Surgical palliation in poorly differentiated neuroendocrine carcinoma of the hypopharynx: Case report.

BACKGROUND: Primary neuroendocrine carcinomas (NECs) are very rare entities accounting for 0.49% of all malignancies. Within the head and neck, the most common sites are the larynx and paranasal sinuses, while the hypopharynx is seldom described. CASE: We present a patient with a poorly differentiated metastatic NEC of the hypopharynx treated palliatively with organ-preserving surgery and post-operative chemotherapy, and literature review for well-documented pure hypopharyngeal NECs. Our patient died of chest infection during chemotherapy, 4 months after surgery. CONCLUSION: Chemotherapy remains the mainstay of treatment in the presence of metastases with 2-year overall survival of 15.7%. Due to the aggressive nature of poorly differentiated metastatic NECs, surgical management is seldom considered. We report and advocate the successful palliative role of organ-preserving, minimally invasive trans-oral LASER micro-surgery and neck dissection to control loco-regional head and neck disease, safe-guarding better quality of home life, despite limited life expectancy for this condition.

Pediatric otosyphilis-An unusual cause of conductive hearing loss.

We present the case of a 5 year old female with a unilateral conductive hearing loss which had a relapsing and remitting course over a 3 year period. An initial noncontrast CT temporal bone study was unremarkable and a diagnosis of otitis media was made in the first instance. However, a second CT temporal bone study performed 3 years later demonstrated bilateral demineralisation of the ossicles and abnormal lucency affecting both the otic capsules. A diagnosis of otosyphilis was proposed on the basis of the imaging features and a prior medical history of previously treated congenital syphilis. With the benefit of hindsight, early pericochlear lucency was identified on the initial CT temporal bone study. There has been a steady rise of syphilis cases since the millennium with resurgence in many high income countries. Otosyphilis has a highly variable clinical presentation and there is limited data to establish the pattern of hearing loss in pediatric patients with a background of congenital otosyphilis. Temporal bone and otic capsule demineralisation carries a broad differential diagnosis including osteogenesis imperfecta, otosclerosis, Paget's disease and radiation related changes. Otosyphilis is a rare but potentially treatable cause of deafness and a high index of suspicion is required to make the diagnosis. In conjunction with a positive syphilis serology, a noncontrast temporal bone CT can aid the diagnosis and expedite the treatment.

Intratympanic Steroid Use for Sudden Sensorineural Hearing Loss: Current Otolaryngology Practice.

OBJECTIVE: To investigate the current practice of intratympanic steroid (ITS) injection for sudden sensorineural hearing loss (SSNHL) in the United Kingdom and link the data with data from the United States and continental Europe. METHODS: A survey of 21 questions was distributed to members of the British Society of Otology using an online survey platform via ENT UK. Data obtained from UK otolaryngologists (n = 171) were integrated with previously published data from other countries, including the United States (n = 63) and continental Europe (n = 908). RESULTS: In the United Kingdom, 62% of responding otolaryngologists use ITS injection for SSNHL, while 38% do not. Of those using ITS, 59% use it as first-line treatment, either using it in conjunction with oral steroids (51%) or using it as monotherapy (8%). Of those that use ITS, a majority (83%) use it as salvage therapy when primary treatment with systemic steroids has failed, and similar results are found in the continental Europe and US surveys. The most commonly used preparation is dexamethasone. Responses to questions regarding treatment regimes used are enlightening and show considerable variation in the treatment regimes used within and between countries. CONCLUSIONS: There is a wide variation in practice with regards to ITS for SSNHL hearing loss in the United Kingdom, United States, and continental Europe. In the absence of protocols or definitive guidance from published literature, knowledge of contemporary practice may help guide or encourage reevaluation of clinical practice and will help guide the design of future clinical trials.

Pilot study of quality of care training and knowledge in Sub-Saharan African medical schools.

OBJECTIVES: To identify the level of knowledge and competencies related to quality of care during medical education in sub-Saharan African medical schools. METHODS: A cross-sectional study design was utilized to examine the capacity of medical schools in sub-Saharan African (SSA) countries to teach about the concepts of quality of care and the inclusion of these concepts in their curriculum. A purposeful convenience sampling technique was used to select participants from 25 medical schools in 5 sub-Saharan African countries. Respondents included medical school deans or senior academic personnel.  A survey was developed using the Institute of Medicine's definition of quality of care as the guiding framework.  Sample means and summary statistics were used to present the results of the survey responses. RESULTS: While 45% of the schools surveyed are teaching on at least one of the six domains of the Institute of Medicine's definition of quality of care, there are some schools who report not teaching about quality at all, or that they "do not know". Despite these low numbers, when asked about topics related to quality of care, many schools are teaching applied management related topics and almost all schools teach about equity and patient-centered care. CONCLUSIONS: The results have important impacts both for incorporating quality of care into medical education and for practitioners.  The tool developed for this study can be used in future qualitative and quantitative studies to further understanding of how to improve the teaching and learning about quality of care in medical schools. Keywords: quality of care, medical schools, sub-Saharan Africa, medical errors, healthcare improvement.

Choosing a Nursing Home: What Do Consumers Want to Know, and Do Preferences Vary across Race/Ethnicity?

OBJECTIVE: To identify what consumers want to know about nursing homes (NHs) before choosing one and to determine whether information preferences vary across race/ethnicity. DATA SOURCES/STUDY SETTING: Primary data were collected in Greater Boston (January 2013-February 2014) from community-dwelling, white, black, and Latino adults aged 65+ and 40-64 years, who had personal/familial experience with a NH admission or concerns about one. STUDY DESIGN: Eleven focus groups and 30 interviews were conducted separately by race/ethnicity and age group. PRINCIPAL FINDINGS: Participants wanted detailed information on the facility, policies, staff, and residents, such as location, staff treatment of residents, and resident conditions. They wanted a sense of the NH gestalt and were interested in feedback/reviews from residents/families. Black and Latino participants were especially interested in resident and staff racial/ethnic concordance and facility cultural sensitivity. Latino participants wanted information on staff and resident language concordance. CONCLUSIONS: Consumers want more information about NHs than what is currently available from resources like Nursing Home Compare. Report card makers can use these results to enhance their websites, and they should consider the distinct needs of different racial/ethnic groups. Future research should test methods for collecting and reporting resident and family feedback/reviews.

[RARE CASE OF HUGE OMENTAL DERMOID].

INTRODUCTION: Ovarian dermoid cyst is a benign germ cell tumor usually occurring during fertile age. In contrast, giant omental dermoid is extremely rare and is thought to originate from ovarian torsion, detachment and omental implantation. We present a case of a 73 year old patient with 26 cm giant omental dermoid weighing more than 6 kg. During surgery, aspiration of the cystic part facilitated the delivery of the big mass through a relative small abdominal incision.