RSS 1.0Head, Neck, Eyes and Plastics
Browse by
Recent Submissions
-
Investigating the potential association between tattoos and lymphoma: an exploratory systematic review and meta-analysis.BACKGROUND: The tattooed population has risen significantly over the last few decades, leading to increased scrutiny into potential side effects. The recent publication of scientific articles linking tattooing to lymphoma has led to a systematic review being conducted to investigate if an association exists. METHODS: Following the PICO framework, we formed a systematic review comparing tattooed to non-tattooed adults belonging to any region of the world and investigated the likelihood of lymphomagenesis. The protocol was pre-registered on PROSPERO (ID: CRD42024586505). Relevant studies were searched for in PubMed, Web of Science, Embase, Google Scholar, and CENTRAL on 10/09/2024 and updated on 16/07/25. The inclusion criteria consisted of primary studies, including observational studies and case reports which investigated the association between tattoos and non-Hodgkin lymphoma. Exclusion criteria were publications involving subjects under 18 and non-English papers. Data extraction was performed using published numbers from individual papers after requesting raw data. Study quality was assessed using ROBINS-E, and evidence certainty using GRADE. Outcomes assessed were any odds/risk/incidence ratios that associated tattooing with non-Hodgkin lymphoma. FINDINGS: A total of four observational studies, totalling 17,941 participants (2485 cases and 15,456 controls) and three case reports were identified. None of the included studies demonstrated a statistically proven link between lymphomagenesis and tattooing. ROBINS-E showed relatively low bias for our three included studies; however, the certainty of our evidence is low due to the lack of high-quality studies with similar methodologies. The meta-analysis conducted for non-Hodgkin's lymphoma, with subtypes follicular lymphoma and diffuse large B-cell lymphoma, produced odds ratios of 1.01 (95% CI 0.82-1.24), 1.01 (95% CI 0.77-1.33) and 0.89 (95% CI 0.54-1.46), respectively. INTERPRETATION: No significant association was found between tattooing and lymphoma. Due to limitations in the data quality and lack of standardised measurable outcomes, further high-quality research is needed. FUNDING: There was no funding for this study.
-
Emerging perspectives in quality of life after trabeculectomy surgery.BACKGROUND/OBJECTIVES: Trabeculectomy is the gold standard surgery in treatment of glaucoma but there is little reported on its early impact in health-related quality of life (HRQoL). Here we characterise HRQoL in the early post-operative period with two generic patient-reported outcome measures tools (PROMs), the EQ-5D and SF-6D, and compare them to visual-related and glaucoma-specific PROMs, the VF-25 and GUI. SUBJECTS/METHODS: We prospectively enrolled 168 patients with failed medical treatment undergoing trabeculectomy and assessed HRQoL at baseline and in the post-operative period using the PROMs above. Paired t-tests, ANOVA and linear regression tests were used to analyse outcomes. RESULTS: A significant drop in HRQoL was identified in the first month post-operatively with the SF-6D, the VF-25 and the GUI but not with the EQ-5D. This drop was reversed to pre-operative levels by month 3. Four dimensions of HRQoL, including physical functioning, social functioning and adaptation to physical and to emotional roles had the most impact on the generic HRQoL. Visual acuity dropped one line in the operated eye at month 1 and was the only measurable clinical factor contributing to HRQoL. CONCLUSIONS: The early post-operative period in trabeculectomy surgery is associated with a reversible loss of HRQoL, which is the result of transient worsening of vision but also physical, emotional and social restrictions caused by the busy medication regimen and drastic lifestyle changes. The SF-6D was better than the EQ-5D at picking up changes in HRQoL.
-
LAsting Symptoms after Oesophageal Resectional Surgery (LASORS): multicentre validation cohort study.BACKGROUND: Long-term symptom burden and health-related quality-of-life outcomes after curative oesophageal cancer treatment are poorly understood. Existing tools are cumbersome and do not address the post-treatment population specifically. The aim of this study was to validate the six-symptom LASORS tool for identifying patients after curative oesophageal cancer treatment with poor health-related quality of life and to assess its clinical utility. METHODS: Between 2015 and 2019, patients from 15 UK centres who underwent curative-intent oesophageal cancer treatment, and were disease-free at least 1 year after surgery, were invited to participate in the study and complete LASORS and European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 questionnaires. Receiver operating characteristic curve analysis was used to examine the accuracy of the LASORS tool for identifying patients with poor health-related quality of life. RESULTS: A total of 263 patients completed the questionnaire. Four of the six LASORS symptoms were associated with poor health-related quality of life: reduced energy (OR 2.13 (95% c.i. 1.45 to 3.13)); low mood (OR 1.86 (95% c.i. 1.20 to 2.88)); diarrhoea more than three times a day unrelated to eating (OR 1.48 (95% c.i. 1.06 to 2.07)); and bloating or cramping after eating (OR 1.35 (95% c.i. 1.03 to 1.77)). The LASORS tool showed good diagnostic accuracy with an area under the receiver operating characteristic curve of 0.858 for identifying patients with poor health-related quality of life. CONCLUSION: The six-symptom LASORS tool generated a reliable model for identification of patients with poor health-related quality of life after curative treatment for oesophageal cancer. This is the first tool of its kind to be prospectively validated in the post-esophagectomy population. Clinical utility lies in identification of patients at risk of poor health-related quality of life, ease of use of the tool, and in planning survivorship services.
-
Microbiological profiles of infectious corneal ulcers in Derbyshire and North Nottinghamshire-a 10-year analysis.PURPOSE: To assess the spectrum of organisms causing microbial keratitis and their in-vitro anti-microbial sensitivities out of 2 hospitals in the East Midlands Region of the United Kingdom. METHODS: A retrospective review was undertaken of all patients who underwent corneal scrapes for infectious keratitis between 2011 and 2021 at Royal Derby Hospital (RDH) in Derby and between 2009 and 2021 at King's Mill Hospital in Mansfield. RESULTS: In total, the results of 645 corneal scrapes (from 622 patients) were analysed after exclusions. Of these, 307 (47.6%) yielded positive cultures. The mean patient age was 52.6 ± 22.1 years (Mean ± St Dev) across both sites and 332 (51.4%) were from female patients. At RDH, there were 195 positive corneal scrape cultures, from which 250 species of organisms were isolated. At RDH, 64% (160/250) were Gram-positive bacteria, 32% (81/250) were Gram-negative bacteria, 2.4% (6/250) were Acanthamoeba species and 1.2% were fungi (3/250). At KMH, there were 112 positive cultures, from which 128 species of organisms were isolated. 14 corneal scrapes from KMH were polymicrobial. At KMH, 96% (123/128) were bacterial (51% Gram positive, 45% Gram negative), 3/128 (2.3%) were fungi and 2/128 (1.6%) were Acanthamoeba. Sensitivity testing confirmed that the fluoroquinolone class of antibiotics appeared to be effective against the majority isolates across the two hospital sites. CONCLUSION: There are differences in microbiological profiles between these neighbouring hospitals covering neighbouring populations. Despite these differences, reassuringly, the current first-line fluoroquinolone monotherapy treatment is an appropriate first-line treatment for both hospital sites.
-
Implementing Mental Practice in Postgraduate Surgical Training for Minimally Invasive Surgery: A Systematic Review and Thematic Analysis.BACKGROUND: Unprecedented pressure on the National Health Service (NHS) has meant that there are increasing obstacles to surgical training. Simulation training is an option to improve surgical performance but is limited due to availability, accessibility and financial constraints. Mental practice (MP) has been proposed as a potential solution to supplement the traditional method of apprenticeship-style learning. Despite increasing evidence that MP may be a useful tool to improve surgical performance and reduce surgeon anxiety, it is not widely adopted. This systematic review and thematic analysis aims to identify key themes that would allow for the successful implementation of MP in postgraduate surgical training. METHODS: Medline, Embase and PsycINFO databases were systematically searched to identify articles that investigate the role of MP in improving surgical performance amongst surgical trainees. Retrieved papers were studied to inform thematic analysis of their content and studies were assessed for bias. RESULTS: A total of 321 studies were retrieved, of which 11 met the inclusion criteria. Overall risk of bias was assessed to be between critical and moderate for seven nonrandomized studies and between fair and good for four randomized studies. Key themes were identified and discussed using a thematic analysis approach. CONCLUSION: This study has identified that attaining high quality mental imagery is fundamental to success in mental practice and this can be augmented by the use of relaxation therapy and/or motivational imagery. Future research should focus on the application of MP in real-world surgical practice and breaking down complex procedures into fewer operative steps.
-
A woman with recurrent spontaneous throat swellingNo abstract provided.
-
An Update Summary on the Learning Sciences Within an Ophthalmic Context.Clinical reasoning, specifically diagnostic decision-making, has been a subject of fragmented literature since the 1970s, marked by diverse theories and conflicting perspectives. This article reviews the latest evidence in medical education, drawing from scientific literature, to offer ophthalmologists insights into optimal strategies for personal learning and the education of others. It explores the historical development of clinical reasoning theories, emphasising the challenges in understanding how doctors formulate diagnoses. The importance of clinical reasoning is underscored by its role in making accurate diagnoses and preventing diagnostic errors. The article delves into the dual process theory, distinguishing between type 1 and type 2 thinking and their implications for clinical decision-making. Cognitive load theory is introduced as a crucial aspect, highlighting the limited capacity of working memory and its impact on the diagnostic process. The zone of proximal development (ZPD) is explored as a framework for optimal learning environments, emphasising the importance of scaffolding and deliberate practice in skill development. The article discusses semantic competence, mental representation, and the interplay of different memory stores-semantic, episodic, and procedural-in enhancing diagnostic proficiency. Self-regulated learning (SRL) is introduced as a student-centric approach, emphasising goal setting, metacognition, and continuous improvement. Practical advice is provided for minimising cognitive errors in clinical reasoning, applying dual process theory, and considering cognitive load theory in teaching. The relevance of deliberate practice in ophthalmology, especially in a rapidly evolving field, is emphasised for continuous learning and staying updated with advancements. The article concludes by highlighting the importance of clinical supervisors in recognising and supporting trainees' self-regulated learning and understanding the principles of various teaching and learning theories. Ultimately, a profound comprehension of the science behind clinical reasoning is deemed fundamental for ophthalmologists to deliver high-quality, evidence-based care and foster critical thinking skills in the dynamic landscape of ophthalmology.
-
Optical coherence tomography angiography: a review of the current literatureThis narrative review presents a comprehensive examination of optical coherence tomography angiography (OCTA), a non-invasive retinal vascular imaging technology, as reported in the existing literature. Building on the coherence tomography principles of standard OCT, OCTA further delineates the retinal vascular system, thus offering an advanced alternative to conventional dye-based imaging. OCTA provides high-resolution visualisation of both the superficial and deep capillary networks, an achievement previously unattainable. However, image quality may be compromised by factors such as motion artefacts or media opacities, potentially limiting the utility of OCTA in certain patient cohorts. Despite these limitations, OCTA has various potential clinical applications in managing retinal and choroidal vascular diseases. Still, given its considerable cost implications relative to current modalities, further research is warranted to justify its broader application in clinical practice.
-
Simplifying placement of bonded retainersThe placement of bonded retainers can be daunting to the inexperienced clinician. The aim of the present article was to share a simple means of using everyday intermaxillay elastics to effortlessly secure the wire, allowing the clinician to easily complete placement of the bonded retainer. The challenge of manipulating the wire, etch, bond and composite simultaneously is thus alleviated! A step-by-step explanation is provided.
-
Revision Transoral Robotic Surgery for Early Stage HPV Positive Oropharyngeal Squamous Cell Carcinoma, it's Timing and Margins: Past and Present- a Prospective Single Centre Observational Study.To review cohort of patients with HPV positive early stage oropharyngeal cancer that underwent revision trans oral robotic surgery for positive or close margin for evidence of residual disease, its impact on survival and discussion about clear margin. This is a prospective observational study. Our TORS revision rate was 20.6%. 91.7% did not need radiotherapy to primary site; mean recurrence free survival is 31 months and no mortality in this cohort due to the primary disease. There is no consensus on what is clear margin. The surgical margins are a surrogate marker for later recurrences or long-term survival and this is what guides our treatment but equally attempts should be made to preserve their function and not increase the morbidity.
-
Morbidity and Mortality Following Transoral Robotic Surgery, a Prospective Single Centre Study.To review complications including mortality after transoral robotic surgery (TORS) for both benign and malignant pathologies. This is a prospective observational study. Postoperative haemorrhage (8.7%) was the most common complication and 2 (1.7%) mortality were seen in this study. Airway complications and tracheostomy (1.7%), aspiration pneumonia (1.7%), swallowing problems and nasogastric feeding (7%), intra-operative pharyngocutaneous fistula (0.9%) and transient nasal regurgitation (3.5%) were also seen. The more tissue is removed the more is the risk of complication. Complications were mainly seen in the first year of starting the service of TORS and it is a reflection of the learning curve. However, secondary haemorrhage did not follow any pattern in our series. The postoperative haemorrhage was more common in patients with T2 oropharyngeal carcinoma. The mortality was seen in 2 patients (1.7%) with T2 oropharyngeal carcinoma due to postoperative haemorrhage. Higher T stage of oropharyngeal squamous cell carcinoma (OPSCC) needs bigger resection with resultant increase in morbidity.
-
Frey's syndrome: A review of the physiology and possible role of neurotrophic factors.OBJECTIVES: Frey's syndrome (FS) describes the phenomenon of gustatory sweating and is a cause of significant social embarrassment for sufferers. It has been attributed to aberrant growth of parasympathetic salivatory fibers in the auriculotemporal nerve toward overlying sweat glands. However, the exact mechanism behind this growth is unknown. This review aims to expand and elucidate the theory of aberrant regeneration in FS. METHODS: A review of the recent literature on nerve regeneration was conducted in order develop further insights into the etiology of both adult onset and pediatric FS. RESULTS: Neurturin, a neurotrophic factor released by both salivary and sweat glands, was identified as a possible key player in the etiology of FS. CONCLUSION: Further research into the role of neurturin could help to elucidate the pathogenic mechanisms underlying the condition and might reveal neurturin to be a potential target for pharmacological intervention. LEVEL OF EVIDENCE: NA (Basic Science Review).
-
Retinal Imaging in InfantsDigital retinal imaging is at the core of a revolution that is continually improving the screening, diagnosis, documentation, monitoring, and treatment of infant retinal diseases. Historically, imaging the retina of infants had been limited and difficult to obtain. Recent advances in photographic instrumentation have significantly improved the ability to obtain high-quality multimodal images of the infant retina. These include color fundus photography with different camera angles, ultrasonography, fundus fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. We provide a summary of the current literature on retinal imaging in infants and highlight areas where further research is required.
-
The Use of Interlocking Polyetheretherketone Patient-Specific Facial Implants in the Treatment of Facial Deformities. A Retrospective Review of Ten PatientsPurpose: Polyetheretherketone (PEEK) is a versatile biocompatible material with a wide variety of clinical applications. Multiple-piece 3-dimensionally milled interlocking PEEK patient-specific implants are used in cases with restricted access or around vital structures. The interlocking joints reduce the number of fixation screws required by converting the multiple segments into one single implant. Stability of such joints is of paramount importance to prevent complications such as infection and implant extrusion. This retrospective study evaluates the clinical outcomes in the use of multiple-piece 3-dimensionally milled interlocking PEEK patient-specific implants as a treatment for various congenital and acquired facial deformities. Methods: Patients' records and clinical interviews were retrospectively reviewed. Results: A total of 10 patients were included; 6 of them (60%) were men. A planning cone beam scan (90%) or computed tomography scan (10%) were obtained following a standard protocol. All treatments were performed by a single surgeon, following a standardized approach. The follow-up time ranged from 11 to 61 months (mean = 37.1 months), No implant exposure, extrusion or removal were reported. Three patients (30%) have experienced complications. Recurrent edema was observed in 1 patient (10%), another patient (10%) experienced bilateral mental nerve paresthesia, and the third patient (10%) had recurrent sinusitis, which was successfully treated with functional endoscopic sinus surgery without removing the implant. Conclusion: Within the limitation of this study, 3-dimensionally milled interlocking PEEK patient-specific implants are safe, predictable, potentially save operative time, and readily adjustable. Extra stability and antislippage mechanism can be achieved by using the interlocking joint. Further studies on a larger cohort of patients is needed to confirm these results.
-
What still presents urgently to ENT during a pandemic? Experience of an ENT rapid access clinic during the coronavirus disease 2019 pandemicObjectives: This study sought to determine the conditions that still present to ENT despite government advice to avoid unnecessary travel. It also assessed the impact of social distancing on pathologies presenting to ENT and reviewed the usefulness of telephone consultations in semi-urgent presentations. Method: A retrospective review was conducted of 97 instances of patient care carried out in the rapid access ENT clinic at a large district general hospital. Results: Otitis externa and foreign bodies represented 25 per cent and 13 per cent of consultations respectively. Tonsillitis and peritonsillar abscess were uncommon, representing 6 per cent of total consultations. Telephone appointments represented only 28 per cent of total consultations; however, they appeared to reduce the number of physical appointments required. Conclusion: Otitis externa and foreign bodies continue to be common during the pandemic. Social distancing measures reduced the number of tonsillitis and quinsy presentations. Telephone consultations are effective for certain urgent presentations to ENT, most noticeably nasal trauma and follow up of non-serious pathologies.
-
Food bolus and oesophageal foreign body: a summary of the evidence and proposed management processPurpose: Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. Methods: An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. Results: This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. Conclusion: This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.
