Biomedical subjects

D A Bowdler

Publications and source records attributed to D A Bowdler.

17 recordsLinked to original sources

PubMed1995

Management of retraction pockets of the pars tensa in children by excision and ventilation tube insertion.

Retraction pockets of the pars tensa in children can result in erosion of the ossicles leading to hearing loss and eventually cholesteatoma formation. Several different types of treatment for the more severe grades of retraction pocket have been described. The aim of this pilot study was to assess the outcome following simple excision and ventilation tube insertion of grade II, III and IV retraction pockets of the pars tensa. The eardrums were graded according to Sadé's classification (1979). There were seven grade II and four grade III retractions. Ten eardrums healed completely in a mean time of 3.6 months (mean follow-up 16 months) and there was one residual perforation. Two retractions recurred and both of these were only grade I. Clinically, an improvement in hearing was reported in seven children (eight ears) and the average air conduction threshold gain for these patients was 16 dB. A larger prospective study is currently underway.

Auditory Threshold↗

PubMed1995

The use of Davis pinch grafts to promote epithelialization in a post- mastoidectomy cavity.

Otorrhoea following open mastoid cavity surgery is common and is estimated to occur in 10 to 35% of patients. It is usually due to failure of epithelialisation of the mastoid cavity for a variety of reasons. Even in the ideal cavity, which is small with a low facial ridge and large meatus, 10% discharge recurrently. Various techniques designed to promote epithelialisation have been proposed including cavity revision with or without a meatoplasty, cavity obliteration by different methods and partial or total reconstruction of the cavity. No single technique has proved superior. Other approaches that directly address the problem of epithelialisation have been used, including partial thickness skin grafting, autologous and indeed synthetic epidermal cell grafting, with varying degrees of success. We describe the Davis pinch graft technique, as devised by Holsted and popularized by Davis for venous ulcers. Free pinch grafts consisting of epidermis and small amounts of dermis are taken from the anterior abdominal wall and inserted into the revised mastoid cavity. We present a retrospective study of 15 patients who underwent revision mastoidectomy and Davis pinch grafting for persistent ottorrhoea, and discuss the results with respect to patient symptomatology and the surgeons assessment of the cavity. In conclusion, we believe that the Davis pinch graft has a proven beneficial effect in the management of post-mastoidectomy otorrhoea.

Adolescent↗

PubMed1994

Massive epistaxis following sphenoid sinus exploration.

Internal carotid artery trauma is a rare but potentially disastrous complication of surgery to the sphenoid sinus and pituitary gland. Emergency and elective procedures to establish haemostasis are discussed.

Aneurysm, False↗

PubMed1991

Solitary keratoacanthoma of the nasal vestibule.

Keratoacanthomas are lesions which rarely present to Otorhinolaryngologists; however they must be considered in the differential diagnosis of any rapidly growing lesion in the head and neck. We report a case of a keratoacanthoma of the nasal vestibule which caused clinical and histopathological difficulties in diagnosis. Keratoacanthomas and the treatment options are discussed.

Adult↗

PubMed1991

Interpretation of maxillary sinus radiographs in children.

Nasal symptoms are a frequent cause of referral to paediatric ENT clinics. It is the policy of our unit to view sinus radiographs without a report at the initial clinic attendance. This study demonstrates there is no statistically significant difference in the interpretation of the radiographs between two ENT surgeons and a radiologist although there was a tendency for the radiologist to have a greater specificity. This finding may have financial implications. In addition a clear sinus radiograph is shown to be a significant negative finding.

Adolescent↗

PubMed1991

Verrucous carcinoma of the maxillary antrum.

Verrucous carcinoma is a rare variant of squamous cell carcinoma which occurs most frequently in the oral cavity and larynx. In this article we describe a patient with verrucous carcinoma of the maxillary antrum, and present a review of the literature.

Aged↗

PubMed1991

Disposition and tumour concentrations of platinum in hypoalbuminaemic patients after treatment with cisplatin for cancer of the head and neck.

1 Platinum concentrations in the tumour reached a peak of 3.8 +/- 1.5 micrograms g-1 wet weight tissue at the end of an 8 h intravenous infusion of cisplatin. The tumour concentrations of platinum were higher than the corresponding plasma concentrations (2.5 +/- 0.9 micrograms ml-1) and declined more slowly. 2 Patients with squamous carcinoma of the head and neck had a significantly shorter median survival time if they had low plasma albumin concentrations (less than 40 g l(-1) compared with patients in the normal range, 133 days and 768 days respectively (P less than 0.05) after treatment with cisplatin. 3 No changes in the pharmacokinetics of platinum were detected to account for this poor response of hypoalbuminaemic patients, but plasma albumin concentration was found to be negatively correlated with the first order elimination rate constant. 4 The cumulative urinary excretion of platinum in the first 24 h was not altered by lowered plasma albumin. 5 The concentration of platinum in the tumour did not correlate with the survival time of the patient, but was found to be correlated with the volume of distribution in the post-distributive phase.

Adult↗

PubMed1989

The management of pseudohypacusis in school-age children.

Pseudohypacusis is a condition in which there is an apparent hearing loss in the absence of clinical or audiological evidence; indeed, audiological assessment for inconsistencies is the mainstay of diagnosis. It is easier to diagnose in children than in adults, due to a child's inability to produce consistently similar results on repeat tests. We have reviewed 15 children with pseudohypacusis, who had an average loss in the right ear of 57 dB, and of 59 dB in the left ear when tested by pure tone audiometry. Eight children were diagnosed by clinical impression and inconsistent pure tone audiograms but in order to confirm the diagnosis in the other seven children further testing with a speech audiogram was necessary and proved sufficient to establish the diagnosis in all cases. The hearing of all 15 children resolved spontaneously at between 2 and 70 months, when treated by careful monitoring and supportive therapy, and none of the children needed psychiatric referral.

Audiometry, Pure-Tone↗

PubMed1987

Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum).

Carcinoma is a rare but recognized complication of posterior pharyngeal pulsion (Zenker's diverticulum). Such diverticula merit radiological and endoscopic examination before operation. Surgery is preferred to radiotherapy in the treatment of carcinoma, the choice of operation resting between one-stage diverticulectomy for cancer confined to the body of the sac and pharyngolaryngectomy for more extensive lesions.

Aged↗

PubMed1987

Surgical management of posterior pharyngeal pulsion diverticula: inversion versus one-stage excision.

At present one-stage excision of the posterior pharyngeal pulsion diverticulum is the most popular method of treatment in the UK and the USA. We have reviewed 53 patients who have presented to this unit between 1968 and 1986, to compare the results of different surgical techniques. Of these, 21 underwent excision and myotomy, 20 inversion and myotomy, and 9 myotomy alone. The results show that the mortality for the whole group was 4 per cent, but there were no deaths in either the inversion or myotomy group. The excision group had a complication rate of 52 per cent, compared with 30 per cent for inversion, and also had more major problems such as fistula. Median hospital stay was shorter for inversion than for excision, at 7 and 10 days respectively. In summary we believe that inversion of the posterior pharyngeal pulsion diverticula is now the surgical treatment of choice.

Aged↗

PubMed1987

Subglottic stenosis in children: a conservative approach.

Subglottic stenosis may be either congenital or acquired and is one of the commonest causes of acute and chronic airways obstruction in neonates and infants. Most acquired stenoses result from perinatal intubation. The management of these lesions remains controversial, particularly regarding the timing of surgical intervention. At Alder Hey Children's Hospital a series of 33 patients with subglottic stenosis have been reviewed. A conservative approach, employing long-term tracheotomy as the mainstay of treatment, has achieved a success rate of 72.7%, and only 3 patients have so far needed corrective surgery (9%), of which 1 has been decannulated to date. One patient (3%) died of bronchopulmonary dysplasia. We believe that, where close follow-up is possible, a conservative approach is the method of choice.

Follow-Up Studies↗

PubMed1986

Internal jugular phlebectasia.

Varicose veins are a common venous anomaly, but rarer varieties also occur including phlebectasia, which is an abnormal dilatation of an isolated vein. Phlebectasia may affect any vein and is usually asymptomatic. When the internal jugular vein is involved, it presents as a cervical swelling that closely mimics the signs of either a pharyngocoele or a laryngocoele and, due to its rarity, is frequently misdiagnosed. A review of the English literature demonstrates that the diagnosis has generally been confirmed either by invasive contrast radiographic techniques, or surgical exploration, though many authors had made a tentative clinical diagnosis prior to surgical confirmation. No treatment is indicated for this benign self-limiting condition, except for the few patients who complain of symptoms and require surgical removal of the affected vein, and therefore, if a diagnosis cannot be made with certainty from the clinical features, investigations should be as non-invasive as possible, employing either a CAT scan or Digital Subtraction Angiography, though the latter is not yet universally available.

Child↗

PubMed1985