National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Radiological staging for squamous carcinoma of the head and neck: a standardised practice?

The choice of investigations for radiological staging of squamous carcinoma of the head and neck can be highly variable. The aims of this study were to establish the practice amongst otolaryngologists in Scotland, to determine what, if any, consensus of practice exists and also to stimulate debate in this controversial area. The results of a postal survey to which there was a 65% response rate are reported. Of the primary sites, the greatest consensus on the need for imaging was of the nasopharynx, oropharynx and hypopharynx. For metastatic disease, all respondents imaged the chest but most did not image the abdomen or skeleton. The results for the other sites and imaging modalities chosen are discussed. A protocol for radiological staging based on the survey findings and interpretation of the literature is suggested.

Radiological staging of the chest and abdomen in head and neck squamous cell carcinoma--are computed tomography and ultrasound necessary?

The need for, and choice of, radiological staging investigations for distant metastases in the management of head and neck squamous cell carcinoma is a contentious issue. To address this problem a retrospective audit of routine computerized tomography (CT) and ultrasound scanning of the chest and abdomen respectively was undertaken. The records of 103 patients who, over a six and a half year period, underwent major surgery for head and neck squamous cell carcinoma were reviewed. A total of 57 patients (59 per cent) had CT scanning of the chest of whom two were identified as having synchronous tumours. In both cases, the lesions were identified on chest X-ray prior to scanning. Seventy patients (68 per cent) had routine ultrasound scanning of the abdomen. In none of these was metastatic disease identified. As a result of the audit findings routine CT and ultrasound scanning of the chest and abdomen has been discontinued.

Target oriented computed tomography-scanning of the paranasal sinuses

A limited computed tomography (CT) scanning protocol for the paranasal sinuses is proposed consisting of only seven cuts in the coronal plane. A retrospective observational study has shown the ability of these cuts to demonstrate the regions of interest to the FESS surgeon. The regions are detected at a rate ranging from 85% to 96% in this sample of 100 patients. The novelty of the protocol is the principle of targeting those regions. We believe that the targeted protocol is practically feasible and provides the necessary information concerning benign sinus disease, along with the expected reduction of exposure to radiation and reduction of cost.

Exophthalmos and facial swelling: a case of limited Churg-Strauss syndrome

We report a case of vasculitis causing facial swelling and exophthalmos which on clinical and histological grounds is thought to be limited Churg-Strauss syndrome. An excellent response was achieved to high doses of systemic steroids and cyclophosphamide.

Infectious mononucleosis presenting as thrombocytopenic haemorrhage

A 29-year-old male presented with major thrombocytopenic bleeding as the sole clinical manifestation of infective mononucleosis. Oral steroids proved highly effective despite the absence of any demonstrable auto-immune mechanism for the thrombocytopenia.