Achromobacter xylosoxidans in idiopathic cystic bronchiectasis.

This is the first case in the English language describing Achromobacter xylosoxidans in a patient with idiopathic bronchiectasis. A 66-year-old man with bronchiectasis presented with shortness of breath to the emergency department of our institution, a district hospital in the UK. His medications included long-term supplemental oxygen therapy and prophylactic azithromycin. Following 2 days admission to the respiratory unit, his saturations significantly deteriorated, and the patient was admitted to intensive care with type II respiratory failure. Following a week of intubation and ventilation, multidrug resistant A. xylosoxidans was isolated from the tracheal aspiration secretions. The patient recovered after receiving targeted intravenous antimicrobial therapy.

Quality improvement in documentation for patients with suspected facial fractures: use of a structured record keeping tool.

OBJECTIVE: Patients with injuries to the midface frequently sustain ophthalmic injuries and fractures to the facial bones. Despite this, basic ophthalmic examination and assessment of important clinical signs are often missing from the records of patients attending the emergency department (ED). We implemented a structured record keeping tool to improve documentation for patients presenting to the ED with midface injuries. METHODS: At our institution, a structured record keeping tool was introduced to document important clinical features of maxillofacial injuries. This assessment tool included 17 key clinical diagnostic signs and symptoms including a six-part basic ophthalmic examination. We audited 369 patients attending the ED with suspected midface bony injuries using this tool. RESULTS: A statistically significant improvement in the documentation of all six ophthalmic parameters was seen. The documentation rate of visual acuity increased by 41.1% (SE 2.8; p<0.001); diplopia by 45% (2.9; p<0.001); double vision by 51% (2.9; p<0.001); lateral subconjunctival haemorrhage with no posterior limit by 83% (2.6; p<0.001) and enopthalmous by 86% (2.4; p<0.001). Documenting whether pupils were equal and react to light increased by 14% (1.4; p<0.001). In addition, 10 out of 11 non-ophthalmic parameters showed significant improvement. The mean global record keeping score increased from 45.3% (95% CI 42.7% to 47.7%) to 99.1% (95% CI 98.2% to 100%; p<0.001). CONCLUSIONS: This work demonstrates that a structured record keeping tool is a simple and effective method of significantly improving clinical documentation for patients with facial injuries presenting to the ED.

Myopericytoma of the parotid region treated by extracapsular dissection.

Myopericytoma (MPC) is a vascular neoplasm exhibiting differentiation towards perivascular cells. Variable cytoarchitechtural features are visible within MPC, and there is much overlap between MPC, myofibroma and glomus tumours. MPC have a local recurrence rate of 10-20% and malignancy has been described in a few published cases. Previously, superficial parotidectomy has been recommended for MPC but, in this case, the surgical approach was via extracapsular dissection (ECD). A 66-year-old Caucasian man presented with a palpable mass arising from the superficial lobe of the right parotid gland. Following removal by ECD, the histopathological diagnosis of MPC was made. This is the first published report describing ECD of MPC associated with the parotid gland. ECD is preferable to superficial parotidectomy for small superficial lesions such as MPC, with similar oncological outcomes and fewer functional and aesthetic complications.