Case received on the 8th December 2016 from New Foundations Medical Missions in the river Niger Delta, Nigeria, of a 19 year old man with a Parotid swelling over four months, tender, firm to palpate, no encroachment into oral cavity. Attached USS showing heterogenous cyst 6cm diameter. Systemically well. No fever, no lymphadenopathy. Could you suggest diagnosis and possible treatment?
The case was allocated to an Endocrinology, Internal Medicine consultant in Brisbane, Australia who asked a number of questions and discussed the case with a Maxillo/facial surgeon, who agreed that the most likely diagnosis is parotid tumour very probably malignant. That makes biopsy and histology the likely course to follow if that is possible in your setting. I am pleased that the Swinfen team has referred Sunny to their Maxillo/facial expert.
A Maxillo/facial Surgeon from the UK was involved in the case with comments: “I agree with the points made regards infectious, inflammatory and granulomatous conditions. The size and rate of growth suggests a malignant process. Other signs that would suggest this would be ipsilateral lymphadenopathy and impairment of the facial nerve.” He also stated that there was some echogenic lumps at the periphery of the lesion which may be a soft sign for a nematode. “It may be worth reviewing the image again for a worm shaped/ or moving string like shape within it, assuming non haematological disease would be at least a diagnostic /therapeutic superficial parotidectomy and if FNAC demonstrates malignancy then total parotidectomy may be worthwhile.”
Our UK systems operator informs the New Foundations Mission that we have a contact with Mercy Ships and how would the referrer like to proceed? Case was passed on to Mercy Ships 15/12/2016. As the young man lived near the clinic this was fantastic news. Passport and visa was arranged.
Message was received from the referring doctor in March 2017 – “you will share our joy that today Sunny was seen by the team on the Mercy Ship at Cotonou and surgery was completed. After ‘pulling’ their canoe all night to reach our clinic from their remote riverine community both he and his father were escorted to Lagos, where they switched to local taxi to take them into Benin and liaise with the Mercy ship. Sunny is recovering well.”
This case started on the 8th December 2016, 64 messages were exchanged through the Swinfen system involving an Endocrinologist/Internal medicine specialist from Australia, a Max.Facial surgeon from the UK and the Swinfen System operators, working together with the New Foundations Medical Mission and Mercy Ships. We estimate that this case would have cost around £5,000 if fees had to be paid.
A 6 month old infant was seen by doctors on the 16th July at one of our mobile medical clinics in rural Zambia. The rash developed 1 week before attending clinic. Some lesions were crusting and the rash was present on the face, arms, back and buttocks. The rash did not appear to be bothering the infant and there was no fever or systemic symptoms. The infant was otherwise fit and well, HIV negative and had been seen previously by our doctors at which time there was no evident rash. This rash had been treated by the community health worker with IM benzylpenicillin with some effect.
We sent the case to a Professor specialising in Paediatric Dermatology from the USA.
“This very prominent facial rash with an overall annular scaly appearance and impressive hypopigmentation is characteristic of NEONATAL LUPUS ERYTHEMATOSIS, a rare disorder in which infants have maternal antibodies (SS-A, SS-B sometimes called Ro and La antibodies, rarely RNP antibodies) which are photosensitizing so the rash appears after sun exposure. The rash will fade in time as the infant clears maternal antibodies but sun protection is important until this occurs. Scarring is unlikely. Topical hydrocortisone 1% or 2.5% ointment or Cream applied twice daily is safe and should result in improvement although return of normal pigmentation will likely take many months. Sunscreens and/or complete sun avoidance is strongly recommended until this occurs. The most IMPORTANT ASPECT of NLE is the possibility of CONGENITAL HEART BLOCK which is often complete and can be fatal. When NLE is suspected an EKG as soon as possible after delivery is key. In this infant who appears to be thriving and has reached the age of 6 months, heart block is less likely but EKG is still recommend. Other organ systems can be involved causing, among other things, anemia and liver enzyme elevations. Mothers of infants with NLE are more often than not asymptomatic and unaware of the presence of antibodies. There is a high risk of NLE in subsequent pregnancies. Serologies may not be available for this infant but I hope an EKG can be arranged. This is an absolutely fascinating case and I am so pleased to review it.”
7 messages were exchanged between referring doctor, Consultant and Swinfen System operator saving approx. £1400 as Swinfen Telemedicine service is FREE.
“Brilliant case which beautifully illustrates just why Swinfen Telemedicine is making such an important contribution to world health one person at a time. Love this!”
Dr. A. Howland Hartley, MD, FAAP, FAAD, Swinfen Consultant
This interesting case was sent to us from our link in Yemen on the 18th March 2017 and was ongoing till the 22nd April.
An 8 year old child was subjected to a direct blow from a small pebble to his left eye. Immediately after the incident he could not see with his injured eye. The pupil of the eye was partially filled with blood. He was taken to the ophthalmologist on the same day and he reported that he is suffering from a traumatic corneal ulcer and hyphaema. Hospitalization was not required and home care instructions along with medications were prescribed. No movement, Most of the time in a semi sitting position. The patient and the doctor are in Sana’a and under nightly bombing. There is little water and starvation has been declared.
A second opinion was requested from the referring doctor, especially if any additional measure should be taken in order to save the vision of the child, so the case was sent to us where it was allocated to two Ophthalmic surgeons in the UK. “The trauma seems pretty severe but not necessarily devastating for the eye. If the pressure in the eye is soft then this would suggest a posterior rupture which is VERY serious. If normal or high then things are better. Check his vision regularly and it should be coming back if it does not then obviously something much more serious is happening”.
Three weeks after surgery to remove the cataract, further surgery was performed, the retina was examined more closely and he was seen to have “commotio retinae”.
18 messages between the referring doctor, the two Ophthalmic specialists and the Swinfen system operators were exchanged. As we offer our Telemedical system and the Consultants advice, diagnoses and recommended treatment for FREE we estimate that the money saved on this case would have been approx.£1600
As some of you are aware my gentle giant of a father in law is battling cancer. He was first diagnosed over 2 years ago with bowel cancer and had surgery to remove part of his bowel. We all thought he was in the clear after 2 years of being in remission but sadly that wasn’t the case. While on his “once in a lifetime” holiday to see the world, with his wife Loveday, he started to become sick again and things weren’t quite right. When he arrived back from his 8 week trip he went for more tests and unfortunately he was told he had secondaries in his lungs. So he is now having chemotherapy and immunotherapy as part of his treatment. Unfortunately they will never be able to cure his cancer but hopefully the treatment will be able to prolong his life. At the moment he’s going through intense and gruelling treatment which makes him feel sick and tired and we all as a family feel so helpless. We all wish we could take it away and I especially wished there was more I could do. So I thought to myself “What can I do to help?” Not a lot, was my conclusion. But then I had a “lightbulb” moment…
I thought as I have recently started running, I could put all my effort into training and could sign up for something I’ve never done before and help raise some money for a charity that would be close to both Brian and Loveday’s heart. I asked them what charity they would like the donations to go to and I will be running in Brian’s honour.
So on the 9th July I’ll be taking part in my first 10k at Loseley House as part of their “Run for Champagne” event.
I’ve always respected and looked up to all he has done in his career as a Professor in Urology. He tirelessly helped many people who battled with prostate cancer in particular and other urological disorders and it’s just so unfair that life has thrown this set of cards his way, after all he’s done to help others!
I know my husband David, my sister in law Rebecca and mother in law Loveday and all of the family are so proud of what he achieved in his career and we just want to show him how much he is loved and respected and that we are all fighting this disease with him and that he’s not alone.
I’m not just doing this for Brian, but for all of those who are living with cancer on a daily basis. And I’m also doing this in memory of my beautiful Auntie Brid who lost her battle to cancer nearly 3 years ago, she is so sadly missed. Lastly not forgetting all those who have lost family and friends to this awful disease, let’s keep praying that with all this fundraising money they can finally find a cure!
Both Brian and Loveday work for Swinfen Telelmedicine as system oporators and help people from all over the world who need medical help and attention. With the help of the internet and mobiles, people from all over the world are only a click away from getting the help that they need.
Thanks so much for reading and for any donations (big or small) that you are able to make.