Felton S.; Felton M.; Kingston T.Journal of the American Academy of Dermatology; May 2014

Bilateral superficial granulomatous pyoderma of the auricular and periauricular skin
Journal of the American Academy of Dermatology, May 2014, vol./is. 70/5 SUPPL. 1(AB202), 0190-9622 (May 2014)
Author(s): Felton S.; Felton M.; Kingston T.

Abstract:

A 36-year-old presented with a 3-month history of a nonhealing 5-mm diameter ulcer in the left conchal bowl. Swabs revealed no bacterial growth, and blood tests, including eosinophil count, were normal and antineutrophil cytoplasmic antibody negative. Histology from excisional biopsy, performed because of suspected malignancy, described extremely acanthotic squamous epithelium with ulcerated areas lined by palisading histiocytes. The dermis had a neutrophilic and in some areas eosinophilic infiltrate, again with palisading histiocytes. The cartilage was degenerate but not inflamed. There was no dysplasia. The key diagnosis proposed was superficial granulomatous pyoderma. The other histologic differentials, infection and systemic vasculitis, were excluded clinically.

Unfortunately, he subsequently developed marked ulceration across the ipsilateral periauricular skin and within the contralateral conchal bowl. Some areas have healed with cribriform scarring. Treatment with high-dose oral prednisolone and azathioprine did not provide sustained improvement. Minocycline and dapsone had limited success, whilst more recently he has commenced anti-tumor necrosis factor therapy with infliximab after
excluding underlying malignancy.

Publication Type: Journal: Conference Abstract
Source: EMBASE

Iyer S.; Collum J.; Babores M; Ear Nose and Throat; March 2014

Descending necrotizing mediastinitis: A conservative approach
Citation: Ear, Nose and Throat Journal, March 2014, vol./is. 93/3(E11), 0145-5613 (March 2014)
Author(s): Iyer S.; Collum J.; Babores M.

Abstract:

Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous
pleural drainage may be initially appropriate for the stable patient.

Publication Type: Journal: Article

Source: EMBASE

Full Text: Available from ProQuest in Ear, Nose and Throat Journal
Available from EBSCOhost in ENT: Ear, Nose & Throat Journal

Lakhanpal A.; Watters C.; Hughes C.; Iyer S.; Babores M. Thorax; Dec 2013

Outpatient management of pulmonary embolism-patient characteristics and outcomes. 

Citation: Thorax, December 2013, vol./is. 68/(A145), 0040-6376 (December 2013)
Author(s): Lakhanpal A.; Watters C.; Hughes C.; Iyer S.; Babores M.

Abstract:

Management of Pulmonary Embolism (PE) has been until recently largely in-patient based and markedly affects length of stay in these patients. Recent evidence suggests that suspected or confirmed cases of PE can be managed out of hospital. We present our experience of outpatient management of PE in a small district general hospital.

Method:

We identified 35 patients investigated/treated for PE as outpatient
between March 2012 and June 2013. Demographic and clinical data was collected from case notes. Statistical analysis was performed on Medcalc based on normality.

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SG Anderson, NS Malipatil, H Roberts, G Dunn; Primary Care Diabetes 2014

Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes

Volume 8, Issue 1, April 2014, Pages 65–69

George Dunn of East Cheshire Trust Podiatry Service co-authored this article published in Primary Care Diabetes.

Abstractpcarediabetes
Introduction: Painful peripheral neuropathy in people with type 1 diabetes is a disabling and costly complication. A greater understanding of predisposing factors and prescribing may facilitate more effective resource allocation.

Methods: The Townsend index of deprivation (numerically higher for greater disadvantage) was examined in the pseudonymised records of 1621 (684 females) individuals with type 1 diabetes and related to prevalence of drug treated severe diabetes related neuropathic pain.

Results: Treatment for neuropathic pain was initiated in 280 patients, who were older at 57.1 vs 45.6 years and had greater BMI (29.8 vs 27.8 kg/m2p < 0.0001). HbA1C was similar between groups, whilst eGFR was lower in the neuropathic pain group.

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BMJ Learning latest modules

Scenario from BMJ Learning – what would you do?

A 6 week old baby is examined at his baby check. His legs appear to be the same length but he has asymmetrical leg creases. You perform Ortolani’s test and feel a clunk. What is likely to be going on? If you are not sure, then this module should help. Click on the link to complete it today:

How to do the infant physical examination at 6-8 weeks (baby check)

And here are our most popular modules in emergency medicine for you to complete:

Chest pain of recent origin – assessment and diagnosis: in association with NICE

Early management of adults with an uncomplicated first generalised seizure

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