SUMMARYSmall intestinal intramural haematomas may develop spontaneously, especially in patients with deranged clotting function. We present a case of a 57-year-old man who developed abdominal pain in the setting of abnormal clotting function secondary to an inadvertent warfarin overdose. A CT scan showed thickening of parts of the distal ileum, terminal ileum and duodenum. Dilation of the small bowel proximal to the thickening was also reported, indicative of a degree of small bowel obstruction. The patient was treated conservatively with a nasogastric tube and intravenous fluids. His anticoagulation was fully reversed with fresh frozen plasma and vitamin K. The patient remained well 6 months following discharge, with well-controlled anticoagulation levels and resolution of the findings on CT. BACKGROUND

Introduction. DiGeorge syndrome is a developmental defect commonly caused by a microdeletion on the long arm of chromosome 22 or less frequently by a deletion of the short arm of chromosome 10. Case report. We report a case of a gentleman with mild dysmorphic features who presented with hypocalcaemia-induced seizures and an associated thyroid mass with a background of learning difficulties and abnormal immune function. Discussion. DiGeorge syndrome was initially described in 1967 by Angelo DiGeorge. The majority of cases are due to a novel mutation. The resulting learning difficulties, congenital heart disease, palatal abnormalities, hypoplasia/aplasia of the parathyroid and thymus glands, and immune deficiency generally lead to diagnosis in childhood. Presentation in adulthood is rare but must be borne in mind when dealing with cases of hypocalcaemia even in the absence of florid phenotypic features. A link with malignant disease has also been reported and should lead to prompt investigation of concerning masses.

Introduction: Globus pharyngeus is a well-known disorder accounting for 3-4% of ENT referrals. Various treatment strategies have been proposed for this condition, including speech and language therapy. The aim of this article is to highlight the evidence-based approach to the development of a mobile application to improve patient access to speech therapy as a treatment for globus pharyngeus. Patients and Methods: A literature search was performed to identify articles exploring the use of speech therapy as a management option for this disorder. A survey of speech and language therapists (SLT) in the UK to determine patient access to this treatment and their views on the development of a mobile application is also described. Results: Four studies were identified, including one randomised controlled study. All articles demonstrate a significant improvement in symptoms following the use of speech therapy. SLTs from 27 departments responded to the survey. The globus pharyngeus patient workload was variable and in excess of 1000 patients per year in some departments. Most respondents supported the development of a mobile application for speech therapy for use by globus pharyngeus patients. Conclusion: Speech therapy is an effective treatment for globus pharyngeus patients. Speech therapy is not available in all NHS Trusts in England and some SLT departments have a high workload. Alternative methods for the delivery of this effective treatment should be considered including the use of mobile applications. It is important to rule out the possibility of upper aerodigestive tract malignancy before referring a patient for speech therapy.