ABSTRACT
INTRODUCTION: Klippel-Trenaunay Syndrome (KTS) is a rare genetic disorder which is characterised by vascular nevi, venous varicosity, and hyperplasia of soft tissue or bone. Renovascular involvement is considered uncommon in KTS. PRESENTATION OF CASE: A 79-year-old man presented with a left sided varicocele, lymphedema, hydrocele, and microscopic haematuria. After a series of investigations his imaging and clinical features were suggestive KTS. His images, which showed a 2.7 cm renal artery aneurysm, were discussed in the multi-disciplinary team (MDT) meeting and the decision was made to proceed with a laparoscopic nephrectomy. DISCUSSION: Given the size of the aneurysm, treatment was offered and accepted by the patient. This is first recorded case in the literature in which a successful laparoscopic nephrectomy has been carried out for preventing severe haemorrhage in KTS. The patient presented in his 7th decade with a varicocele which would be considered unusual for KTS. Like in many cases, the renal artery aneurysm was asymptomatic. Pathological outcomes of the sample confirmed features suggestive of KTS, thus, validating the radiological findings. CONCLUSION: Here, we report a favourable outcome of a patient referred for consideration of varicocele management, diagnosed with renal artery aneurysms on a background of KTS. KTS, with significant renovascular abnormalities, can be treated with laparoscopic nephrectomy. Careful discussion in MDT with regards to management options should be performed and a shared decision reached with the patient with regards to management. Though rare, patients presenting with varicoceles and lymphedema may have underlying capillary-lymphatic-venous malformations.
ABSTRACT
The Mid Essex teaching team have adapted and innovated to ensure delivery of the curriculum to over 150 students from two medical schools during COVID-19. A fully immersive education experience was created through protected teaching time, the introduction of a simulation package (virtual reality simulation, ward simulation and bleep simulation), the proactive recruitment of fourteen dedicated teaching fellows, and the procurement of technology-based platforms. The blended learning approach we designed supplemented student-patient interaction on the ward with virtual and face-to-face teaching sessions where appropriate. Preliminary data from student feedback suggests that the pandemic induced adaptations, technological innovations and simulation-based teaching have been successful. Students have rapidly gained confidence, knowledge and skills that they need to progress. It may be a consideration for teaching hospitals elsewhere to consider such methods to ensure students are prepared for life as a doctor both in the midst of and after the pandemic.
ABSTRACT
Insufficient young doctors choose careers in general practice - this may relate to cultural, personal and educational influences during medical school. University of East Anglia (UEA) medical school historically produces more GPs than most but no previous studies have aimed to quantify factors which may be leading to this. This study's aim was to improve understanding of the attitudes of students towards general practice (GP) at UEA. A questionnaire study compared views of three different years of students. GP was the most popular choice for male and female students, with women expressing higher levels of commitment. Students saw GP as intellectually stimulating and making key contributions to the NHS. The main reason for the choice of GP was interest in the speciality, with positive influences attributed to contact with GPs and general practice as a setting during their course. These results suggest course design and presence of GP faculty in core teaching have crucial influences on career choices. GP can be a popular career choice, but the perceptions which lead to that choice are course-and experience - dependent. Reforms towards community-based learning and the involvement of GPs in training are crucial levers for change if workforce needs are to be achieved.
