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Biomedical subjects

D J Watson

Publications and source records attributed to D J Watson.

At least 19 recordsLinked to original sources

Fractured-nose reduction under local anaesthesia. Is it acceptable to the patient?

This article examines patients' acceptance of fractured-nose reduction under local anaesthesia, both objectively and subjectively. At each stage of the reduction the level of the discomfort, the patients' experiences were recorded. The success rate of complete reduction of the nasal fracture was found to be 71% and this was similar to that obtained in other studies that have used general anaesthesia. An overall level of discomfort for the procedure in terms a layman can understand was obtained by comparing the manipulation with that of having a tooth filled at the dentist. Sixty-three percent of the patients said that the nasal fracture reduction was no worse or the same as a dental filling. Our study showed that 96% of patients would be willing to undergo the same local anaesthetic procedure if they fractured their nose a second time. We conclude that it is possible to reduce the majority of fractured noses adequately with little inconvenience to the patient under local anaesthesia, and so we recommend that this procedure should be considered in the first-line treatment of the displaced fractured nose.

Adolescent

Lymphogranuloma venereum of the tonsil.

A case of lymphogranuloma venereum of the tonsillar lymph tissue is presented. The similarities of tonsils to cervical lymph nodes are discussed and the importance of histological examination of abnormal tonsil tissue is reiterated.

Adult

Death following suspected alprazolam withdrawal seizures: a case report.

This is a case report of severe psychosis and seizures following abrupt discontinuation of alprazolam and then the recurrence of seizures at the end of a gradual tapering schedule. The last of these seizures appeared to be a contributing factor in the patient's death. To the authors' knowledge, this is the first published report of a fatality associated with alprazolam withdrawal.

Alprazolam

The safety and efficacy of intra-nasal ethmoidectomy.

Each of the three types of ethmoidectomy: intra-nasal, trans-antral and external, has its supporters and detractors who argue about the efficacy and safety of the procedures. One hundred and five ethmoidectomies for nasal polyps are reviewed retrospectively. Regardless of the approach used, approximately half of these had recurrence of polyps and some patients had several revision operations. There were six complications specific to the surgery. None was serious but most occurred with external ethmoidectomy. The limitations of ethmoidectomy for nasal polyps, the reasons for the good safety record and the best means of training juniors in the procedures are discussed.

Ethmoid Bone

Local versus general anaesthetic in the management of the fractured nose.

Displaced fractured noses are usually manipulated under general anesthetic. The appearances of fractured noses were assessed and the airways measured by rhinomanometry before and after nasal manipulation in 29 patients. Seventeen received a local anaesthetic (LA) and 12 a general anaesthetic (GA) for the manipulation. Patients were generally pleased with the outcome and there were no significant differences between results in the 2 groups. Bony manipulation did not affect the nasal airway. Local anaesthesia was acceptable to all but one patient. The benefits, including those of cost and safety, of local anaesthetic for manipulation of almost all fractured noses are discussed.

Adolescent

Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation.

Vitamin B12 deficiency is a frequently considered diagnosis for which there is no single, commonly available and accurate test. A urinary methylmalonic acid assay using gas chromatography-mass spectrometry has been proposed as the preferred test. We reviewed vitamin B12 assays on 1599 consecutive patients and prospectively studied all patients with low serum B12 levels (n = 75) and a random sample of patients with normal levels (n = 68). Of 96 evaluable patients, 7 had clinical deficiency. All 7 deficient patients had urinary methylmalonic acid levels greater than 5 micrograms/mg creatine (sensitivity, 100%; confidence interval, 65% to 100%). Of the 89 patients who were not clinically deficient, 88 had urinary methylmalonic acid levels less than or equal to 5 micrograms/mg creatinine (specificity, 99%). The overall test accuracy in this population was 99%. If the high sensitivity and specificity of the gas chromatography-mass spectrometry assay for urinary methylmalonic acid is supported by other clinical studies, the methylmalonic acid assay may become the reference standard for the diagnosis of vitamin B12 deficiency.

Aged

The effect on the ear of late closure of the cleft hard palate.

Thirty-three patients with cleft palate are reviewed. The late effects on the ear of delayed closure of the hard palate after early soft palate repair are compared with the results of simultaneous early closure of both hard and soft palate clefts. Delayed closure of the hard palate does not affect the incidence of otitis media, the number of insertions of ventilation tubes or the findings on otoscopy. The prevalence of sensorineural hearing loss is significantly raised by late closure of the hard palate. The reason for this is unknown.

Adolescent

Large-cell calcifying sertoli cell tumor of the testis. An ultrastructural, immunocytochemical, and biochemical study.

This report describes the ultrastructural and hormonal characteristics of the recently described large-cell calcifying Sertoli cell tumor of the testis, a rare subtype of pure Sertoli cell tumor. The ultrastructural findings showed similarity to normal Sertoli cells, pure Sertoli cell tumors, Sertoli cells in azoospermic human testes, and the Sertoli cell component of Sertoli-Leydig cell tumors. Ultrastructure indicated features common to steroid-producing cells. Testosterone and estradiol were demonstrated in the tumor by immunocytochemical and biochemical methods.

Basement Membrane