There is a higher incidence of thyroid cancer and an altered sex distribution in the renal transplant population. A significant proportion presents with lymphatic metastasis requiring lymph node dissection and radioactive iodine treatment.

Thoracic outlet syndrome occurs due to compression of the neurovascular structures as they exit the thorax. Subclavian arterial compression is usually due to a cervical rib, and is rarely associated with thromboembolic stroke. The mechanism of cerebral embolisation associated with the thoracic outlet syndrome is poorly understood, but may be due to retrograde propagation of thrombus or transient retrograde flow within the subclavian artery exacerbated by arm abduction. We report an illustrative patient and review the clinical features, imaging findings and management of stroke associated with thoracic outlet syndrome.

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Acute otitis externa is a common condition that can be extremely painful. When there is considerable canal oedema, packing is necessary to facilitate the passage of medication. The experience at the Royal Victoria Eye and Ear Hospital is that ear wicks generally require removal in two to three days by medical staff and can be labour intensive as they often involve serial removals following re-insertions. Alternatively, medicated ribbon gauze is cheap and can be removed by the patient at home. Ear wick and mediated ribbon gauze were investigated by a prospective randomized trial involving 94 patients. Fewer out-patient visits were required for the ribbon gauze group (two vs. three, p<0.0001) with considerably less material and labour costs than the wick group. Similar resolution rates were achieved (70 per cent vs. 64 per cent, p = 0.58). Following development of guidelines, the proportion of otitis externa patient reviews in the accident and emergency department declined from 49 per cent to 36 per cent. Compared with the ear wick, medicated ribbon gauze is a cost-effective method of treating oedematous acute otitis externa.

Background:To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages. Methods: Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone iodine solution. The first compared 1, 2 or 3 non-timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals. Results: The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30 s wash was as effective as washing for longer periods in reducing fingertip flora. Conclusions: These findings suggest that prolonged vigorous pre-operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis.