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.


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.


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.


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.


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.

Continue reading

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.

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.

Continue reading

News from Health Technology Assessments

NHS patients will benefit from £20 million investment into surgical research

Patients will benefit from £20 million funding into research on new cutting-edge surgical techniques, the President of the Royal College of Surgeons (RCS) has said. Ten of these projects have been funded by the NIHR HTA Programme. These include a project looking at total ankle replacement versus ankle arthrodesis and bypass versus angioplasty in severe ischaemia of the leg. [more…]

Intraoperative Radiation for Breast Cancer Study in The Lancet

The five year results of an NIHR HTA-funded study, on targeted intraoperative radiotherapy (TARGIT) for patients with breast cancer, have been published in The Lancet. [more…]

NIHR launches “Focus on Stroke” as ground-breaking stroke trial opens in the UK

EuroHYP-1, the largest worldwide clinical trial of a new revolutionary stroke treatment called Therapeutic Hypothermia, is due to open in the UK. The study is just one of those featured on “Focus on Stroke”, a new online resource from the NIHR aimed at raising public awareness of the exciting developments happening in stroke research. [more…]