RESUMEN
Papillary thyroid carcinoma (PTC) is the most common malignancy originating from the thyroid, with a good overall prognosis. However, distant metastasis of such lesions is very rare, with the brain being an incredibly uncommon site for secondary spread. The authors report a case of PTC brain metastasis 17-years after successful treatment of the primary malignancy, with no local or locoregional recurrence. Initial diagnostic uncertainty necessitated the involvement of a multidisciplinary team, and eventually the patient underwent image-guided gross surgical resection with intraoperative neuromonitoring (IOMN).
RESUMEN
Introduction Electric scooters (e-scooters) are rife but are yet to be legalised in the UK. The aim of this paper was to investigate whether there had been an increase in the number of e-scooter injuries referred to the oral and maxillofacial surgery (OMFS) service at our unit. We present here what is, to our knowledge, the largest dataset regarding e-scooter-related injuries in the UK.Method A double cohort study in which details of patients sustaining e-scooter-related injuries that were referred to the OMFS department were collected, prospectively, for a 16-week period in 2020 (investigation period). This was compared with data collected, retrospectively, from the emergency department (ED) referral database for the same date range in 2019 (control period).Results In the investigation period, 12/649 referrals to OMFS from the ED were for e-scooter-related injuries. There were eight male patients and four female patients with a mean age of 35 years (interquartile range 24-48). Of these, only one patient was wearing a helmet and 8/12 had consumed alcohol. Head and neck injuries sustained included avulsed teeth, mandibular and midface fractures, skull fractures, facial lacerations and cervical spine injuries. One patient died as a result of their injuries. During the control period, 2/997 ED referrals to OMFS were for e-scooter-related injuries (12/649 versus 2/997; Fisher's exact test p <0.001).Conclusion There was a significant rise in e-scooter-related injuries seen at our major trauma unit compared with 2019. We recommend that e-scooters are subject to at least the same requirements in safety equipment and sobriety as bicycles and that their top speed is limited to 12.5 mph. We hope that these measures will allow the benefits of this technology to be enjoyed while reducing associated morbidity and mortality.