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Biomedical subjects

A C Swift

Publications and source records attributed to A C Swift.

At least 19 recordsLinked to original sources
PubMed1998

Skull base osteitis following fungal sinusitis.

Aspergillus sp. sinusitis is not uncommon in immunocompromised patients but is unusual in patients who are not immunocompromised. The disease may occur as a saprophytic condition, as an allergic sinusitis or as a potentially lethal invasive disease. The differentiation between non-invasive and invasive Aspergillus sp. sinusitis is crucial and this distinction is fully discussed. The treatment options are also considered. Invasive disease requires aggressive treatment with long-term antifungal agents in sufficient doses combined with wide surgical excision. We present a patient who presented with invasive Aspergillus fumigatus sinusitis and subsequently developed cranial neuropathies and skull base osteitis. She was initially treated with oral itraconazole (400 mg daily) for 18 months but due to lack of response this was changed to a new experimental oral azole (voriconazole) which was continued for a further 14 months. She has since remained well for the last five years.

Adult↗
PubMed1997

Acute non-tuberculous retropharyngeal abscess in an adult. A case report and review of the literature.

Retropharyngeal abscesses in adults are very rare and usually secondary to chronic tuberculous cervical spine osteomyelitis. We report a case of Staphylococcus aureus septicaemia with multifocal abscesses and osteomyelitis of the cervical spine causing a retropharyngeal abscess. This presented as neck pain and dysphagia following a fall. In addition, we have reviewed related cases.

Anti-Bacterial Agents↗
PubMed1996

Persistent nasal crusting due to hypohidrotic ectodermal dysplasia.

Hypohidrotic ectodermal dysplasia is an hereditary condition of the ectodermal tissues which may escape recognition because of lack of clinical awareness due to its rarity. Otorhinolaryngological features of this syndrome include chronic respiratory tract infections, persistent foul-smelling nasal discharge and crust formation, and hearing problems. The condition is usually an X-linked recessive disease affecting mainly ectodermal tissue, although nonectodermal tissue may also be affected. The notation 'ectodermal' is used because ectodermal tissues are always involved. The syndrome is characterized by complete or partial absence of sweat glands, sparse hair growth, absent or deformed peg teeth, sparse sebaceous glands, occasional absence of salivary and lacrimal glands, scanty mucous glands and deficient cilia. We describe two children with this disorder with specific reference to the effect on the upper respiratory tract.

Child, Preschool↗
PubMed1996

Beta-2-transferrin and cerebrospinal fluid rhinorrhoea.

Beta-2-transferrin is a protein produced by neuraminidase activity in the brain which is uniquely found in the cerebrospinal fluid (CSF) and perilymph. Its absence in other body secretions makes its detection invaluable in diagnosing a CSF leak. In this series samples were analysed from 25 patients with suspected CSF rhinorrhoea. The presence of beta-2-transferrin was determined by immuno-fixation electrophoresis. Out of 25 patients 16 were positive for beta-2-transferrin. A dural defect and CSF leak were confirmed during surgery in 13 of the 16 patients. In three patients the rhinorrhoea stopped spontaneously. Out of nine patients who were negative for beta-2-transferrin in the nasal fluids, two underwent a craniotomy and neither had evidence of CSF leak or dural effect. Two of the eight patients had a normal computerized coronal tomography (CT) despite a CSF leak. Seventeen patients underwent CT cisternography (six in the beta-2-transferrin negative group and 11 in the positive group). A leak was shown by CT cisternography in seven patients in the positive beta-2-transferrin group, but a leak could not be confirmed in the other four patients. No leak was demonstrated in the six patients in the negative beta-2-transferrin group. Beta-2-transferrin is a valuable and sensitive means of confirming the diagnosis of CSF leaks. Patients with a suspected CSF leak but no beta-2-transferrin in their nasal discharge can avoid unnecessary invasive investigations.

Adult↗
PubMed1995

Mucosal-strip/uvulectomy by the CO2 laser as a method of treating simple snoring.

The effect of stiffening the soft palate by inducing scarring after removing a central strip of mucosa with a CO2 laser was investigated in 25 heavy snorers. The results were assessed using a series of Visual Analogue Score (VAS) assessment questionnaires completed by the partner over a period of 6 months. Of the 22 patients who had the laser-strip and uvulectomy, snoring improved in 18 (82%) (median improvement of 75% at 3 months). Four patients did not improve. Between 3 and 6 months, snoring increased in one patient and decreased in four (< 10% change on VAS). Snoring did not improve in the three patients who did not undergo uvulectomy. We conclude that the laser-strip/uvulectomy can reduce snoring to a tolerable level in eight out of 10 heavy snorers, but the procedure is painful for several days.

Adult↗
PubMed1995

A histopathological comparison of the uvula between snorers and non-snorers.

Snoring is a very common problem but there are few publications on the histological findings of the soft palate/uvula and these lack consistency. The relative proportions of tissue types in the base of the uvula removed from 17 adults who underwent uvulopalatopharyngoplasty for heavy snoring were therefore compared with 14 cadaveric specimens. The mean percentage of muscle from the snoring group was 12.1% compared with 7.2% in the control group (P < 0.05). The percentage of fibrous tissue was greater in the cadavers (52.8% vs 45.5% in the snorers, P < 0.05). The percentage of muscle was inversely related to the percentage of fibrous tissue in the snoring group (P < 0.02). We hypothesize that these changes are a consequence of the repetitive forces on the soft palate during snoring rather than being related to the pathogenesis of snoring.

Adult↗
PubMed1994

Serious unexpected sinus infection discovered by CT scanning for presumed neurological disease.

Serious infection in the paranasal sinuses may present with symptoms suggestive of neurological disease and thus lead to delay in the diagnosis and subsequent treatment. We present three such cases in whom the initial diagnoses had been acute optic neuritis, a posterior communicating aneurysm and an intracranial space occupying lesion. The fourth patient had meningitis but the paranasal sinuses had not initially been considered as a possible source of infection. The current methods of diagnosing sinusitis are discussed.

Adult↗
PubMed1991

Primary mucosal malignant melanoma of the middle ear.

Only one case of primary malignant melanoma of the middle ear has been reported in the literature to date. We report a case of middle ear and nasopharyngeal malignant melanoma where the primary is likely to have arisen in the middle ear and discuss the relevant literature.

Aged↗
PubMed1990

Sinusitis and the acute orbit in children.

Acute orbital infection is an uncommon condition which is often secondary to acute sinusitis. Although it can present in any age group it is most prevalent in children and may cause impaired vision, blindness, intracranial complications and death. This paper documents the experience at the Royal Liverpool Childrens Hospital, Alder Hey, from 1973 to 1989. Clinical details were recorded retrospectively from the hospital case notes. Sixty-eight children had orbital sepsis of whom 30 had associated acute sinusitis. Of these 30 children, orbital sepsis was always unilateral with a preference for the left side; ten had diplopia of whom four had a sub-periosteal abscess which was subsequently drained. There were no serious complications although two children had diplopia for two to three months.

Acute Disease↗
PubMed1988

Oronasal obstruction, lung volumes, and arterial oxygenation.

The effects were studied on lung volumes of partial (chronic) nasal obstruction, total overnight nasal occlusion with a nasal pack, and interdental wiring for 6-8 weeks. Total lung capacity, functional residual capacity, and residual volume decreased significantly with total nasal occlusion and with surgical relief of chronic nasal obstruction. All three volumes increased with interdental wiring. It is concluded that these effects are a result of changes in oronasal resistance: lung volume is enlarged by an overall increase in resistance and diminished by a decrease in resistance. These findings imply that the resistance to expiration provided by the nose helps maintain lung volumes and so may indirectly determine arterial oxygenation.

Adolescent↗