ABSTRACT
BACKGROUND: The Royal Victoria Eye and Ear Hospital provides a specialised ear, nose and throat (ENT) Emergency department (ED) service open to patients from the entire country, operating from 9 am to 5 pm on weekdays. Recently, this has been under threat of closure. AIMS: We analyse and determine the role of this ED in the current context and compare results to a previous study from June 1990. METHODS: A prospective study over a 1-month period (March 2014) was conducted. A questionnaire was used, adapted from the study in 1990. RESULTS: Comparative figures from June 1990 are in parentheses. During the study period, there were 945 (1167) consultations from 887 (779) patients. 57 % (45 %) were new patients and 43 % (55 %) were return patients. Repeat attendances were necessary in 54 (325) patients during this month. 56 % (35 %) were referred by their General Practitioner (GP), 38 % (52 %) self-referred, 2 % (8 %) by other hospitals and 4 % (5 %) from other sources. Diagnoses included otitis externa in 24 % (21 %), cerumen in 20 % (15 %), epistaxis in 6 % (9 %), Eustachian tube dysfunction in 12 %, foreign body removal in 4 % (5 %) and four new cases of head and neck cancer. Attendance numbers vary during the year but demand has risen over time. CONCLUSIONS: A dedicated ED provides an important role for ENT in Ireland and offers valuable experience for trainees. The loss of such a department may lead to an overwhelming burden on services in other hospitals.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Hospitals , Otorhinolaryngologic Diseases/epidemiology , Adolescent , Adult , Child , Child, Preschool , Ear Diseases/therapy , Female , General Practitioners , Humans , Infant , Infant, Newborn , Ireland , Male , Middle Aged , Nose/pathology , Otorhinolaryngologic Diseases/therapy , Pharynx/pathology , Prospective Studies , Referral and Consultation , Young AdultABSTRACT
BACKGROUND: Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains. METHODS: A systematic review and meta-analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed. RESULTS: Twenty-five RCTs were included in the meta-analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound-assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. -0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units). CONCLUSION: The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.
Subject(s)
Parathyroid Diseases/surgery , Thyroid Diseases/surgery , Drainage/methods , Humans , Length of Stay , Postoperative Care/methods , Publication Bias , Randomized Controlled Trials as Topic , Suction/methods , Treatment OutcomeABSTRACT
Epithelioid sarcoma, first described by Enzinger in 1970, classically presents in young adults and usually arises in the distal extremities. The proximal-type variant, first described in 1997 as a rare aggressive form of sarcoma, usually arises more proximally. It carries a higher mortality rate than classical limb epithelioid sarcoma and is often resistant to multimodal treatment. We report the case of a 27-year old male who had a delayed diagnosis of proximal-type epithelioid sarcoma of the forearm. This was originally thought to be a necrotising soft tissue infection and was unfortunately metastatic at the time of eventual diagnosis. The clinical and histopathological features of this challenging tumour are discussed and the relevant literature is reviewed.
