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Biomedical subjects

D S Stevenson

Publications and source records attributed to D S Stevenson.

11 recordsLinked to original sources
PubMed2002

An unusual cause of epistaxis: a haemophilic pseudotumour in a non-haemophiliac, arising in a paranasal sinus.

Most cases of epistaxis are due to simple causes and are easily treated on an out-patient basis. However, there are some cases where the origin of bleeding is not obvious or arises from an unusual pathological source. The authors describe a case of epistaxis due to a mass in the maxillary antrum that when biopsied showed the histological appearances of a haemophilic pseudotumour. The patient was anticoagulated on warfarin for a cardiac valve replacement and this was thought to be the cause of the ongoing haemorrhage necessary for development of the pseudotumour. Even in haemophiliacs, pseudotumours are rare and we believe this case is unique in that the patient is a non-haemophiliac. The epistaxis was eventually controlled by external beam radiotherapy to the pseudotumour. The management of this case is outlined as well as a review of the literature on haemophilic pseudotumour.

Aged↗
PubMed1996

Pathological changes associated with short-term nasal intubation.

In order to define the incidence and anatomical site of nasal damage following nasotracheal intubation, we investigated 100 consecutive patients undergoing dental extractions under general anaesthesia. Patients were questioned pre-operatively about the physiological function of their noses and examined by anterior rhinoscopy for anatomical abnormalities. Examinations were repeated postoperatively, looking specifically for haemorrhage, mucosal tears and septal and turbinate disruption. Minor bruising was common (54%) and most frequently involved mucosa overlying the inferior turbinate and adjacent septum. In two cases bruising involved the middle turbinate. There was no relationship between the number of attempts at intubation and subsequent damage. Pre-operative otolaryngological assessment failed to identify those patients who subsequently proved difficult or impossible to intubate nasally and incorrectly predicted difficulty in 11 patients who had pre-existing deviation of the nasal septum. In conclusion, short-term nasotracheal intubation was not associated with significant nasal morbidity, and pre-operative anatomical assessment failed to identify those in whom nasal intubation proved difficult or impossible.

Adolescent↗
PubMed1993

VISTAnet: interactive real-time calculation and display of 3-dimensional radiation dose: an application of gigabit networking.

Three-dimensional treatment planning can allow the clinician to create plans that are highly individualized for each patient. However, in lifting the constraints traditionally imposed by 2-dimensional planning, the clinician is faced with the need to compare a much larger number of plans. Although methods to automate that process are being developed, it is not yet clear how well they will perform. VISTAnet is a 3 year collaborative effort between the Departments of Radiation Oncology and Computer Science at the University of North Carolina, the North Carolina Supercomputing Center, BellSouth, and GTE with the medical goal of providing real-time 3-dimensional radiation dose calculation and display. With VISTAnet technology and resources, the user can inspect 3-dimensional treatment plans in real-time along with the associated dose volume histograms and can fine tune these plans in real-time with regard to beam position, weighting, wedging, and shape. Thus VISTAnet provides an alternate and, possibly, complementary approach to computerized searches for optimal radiation treatment plans. Building this system has required the development of very fast radiation dose code, methods for simultaneously manipulating and modifying multiple radiation beams, and new visualizations of 3-dimensional dose distributions.

Computer Communication Networks↗
PubMed1993

Osseointegrated implants in the management of childhood ear abnormalities: the initial Birmingham experience.

Over a four-year period 72 children with ear abnormalities have been referred for assessment by the extraoral osseointegrated implant team at The Queen Elizabeth Hospital, Birmingham. Thirty-two children have been judged suitable for rehabilitation. Twelve children have completed rehabilitation using bone-anchored hearing aids and/or auricular prostheses. Two fixtures (seven per cent of those loaded) have dislodged and required replacement. Audiological assessment of the bone-anchored hearing aid users shows only small improvements in their aided thresholds, compared to thresholds obtained with their previous aid. However all now have thresholds of 30 dB(A) or better and report a marked improvement in sound quality. When surveyed, hearing aid and prosthesis users report high levels of satisfaction with this form of rehabilitation. The technique adds a new dimension to the management of children with aural anomalies. The approach and results of a multidisciplinary programme are reported.

Adolescent↗
PubMed1993

Severe cochlear dysplasia causing recurrent meningitis: a surgical lesson.

Meningitis may be the sole presenting sign of a cerebrospinal fluid (CSF) fistula of the temporal bone. An eight-year-old boy suffering from recurrent meningitis was found to have bilateral severe cochlear dysplasia. Bilateral tympanotomies were performed, planning to obliterate each vestibule. In the right ear a stapedectomy was performed, resulting in a torrential 'CSF gusher' and difficulty in packing the vestibule. CSF rhinorrhoea requiring revision surgery and two episodes of gram-negative bacterial meningitis complicated the post-operative management, resulting in a prolonged hospital stay. Subsequently, the left ear was managed in a different fashion, leaving the stapes in situ, with grafts placed to seal the oval window niche. We would recommend this alternative procedure in cases of severe cochlear dysplasia, where abnormalities of the vestibule and basal turn of the cochlea mean that performing a stapedectomy to pack the vestibule may result in a severe 'CSF gusher', by opening directly into the subarachnoid space.

Bone Diseases↗
PubMed1992

Carcinoma of the glottic larynx: the Christchurch experience.

AIMS: to establish the local control and survival rates for glottic laryngeal cancer, and to determine the incidence of second primary cancers after treatment of the original tumour. METHODS: a retrospective review of all patients with glottic cancers treated in Christchurch over a five year period, with a minimum follow up of five years. RESULTS: between 1979 and 1984, 83 patients with laryngeal cancer were treated in Christchurch Hospital. Forty-seven of these patients had cancers of the glottic larynx. Overall, 39 of 45 patients were free of their laryngeal cancer at five years (two were lost to follow up). Eight of 45 developed a second primary cancer, usually lung or oesophagus, and this was invariably fatal. CONCLUSION: with multidisciplinary management of head and neck cancers satisfactory control rates can be achieved, but since these patients are usually heavy smokers and drinkers, they are at high risk of developing a second primary cancer. The use of chemopreventative agents is mentioned.

Aged↗
PubMed1992

Acute tonsillectomy in the management of infectious mononucleosis.

Life-threatening upper airway obstruction can be caused by tonsillopharyngitis secondary to infectious mononucleosis (IM). The administration of corticosteroids, emergency tracheostomy and acute tonsillectomy have been advocated as ways of managing this problem. In a series of 25 patients admitted over a five-year period with IM, 15 were judged to have symptoms severe enough to warrant the administration of corticosteroids. Six of these 15 patients had little improvement in their condition and thus underwent acute tonsillectomy. There were no significant complications of this surgery. A further three patients who received corticosteroids required tonsillectomy for recurrent tonsillitis later in the study period. By contrast, only one of the ten patients who did not receive corticosteroids subsequently required tonsillectomy. Acute tonsillectomy is of value in selected cases of IM tonsillopharyngitis. It may decrease the morbidity of recurrent tonsillitis after IM, in addition to averting the immediate risk of respiratory obstruction.

Acute Disease↗
PubMed1989

Aspiration cytology in the diagnosis of head and neck masses: the early Christchurch experience.

Fine needle aspiration cytology has been performed on patients presenting with head and neck masses in Christchurch since mid-1985. The results of an initial 120 aspirations were reviewed. Histology was available to compare with the cytology result in 58% of cases. Clinical review was used to assess the accuracy of the cytology result in the remaining cases. The majority of the masses aspirated were of benign origin (72%). The cytological diagnosis was accurate in 79% of cases. Of the remaining aspirates, 13% were inaccurate and 8% nondiagnostic. The sensitivity for malignant lesions was 100%, with 86% specificity (for benign lesions). Particular diagnostic difficulty was found in the differentiation between some salivary gland tumours, and the assessment of aspirates from neck masses after combined therapy (radiotherapy and surgery). Fine needle aspiration cytology is of considerable value in the management of head and neck masses.

Adolescent↗