Care of laryngectomy stomas in general practice.

BACKGROUND: Laryngectomy stomas are formed following excision of the larynx, usually for the treatment of an underlying malignancy. This is a permanent stoma in which the trachea is separated from the oesophagus and brought to an opening in the neck. The complication rate of laryngectomy stomas is reported to be more than 60%. OBJECTIVE: The purpose of this article is to provide an overview of total laryngectomy stomas and inform general practitioners (GPs) of the frequently encountered complications, to improve stoma-related care and ultimately patient outcomes. DISCUSSION: Numerous early and late complications can be encountered by a GP, some of which are potentially life-threatening and require prompt recognition. Care of patients who have had a laryngectomy is multi-disciplinary, and GPs are often the first point of contact. The importance of a well-informed GP who can treat the patient and identify when they require referral to a stomal therapy nurse, speech pathologist or surgeon cannot be understated.

Removal of ear, nose and throat foreign bodies: A review

BACKGROUND: Patients with foreign bodies in their ear, nose or throat typically present to general practitioners. The safe and timely removal of foreign bodies ensures good patient outcomes and limits complications. OBJECTIVES: The aim of this paper is to outline common foreign objects and review the associated anatomy that may make removal difficult. A description of instruments and indications for use is provided, along with circumstances where specialist referral is warranted. DISCUSSION: The use of appropriate techniques for removal of foreign bodies reduces the complications of removal and associated distress, and limits the number of cases that require surgical input.

Diagnosis and Treatment of Hereditary Hemorrhagic Telangiectasia.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disorder known for its debilitating symptoms. More than 90% of patients with HHT experience epistaxis, and they average up to 18 bleeds per month. We review the current literature on the pathophysiology, clinical presentation, and management of HHT. METHODS: We searched MEDLINE, EMBASE, and PubMed and identified 19 articles published since 2000 with current information on HHT. RESULTS: HHT is a disease more commonly associated with significant morbidity rather than mortality. The morbidity of the disease and decreased quality of life are the result of the recurrent and potentially severe epistaxis that the majority of patients with HHT experience. During active epistaxis, the effective emergency techniques of locally applied pressure, nasal packing anteriorly and/or posteriorly, and cauterization are effective. Medical treatment with antiestrogen therapy has shown promising results, but further research is needed to determine the long-term side effects and the limitations of lifelong therapy. Research directed toward bleeding reduction and prevention has yet to have a breakthrough. Although initial reports suggest that intranasal bevacizumab is an effective agent, further research is required. CONCLUSION: Interventional treatments in life-threatening and/or severe circumstances will continue to be used because of their effectiveness. Research into the pathophysiology of HHT has led to the development of potential therapies that prevent and decrease the severity of epistaxis, but the current evidence is insufficient to ascertain best practice. At present, appropriate management of acute epistaxis coupled with early diagnosis and referral to an ear, nose, and throat specialist should be the mainstay of treatment.

Lisfranc injuries.

BACKGROUND: Injury to the tarsometatarsal joint is a relatively rare occurrence that is commonly missed, leading to debilitating outcomes. For this reason, it is considered a red flag in general practice. OBJECTIVE: This article reviews the current literature on tarsometatarsal injuries and describes clinical assessment, imaging and management. DISCUSSION: Lisfranc injuries refer to the displacement of the metatarsals from the tarsus, with special attention placed on the second tarsometa-tarsal joint and Lisfranc ligament. These injuries can occur in numerous circumstances, such as motor vehicle accidents, crush inju-ries and falls. Indirect mechanisms include axial force through the foot or twisting on a plantar flexed foot. Suggestive examination signs include plantar ecchymosis, mid-foot pain and positive findings in the provocative tests described in the article. Weight-bearing radiographs are vital for diagnosis. Correct and prompt management is key to avoiding posttraumatic arthritis, a devastating but common complication of Lisfranc injuries.