A change in clinical practice for aural foreign bodies - what we learnt from the coronavirus disease 2019 pandemic.

OBJECTIVE: This case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts. METHOD: A retrospective study of aural foreign body referrals over a six-month period was carried out. RESULTS: Thirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent). CONCLUSION: Because of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.

Ethanol induces the formation of water-permeable defects in model bilayers of skin lipids.

We show that ethanol can induce the formation of water-permeable defects in model membranes of skin, providing a fresh perspective on ethanol as a membrane modulator. We rationalise our findings in terms of the chemical nature of ethanol, i.e., a combination of its hydrogen bonding propensity and amphiphilic character.

Long-term outcomes after ROLL lumpectomy.

BACKGROUND: Occult breast lesions are being successfully targeted by means of Radioactive-guided Occult Lesion Localization (ROLL). Several reports demonstrate suitability of ROLL technique to excise non-palpable breast lesions with immediate advantages. AIM: Evaluation of long-term outcomes after ROLL guided lumpectomy for early breast cancer. MATERIALS AND METHODS A CONSECUTIVE SERIES OF NON PALPABLE EARLY INVASIVE BREAST CANCERS EXCISED WITH ROLL (151 PTS; DECEMBER 2002#ENTITYSTARTX02013;JUNE 2006) WERE FOLLOWED UP FOR LONG-TERM OUTCOMES, I.E. LOCAL AND/OR SYSTEMIC RECURRENCE. OUR FOLLOW-UP PROTOCOL INCLUDED 6 MONTHLY PHYSICIAN ADMINISTERED CLINICAL EXAMINATIONS AND 18 MONTHLY IMAGING, I.E. MAMMOGRAM. BONE SCAN, LIVER AND BRAIN IMAGING WERE REQUESTED ON CLINICAL NEED. CLINICAL AND/OR RADIOLOGICAL SUSPICIOUS LESIONS FOR LOCAL RECURRENCE WERE CONFIRMED PATHOLOGICALLY: RESULTS: The median follow-up was 46 months with all patients having a minimum 22 months follow-up. 3/151 local recurrences occurred (1.98%). CONCLUSIONS: Long-term outcomes, i.e. local recurrence of invasive breast cancer excised with ROLL guidance compares well with existing localization techniques.

Brief constant light accelerates serotonergic re-entrainment to large shifts of the daily light/dark cycle.

Brief ( approximately 2 day) constant light exposure (LL(b)) in hamsters dramatically enhances circadian phase-resetting induced by the 5-HT receptor agonist, (+/-)-2-dipropyl-amino-8-hydroxyl-1,2,3,4-tetrahydronapthalene (8-OH-DPAT) and other nonphotic stimuli. The present study was undertaken to determine if LL(b) can also amplify phase-resetting responses to endogenous 5-HT and accelerate re-entrainment to large-magnitude advance and delay shifts of the light/dark (LD) cycle. First, central serotonergic activity was increased by i.p. injection of L-tryptophan+/-the 5-HT reuptake inhibitor fluoxetine. Hamsters under LD or exposed to LL(b) received vehicle or drugs during the early morning, and phase-shifts of the locomotor activity rhythm were measured after release to constant darkness. Neither drug phase-shifted animals not exposed to LL(b) (P>0.5 vs. vehicle); however in animals receiving LL(b,)L-tryptophan with and without fluoxetine produced large phase-advance shifts (means=2.5+/-0.4 h and 2.6+/-0.2 h, respectively; both P<0.035 vs. vehicle). Next, the effects of LL(b) combined with 8-OH-DPAT or L-tryptophan+fluoxetine on serotonergic re-entrainment to 10 h phase-advance and phase-delay shifts of the LD cycle were assessed. In groups not exposed to LL(b), vehicle controls re-entrained slowly to the advance and delay shifts (means=16+/-1 and 24+/-4 days, respectively), but those treated with 8-OH-DPAT re-entrained faster (means=11+/-2 and 9+/-2 days, respectively; both P<0.05 vs. vehicle). In groups exposed to LL(b), vehicle controls re-entrained slowly to the advance and delay shifts (means=15+/-2 and 25+/-3 days, respectively); however those receiving 8-OH-DPAT rapidly re-entrained to the delay and advance shifts, with the majority (75%) requiring only 1-2 days (means=2+/-1 and 4+/-2 days, respectively; both P<0.05 vs. vehicle). Animals exposed to LL(b) and treated with L-tryptophan+fluoxetine also exhibited accelerated re-entrainment to a 10 h advance shift (mean=5+/-2 days; P<0.05 vs. vehicle). Thus through enhancing serotonergic phase-resetting, LL(b) facilitates rapid re-entrainment to large shifts of the LD cycle which offers a potential approach for treating circadian-related desynchronies.

Recurrence after ROLL lumpectomy for invasive breast cancer.

BACKGROUND: Impalpable breast lesions are being successfully targeted by means of radio-guided occult lesion localisation (ROLL). Although ROLL allows adequate removal of sub-clinical breast lesions within a smaller volume of glandular tissue no long-term outcomes have been reported. AIM: To evaluate the recurrence of invasive cancer after ROLL lumpectomy. METHODS: A consecutive series of impalpable invasive breast cancers excised with ROLL (151 pts; Dec 2002-June 2006) has been followed up for local and/or systemic recurrence with six monthly clinical examinations and 18 monthly mammograms. Bone scan, liver and brain imaging were requested when clinically appropriate. Clinical and/or radiological suspicious lesions for local recurrence were confirmed pathologically. RESULTS: The median follow-up was 33 months with all patients having a minimum 22 months follow-up. Three (out of 151 impalpable invasive cancers) local recurrences occurred (1.98%). CONCLUSIONS: Local recurrence of sub-clinical invasive breast cancer excised with radioisotope guidance compares well with the existing localisation techniques. Its implementation is highly recommended.

The Service Review Committee: Royal College of Radiologists. Philosophy, role, and lessons to be learned.

The Service Review Committee (SRC) was established by the Board of the Faculty of Clinical Radiology in 2000. At the time, the RCR identified a clear need to respond appropriately and swiftly to requests for review of service provision in clinical radiology departments where trusts were concerned about standards or performance issues. It was recognized by the College that the poorly performing radiologist is often part of a department that is itself dysfunctional, and that sub-optimal performance may often reflect inadequate management, lack of support, overwhelming workload, or inadequate facilities. Following the completion of a range of service reviews during its first 6 years, the SRC recognized that among the reviews there were recurring themes and causes for poorly functioning departments. The committee felt it appropriate to share these with the wider radiological community. In doing so, it is hoped that other departments may recognize their own problems at an early stage and take appropriate steps to prevent any escalation of difficulties.

Tumour localisation with a metal coil before the administration of neo-adjuvant chemotherapy.

Complete clinical response (CR) with tumour disappearance is not uncommon after neo-adjuvant chemotherapy (NAC) for locally advanced breast cancer, avoiding 25% mastectomies by facilitating breast-conserving procedures. We reviewed our series to understand the feasibility and utility of marking the cancer site before administering NAC. In total, 23 women (median age 47 years) with T2-4, N0-1, M0 tumours were considered unsuitable for breast conserving surgery between January 2002 and November 2003, thus received NAC following a coil placement at the core of tumour. All patients had the coil successfully inserted and no migration or infection was recorded. Eight patients (35%) had a radiological CR (rCR) including 3 (13%) with pathological CR (pCR). In total, 87% patients were managed conservatively. The insertion of a metal coil is a simple mean to provide a landmark for localisation and excision when the breast lump becomes impalpable and radiologically undetectable after the administration of NAC.

Occult breast lesions: A comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL).

Mammographic screening increases the number of impalpable breast cancers requiring surgical excision. It is important to optimise the localisation technique to remove the smallest amount of tissue, still adequately excising the lesion. The last 65 wire-guided lumpectomies (WGLs) were compared vs. the first 65 radioguided occult lesion localisations (ROLLs) performed for impalpable breast cancers. Data collection included patient's age, radiological abnormality, pre-operative core biopsy, type of primary surgery, length of localisation and excision, hospital stay, cancer size, weight and volume of the excised specimen, clearance margins. All patients were successfully localised with ROLL and WGL. Localisation time was reduced with ROLL (P<0.001). Clear margins were achieved in 83% ROLLs and 57% WGLs (P=0.001). Pathological cancer size and specimen weight were similar in both groups, although the specimen volume was slightly smaller for ROLL. A total of 74% ROLLs had excellent cosmetic outcomes and 26% good, vs. 55% excellent and 45% good in WGLs. A larger amount of normal breast tissue was excised with WGL, without achieving any better cancer clearance. ROLL provides a feasible alternative to WGL. This quick and simple technique achieves an improved rate of clear margins.

Repair of anterior secondary palate fistula using tongue flaps.

Seventy-two cases of palatal fistulae are presented. The location on anterior part of secondary palate is due to lack of double layer closure. Vascular pattern of tongue is detailed. Operative details of using tongue flap as oral layer in closure of fistula are described. Undue mobility of tongue and prevention of breakdown of tongue flap repair incidence of which is low in present series are mentioned. It is suggested as excellent method of closure of palatal fistulae in difficult cases.