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Biomedical subjects

A Karkanevatos

Publications and source records attributed to A Karkanevatos.

At least 19 recordsLinked to original sources
PubMed2006

Preseptal cellulitis due to Mycobacterium marinum.

Mycobacterium marinum is an atypical mycobacterium found in both salt and fresh water. It occasionally causes soft tissue infections after minor trauma, principally affecting the limbs. A 17-year-old male aquarium worker presented with preseptal cellulitis of his right eye, after attempting to lance a hordeolum some days previously. The condition failed to respond to antibiotics and a necrotic area developed, which subsequently required debridement. Histology of the debrided area demonstrated granulomatous inflammation which when considered with his occupation led to the diagnosis of Mycobacterium marinum--'fish-tank granuloma'. A Medline search did not demonstrate any previous cases of Mycobacterium marinum infection occurring peri-orbitally. The current literature regarding diagnosis and management is reviewed. Although infection with Mycobacterium marinum is rare in the general population, this case demonstrates the importance of considering the diagnosis when dealing with patients frequently exposed to fresh or salt water.

Adolescent↗
PubMed2005

No frills management of epistaxis.

Epistaxis is a common, potentially life threatening, emergency but first line medical staff are often not adequately trained in its management. This paper presents an illustrated step by step guide to the management of epistaxis by junior doctors in the emergency department.

Cautery↗
PubMed2005

Aryepiglottoplasty for laryngomalacia: the Alder Hey experience.

Laryngomalacia is the most common cause of stridor in infants. Severely affected children are at risk of feeding difficulties, apnoeic episodes and cor pulmonale secondary to upper airway obstruction. The aim of this study was to assess the outcome of aryepiglottoplasty. This is a simple surgical procedure that relieves the obstruction by dividing the aryepiglottic folds. Thirty children had an aryepiglottoplasty at the Royal Liverpool Children's Hospital between January 1995 and June 2001. The case notes of all 30 children were reviewed for age, sex, age at operation, indications, operative technique, complications and long-term outcomes. Complete resolution of stridor was obtained in 83 per cent of patients, with an improvement in a further 7 per cent. Post-operative complications included lower respiratory tract infections (13 per cent) and vomiting (7 per cent). In conclusion, simple endoscopic aryepiglottoplasty remains an effective way of treating upper airway obstruction in children. Its high resolution and low complication rate make it a safe, first choice procedure for treatment of moderate to severe laryngomalacia.

Arytenoid Cartilage↗
PubMed2005

Conservative management of epistaxis: are we putting patients at risk of developing venous thromboembolic complications?

A retrospective study of 1585 patients, admitted with epistaxis to a busy District General Hospital in the United Kingdom between 1990 and 2000, was undertaken in order to identify the relationship between hospital admission for epistaxis and the development of a venous thromboembolic event. Only one person (0.06%) developed pulmonary embolus (PE) within 6 weeks of hospital admission. No one developed a deep vein thrombosis (DVT). This compares with the incidence of DVT and fatal PE in the general population. In our study population, the incidence of both PE and DVT was found to be no greater than that seen within the community and certainly less than the incidence seen within a group of high risk hospitalised patients. We conclude that hospital admission for epistaxis does not place the patient at increased risk of thromboembolic disease.

Adult↗
PubMed2004

Massive recurrent epistaxis from non-traumatic bilateral intracavernous carotid artery aneurysms.

Recurrent epistaxis may rarely follow traumatic intracavernous carotid artery aneurysm. This occurs nearly always after head injury and is usually associated with fracture of the skull base. Severe torrential epistaxis due to non-traumatic intracavernous carotid artery aneurysm is extremely uncommon and potentially fatal, with only a few cases having been reported in the literature. We present the case of a 23-year-old female with a history of recurrent severe epistaxis and otalgia due to bilateral intracavernous carotid artery aneurysms, illustrating the diagnostic difficulties. The radiological investigations and the management of the patient are discussed and relevant literature is reviewed.

Adult↗
PubMed2004

A sinonasal primary Ewing's sarcoma.

Nasal fractures are a common complaint familiar to all otolaryngologists. Sinonasal primary Ewing's sarcomas are extremely rare. The case of a 9-year-old boy is presented whose nasal fracture and subsequent lateral nasal wall hematoma revealed an underlying Ewing's sarcoma. There are several unusual features in the history and clinical course of this patient. Following biopsies, immunohistochemistry proved essential in distinguishing a Ewing's sarcoma from other small cell tumours. It is important that a seemingly common condition can be the first presentation of a less common, more sinister pathology.

Biopsy, Fine-Needle↗
PubMed2004

Recurrent periorbital cellulitis in a child. A random event or an underlying anatomical abnormality?

We present a case of recurrent periorbital cellulitis in a child. From the age of 2 years the child was admitted with periorbital cellulitis a total of six times with the first five episodes responding to conservative management with intravenous antibiotics. On the sixth admission endoscopic surgical treatment was carried out. Two abnormalities were noted: an anatomically abnormal uncinate process and an isolated abscess in an ethmoidal cell. It is believed that the abnormal uncinate process caused obstruction of the osteomeatal area, predisposing to recurrent peri-orbital cellulitis. We discuss the importance of early imaging and surgery in recurrent periorbital cellulitis.

Cellulitis↗
PubMed2004

A systematic approach to the nasendoscopic examination of the larynx and pharynx.

Several nasendoscopic techniques have been described to improve the view of different anatomical subsites when assessing the laryngopharynx. A prospective study was undertaken to compare and evaluate the views obtained with each of the different techniques employed in the nasendoscopic examination of the upper aero-digestive tract. No visualization manoeuvres were found to be beneficial in improving the view of the tongue base; however, tongue protrusion did improve the view of the valleculae. Both the post-cricoid and the upper oesophageal sphincter were best seen when the trumpet manoeuvre was performed along with skin traction of the anterior neck. Pyriform apices were best viewed when the trumpet manoeuvre was coupled with head turn - a manoeuvre we believe not to have been recorded in the literature previously with respect to this topic. The authors present a systematic routine for examining the upper aero-digestive tract by nasendoscope on the basis of obtaining the best view for each anatomical subsite.

Head Movements↗
PubMed2004

Myringoplasty using a subcutaneous soft tissue graft.

A retrospective study was performed on patients who underwent myringoplasty using an autologous subcutaneous soft tissue graft over a 5-year period. Details including age, site and size of perforation, grade of surgeon, surgical approach, postoperative dressings, overnight stay, complications and outcome were recorded and analysed. Fifty-two patients underwent myringoplasty using a subcutaneous soft tissue graft. Their ages ranged from 4 to 78 years (median = 36 years). The mean follow-up period was 19 months. Successful closure to give an intact tympanic membrane was obtained in 82.7% of patients. Thresholds improved on pure tone audiometry in 57.1% and deteriorated in only one patient. There was no case of dead ear as a result of surgery. Subcutaneous tissue graft has comparable outcomes with temporalis fascia graft with additional advantages of a smaller incision, minimum dissection and a lower risk of bleeding.

Adolescent↗
PubMed2003

Hereditary vocal cord palsy.

Hereditary vocal cord palsy is an uncommon cause of neonatal stridor that has significant implications for patients, their families, and their future progeny.

Genetic Counseling↗
PubMed2003

Pupil size and reaction during functional endoscopic sinus surgery (FESS).

This aim of this study was to evaluate the size and light reflex of the pupils during endoscopic sinus surgery (FESS). Pupil size and light reflexes were recorded prospectively in 20 patients undergoing FESS under general anaesthesia. Nasal mucosal vasoconstriction was induced by Moffett's solution. A control group of 20 patients underwent other standard ENT operations under general anaesthesia. Myosis occurred in all 40 patients after induction of general anaesthesia. During surgery, the light reflex was negative for all 40 patients. However, the light reflex became positive in 22 patients within 5 min of surgery, and in all patients after 20 min. Monitoring pupillary size and reflexes during FESS as a means of assessing trauma to the orbital structures is difficult because of the presence of myosis induced by anaesthetic agents. Moffett's solution did not have a mydriatic effect from the systemic absorption of cocaine during the operative period.

Adolescent↗
PubMed2003

Day-case myringoplasty: five years' experience.

A retrospective study of patients who underwent myringoplasty as a day-case procedure in two freestanding day-surgery units during a five-year period was carried out. Their case notes were identified and details including age, site and size of perforation, grade of surgeon, surgical approach, graft material, post-operative dressings, overnight stay, complications, and outcome were noted and analysed. The total number of patients including both children and adults who had myringoplasty as a day case was 144. Of these, 125 patients with 143 procedures were included in this study. Their ages ranged from four to 74 years (mean = 31 years). The perforation size was small in 40 cases, medium in 61 cases, and large/subtotal in 42 cases. The overnight stay rate was 2.7 per cent and this was for immediate post-operative problems such as nausea and bleeding from the wound. The readmission rate for post-operative complications was 2.1 per cent. The follow-up ranged from six months to five years (mean = 19 months). The success rate was 83.3 per cent and thresholds on pure tone audiometry improved in 69.2 per cent of cases. The age of the patient, grade of the surgeon, and graft material did not influence the surgical outcome. There was no case of dead ear as a result of surgery. Myringoplasty can be safely performed in both adults and children as a day-case procedure with low overnight stay and readmission rates. Success rates are comparable to when the procedure is performed on an in-patient basis.

Adolescent↗
PubMed2002

An immunogold investigation of the distribution of calmodulin in the apex of cochlear hair cells.

Calmodulin is found in the mechanosensitive stereociliary bundle of hair cells where it plays a role in various calcium-sensitive events associated with mechanoelectrical transduction. In this study, we have investigated the ultrastructural distribution of calmodulin in the apex of guinea-pig cochlear hair cells, using post-embedding immunogold labelling, in order to determine in more detail where calmodulin-dependent processes may be occurring. Labelling was found in the cuticular plate as well as the hair bundle, the rootlets of the stereocilia being more densely labelled than the surrounding filamentous matrix. In the bundle, labelling was found almost exclusively at the periphery rather than over the centre of the actin core of the stereocilia, and was clearly associated with the attachments of the lateral links that connect them to their nearest neighbours. It was also found to be denser towards the tips of stereocilia compared to other stereociliary regions and occurred consistently at either end of the tip link that connects stereocilia of adjacent rows. The contact region between stereocilia that is found just below the tip link was also clearly labelled. These concentrations of labelling in the bundle are likely to indicate sites where calmodulin is associated with calcium/calmodulin-sensitive proteins such as the various myosin isoforms and the plasma membrane ATPase (PMCA2a) that are known to occur there, and possibly with the transduction channels themselves. At least one of the myosin isoforms, myosin 1c, is thought to be associated with slow adaptation, and PMCA2a with control of calcium levels in the bundle. The concentration of calmodulin in the contact region further supports the suggestion that this is a functionally distinct region rather than a simple geometrical association between adjacent stereocilia.

Animals↗
PubMed2001

Nasogastric tube insertion using flexible fibreoptic nasoendoscope.

The insertion of a nasogastric tube, especially a fine bore feeding tube, can occasionally be problematic because of an anatomical variation or pathology. A method of passing an nasogastric tube under direct vision using a flexible fibreoptic nasoendoscope introduced through the nostril is described, which is reserved for cases where traditional methods of insertion failed.

Endoscopes, Gastrointestinal↗
PubMed2001

Delivery of nasal drops to the middle meatus: which is the best head position?

BACKGROUND: Chronic sinusitis and intranasal polyps require long-term topical drug therapy. The issue of drug delivery to the critical area of the middle meatus is rarely addressed. AIM: The aim of this study was to compare the delivery of drops to the middle meatus using four different head positions (Mecca, Mygind, Ragan and Head back). The study also assessed the discomfort with each position whilst administering the nasal drops. METHODS: Nine nostrils in five healthy volunteers were studied to compare the delivery of drops to the middle meatus using the four different head positions. A neurosurgical patty was placed under direct vision in the middle meatus using a rigid nasendoscope. Six drops of dyed-saline were administered into each nostril. Upon removal, a quantitative assessment was made of the amount of dye absorbed and discomfort assessed. The direction of flow of the nasal drops in the nose was also demonstrated. RESULTS: The 'Mygind' and 'Ragan' positions were superior to the 'Mecca' and 'Head back' positions in delivery of drops to the middle meatus. The 'Mecca' position was the most uncomfortable. CONCLUSION: We recommend that the 'Mygind' or 'Ragan' position should be used for nasal drop administration.

Cross-Over Studies↗
PubMed2000

Pleomorphic adenoma causing acute airway obstruction.

A case is reported of a pleomorphic adenoma of the minor salivary glands of the oral cavity presenting with acute airway obstruction. This is the first reported case to our knowledge of a mixed salivary tumour of the upper respiratory tract causing upper airway obstruction and acute respiratory failure. The patient had to be intubated and transferred to the intensive care unit. After an elective tracheostomy was performed, the adenoma was excised from its fibrous capsule. It was found to originate from the soft palate and occupied the parapharyngeal space. A high index of suspicion should be kept in order to diagnose tumours of the parapharyngeal space with unusual presentation. These tumours which are usually benign should be considered in the differential diagnosis from more common infectious or traumatic conditions and surgical morbidity should be minimal.

Acute Disease↗