO

The transition period from foundation program doctor to specialty trainee can be difficult for junior doctors. This difficult period often acts as a major obstacle for learning in the workplace. Existing induction programs are commonly seen as inadequate at easing this transition, and therefore, a pilot study intervention was undertaken to assess if the initiation of "learner-centered induction programs" could help improve the confidence, knowledge acquisition, and satisfaction of junior doctors as they begin specialty training in neurosurgery. Ethnographic and anecdotal evidences were collated from junior doctors, specialty trainees, and consultants in order to investigate if further work on this subject would be beneficial. All participants were working in the Department of Neurosurgery at University Hospital Coventry and Warwickshire, Coventry, UK, over a 4-week period in March/April 2015. A review of the relevant literature was also undertaken. This report found that despite the reservations around the increased organizational demands of induction programs of this nature, as well as concerns around a single junior doctor covering the ward alone during the induction period, feedback following the intervention was largely positive. Junior doctors appreciated being taught about their roles and responsibilities from their predecessors as well as deciding among themselves what topics they wanted covering. As a result, the induction sessions tended to focus on clinical skills rather than theoretical knowledge, which most of the junior doctors believed they could cover adequately in their own time. The junior doctors felt that they benefited from learning/refreshing their relevant practical skills in a safe environment under senior supervision, prior to starting on the wards. Finally, as the induction program was of a greater duration than the traditional half day, they felt they had sufficient time to ask questions and address concerns while "on the job". Overall, "learner-centered induction programs" did appear to show promise in this pilot study with regards to increasing the confidence of junior doctors starting a neurosurgical placement and helped ease the transition process from foundation doctor to specialty trainee in neurosurgery. We believe further work to formalize and quantify these findings using questionnaires and a larger sample group as well as across successive is indicated and may help junior doctor learning and transition processes in future practice.

11.
Adv Med Educ Pract ; 6: 583-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26508899

RESUMO

Ward rounds are widely considered an underutilized resource with regard to medical education, and therefore, a project was undertaken to assess if the initiation of "trainee-centered ward rounds" would help improve the confidence, knowledge acquisition, and workplace satisfaction of junior doctors in the clinical environment. Data were collated from junior doctors, registrar grade doctors, and consultants working in the delivery suite at Luton and Dunstable University Hospital in Luton over a 4-week period in March-April 2013. A review of the relevant literature was also undertaken. This pilot study found that despite the reservations around time constraints held by both junior and senior clinicians alike, feedback following the intervention was largely positive. The junior doctors enjoyed having a defined role and responsibility during the ward round and felt they benefited from their senior colleagues' feedback. Both seniors and junior colleagues agreed that discussing learning objectives prior to commencing the round was beneficial and made the round more learner-orientated; this enabled maximal learner-focused outcomes to be addressed and met. The juniors were generally encouraged to participate more during the round and the consultants endeavored to narrate their decision-making, both were measures that led to greater satisfaction of both parties. This was in keeping with the concept of "Legitimate peripheral participation" as described by Lave and Wenger. Overall, trainee-centered ward rounds did appear to be effective in overcoming some of the traditional barriers to teaching in the ward environment, although further work to formalize and quantify these findings, as well as using greater sample sizes from different hospital departments and the inclusion of a control group, is needed.

12.
Int J Surg Case Rep ; 16: 15-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26406313

RESUMO

INTRODUCTION: The authors report a case of symmetrical peripheral gangrene (SPG) following emergency neurosurgery. PRESENTATION OF CASE: A 35-year-old female presented to hospital in Thailand with nausea, headache, and subsequent seizures. She was found to have a large intracranial space-occupying lesion with mass effect. Following emergency surgical debulking and decompression, she suffered from severe sepsis with multiple organ failure, treated with high dose intravenous vasopressors and developed secondary gangrene in all four limbs. She was repatriated to the UK with a baseline GCS of 8 and multiple postoperative medical complications. With initial conservative management, the patient made a prolonged but satisfactory progression to recovery prior to semi-elective debridement and selected digit amputation of the gangrene. DISCUSSION: This is the first reported case of four limb symmetrical peripheral gangrene following an emergency craniotomy. CONCLUSION: Although rare, SPG is a substantial complication with high mortality and morbidity and therefore should be especially taken into account for emergency intracranial pathologies in neurosurgical patients, particularly if they require emergency surgery.

13.
J Surg Case Rep ; 2015(5)2015 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-25994827

RESUMO

Most bariatric procedures are now performed laparoscopically. Here, we describe a case of incidental oesophageal leiomyoma found during laparoscopic Roux-en-Y gastric bypass (LRYGB). To our knowledge, this is the first such case reported. Our patient was admitted for an elective LRYGB. She had no upper gastrointestinal symptoms, and therefore did not undergo preoperative oesophagogastroduodenoscopy (OGD). During surgery, a hiatus hernia and an incidental oesophageal leiomyoma were found and treated with hernia repair and enucleation. The end outcome was unaffected. We were able to concomitantly treat the unexpected finding of an oesophageal leiomyoma and a hiatus hernia during the LRYGB. The routine use of OGD prior to bariatric surgery is still controversial. While surgeons should be prepared for unexpected pathologies, when performing laparoscopic bariatric surgery, a routine OGD prior to LRYGB is probably not necessary in asymptomatic patients. Laparoscopic enucleation of oesophageal leiomyoma during LRYGB is feasible and safe.

14.
Int J Surg Case Rep ; 5(7): 358-60, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24858979

RESUMO

INTRODUCTION: The authors present an unusual case of small bowel obstruction in a 62-year-old man. PRESENTATION OF CASE: A 62-year-old man with a background of transitional cell carcinoma (TCC) of the bladder presented to the emergency department with abdominal pain, distension, vomiting and had not opened his bowels for three days. 3 weeks previously he had a repeat Transurtheral resection of bladder tumour (TURBT), during which there was an iatrogenic perforation of the bladder. A CT scan of the abdomen and pelvis revealed small bowel obstruction but did not identify a cause. At laparotomy the cause of the obstruction was identified as a section of the small bowel that had partially herniated into the bladder, via the perforation. The defect was repaired and the patient made an uneventful recovery. DISCUSSION: Herniation of the bowel into a defect in the bladder wall is a rare event with only 6 previous cases reported in the literature. It can cause signs and symptoms of bowel obstruction. CONCLUSION: In patients with known bladder perforations who present with symptoms and signs of bowel obstruction, bowel herniation into the bladder should be considered. Early surgical intervention may be necessary if the patient is clinically unwell with appropriate symptoms and signs and imaging does not provide conclusive answer.

15.
BMJ Case Rep ; 20142014 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-24798355

RESUMO

We present an unusual case of a 75-year-old woman, with no significant medical history, presenting with ongoing weight loss and change in bowel habit. Her physical examination and initial blood tests were all normal, and, therefore, radiographic imaging was undertaken. Ultrasound and CT of the abdomen confirmed a gallbladder polyp and a laparoscopic cholecystectomy was subsequently performed. Histological analysis confirmed primary gallbladder lymphoma. This case report is the first to present gallbladder lymphoma presenting as a polyp. The authors discuss the incidence, presentation and management of gallbladder lymphoma.


Assuntos
Adenoma/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico , Linfoma Folicular/diagnóstico , Pólipos/diagnóstico , Idoso , Colecistectomia Laparoscópica , Diagnóstico Diferencial , Feminino , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Linfoma Folicular/cirurgia , Pólipos/cirurgia
16.
BMJ Case Rep ; 20122012 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-22778464

RESUMO

The authors present the unusual case of a 37-year-old man, with a history of hepatitis C, presenting with a 3 year history of progressive trigeminal, facial and vestibular nerve defects. Intracranial imaging demonstrated a cystic middle and posterior fossa lesion, that was ultimately diagnosed as a cystic trigeminal schwannoma. Due to the uncertainties of diagnosis he was managed in two stages with an open biopsy and then a subsequent partial resection. Surveillance of the tumour remnant is planned. The rare nature of this diagnosis is discussed, along with the more common findings in intracranial schwannoma, and the wide differential to be considered. Briefly, the authors describe the surgical option for a complex multi-fossa schwannoma and the importance of the multi-disciplinary team in the diagnosis and management of such patients.


Assuntos
Fossa Craniana Média , Neoplasias dos Nervos Cranianos/diagnóstico , Neurilemoma/diagnóstico , Doenças do Nervo Trigêmeo/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
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