Economic impact of recurrent respiratory papillomas in a UK adult population

2016 ◽  
Vol 130 (7) ◽  
pp. 645-649 ◽  
Author(s):  
A Harrison ◽  
J Montgomery ◽  
F B Macgregor
Keyword(s):  
Financial Burden ◽  
Adult Population ◽  
Information Services ◽  
Single Centre ◽  
Cost Information ◽  
Benign Condition ◽  
Papilloma Virus ◽  
History Of ◽  
Recurrent Nature

AbstractObjective:To calculate the financial burden of recurrent respiratory papilloma. This study is UK-based, where up until now no financial estimates have been calculated for this group of patients.Background:Recurrent respiratory papilloma is caused by the human papilloma virus (subtypes 6 and 11). The burden for the patient and the healthcare system is significant given the recurrent nature of the disease.Methods:Data were collected, using a questionnaire completed during routine clinical follow up, from a single centre managing recurrent respiratory papilloma in Glasgow, Scotland. Cost information was sourced from the Scottish Government's Information Services Division.Results:Fourteen patients with active recurrent respiratory papilloma between 2013 and 2014 were identified. The direct measurable cost to NHS Greater Glasgow and Clyde amounted to £107 478.Conclusion:Recurrent respiratory papilloma is a benign condition, but the financial implications of diagnosis are significant. Recurrent respiratory papilloma has a natural history of relapse and remission, and patients may require healthcare input over a period of several years.

scholarly journals A case of pigmented fungiform papillae of tongue in a young female with iron deficiency anaemia

2020 ◽  
Vol 8 (3) ◽  
pp. 1145
Author(s):  
Shoiab M. Patto ◽  
Nazish M. Keena ◽  
Beenish M. Keena
Keyword(s):  
Iron Deficiency ◽  
Clinical Diagnosis ◽  
Iron Deficiency Anaemia ◽  
Young Female ◽  
Fungiform Papillae ◽  
Benign Condition ◽  
Deficiency Anaemia ◽  
History Of ◽  
Benign Nature

Fungiform papillae are red/pink, mushroom shaped projections located on the tip and dorsolateral part of tongue. It harbours several taste buds. Pigmented fungiform papillae is a not so common benign condition which involves pigment deposition in fungiform papillae. Authors report a case of 35 years female who presented with history of blackish spots over tongue for past 10 years with no other associated symptom. Patient had conjunctival pallor (moderate) and rest of the examination was normal. Investigations showed iron deficiency anaemia with Hb. of 9.5 mg/dl. A clinical diagnosis of Pigmented Fungiform Papillae (PFP) with associated Iron Deficiency Anaemia (IDA) was made. Patient was explained in detail about the benign nature of disease and was put on oral iron therapy. Follow up after 2 months was advised.

Subacute Meckel’s diverticulum perforation

2021 ◽  
Vol 14 (3) ◽  
pp. e237840
Author(s):  
Alberto Robles Méndez Hernández ◽  
Oscar Alejandro Mora-Torres ◽  
Hugolino Andrade Lopez ◽  
Jorge Alfonso Perez Castro Y Vazquez
Keyword(s):  
Abdominal Pain ◽  
Adult Population ◽  
Meckel’S Diverticulum ◽  
Ileocecal Valve ◽  
The Elderly ◽  
Meckel's Diverticulum ◽  
Intestinal Bleeding ◽  
History Of ◽  
Mechanical Anastomosis

Meckel’s diverticulum is the most common intestinal congenital defect, its prevalence is 0.2%–4.0% and it occurs more commonly in children younger than 2-year old with intestinal bleeding and abdominal pain. Perforation in the elderly is very rare with no more than 35 articles reported worldwide. Here we report the case of a 62-year-old man who was admitted to hospital with a history of acute abdominal pain with a 20-day onset. The patient was treated with laparotomy and 30 cm ileal resection was performed for an 8×5 cm perforated ileum tumour at 50 from ileocecal valve with a side-to-side mechanical anastomosis for reconstruction. Having morbidity Clavien-Dindo scale I in postsurgical and good outcome in 6-month follow-up. Meckel’s diverticulum is an infrequent pathology in paediatric and even rarer in adult population, however, it is always important to keep in mind how to act when is seen either as a finding or as a complication.

Spinal Arachnoid Cyst in Children

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Wihasto Suryaningtyas
Keyword(s):  
Arachnoid Cyst ◽  
Nerve Root ◽  
Financial Burden ◽  
Trauma Surgery ◽  
Arachnoid Cysts ◽  
History Of ◽  
Spinal Arachnoid Cyst ◽  
Intradural Arachnoid Cysts ◽  
Nerve Root Involvement

Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel.

Dystonia and acute psychotic episode complicated by neuroleptic malignant syndrome in an adolescent with CYP2D6 deficiency

2011 ◽  
Vol 26 (S2) ◽  
pp. 1048-1048
Author(s):  
T. Wolańczyk ◽  
A. Butwicka ◽  
K. Szymańska ◽  
W. Retka
Keyword(s):  
Case Report ◽  
Neuroleptic Malignant Syndrome ◽  
Pediatric Population ◽  
Adult Population ◽  
Hepatic Metabolism ◽  
Poor Metabolizers ◽  
Psychotic Episode ◽  
Initial Symptoms ◽  
History Of

IntroductionCYP2D6 gene encodes an isozyme of the P450 cytochrome mono-oxygenase family, responsible for hepatic metabolism of the majority of neuroleptics. Phenotypes of CYP2D6 activity are ultrarapid, extensive, intermediate, and poor metabolizers. Prevalence of poor metabolizers is relatively high in European Caucasian population and ranges between 5–10%. The subjects with such phenotype are more likely to manifest adverse reactions and toxicity following administration of drugs in standard doses.ObjectiveWe describe a case report of a 16 year old male patient with dystonia and acute psychotic episode who developed neuroleptic malignant syndrome (NMS) associated with antipsychotic medication and a non-functional CYP2D6*4 allele.MethodsThe patient's clinical course is a case report.ResultsThe patient developed NMS after treatment with standard doses of antipsychotics. Genotyping revealed that this patient was homozygous for non-functional CYP2D6*4 allele. Ziprasidone was used for a follow-up treatment after recovery from the NMS. Persistent neuropsychiatric impairment was noted after 9-months.ConclusionsInitial symptoms developed by this patient may be explained by overuse OTC cough medication. This case suggest that as in adult population, non-functional CYP2D6 allele could be associated with NMS in pediatric population. This means that screening for CYP2D6*4 allele in pediatric patients with NMS and history of adverse drug reactions could be helpful in the treatment of residual state after NMS.

scholarly journals Five-year follow-up and clinical outcome in euthyroid patients with thyroid nodules

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Katica Bajuk Studen ◽  
Simona Gaberscek ◽  
Edvard Pirnat ◽  
Katja Zaletel
Keyword(s):  
Cohort Study ◽  
Clinical Outcome ◽  
Thyroid Nodules ◽  
Thyroid Ultrasound ◽  
Single Centre ◽  
Need For Treatment ◽  
End Point ◽  
Single Centre Experience ◽  
History Of

Abstract Background Thyroid nodule diagnosis has become increasingly frequent. Defining optimum surveillance intervals for patients with unsuspicious thyroid nodules remains a challenge. This was a single centre cohort study in which patients diagnosed with unsuspicious thyroid nodules in whom no treatment was indicated were invited for re-evaluation 5 years after the diagnosis. The primary end point of the study was to estimate the change in nodule size with thyroid ultrasound (US) and the secondary end point was to assess the need for clinical management 5 years after the diagnosis. Patients and methods Baseline patient parameters and ultrasound characteristics of the nodules were retrospectively collected. At follow-up, thyroid ultrasound was performed. Results A hundred and eighteen (107 women / 11 men, aged 56.8 ± 13.4 years) patients were included in the study having 203 nodules at baseline, with mean largest nodule diameter 10.5 ± 7.4 mm. After 5 years, 58 (28.6%) nodules significantly increased in size, 27 (13.3%) decreased, and for 104 (51.2%) of nodules, no change in size was noted. Fourteen (6.9%) nodules disappeared. Additional 26 new nodules (mean largest diameter 7.7 ± 5.0 mm) in 16 patients were identified at follow-up. Regarding the clinical outcome, no new thyroid cancers were found. For 107 (90.7%) patients no further management was indicated. Five (4.2%) patients were referred to thyroidectomy because of the growth of the nodules. Two (1.7%) patients were treated for hyperthyroidism. Four (3.4%) patients did not complete the study. Conclusions We report a single centre experience of the natural history of unsuspicious thyroid nodules. Our results showed that 71.4% of such nodules remained stable in size, decreased or even disappeared and that the vast majority of the patients remained clinically stable with no need for treatment 5 years after the diagnosis.

Brown tumors of the skull base

2003 ◽  
Vol 98 (2) ◽  
pp. 417-420 ◽  
Author(s):  
Mubarak Al-Gahtany ◽  
Michael Cusimano ◽  
William Singer ◽  
Juan Bilbao ◽  
Kalman Kovacs ◽  
...  
Keyword(s):  
Skull Base ◽  
Brown Tumor ◽  
Benign Condition ◽  
Content Type ◽  
Long Term Follow Up ◽  
History Of ◽  
Brown Tumors ◽  
Fine Print

✓ The natural history of brown tumor of the skull base, a rare and benign condition, has not been adequately documented, particularly after nonsurgical treatment and over a long follow-up period. The authors report a case of brown tumor of the ethmoidal sinus, documenting its clinical, neuroimaging, and pathological features with long-term follow-up results, and review previous reports on this disorder.

scholarly journals P-BN18 Cholecystectomy following ERCP: A retrospective audit from a single centre

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Lauren Wallace ◽  
Joshua Brown ◽  
Michele Calabrese ◽  
Pooja Prasad ◽  
Jakub Chmelo ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adult Population ◽  
Operative Management ◽  
Single Centre ◽  
Joint Decision ◽  
Nice Guideline ◽  
Retrospective Audit ◽  
Elective Procedure ◽  
Bile Duct Calculi

Abstract Background 15% of the adult population are estimated to have gallstones (GS) and managing GS related disease can represent a significant challenge to surgical and endoscopic services alike. One particular challenge is the management of bile duct calculi (BDC), and treatment can vary according to the unit/institution. NICE has published guidelines (CG188) on the management of GS disease with the recommendation that bile duct clearance and cholecystectomy be offered for symptomatic and asymptomatic BDC. This retrospective audit was performed to determine compliance of a single centre with respect to offering cholecystectomy following ERCP for BDC. Methods A retrospective audit was performed for the year 2018 at a single centre utilising the trust ERCP database. The audit was analysed against NICE guideline CG188 and specifically whether patients treated with ERCP for BDC were then treated with cholecystectomy or had a documented justification as to why cholecystectomy was declined. 2018 was chosen so that at least a 2-year period of follow-up could be analysed. As well as the trust ERCP database, the trust electronic documentation record and paper notes were consulted to determine compliance with the guideline. Results 149 ERCPs were performed on 121 patients at this centre in 2018. Of these, 82 patients were included as 39 had an ERCP for malignant disease or had already had a cholecystectomy. Of those 82, 51 (62%) had an ERCP as an emergency while 31 (38%) had an elective procedure. The median age was 65, 54% being male and 46% female. 45 (55%) had a cholecystectomy following ERCP, 29 as an emergency, and 16 electively. Of those 37 who did not have a cholecystectomy, 20 (54%) had no recorded documentation to justify a decision not to proceed to cholecystectomy. Conclusions GS disease has the potential to cause significant morbidity. If an ERCP has been performed for BDC, NICE recommends that cholecystectomy should be offered to mitigate further GS related complications. Patients may of course decline an operation, or a joint decision made not to pursue operative management due to identified surgical risks. This audit demonstrated that 54% of patients at this institution who did not have a cholecystectomy following ERCP had no documented reason why cholecystectomy was declined. Robust follow-up and documentation measures have since been put in place and a follow-up audit is being performed to monitor improvement.   

Long-term natural history of highly myopic eyes with a dome-shaped macula with or without untreated serous retinal detachment: a 4-year follow-up study

2020 ◽  
pp. bjophthalmol-2020-316629
Author(s):  
Francesco Viola ◽  
Gaia Leone ◽  
Elena Garoli ◽  
Claudia Mainetti ◽  
Davide Galli ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Morphological Changes ◽  
Serous Retinal Detachment ◽  
Single Centre ◽  
Follow Up Study ◽  
Corrected Visual Acuity ◽  
Single Centre Study ◽  
History Of

PurposeTo evaluate the long-term functional and morphological changes occurring in myopic eyes with a dome-shaped macula (DSM), with or without untreated serous retinal detachment (SRD).MethodsThis prospective, single-centre study enrolled consecutive cases of highly myopic patients with DSM with or without a SRD. Patients underwent complete ophthalmological examinations, optical coherence tomography, axial length measurements and autofluorescence. Follow-up visits were performed with a maximum interval of 6 months for 4 years. Eyes with choroidal neovascularisation were excluded.ResultsTwenty-six eyes from 18 patients (mean age 61.2) were included. At baseline, 13 eyes had SRD and 13 did not. The DSMs were either horizontal (69%) or round (31%). There were no significant differences in best-corrected visual acuity (BCVA) between eyes with and without SRD during the 48-month follow-up period. Multivariate analysis showed that baseline BCVA was the only parameter among those analysed (age and SRD height) to have a significant effect on the final BCVA (p<0.0001). SRD fluctuated overtime and SRD height was significantly influenced by choroidal thickness (p=0.002). The scleral bulge thickness had no effect on SRD thickness.ConclusionsBCVA remained clinically stable over 4 years without treatment despite the fluctuations and persistence of the SRDs.

Isolated pancreatic and peripancreatic nodal tuberculosis: A single-centre experience

2020 ◽  
pp. 004947552096294
Author(s):  
Sukanta Ray ◽  
Kshaunish Das ◽  
Ranajoy Ghosh
Keyword(s):  
Single Centre ◽  
Antitubercular Drugs ◽  
Pancreatic Tuberculosis ◽  
Number Of Patients ◽  
Single Centre Experience ◽  
History Of ◽  
High Index Of Suspicion ◽  
Modern Image ◽  
Extensive Surgery

Isolated pancreatic and peripancreatic nodal tuberculosis may mimic pancreatic malignancy and may result in unnecessary surgery. Being a treatable disease, it is desirable to diagnose this condition without a laparotomy. Pancreatic tuberculosis should be considered in the differential diagnosis of a peripancreatic mass if the patient is young, residing in endemic tuberculosis regions, or has had a history of tuberculosis. We report our experience with pancreatic tuberculosis. Over a period of 12 years, we have managed 16 such patients, of whom 10 were diagnosed preoperatively. In six, the diagnosis was only made after extensive surgery. All 16 patients received antitubercular drugs and were well at a median follow-up of 52 months. Although pancreatic tuberculosis can be diagnosed by modern image-guided biopsy in a fair number of patients, if a high index of suspicion is maintained, a laparotomy may still be unavoidable in a subset of patients.

scholarly journals Acute Confusional Migraine: Unusual Great Masquerader—Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Bashar Tanous ◽  
Raad Tahtouh ◽  
Sundus Sardar ◽  
Sara Mohamed ◽  
Aseel Sukik ◽  
...  
Keyword(s):  
Literature Review ◽  
Children And Adolescents ◽  
Diagnostic Criteria ◽  
Rare Variant ◽  
Adult Population ◽  
Case Presentation ◽  
History Of ◽  
Recent Edition

Background. Acute confusional migraine (ACM) is a rare variant of migraine, mainly prevalent in children and adolescents. It is not currently indexed as a distinct variant of migraine likely since only a few cases were reported in the adult population. We report a case of delayed ACM diagnosis in a young man and present a concise-related literature review. Case Presentation. A thirty-eight-year-old man with a past medical history of migraine, not on any treatment, presented with headaches accompanied by confusion. Over a two-year period before the current presentation, he experienced two episodes of confusion, which required hospital admission for evaluation: once mislabeled as a psychiatric illness and diagnosed as a migrainous infarct in the second hospitalization. In the current presentation, he reported a similar history of headache accompanied by confusion. The examination was remarkable for disorientation; otherwise, no focal deficit was elicited. Laboratory testing, cerebrospinal fluid, and neurological imaging were all unremarkable. His symptoms improved spontaneously within less than twenty-four hours, similar to his previous presentations. After two-year history of episodic confusion and after excluding other plausible causes of confusion, guided by proposed diagnostic criteria, we diagnosed him as a case of ACM. The patient remains well at the follow-up of two months after discharge. Discussion and Conclusion. ACM is a rare variant of migraine and is often a challenge for clinicians to diagnose appropriately. Until recent years, the disease was thought to be limited to children and adolescents. However, recently few reports also expanded the incidence of this entity to the adult population. There is a significant gap in knowledge about proper identification and treatment of this condition, leading to delayed or overlooked ACM diagnosis. Moreover, the recent edition of the International Classification of Headache Disorders (ICHD-3) does not account for this entity, thereby further adding to physicians’ lack of awareness regarding this migraine subtype. The authors emphasize that clinicians be aware of this entity and adequately utilize the existing proposed diagnostic criteria for ACM until standardized and validated tools are available. We also believe that this entity should be acknowledged in the subsequent migraine guidelines and classifications.

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