Reversible atrial fibrillation secondary to a mega-oesophagus

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it increases in prevalence with advancing age to about 5% in people older than 65 years. CASE PRESENTATION: We present a rare case of atrial fibrillation secondary to a mega-oesophagus occurring in an 84-years-old Caucasian woman. The patient had a history of progressive dysphagia and the accumulation of food debris lead to mega-oesophagus. CONCLUSION: The diagnosis was made by barium swallow and electrocardiogram; evacuations of 300 ml of the food debris lead to complete resolution of the arrhythmia. The possible aetiology leading to this AF is discussed

Laryngocele: a rare complication of surgical tracheostomy

BACKGROUND: A laryngocele is usually a cystic dilatation of the laryngeal saccule. The etiology behind its occurrence is still unclear, but congenital and acquired factors have been implicated in its development. CASE PRESENTATION: We present a rare case of laryngocele occurring in a 77-year-old Caucasian woman. The patient presented with one month history of altered voice, no other associated symptoms were reported. The medical history of the patient included respiratory failure secondary to childhood polio at the age of ten; the airway management included a surgical tracheostomy. Flexible naso-laryngoscopy revealed a soft mass arising from the posterior pharyngeal wall obscuring the view of the posterior commissure and vocal folds. The shape of the mass altered with respiration and on performing valsalva maneuver. A plain lateral neck radiograph revealed a large air filled sac originating from the laryngeal cartilages and extending along the posterior pharyngeal wall. The patient was then treated by endoscopic laser marsupialization and reviewed annually. We discuss the complications of tracheostomy and the pathophysiology of laryngoceles and in particular the likely aetiological factors in this case. CONCLUSION: A laryngocele presenting in a female patient with tracheostomy is extremely rare and has not been to date reported in the world literature. A local mechanical condition may be the determinant factor in the pathogenesis of the disease

Experience versus complication rate in third molar surgery

OBJECTIVES: The records of 1087 patients who underwent surgical removal of third molar teeth were prospectively examined to analyse the possible relationship between postoperative complications and the surgeon's experience parameter. METHOD AND MATERIALS: Seven surgeons (three specialists in surgical dentistry [specialists SD] and four oral and maxillofacial Senior House Officers [OMFS residents]) carried out the surgical procedures. For each patient, several variables were recorded including age, gender, radiographic position of extracted teeth, treating surgeon, duration of surgery and postoperative complications. RESULTS: Analysis of the data revealed some differences in the incidence of complications produced by the specialists SD and OMFS residents. The main statistically relevant differences were increase the incidences of trismus, nerve paraesthesia, alveolar osteitis and infection in the resident-treated group, while the specialist-treated group showed higher rates of post-operative bleeding. CONCLUSION: The higher rate of postoperative complications in the resident-treated group suggests that at least some of the complications might be related to surgical experience. Further work needs to compare specialists of training programmes with different years of experience, using large cross – sectional studies

Recent technological developments: In situ histopathological interrogation of surgical tissues and resection margins

Objectives: The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. Materials and methods: Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. Results: Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. Conclusion: The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery

Communicating Auditory Impairments Using Electroacoustic Composition

Changes in human sensory perception can occur for a variety of reasons. In the case of distortions or transformations in the human auditory system, the aetiology may include factors such as medical conditions affecting cognition or physiology, interaction of the ears with mechanical waves, or stem from chemically induced sources, such the consumption of alcohol. These changes may be permanent, intermittent, or temporary. In order to communicate such effects to an audience in an accessible, and easily understood manner, a series of electroacoustic compositions were produced. This concept follows on from previous work on the theme of representing auditory hallucinations. Specifically, these compositions relate to auditory impairments that humans can experience due to tinnitus or through the consumption of alcohol. In the case of tinnitus, whilst much is known about the causes and symptoms, the experience of what it is like to live with tinnitus is less explored and those who have acquired the condition may often feel frustration when trying to convey the experience of ‘what it is like’ for them. In terms of impairment from alcohol consumption, whilst there is much hearsay, little research exists on the immediate and short-term effects of alcohol consumption on the human auditory system, despite over half of the UK population reported as consuming alcohol in 2017. The methodology employed to design these compositions draws upon scientific research findings, including experimental and explorative studies involving human participants, coupled with electroacoustic composition techniques. The pieces are typically constructed by mixing field recordings with synthesised materials and incorporating a range of temporal and frequency domain manipulations to the elements therein. In this way, the listener is able to experience the phenomenon in a recognisable context, where distortions of reality can be emulated to varying degrees. It is intended that these compositions can serve as easily accessible and understood examples of auditory impairments and that they might find utility in the communication of symptoms to those who have never experienced the underlying causes or conditions. This presents opportunities for pieces like these to be used in scenarios such as education and public health awareness campaigns