Case report of glomus jugulare tumour associated with a posterior fossa cyst.

A subgroup of complex glomus jugulare tumours exists. This includes: multiple, giant or neuropeptide-secreting lesions; those associated with other lesions, such as dural arterio-venous malformation or an adrenal tumour; and tumours in which there has been previous treatment with adverse outcome. To our knowledge, we present the first case of a glomus jugulare tumour associated with a posterior fossa cyst. This entity should be included in the subgroup of complex glomus jugulare tumours.

Continuity of care and the European working time directive: a maxillofacial perspective.

The European Working Time Directive (EWTD) was introduced in 1993 and was heralded as both a challenge and an opportunity for the NHS to modernize its services Continuity of care is usually viewed as the ongoing relationship between a patient and a single practitioner. Fragmentation of this continuity by many doctors being involved in a patient's management may weaken this relationship. The effect of the EWTD on junior doctors training in various specialities is well studied, we however were interested to assess the effect of the EWTD on the patient-doctor relationship in a maxillofacial setting and aimed for this paper to serve as an indicator of current practice and facilitate future research in this area. Seventy-five consecutive patients were studied with 72 patient proformas analysed. Our findings show greater same consultant patient contact than that of the specialist registrars and senior house officers. We feel that this is largely due to new work patterns introduced through the advent of the EWTD.

The role of matrix metalloproteinases -9 and -2 in development of neonatal chronic lung disease.

AIM: Matrix metalloproteinases (MMPs) -9 and -2 degrade type-IV collagen, a major constituent of lung basement membrane, and may have a role in the pathogenesis of neonatal chronic lung disease (CLD). We determined factors influencing MMP levels in neonatal bronchoalveolar lavage (BAL) fluid to establish whether an imbalance between MMP and its inhibitor could be implicated in CLD. METHODS: We measured MMP-9 and -2 and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in 316 BAL fluid samples from 121 babies of gestational ages 23 to 42 wk over the first 14 d of life to determine effects of gestation and postnatal age. Median MMP-9, -2, TIMP-1 and MMP-9/TIMP-1 ratio in BAL were further studied in a subgroup of 85 babies <33 wk gestation to determine their ability to predict CLD and to establish effects of antenatal corticosteroid therapy (ANCS). RESULTS: MMP-9, -2 and TIMP levels did not vary with postnatal age over the first week. Median MMP-9 levels and MMP-9/TIMP-1 ratio increased with decreasing gestation in preterm babies. The MMP-9/TIMP-1 ratio was higher in babies who developed CLD, implying a proteinase/antiproteinase imbalance, but this association disappeared when controlled for gestational age. ANCS had no effect on BAL fluid MMP or TIMP levels. CONCLUSION: MMPs may have a role in the development of lung injury and fibrosis, but estimating their levels in the first week of life does not help with prediction of CLD.