Difficult oesophageal foreign body removal: a novel surgical approach to a complex situation.

BACKGROUND: Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches. METHODS: This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed. RESULTS: The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well. CONCLUSION: This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patient's history, the nature and location of the foreign body, and associated risks.

Building a competitive application: exploring the entry routes and educational choices of otolaryngology higher surgical trainees in the UK.

BACKGROUND: This cross-sectional study investigates the educational background and entry routes of otolaryngology higher surgical trainees in the UK. METHOD: A survey was disseminated to trainees through training programme directors and 60 responses were received. RESULTS: Most trainees decided to pursue otolaryngology early in their training, with 50 per cent making the decision four or more years before applying for a higher surgical traineeship. Similarly, 68.3 per cent of trainees undertook otolaryngology-themed core surgical training, while two-thirds had an otolaryngology rotation during their foundation training. Most trainees (86.7 per cent) were accepted into core surgical training on their first attempt, and 71.7 per cent gained entry to higher surgical training on their first attempt. CONCLUSION: The findings highlight the importance of early exposure to otolaryngology and the pursuit of themed core surgical training programmes for building a competitive application. However, unsuccessful first attempts at core surgical training or higher surgical training should not discourage candidates from pursuing a career in otolaryngology.

Bilateral Warthin's tumour of the parotid gland: a 16-year retrospective analysis and systematic review.

OBJECTIVE: Warthin's tumours are the second most common benign parotid tumours in the UK. The World Health Organization states that 5-14 per cent of patients have bilateral Warthin's tumours. This study aimed to: assess the presence of contralateral Warthin's tumours in patients who underwent surgery over the past 16 years at a head and neck unit in England, and perform the first systematic literature review on bilateral Warthin's tumours. METHODS: A retrospective analysis was conducted on patients diagnosed with Warthin's tumour based on histology between 2005 and 2020. Additionally, a systematic review (International Prospective Register of Systematic Reviews ('PROSPERO') registration number: CRD42022326846) was performed using PubMed and the Cochrane Library. RESULTS: Among 290 patients diagnosed with Warthin's tumours based on histology following surgery, 24.5 per cent had bilateral Warthin's tumours. The systematic review identified 157 papers, with 14 meeting the inclusion criteria. CONCLUSION: This study revealed that 24.5 per cent of patients had bilateral Warthin's tumours, deviating from the suggested range. These findings are of interest to surgeons discussing the disease with patients.

Head and neck cancer: A 6-year retrospective analysis and review of three common triaging systems.

OBJECTIVES: In the United Kingdom, head and neck cancer (HNC) cases continue to rise and are the fourth commonest cancers in men. Additionally, in the last decade, the incidence rise in women is twice their male counterpart, signifying the need for robust and dynamic triaging systems to maintain high pick-up rates across both genders. This study investigates local risk factors associated with HNC and reviews the most commonly used guidelines and risk calculator tool for two-week-wait (2ww) HNC clinics. DESIGN: Six-year retrospective case-control analysis of 2ww HNC clinics within a district general hospital in Kent studying symptoms and risk factors. RESULTS: Two hundred cancer patients (128M:72F) were identified and compared against 200 randomised non-cancer patients (78M:122F). Increasing age, male gender, smoking, previous cancer and neck lumps were statistically relevant risk factors for HNC (p < .001). HNC mortality at 1 and 5 years was 21% and 26%, respectively. Adjusting guidelines to improve local services obtained the following area under curve (AUC) scores: NICE guidelines 67.3, Pan-London 58.0 and HNC risk calculator version 2 (HaNC-RC V.2) 76.5. Our adjusted HaNC-RC V.2 improved sensitivity by 10% to 92%, and theoretically reduces local general practice referrals by 61% when utilising triaging staff. CONCLUSION: Our data portray the primary risk factors as increasing age, male gender and smoking for this demographic. The presence of a neck lump was the most significant symptom within our cohort. This study demonstrates a critical balance when adjusting sensitivity and specificity of guidelines and proposes that departments adjust diagnostic tools for their local demographic to improve referral numbers and patient outcomes.

Recovery of Surgical Training Through Extended Laparoscopic Simulation Training.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has adversely affected surgical training internationally. Laparoscopic surgery has a steep learning curve necessitating repetitive procedural practice. We evaluate the efficacy of short- and long-duration simulation training on participant skill acquisition to support the recovery of surgical training.  Methods A prospective, observational study involving 18 novice medical students enrolled in a five-week course. Nodal timed assessments involved three tasks: hoop placement, stacking of sugar cubes and surgical cutting. One month post-completion, we compared the ability of six novice course participants to that of six surgical trainees who completed a smaller portion of the course curriculum. Results Course participants (n=18) completed tasks 111% faster on their third and last course attempt. The surgical trainee group (n=6) took 46% longer to complete tasks compared to the six re-invited course participants, whose ability continued to advance on their fourth effort with a combined 154% earlier completion time compared to try one. Conclusions This study supports the adoption of a structured, extended, regular and spaced-out simulation course or curriculum to cultivate greater skill acquisition and retention amongst surgical trainees, and improve patient care.

The Implementation of Virtual Clinical Skills Teaching in Improving Procedural Confidence in ENT Trainees.

PURPOSE: Medical education has faced new challenges with the recent coronavirus pandemic. Traditional teaching methods for face-to-face learning have shifted towards the delivery of digital teaching. The difficulty arises in specialties, such as otorhinolaryngology, where clinical procedural skills are necessary for diagnosis and management. This article aims to determine the impact of a clinical skills video on the confidence of postgraduate ENT trainees when managing nasal fractures. PATIENTS AND METHODS: Postgraduate ENT trainees completed a baseline questionnaire, declaring their subjective confidence across 5 domains relating to nasal fractures using a 10-point Likert scale. They were then given a lecture, and this questionnaire was repeated. Lastly, trainees were shown a clinical skills video, and the questionnaire was repeated once more. The qualitative data was analysed using Kruskal-Wallis testing. RESULTS: There was poor overall confidence in the management of nasal fractures prior to focused teaching. There was a marked statistically significant (P < 0.01) improvement in subjective confidence following the lecture intervention. There was further statistically significant improvement across all domains following the introduction of the clinical skills video. CONCLUSION: This study confirms that clinical skills videos are a useful accessible learning tool in medical education. We advocate their use in the postgraduate setting, to mirror their current use in undergraduate medical education.

The management of paediatric rhinosinusitis.

Paediatric rhinosinusitis (PDRS) is commonly used as a synonym for rhinitis within healthcare. Although they may share common symptoms, the pathophysiology does differ; PDRS is the inflammation of the nasal mucosa in addition to the sinuses whereas rhinitis is the inflammation of just nasal mucosa. This review provides a comprehensive overview of the epidemiology, pathophysiology, symptoms, diagnosis and management of PDRS. There is a greater emphasis on the diagnosis and management of PDRS within this review due to a lack of clear guidelines, which can lead to the common misconception that PDRS can be treated indifferently to rhinitis and other upper respiratory conditions. PDRS has detrimental effects on children's current health, long-term health into adulthood and education. Therefore, having a comprehensive guide of PDRS would provide a greater understanding of the condition as well as improved diagnosis and management. This article primarily focuses on the position of Europe and the United Kingdom; however, the recommendations can be applied to other countries as the causes and treatments would not differ significantly.

Corrigendum to: Obturator hernia: a delayed diagnosis. A case report with literature review.

[This corrects the article DOI: 10.1093/jscr/rjaa599.].

Non-aesthetic uses of botulinum toxin in the head and neck.

INTRODUCTION: The use of botulinum toxin in the specialty of aesthetic surgery in the head and neck is well known. However, it has also been used for other conditions affecting the head and neck, and in recent years its use, as well as the number of relevant applications, has expanded enormously. REVIEW: This article presents a summary of the current range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles and salivary glands. We highlight particular conditions focusing on dystonia (laryngeal, craniocervical, oromandibular and cervical), multiple system atrophy, migraines, facial nerve palsy, post-laryngectomy, cricopharyngeal dysphagia, Zenker's diverticulum, retrograde cricopharyngeal dysfunction disorder, sialorrhea and gustatory sweating (Frey's syndrome). CONCLUSION: This article should aid the ear, nose and throat surgeon garner knowledge about the range of uses for botulinum toxin in the head and neck.

Obturator hernia: a delayed diagnosis. A case report with literature review.

Obturator hernias are classically difficult to diagnose, have a high mortality and are an uncommon cause of intestinal obstruction. They are usually found in thin, elderly female patients. We present a case of a misdiagnosed 89-year-old female who presented to accident and emergency with a short history of abdominal pain. The diagnosis of an incarcerated obturator hernia was confirmed after re-discussion of computed tomography scan with the consultant radiologist in the morning. The patient underwent emergency laparotomy and the defect reduced. The patient recovered well post-operation; however; on the fourth day post-operation, the patient suffered a cardiac arrest. We report this case as a reminder to our health care colleagues to be mindful of elderly female patients who present with small bowel obstruction due to the high risk of mortality of this type of hernia.

Hierarchical regression of ASA prediction model in predicting mortality prior to performing emergency laparotomy a systematic review.

BACKGROUND: In light of increasing litigations around performing emergency surgery, various predictive tools are used for prediction of mortality prior to surgery. There are many predictive tools reported in literature, with ASA being one of the most widely accepted tools. Therefore, we attempted to perform a systematic review and meta-analysis to conclude ASA's ability in predicting mortality for emergency surgeries. METHODS: A wide literature search was conducted across MEDLINE and other databases using PubMed and Ovid with the following keywords; "Emergency laparotomy", "Surgical outcomes", "Mortality" and "Morbidity." A total of 3989 articles were retrieved and only 11 articles met the inclusion criteria for this meta-analysis. Data was pooled and then analysed using the STATA 16.1 software. We conducted hierarchal regression between the following variables; mortality, gender, low ASA (ASA 1-2) and high ASA (ASA 3-5). RESULTS: 1. High ASA was associated with a higher rate of mortality in males with 'p' value of 0.0001 at alpha value of 0.025. 2. The female gender itself showed a significantly high mortality rate, irrespective of low ASA or high ASA with 'p' value of 0.04 at alpha value of 0.05. 3. ITU admissions with a high ASA had a greater number of deaths compared to low ASA. 'p' value of 0.0054 at alpha value of 0.01. CONCLUSION: Higher ASA showed a direct association with mortality and the male gender. The female gender was associated with a higher risk of mortality regardless of the ASA grades.

An overview of parasitic infections of the gastro-intestinal tract in developed countries affecting immunocompromised individuals.

In both developed and developing countries, parasitic infections continue to be a frequent cause of mortality and morbidity. Due to the globalization of the world, doctors must be fully prepared to deal with a plethora of parasitic infections. More commonly the gastrointestinal (GI) tract is infected and in developed countries protozoans are more likely to be the cause of infection compared to helminths. These GI protozoa are progressively becoming recognized as important pathogens in patients that are immunocompromised. The number of immunocompromised patients is increasing and therefore the likelihood of similar infections will also increase. This paper aims to highlight the key GI parasites affecting immunocompromised individuals in developed countries, discussing diagnosis, treatment options and also prevention. Cryptosporidium parvum may be the most common GI parasite found in the immunocompromised host closely followed by Cyclospora, however, Giardia duodenalis is the most common GI parasite found in developed countries. The pathogenesis of parasitic infection is not clear, poorly understood and diagnostic testing remains difficult with management continuing to be a challenge.

A case of a chronic salmonella infection following Roux-en-Y gastric bypass surgery, treated successfully by a laparoscopic cholecystectomy.

We report a case of chronic infection caused by Salmonella and cured by a laparoscopic cholecystectomy after Roux-en-Y gastric bypass (RYGB) surgery for obesity. This patient presented with a 2-year history of chronic abdominal pain, loose stools and excessive weight loss. Her stool and urine cultures were positive for Salmonella Despite multiple courses of antibiotics, she remained positive.After undergoing a laparoscopic cholecystectomy, the patient became asymptomatic and stools remained negative. In chronic carriers for Salmonella, the gall bladder is the common reservoir for the bacteria and removing it is usually curative.The possibility that the source of the may be in the biliary limb of her bariatric procedure and not in the gall bladder remained a concern.In patients who have had a RYGB, cholecystectomy is an effective treatment.All patients presenting with abdominal symptoms following RYGB should have stool and urine cultures taken as part of their work up.

Port site endometrioma: a rare cause of abdominal wall pain following laparoscopic surgery.

Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic endometriosis 6 months previously and presented with a swelling around her umbilical port site scar associated with cyclical pain during menses. Ultrasound scan reported a well-defined lesion in the umbilicus and MRI scanning excluded other pathology. As she was symptomatic, she underwent an exploration of the scar and excision of the endometrioma with resolution of her symptoms. Precautions should be taken to reduce the risk of endometrial seeding during laparoscopic surgery. All tissues should be removed in an appropriate retrieval bag and the pneumoperitoneum should be deflated completely before removing ports to reduce the chimney effect of tissue being forced through the port site. The diagnosis should be considered in all women of reproductive age presenting with a painful port site scar.