The authors report the case of a 13-year-old girl with Kikuchi-Fujimoto disease who presented with features of raised intracranial pressure due to subdural effusions. A biopsy revealed dural involvement in the disease process. The authors review the medical literature of this rare disease and highlight the paucity of documented cases with CNS involvement.

Aim A systematic review of 43 randomised controlled trials (RCTs) concluded that single dose oral dexamethasone is effective in the treatment of croup. Dexamethasone was associated with an improved Westley score at 6 h to 12 h with an effect size of –1.0 (95% CI –1.5 to –0.6) which was significant, but was no longer significant at 24 h. To date, no RCTs have determined whether administering two doses of dexamethasone, compared with a single dose, improves outcomes in children with croup. We completed an audit to review the use of dexamethasone in children with croup. Method Inpatient notes of 50 children admitted between 2010 and 2011 were reviewed at a district general hospital. To gauge the readmission rate, a comparative notes review was performed for attendances at the Emergency Department of a local tertiary paediatric centre (150 attendances, June–November 2014). Results Figure 1 shows results at the district general hospital Abstract G95(P) Figure 1 Half of the children who required readmission had the same croup score on their first admission and their second, implying that readmission was necessary due to lack of clinical improvement. At the tertiary centre, 90% (135) patients received a dose of dexamethasone on their first presentation and 10% (15) children re-attended. With 1 in 10 patients being readmitted despite one dose of dexamethasone, we conducted a regional survey of paediatricians in our deanery to assess baseline practice for multi-dose dexamethasone. The survey contained a hypothetical case scenario of a child with croup (stridor and chest wall retraction at rest) who received a dose of dexamethasone. At 12 h the patient improved with no symptoms at rest but symptoms on exertion. Respondents were given four management options, as shown in Table 1. A total of 112 responses were received, 44% from consultants. Abstract G95(P) Table 1 Responses from regional survey The results demonstrate a wide variation in practice. 23% of respondents stated that their choice was based on trust guidelines, whereas 77% stated it was personal practice. Conclusion The high readmission rate, variation in practice and lack of evidence for administering a second dose of dexamethasone in croup suggest this is a topic that would benefit from a research project.

Aims To illustrate that although asthma is a common cause for wheezing, there should be high index of suspicion for rarer causes when either the presentation or the response to treatment is atypical. Methods Retrospective review of case notes. Results A 12 year old girl had worsening shortness of breath and wheeze on minimal exertion over a year. She had been diagnosed with asthma and received multiple courses of oral and inhaled steroids with minimal improvement. On chest auscultation she had an inspiratory and expiratory wheeze, more noticeable when she laughed. A chest x-ray showed bulbous widening of the superior mediastinum (Figure 1a). A flow volume loop suggested extrinsic intrathoracic airway compression. A computed tomography (CT) scan showed a mediastinal cystic mass compressing the distal trachea suggesting a foregut duplication (Figure 1b); this was removed thoracoscopically. Abstract G326(P) Figure 1a Widened mediastinum Abstract G326(P) Figure 1b Foregut duplication cyst A 3 year old girl diagnosed with asthma by her GP presented with a worsening cough and wheeze for 3 months. She presented with an exacerbation of symptoms. On examination there was a biphasic wheeze on lying flat. Due to foreign travel, a chest x-ray was requested revealing a large foreign body (Figure 2a). A button battery was retrieved endoscopy from her oesophagus. There was no tracheoeophageal fistula found on rigid bronchoscopy. Abstract G326(P) Figure 2a Foreign body in oesophagus A 4 year old girl presented with a worsening wheeze and wet cough for 1 year. She had received antibiotics and inhalers from her GP. On examination, there was decreased air entry unilaterally. A chest x-ray showed an extensive opacity in the left hemithorax causing mediastinal shift (Figure 3a). A CT scan showed a large cystic mass (Figure 3b). This was a cystic teratoma requiring resection. A 1 year old girl had a similar history, findings on examination and imaging to this, which was also a teratoma (Figure 4a). Abstract G326(P) Figure 3a CXR shwowing extensive opacity in the left hemithorax causing mediastinal shift Abstract G326(P) Figure 3b A CT scan showing a large cystic mass Abstract G326(P) Figure 4a CT scan showing large cystic mass Conclusion Routine imaging is not required to assess asthma, but if symptoms and signs are unusual or there is worsening of symptoms despite treatment, it should be considered, to seek alternative diagnoses. Assessment of asthma should include questioning the diagnosis at every clinic review as ‘all that wheezes is not asthma’.

Technical validation of an EV-D68 PCR.. Determine whether a one-step PCR is sufficient or whether a two-step PCR is required for detection of the virus in respiratory tract samples.. Determine whether any samples that tested HRV positive in our hospital between July 2018-January 2019 were in fact EV-D68 positive. Methods and Results. Primers and probes selected according to those already validated in Poelmana et al and tested in 1 step PCR with negative and positive control: successful.. Sensitivity tested against NGS sequenced EV-D68 positive samples from our own laboratory, 5 from another teaching hospital and 2 QCMD samples: 1 and 2 step PCR sensitive, including 2-step PCR with internal control.. Specificity successfully tested against many non-EV-68 samples positive for other viruses and bacteria.. Comparison of Cq values of 1 step PCR versus 2 step PCR with internal control. Cq values 2-step PCR < Cq values 1step PCR in all dilutions from 1:4-1:4000. 1-step did not detect virus >1:400 dilution.. Epidemiological study retrospectively testing all 104 HRV positive respiratory samples and DNA isolates from last week July 2018 to second week January 2019 with 2-step PCR. There were 8 positive cases, clustered in November and December. 49 35.24 35.3 Nasal aspirate 1 25.53

Aim The enormous increase in the diagnosis of ductal carcinoma in situ (DCIS) by the NHS Breast screening has not lead to an expected decrease in the incidence of invasive breast cancer. It is not clear if all grades of DCIS progress inexorably to invasive cancer if left untreated. There is recognition that DCIS is overtreated, ie if left alone may not cause harm during the woman's lifetime. In the absence of new clinical trial data, surgery still remains the universal treatment. It is known that a higher proportion of patients with screen detected DCIS receive mastectomy than those with screen detected invasive cancer. Recently a randomized trial called the Low risk DCIS Trial has been proposed which intends to specifically compare the current treatment of low grade DCIS ie surgery with active monitoring using annual mammography. In order to effectively implement this, concordance between diagnostic biopsy and excision histology is vital and therefore vacuum assisted mammotome biopsy (VAB) and a central pathology review of diagnostic biopsy specimens prior to randomization will be mandatory. Therefore, in this study, we assessed the concordance between diagnostic biopsies performed by VAB technique and the post operative histology for DCIS in our institution. Methods Retrospective data of all diagnostic breast biopsies specifically using the VAB technique with the primary diagnosis of DCIS from year 2001 to 2010 in our institution was collected. Both screening and symptomatic patients were included. Concordance between diagnostic histology and post operative excision histology was assessed for high, intermediate and low grade DCIS. Demographic details and potential factors influencing concordance including number of cores taken and lesion size were also collected for analysis. Results A total of 161 cases were identified out of which 102 (63%) were of high grade, 35 (22%) of intermediate grade and 24 (15%) were of low grade histology. In the High grade group, the concordance with final histology was 70% (72/102). In this group, the diagnosis was upgraded to invasive carcinoma in 21% (21/102). 9% (9/102) were downgraded to intermediate or low grade. In the intermediate grade group, the concordance with final histology was 66% (23/35). In this group, the diagnosis was upgraded to invasive carcinoma in 11% (4/35) and to high grade in 17% (6/35). 6% (2/35) were downgraded to low grade. In the low grade group, the concordance with final histology was 71% (17/24). In this group, the diagnosis was upgraded to intermediate grade in 17% (4/24) and invasive carcinoma in 12% (3/24). All factors associated with lack of concordance were noted. Conclusion Concordance between VAB diagnostic biopsies of high, intermediate and low grade DCIS and post operative histology is good in this series and is to our knowledge the first to be reported using only large volume biopsies by VAB techniques. This audit has identified possible factors influencing the lack of concordance and these results with concordance data from other UK centres will be used by trial pathologists to refine protocols for the Low risk DCIS trial. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-12-02.