PTEN hamartoma tumour syndrome (PHTS) comprises a group of genetic disorders with varied clinical presentations, including macrocephaly, developmental delay, and increased cancer susceptibility. Recent reports have highlighted the occurrence of tonsil-related issues in PHTS.

Clinical data focusing on tonsil-related pathology and tonsillectomy details (indications, histology and post-operative complications) were collected from 53 patients with PHTS.

Tonsil issues affected 58 per cent of the cohort, with 43 per cent requiring tonsillectomy. Primary indications for tonsillectomy included obstructive sleep apnoea (43 per cent), recurrent tonsillitis (17 per cent) and other causes (17 per cent). Tonsil-related problems were observed both before (45 per cent) and after (55 per cent) PHTS. Tonsillectomy with adenoidectomy was the predominant surgical intervention performed (87 per cent), spanning a broad age range (1–27 years old).

Our findings highlight the complex nature of PHTS and its association with tonsil-related pathology, demonstrating its relevance for ENT surgeons. Early recognition and intervention are pivotal for managing sleep apnoea and the associated health problems.

To determine the current recovery rates and causes for morbidity and mortality in patients suffering aneurysmal subarachnoid hemorrhage (SAH).

We reviewed a recent consecutive series of 95 patients with ruptured intracranial aneurysms who presented to our hospital between 1994 and 1995. When administered, active treatment consisted of early surgery for aneurysm clipping and aggressive prevention and treatment of SAH-related complications.

Eighty-eight (93%) of the patients were admitted within 24 hours of rupture. One-quarter of the patients in this series did not undergo aneurysm clipping due to poor neurological condition on presentation. Of the 75 patients initially considered for active treatment, 83% underwent surgery within 48 hours of rupture, all received nimodipine, 16% received tissue plasminogen activator to lyse subarachnoid or intraventricular clots, 40% underwent hypertensive treatment, and 7% underwent transluminal balloon angioplasty for vasospasm. At one year followup, 29% of patients had died, 7% had severe disabilities, 13% had moderate disabilities, 51% had made a good recovery, and 64% of all surviving patients had returned to their previous work status. Primary and contributing causes of death and disability, affecting 47 patients at one year, were: direct effects of the initial hemorrhage (79% of affected patients), surgical complications (13%), vasospasm (11%), rebleeding (11%) and medical complications (13%).

Almost two-thirds of patients suffering aneurysm rupture make a satisfactory recovery with modern treatment. While vasospasm has become a less common cause of poor outcome following SAH, surgical complications remain an important problem.

Endovascular therapy (ET) is infrequently used in the setting of acute penetrating intracranial trauma.

We report a case where ET was used immediately prior to and following removal of an embedded intracranial knife, which was found to be disrupting the anterior cerebral artery.

The proximal vessel was coiled and angiographically occluded and then the knife was removed with the microcatheter in place. Immediate angiography allowed us to see and quickly treat the contrast extravasation with further coiling. Despite full medical management, the patient died of elevated intracranial pressure.

In this severely injured patient, endovascular therapy represented the most suitable means to attempt safe removal of the knife.

Since the validation of carotid endarterectomy (CEA) as an effective means of stroke prevention, there has been renewed interest in its best indications and methods, as well as in how it compares to carotid angioplasty and stenting (CAS). This review examines these topics, as well as the investigation of carotid stenosis and the role of auditing and reporting CEAresults.

Brain imaging with CTor MRI should be obtained in patients considered for CEA, in order to document infarction and rule out mass lesions. Carotid investigation begins with ultrasound and, if results agree with subsequent, good-quality MRAor CTangiography, treatment can be planned and catheter angiography avoided. An equally acceptable approach is to proceed directly from ultrasound to catheter angiography, which is still the gold-standard in carotid artery assessment.

Appropriate patients for CEA are those symptomatic with transient ischemic attacks or nondisabling stroke due to 70-99% carotid stenosis; the maximum allowable stroke and death rate being 6%. Uncertain candidates for CEA are those with 50 - 69% symptomatic stenosis, and those with asymptomatic stenosis ≥ 60% but, if selected carefully on the basis of additional risk factors (related to both the carotid plaque and certain patient characteristics), some will benefit from surgery. Asymptomatic patients will only benefit if surgery can be provided with exceptionally low major complication rates (3% or less). Inappropriate patients are those with less than 50% symptomatic or 60% asymptomatic stenosis, and those with unstable medical or neurological conditions.

Carotid endarterectomy can be performed with either regional or general anaesthesia and, for the latter, there are a number of monitoring techniques available to assess cerebral perfusion during carotid cross-clamping. While monitoring cannot be considered mandatory and no single monitoring technique has emerged as being clearly superior, EEG is most commonly used. “Eversion” endarterectomy is a variation in surgical technique, and there is some evidence that more widely practiced patch closure may reduce the acute risk of operative stroke and the longer-term risk of recurrent stenosis.

Experience with this endovascular and less invasive procedure grows, and its technology continues to evolve. Some experienced therapists have reported excellent results in case series and a number of randomized trials are now underway comparing CAS to CEA. However, at this time it is premature to incorporate CAS into routine practice replacing CEA.

It has been shown that auditing of CEA indications and results with regular feed-back to the operating surgeons can significantly improve the performance of this operation. Carotid endarterectomy auditing is recommended on both local and regional levels.

Recognition memory dysfunction has been frequently reported in schizophrenic populations, and has been linked with the development of delusions and thought disorder. A range of neuropsychological abnormalities have also been documented in the biological asymptomatic relatives of patients with schizophrenia; however, recognition memory has not been one of them.

This study was carried out in order to investigate: (i) verbal and facial recognition memory in terms of accuracy and false alarm rates; and (ii) contributions from the episodic and semantic memory systems to recognition memory, in the biological asymptomatic parents of a reported schizophrenic patient and a set of male and female psychotic controls.

Gender differences failed to emerge between the psychotic controls on any of the recognition measures (discrimination accuracy, response bias, hit and false alarm rates, ‘remember’ and ‘know’ recognition memory decisions). However, there was evidence of recognition dysfunction in the female relative, and to a lesser extent, in the male. Both parent's recognition memory performance profiles were marked by a pathologically elevated false alarm rate, and an increased dependence ‘remember’ judgements, i.e. input from the episodic memory system, to drive recognition memory decisions.

These findings are discussed in the context of models of episodic and semantic memory impairment in schizophrenia.

Student experience on clinical placement is not well captured with traditional program evaluation tools. This study aims to complete a qualitative analysis of the reflective clinical journals completed during professional placement by radiation therapy (RT) students in order to uncover the issues that affect students on placement and how these change as the student's progress through the program.

A qualitative descriptive analysis (QDA) was undertaken on the descriptive content of student journals completed by 97 students over 3 consecutive years while undertaking professional placement in Radiation Oncology Treatment Centres within Australia. Two coders used a QDA sourcebook specifically designed for the research to independently analyse the descriptive content of the reflective journals for four main categories and 18 subcategories.

The result revealed a statistically significant increased tendency to discuss clinical environment and a decreased tendency to discuss the patient, 92·9–12·5% (coder 1) and 85·7–18·8% (coder 2), as they progressed through the program.

The results of this study showed some similarities with studies completed in other health professions; however, the breadth of issues explored within the content of these RT student journals demonstrates the true diversity of the RT student experience on professional placement.