Incidental finding of an orbital foreign body in a child with microcephaly and developmental delay.

A 3-year-old boy underwent investigations for microcephaly and global developmental delay. An MRI scan identified an ill-defined enhancing lesion in the left superolateral orbit. On subsequent questioning his parents reported that he had been admitted to a neighbouring hospital 2 months earlier with left-sided preseptal cellulitis following a fall onto a plastic toy. Following the episode of cellulitis he developed intermittent mild erythema and oedema of the left upper eyelid for which his parents had not sought further medical attention. The child was admitted for an anterior orbitotomy via a skin-crease approach that identified a large foam plastic foreign body. He made a good recovery from his surgery although he has had intermittent upper eyelid oedema attributed to a persistent granulomatous foreign body reaction. No underlying cause for his microcephaly and delayed development has yet been identified.

Mentoring for doctors. Do its benefits outweigh its disadvantages?

BACKGROUND: Mentoring is widely used in medicine and is an established means of professional development. We have all been mentored, knowingly or otherwise at some stage of our careers. AIMS: To provide an overview of mentoring in clinical and academic medicine, review the literature, discuss various mentoring styles and weigh the advantages and disadvantages of mentoring. METHOD: A discussion paper that describes good mentoring, promotes mentoring as a performance enhancer and gives examples to illustrate issues. It draws on available literature and introduces several novel ideas in mentoring. RESULTS: Doctors at all career stages including medical students can benefit from mentoring. Benefits of mentoring include; benefits to the mentee, benefits to the mentor and benefits to the organization. Overall, both mentees and mentors are highly satisfied with mentoring. Nevertheless, problems exist, such as conflict between the mentoring and supervisory roles of the mentor, confidentiality breaches, mentor bias, lack of "active listening" and role confusion. Problems usually stem from poor implementation of mentoring. Mentors should not be the mentee's educational supervisor or line manager or otherwise be involved in their assessment or appraisal to avoid blurring of these distinct roles. Safeguards of confidentiality are of vital importance in maintaining the integrity of the mentoring process. Good mentoring is a facilitative, developmental and positive process which requires good interpersonal skills, adequate time, an open mind and a willingness to support the relationship. Mentors should encourage critical reflection on issues to enable mentees to find solutions to their own problems. CONCLUSIONS: Mentoring is an important developmental process for all involved. There is a perception amongst mentors and mentees that well conducted, well timed mentoring can reap enormous benefits for mentees and be useful to mentors and organizations. However strong evidence for this is lacking and there is need for further research in this area.

Fascicular keratitis in children: can corneal phlycten be mobile?

Phlyctenulosis is an uncommon condition that usually affects children's cornea or conjunctiva. Although its exact aetiology is unknown, it is thought to be a non-specific delayed hypersensitivity reaction to staphylococci or other bacterial, fungal or parasitic antigens. Herein a case of a 3.5-year-old boy with corneal phlyctenulosis is described in whom the phlycten appears to have has migrated from its origin at the limbus to the central cornea (fascicular keratitis) and become visually disabling. At his last follow up he was asymptomatic. Some stromal scarring of the right cornea remained and his visual acuity improved in both eyes following treatment.