4. Laryngoscope, 128:2072-2075, 2018.

3. Laryngoscope, 2018.

Eosinophilic gastroenteritis is a condition characterised by eosinophilic infiltration of the gastrointestinal tract. Biliary obstruction is an unusual presentation. A case where the initial investigations were consistent with carcinoma of the head of pancreas but the resection specimen showed no malignancy is presented. The diagnosis was suspected from a review of the patient's past history and confirmed by re-examination of the histology.A 47 year old man presented with two weeks of fever, vomiting, anorexia, intermittent right upper quadrant and mid-scapular pain exacerbated by eating, followed by jaundice, pale stools, and dark urine. On examination, he was icteric, temperature 38.8°C, with right upper abdominal tenderness, and a palpable gallbladder. Investigations showed a raised white cell count 15.6 × 10 9 /l (4-11.0), neutrophils 13.4 × 10 3 /µl (2-7.5), amylase 256 IU/l (10-90), bilirubin 85 µmol/l (2-20), alanine transferase 204 IU/l (1-65), and alkaline phosphatase 897 IU/l (30-110). Abdominal ultrasound showed a grossly dilated biliary tract, 13 cm gallbladder, 3 cm common bile duct (CBD), and 8 mm pancreatic duct. No gallstones were present. Abdominal computed tomography showed an abrupt occlusion of the CBD and pancreatic duct at the head of pancreas. Endoscopic retrograde cholangiopancreatography was unsuccessful due to duodenal stenosis. Percutaneous transhepatic cholangiography found a tight stricture requiring an external biliary drain for decompression. The diagnosis was thought either to be carcinoma of the ampulla of Vater or the head of pancreas.At laparotomy, a small hard irregular mass in the head of the pancreas was found. Pylorus preserving pancreaticoduodenectomy was performed. The resection specimen was examined by thin sections. The duodenum and ampulla had a chronic inflammatory infiltrate within normal mucosa. There was periductal chronic inflammation, fibrosis and active inflammatory exudate in the CBD, thought consistent with recent cholangitis. Lymph nodes showed follicular hyperplasia and reactive change only. No malignant cells were identified. He was discharged after an uneventful recovery.He then had repeated hospital admissions with abdominal pain and postprandial vomiting. Initially, all investigations were normal apart from a mild neutrophilia. The symptoms resolved with conservative management. At his next admission, he also had diarrhoea. Investigations showed raised white cell count 18.0 × 10 9

Nasal osteotomy is one of the most challenging steps of rhinoplasty. Lack of hands-on training and confidence with this procedure adds to the complexity for learners and trainees. As three-dimensional (3D) printing becomes increasingly accessible, simulation on 3D printed models has the potential to address this educational need in a safe, reproducible, and clinically realistic manner. The simulation session described in this communication, which utilized our low-cost, 3D-printed nasal osteotomy ($12.37) task trainer, produced both educational and confidence benefits for trainees. Here we describe the design, organization, curriculum, and pilot data for a 3D-printed nasal osteotomy task trainer for the simulation of endonasal and percutaneous nasal osteotomy.

No abstract