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Biomedical subjects

D W Sim

Publications and source records attributed to D W Sim.

At least 19 recordsLinked to original sources
PubMed2002

Health-related quality of life in patients with skull base tumours.

The objective of the investigation was to report on the health-related quality of life (HRQoL) of patients diagnosed with skull base tumours using the Short Form Health Survey questionnaire (SF-36). Those patients suffering with vestibular schwannoma were examined to determine the effect facial nerve function had on their quality of life. It took place at the tertiary referral centre at the Department of Clinical Neurosciences, Western General Hospital, Edinburgh. A prospective study of 70 consecutive patients was taken, who harboured the following tumours: 54 vestibular schwannomas, 13 meningiomas, two haemangioblastomas and one hypoglossal schwannoma. Patients were interviewed using the short form 36 (SF-36) questionnaire. Facial nerve function was assessed in those patients who had vestibular schwannomas. The entire cohort of live skull base patients were assessed after a median follow-up time of 38.4 months. Patients with vestibular schwannoma treated conservatively with interval MRI had a quality of life similar to t he normal population. Those who underwent surgery had a significant difference in two of the SF-36 domains. No statistically significant correlation was found at final assessment between the degree of facial nerve functioning and any of the domains of SF-36. Patients with non-vestibular tumours had an impaired HRQoL in seven of the eight domains. Patients with skull base tumours have a significant impairment of their HRQoL. A conservative policy of follow up with interval MRI for patients with small vestibular schwannomas may therefore be more appropriate to preserve their HRQoL. Facial nerve outcome has little influence on quality of life in vestibular schwannoma patients.

Adult↗
PubMed2002

Excision of large solid haemangioblastomas of the cerebellopontine angle by a skull base approach.

Solid haemangioblastomas can be difficult to treat surgically because of their hypervascularity and requirement for circumferential dissection. We report two cases of large solid cerebellopontine angle haemangioblastomas that were safely resected utilizing wide transtemporal posterolateral skull-base exposures. In both cases, good tumour exposure was achieved with trans-cochlear approaches and division of the sigmoid sinus. These were large tumours and we felt that the added complexity of the approach was justified by providing panoramic exposure to allow safe resection.

Cerebellar Neoplasms↗
PubMed1997

Sensorineural hearing loss in MELAS syndrome.

A case of sensorineural hearing loss (SNHL) in MELAS syndrome, a variety of mitochondrial cytopathy, is presented. Mitochondrial cytopathies have gone almost unreported in the otolaryngology literature, despite evidence from a recent review that about 60 per cent of such patients suffer from SNHL (Gold and Rapin, 1994). The same review revealed that only one of 117 case reports in the period 1984-1993 contained an audiogram (Swift and Singh, 1988), and none presented sequential audiograms. However, audiometry has since been published on 23 members of a family with a mitochondrial point mutation causing only sensorineural hearing loss with no other symptoms (Vernham et al., 1994). We present a case of mitochondrial cytopathy three years after diagnosis with two sequential audiograms.

Adult↗
PubMed1997

Prophylaxis for venous thromboembolism in head and neck surgery: the practice of otolaryngologists.

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are an important cause of morbidity and mortality in the surgical patient. The first guideline produced by the Scottish Intercollegiate Guidelines Network was for the prophylaxis of venous thromboembolism. Patients undergoing major head and neck cancer surgery commonly exhibit risk factors for venous thromboembolism. Currently, however, there are no data on its incidence in these patients. A questionnaire survey was performed to assess the current practice of consultant otolaryngologists regarding DVT prophylaxis in patients undergoing head and neck cancer surgery. Of those respondents who managed these patients, 57 per cent did not use routine DVT prophylaxis while 43 per cent did. A wide variety of techniques were employed among those practising DVT prophylaxis. A consensus is needed concerning the use of thromboembolism prophylaxis in head and neck surgery patients.

Head and Neck Neoplasms↗
PubMed1995

Systematic approach to intradural tumors ventral to the brain stem.

Intradural tumors that are situated anterior to the midbrain, pons, and medulla have historically been among the most inaccessible of all intracranial lesions. The classic approaches to the posterior fossa (e.g., suboccipital, retrosigmoid) provide only limited access to the anterior midline, primarily due to interposition of the cerebellum, brain stem, and numerous cranial nerves between the tumor and the viewpoint of the surgeon. A variety of techniques have been developed in recent years that create a craniotomy by removal of a portion of the lateral skull base. These procedures enhance exposure of the ventral surface of the brain stem while markedly reducing the need for brain retraction. An underlying theme of transbasal craniotomy is judicious removal of a portion of the petrous pyramid. The most radical form of petrosectomy, the extended transcochlear approach, involves removal of the entire petrous pyramid along with the lateral aspect of the clivus. This provides an unimpeded view of the ventral surface of the pons, including the basilar artery, vertebrobasilar junction, and both abducens nerves. Whereas this technique provides splendid exposure along the midsegment of the brain stem, it carries substantial morbidity, including hearing loss and transient facial palsy, which typically recovers incompletely and with synkinesis. Over the past few years transcochlear procedures have been gradually supplanted, at the University of California Medical Center, by techniques that involve creating a simultaneous craniotomy of both the middle and posterior fossae fashioned around a more limited petrosectomy. These versatile procedures, in particular the middle fossa/retrolabyrinthine approach, provide excellent exposure of the region ventral to the midbrain and pons with less morbidity than the transcochlear approach. When tumors extend inferiorly, ventral to the lower medulla and/or upper cervical spinal cord, augmented inferior exposure is required. Approaches to ventrally situated lesions at the craniovertebral junction include the far lateral (transcondylar) approach to the foramen magnum and the transjugular approach, both of which involve removal of the inferior portion of the petrous bone. To efficiently utilize these innovative surgical options the surgeon must decide which of the potential approaches optimizes resection while minimizing morbidity. An analysis of the anatomy of the tumor, the functional integrity of cranial nerves, and the extent of resection planned provides the surgeon with the information needed to arrive at a rational choice.

Brain↗
PubMed1993

Otolaryngological indicator operations: one year's experience.

One year's experience of otolaryngological indicator operations is presented. Of 59 myringoplasties, 47 (79%) were successful; trainees performed 44 (74%) of the procedures. Seventy patients undergoing septal surgery reported significant improvements in nasal obstruction (P < 0.001), catarrh and facial pain (P < 0.005). Seventeen laryngectomies were performed for stage III and IV disease. The median operative time of 3.1 h rose to 5.1 h with a concomitant neck dissection. Eleven complications ensued, and the median stay for an uncomplicated laryngectomy was 16 days and 30 days following complications. Forty-one parotidectomies, 19 submandibular gland excisions and 10 ductal procedures were performed with 5 wound complications and 5 minor temporary facial nerve weaknesses. We have established a baseline for comparison of our practice with others and concluded that septal surgery gives good symptomatic relief, trainees perform reasonable numbers of myringoplasties, and improvements remain to be made in our outpatient septal surgery data collection.

Adolescent↗
PubMed1992

Tuberculoma of the nasopharynx.

A 67-year-old female patient with tuberculosis of the nasopharynx is reported. The diagnosis was confirmed on histological and bacteriological examination of a biopsy from her postnasal space. There was no evidence of any other active foci of tuberculosis but she had had a right nephrectomy 45 years previously for renal tuberculosis. A review of the literature on nasopharyngeal tuberculosis shows this to be a very rare disease in the absence of active pulmonary involvement.

Aged↗
PubMed1991

Reinke's oedema and thyroid function.

Reinke's oedema (RO) of the vocal folds is a condition of unknown aetiology. Cigarette smoking and vocal abuse may contribute to its development. Hypothyroidism has been described as an aetiological factor but, to date, no controlled study has been published confirming this association. This prospective, controlled study compared thyroid function in 61 consecutive RO patients with an age and sex matched control group (n = 65) without laryngeal disease. Thyroid function was assessed by measuring serum thyroid stimulating hormone (TSH), free thyroxine (T4) and tri-iodothyronine (T3). Hypothyroidism was diagnosed when TSH was above normal with a T3 and T4 below the normal range. Four RO patients were hypothyroid at the time of diagnosis, compared to five of the control group. Six RO patients had past or present hypothyroidism compared to seven of the controls. One RO patient and two controls were euthyroid with marginally elevated TSH levels. Although the incidence of hypothyroidism in this group of Reinke's oedema patients is higher than expected in a normal population, it is similar to that in an age and sex matched control group, reflecting the prevalence of hypothyroidism in middle aged women. This study suggests that hypothyroidism is not an aetiological factor in the development of Reinke's oedema.

Adult↗
PubMed1990

Metastatic salivary pleomorphic adenoma.

Pleomorphic adenomas of the salivary gland are usually regarded as benign tumours. We report a case in which a solitary pulmonary metastasis arose from a pleomorphic adenoma of the right parotid gland. The mechanism of metastasis is discussed.

Adenoma, Pleomorphic↗
PubMed1990

Spiral ligament tension fibroblasts and extracellular fibres in the guinea pig.

Fibroblasts with stress fibres and their relationship to extracellular matrix fibres were described in the marginal regions of the spiral ligament in several mammalian species. Location, structure and attachment of these cells suggested that they facilitated the development of radial tension in the basilar membrane-spiral ligament complex. In this study, fibroblast structure and relationship with the extracellular matrix was examined by light and transmission electron microscopy in the guinea pig spiral ligament. Tension fibroblasts were found in marginal and subcentral regions of the spiral ligament. Their ultrastructure was described. They were related to the trabeculated extracellular matrix and were numerous in the marginal region at the spiral ligament-otic capsule interface. Their comparative anatomy and role in the development of spiral ligament-otic capsule tension was discussed.

Animals↗
PubMed1989

The ENT consultation: a prospective study of the doctor's and the patient's perceptions.

In this prospective study of 126 patients attending the ENT outpatient clinic the doctor's and the patient's perception of the consultation were evaluated by questionnaire; 96 patients completed the questionnaire correctly. The results were analysed by scattergram plot and Wilcoxon's matched-pair signed ranks test. There was a statistically significant difference between the doctor's and the patient's perception of the 'history' (p less than 0.01) and the 'explanation of diagnosis and treatment' (p less than 0.05) in the consultation. There was no statistically significant difference between the doctor's and the patient's perception of the 'examination' in the consultation. The results are discussed.

Adolescent↗
PubMed1989

Co-existent inverted papilloma and squamous carcinoma of the nasal septum.

Inverted papilloma is an uncommon benign nasal tumour which usually occurs on the lateral nasal wall and is prone to recurrence and malignant change. Inverted papilloma of the nasal septum is rare. A case of inverted papilloma and coexistent squamous carcinoma of the nasal septum in an adult male is described. The biology and treatment of these lesions are discussed.

Adult↗
PubMed1989

Spiral prominence epithelium.

Recent studies have shown neuroendocrine-type cells in human spiral prominence epithelium. A light microscopic and ultrastructural study was made on the guinea pig spiral prominence epithelium to try and identify neuroendocrine cells. The study showed that such cells were not present in the guinea pig spiral prominence epithelium. The spiral prominence epithelium was characterized by uniformity of cellular staining with Toluidine blue and the ultrastructural appearance. The morphology of the spiral prominence epithelium was similar to that previously described. The absence of neuroendocrine cells in spiral prominence epithelium in the guinea pig is discussed in relation to species differences.

Animals↗
PubMed1989

Relationship of the primary choanae and anterior cranial base in the mouse embryo.

The anteroposterior growth of the primary choanae and anterior cranial base in, morphologically, staged CBA mouse embryos was measured. Embryo heads were cut serially in a frontal plane of section. Serial measurement of the primary choanae and anterior cranial base demonstrated that growth of the primary choanae was downwards and forwards with the primary palate and that it did not occur by upward and backward extension along the stomodeal roof. The results are discussed in relation to previous topographical descriptions of primary choanal development.

Animals↗
PubMed1988

Wax plugs and cotton buds.

Three hundred and ten patients were examined by otoscopy. Age, sex, social class and use of cotton buds for aural toilet were recorded. The incidence of visually occlusive wax plugs in the external auditory canals was not significantly different between users and non-users of cotton buds, either in children or in adults.

Adolescent↗
PubMed1988

Primary nasal tuberculosis masquerading as a malignant tumour.

Primary nasal tuberculosis is rare. We report a case of primary nasal tuberculosis in an elderly lady who presented with symptoms and signs suggestive of a nasal fossa tumour. Histological examination of the lesion revealed the diagnosis. Treatment was with standard anti-tuberculous chemotherapy. The implications of primary nasal tuberculosis are discussed.

Aged↗