Southern General Hospital

An 81-year-old man presented to dermatology in 2024 with a new left sided chest wall mass and associated bruising, having developed within weeks of presentation.

During World War II maternal mortality fell. In the USA deaths were investigated by local committees and in 1949 the RCOG decided Britain should do the same. Its president, Eardley Holland, had worked with George Godber of the Ministry of Health during the war and they set up an Enquiry covering England and Wales. After each death a local obstetrician sent information to a regional assessor, who could request further comments. Assessors' reports, which included no names, were collated by two national obstetric assessors. A team of five authors, including an anaesthetist, compiled a triennial report which anyone could buy. In each case a 'primary avoidable factor' was identified. Deaths were grouped by cause. The Ministry was anxious about the Report’s frankness but its publication in 1957 met with wide approval and no complaints about anonymity. The recommendations were disseminated in medical journals. Government committees recommended wideer availability of hospital birth. The Reports became UK-wide in 1985. New chapters discussed psychiatric illness, social exclusion and ethnicity, showing the need for Enquiries to continue despite the low overall mortality rate.

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Background: Chronic rhinosinusitis (CRS) is a heterogenous group of inflammatory sinonasal disorders with key defining symptoms, but traditionally separated into phenotypes by clinical/endoscopic findings. It is not known if the two phenotypes have differing socioeconomic, co-morbidity and lifestyle differences. Objective: This analysis of the Chronic Rhinosinusitis Epidemiology Study (CRES) database sought to analyse any key differences in the socioeconomic variables between those with CRS with nasal polyps (CRSwNPs) and those without nasal polyps (CRSsNP). We also sought to analyse differences in comorbidities, lifestyle and quality of life. Methods: Patients with a confirmed diagnosis of CRS in secondary and tertiary care outpatient settings were invited to participate in a questionnaire based case-control study. Variables included demographics, comorbidities, socioeconomic factors, lifestyle factors and health related quality of life. Results: A total of 1204 patients’ data were analysed; 553 CRSsNP and 651 CRSwNP participants. The key socioeconomic variables did not demonstrate any notable differences, nor did lifestyle variables other than alcohol consumption being higher in those with CRSwNP (p=0.032). Aside from confirmation of asthma being more common in CRSwNP, it was notable that this group complained less of URTIs and CRSsNP participants showed evidence of lower HRQoL scores in respect of body pain (p=0.001). Conclusions: Patients with CRSwNP experience higher rates of asthma and lower rates of URTIs but otherwise do not demonstrate significant socioeconomic, comorbidity, lifestyle or quality of life issues other than for body pain and alcohol consumption.

To evaluate the protective effects of lipoic acid-niacin (N2L) dimers against blue light (BL)-induced oxidative damage to human retinal pigment epithelium (hRPE) cells in vitro. hRPE cells were divided into a control group (CG), a BL group, an N2L plus BL irradiation group, an α-lipoic acid (ALA) plus BL group, an ALA-only group, and an N2L-only group. hRPE cellular viability was detected by performing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) bromide assays, and apoptosis was evaluated by annexin-V-PE/7-AAD staining followed by flow cytometry. Ultrastructural changes in subcellular organelles were observed by transmission electron microscopy. Reactive oxygen species formation was assayed by flow cytometry. The expression levels of the apoptosis-related proteins BCL-2 associated X protein (BAX), B-cell leukmia/lymphoma 2 (BCL-2), and caspase-3 were quantified by Western blot analysis. BL exposure with a light density of 4±0.5 mW/cm2 exceeding 6h caused hRPE toxicity, whereas treatment with a high dose of N2L (100 mol/L) or ALA (150 mol/L) maintained cell viability at control levels. BL exposure caused vacuole-like degeneration, mitochondrial swelling, and reduced microvillus formation; however, a high dose of N2L or ALA maintained the ultrastructure of hRPE cells and their organelles. High doses of N2L and ALA also protected hRPE cells from BL-induced apoptosis, which was confirmed by Western blot analysis: BCL-2 expression significantly increased, while BAX and caspase-3 expression slightly decreased compared to the CG. High-dose N2L treatment (>100 mol/L) can reduce oxidative damage in degenerating hRPE cells exposed to BL with an efficacy similar to ALA.

Background Airway obstruction can occur during facemask (FM) resuscitation of preterm infants at birth. Intubation bypasses any upper airway obstruction. Thus, it would be expected that the occurrence of low expiratory tidal volumes (VTes) would be less in infants resuscitated via an endotracheal tube (ETT) rather than via an FM. Our aim was to test this hypothesis. Methods Analysis was undertaken of respiratory function monitoring traces made during initial resuscitation in the delivery suite to determine the peak inflating pressure (PIP), positive end expiratory pressure (PEEP), the VTe and maximum exhaled carbon dioxide (ETCO2) levels and the number of inflations with a low VTe (less than 2.2 mL/kg). Results Eighteen infants were resuscitated via an ETT and 11 via an FM, all born at less than 29 weeks of gestation. Similar inflation pressures were used in both groups (17.2 vs. 18.8 cmH2O, P = 0.67). The proportion of infants with a low median VTe (P = 0.6) and the proportion of inflations with a low VTe were similar in the groups (P = 0.10), as was the lung compliance (P = 0.67). Infants with the lowest VTe had the stiffest lungs (P < 0.001). Conclusion Respiratory function monitoring during initial resuscitation can objectively identify infants who may require escalation of inflation pressures.

ABSTRACTOculopharyngeal Muscular Dystrophy (OPMD) is a systemic progressive autosomal dominant myopathy which results in ptosis due to levator weakness. Surgical correction can be complicated by corneal exposure and a non-surgical alternative, such as ptosis props, can be uncomfortable in patients with preserved orbicularis function. We describe a case of a 57-year-old gentleman with OPMD, who declined surgical intervention, and self-manages his ptosis with cosmetic glue.

AimTo survey UK cellular pathology departments regarding their attitudes and practices relating to release of human tissue from their diagnostic archives for use in clinical trial research.MethodsA 30-item questionnaire was circulated to the National Cancer Research Institute’s Cellular Molecular Pathology initiative and Confederation of Cancer Biobanks mailing lists. Responses were collected over a 10-month period from November 2016 to August 2017.Results38 departments responded to the survey, the majority of which regularly receive requests for tissue for research purposes. Most requests come from academia and financial support to facilitate tissue release comes from a variety of sources. A range of practices were reported in relation to selection of the most appropriate sample to release, consent checking, costing and governance frameworks.ConclusionsThis survey demonstrates wide variation in practice across the UK and identifies barriers to release of human tissue for clinical trial research. Until we can overcome these obstacles, patient samples will remain inaccessible to research. Therefore, this study highlights the urgent need for clear and coordinated national guidance on this issue.