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Autumn Dates are now available for the Johnny Vlahos FRCR Grayscale Course
Sep 5th-6th 2015 Sep 12th-13th 2015 Small groups so book early to avoid disappointment
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" I was one of the first candidates to attend this new FRCR course run by Dr Vlahos and cannot recommend it highly enough. He is a charismatic, engaging and inspirational teacher. The small group size and viva type approach means you cover A LOT of ground, see a lot of cases, as well as staying continually engaged and in exam mode. He will force you to tap into your potential to achieve the most from each case, giving you useful tips on style when answering to enhance your exam performance. This is a course like no other. It is small and intimate and tailored to your individual needs. He films are great. His tips give you many eureka moments and his mini tutorials leave you wondering how you never grasped certain things before he made the penny drop." Candidate SS, London
"I thought the course was fantastic. We saw so many cases in all specialties, and many difficult cases that really challenged us. It was clearly well thought out, well paced and different styles of teaching used to keep it interactive and varied. The venue was excellent - easy to find, comfortable and the fact that we could have drinks whenever we wanted made it much more comfortable. Too many times on other courses, we end up longing for a cup of coffee!! I know that's a small thing - but it makes a difference. The unique thing about the teaching was the small group and individual attention. It was an effective, non-threatening environment. We were given the opportunity to get to know each other and get to know you. You are clearly extremely knowledgeable and were able to answer almost every query we had! I aspire! You kept up the energy and enthusiasm at all times and that was really encouraging. It was brilliant to receive cases direct into our inbox too over the weeks before the course! You gave us a lot of tips on delivery which were excellent. Some of these were completely new to me. " Candidate SH, South Coast Dr Vlahos teaching/lecturing at IDKD (International Diagnostic Course - Excellence in Teaching) in Davos, Switzerland till next week so limited updates on Cases to Ponder till then! Lots of snow here! 
The images in this case demonstrate the orthopantomogram of a young child. The orientation of the teeth is a mess! This is even more so than would be expected by the numerous unerupted and extra teeth present. The unerupted teeth of course indicate that the patient is a child, however, in addition to the haphazard arrangement in both the maxilla and mandible the teeth are also associated with numerous cysts. Unerupted teeth are usually associated with a small cystic covering but this is more than would be expected as the cysts are quite large in cases. The cystic lesions are well-defined peripherally with no obvious erosion. Notably, most cysts appear related to the crown of unerupted teeth. The findings are highly suggestive of dentigerous cysts. The presence of multiple mandibular or maxillary cysts, in particular dentigerous cysts is highly suggestive of the Gorlin's syndrome.
These findings are sometimes misinterpreted as ameloblastoma. Ameloblastoma is usually a solitary multiloculated soap bubble type lesion that typically is located at the angle of the mandible. The lesion is frequently associated with resorption of adjacent roots as it is a locally aggressive lesion. Similarly, eosinophilic granuloma may cause tooth root resorption and the classically described “floating teeth” appearance. The possibility of cleidocranial dysostosis is a significant consideration in view of extranumerary teeth. However, the presence of multiple cysts is atypical. Additionally, other features that might be present such as midline failure of fusion of the mandible or maxilla are not demonstrated in this case. Remember, of course that orthopantomograms are often “fuzzy” in the midline. This is a difficult but characteristic (Aunt Minnie) type of diagnosis. Hopefully, once seen this is not forgotten. Recall that there are associations in Gorlin's syndrome that might include basal cell naevi and intracranial calcifications. Johnny Vlahos lecturing at Society of Thoracic Radiology, Annual Meeting, California, US.
Case to Ponder Answer and next case as soon as meeting finished today! Short boy with funny teeth! 
Barium enteroclysis is performed following jejunal intubation and constant irrigation of contrast often with air or a cellulose (or equivalent) solid chaser. The examination is technically more difficult than a standard small bowel meal, requires more screening time and clearly generally less enjoyed by patients. However, this remains the best way to demonstrate mucosal detail and subtle small bowel obstruction.On enteroclysis studies the small bowel is more distended than on routine small bowel meal studies. Generally 1 extra cm is allowed throughout the small bowel. So in this case there is no abnormal dilatation. The small bowel mucosa is also normal. This however, was just a little debris.
But what about the large bowel? It is very dilated, particularly the transverse colon which has lost its haustral pattern and also demonstrates nodularity of the mucosa. The appearances are those of a colitis, the dilatation suggesting the patient is developing a toxic megacolon. The “thumbprinted” nodular indentations of the mucosa represent pseudopolyposis - oedematous residual mucosal islands on a background of denuded mucosa. There was no pneumoperitoneum but you should be looking for it. The appearance may be due to a variety of causes but histology confirmed the most common aetiology for this appearance -Ulcerative Colitis. Moral: This case teaches an important lesson. Always look at the whole film, no matter what the cause for the test. Otherwise the next person to look at the film in the analytical fashion you should have might be a lawyer! On March 7th-8th at Avonmouth House etc venues I hosted the Grayscale Vlahos FRCR 2b Course.
What a great bunch of trainees attended. Engaged, enthusiastic and switched on they kept me alert for the whole weekend. As promised the weekend was well organized, intense and delivered so much more than typical FRCR courses. We had great catering from the Avonmouth team and professional facilities. But above all we had an enjoyable and deeply didactic experience - everyone had their limits pushed, extended and tweaked just a little more. Although giving it my all for the whole weekend is indeed exhausting I feel so grateful and invigorated by the registrants response to the course that I feel raring to go again. After the first morning session one very capable attendee commented: "I have just seen more new cases I did not know in one morning than I have seen on all the other courses I've been to put together" another bright spark said: "This is the first time anyone has instructed me on how to deliver what I know in a way that differentiates me from other candidates". I'll post some more direct testimonials when they come through. In the meantime good luck to you all in the Final FRCR! Johnny Vlahos Registrants to the either the Vlahos Sept 5th-6th or Sept12th-13th FRCR Courses receive emailed cases with feedback to answers. The earlier you register the more great cases and teaching points you get!
LIKE THE CASES? FRCR in October ? BOOK A SEPTEMBER COURSE! Small group teaching - Final places now booking. |
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