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Biomedical subjects

D W Skinner

Publications and source records attributed to D W Skinner.

At least 19 recordsLinked to original sources
PubMed2005

Persistent epistaxis: what is the best practice?

Epistaxis is the commonest otolaryngological emergency, which is often managed by a nasal pack. A significant number of cases fail to respond to nasal packing and various surgical measures are available to control the nosebleed in these cases. However evidence is sparse regarding the best available surgical option for the management of persistent epistaxis. We designed a retrospective cohort study comparing endoscopic ligation of sphenopalatine artery (ELSA) and all other surgical options (non-ELSA) in the management of persistent epistaxis. All consecutive cases of persistent epistaxis between 1997-2004 (Feb) requiring operative intervention were included in the study and divided in two groups according to the surgical intervention. Postoperative epistaxis was excluded. Non-ELSA group consisted of various procedures including nasal cautery and packing, submucous resection, anterior ethmoid artery ligation, external carotid artery ligation, internal maxillary artery ligation. Both groups were matched for age, sex, risk factors, other medical conditions and medications. The main outcome measures evaluated were immediate success in arresting the bleeding and the mean hospital stay. Recurrence and patient acceptability of the procedure were the secondary variables investigated. We found that ELSA proved to be the best practice to manage persistent epistaxis on all measures of immediate success rate, shorter hospital stay, recurrence rate, and patient satisfaction.

Adult↗
PubMed2004

A survey on the management of reactionary haemorrhage following adenoidectomy in the UK and our practice.

We present the results of a nation-wide survey in the management of reactionary haemorrhage following adenoidectomy, in the absence of specific national guidelines for this complication in the UK. We have reported the practice of the consultant members of the BAO-HNS through a confidential postal questionnaire with regard to their preferred method of management and experience. Valid replies were received from 285 ENT surgeons, of which 87.3% (249) prefer to manage reactionary haemorrhage with post-nasal packs and 223 (78.2%) would use an overnight post-nasal pack. 7.7% (22) use other techniques, and 9.1% (26) leave post-nasal packs for as short time as possible. Our experience of using a post-nasal pack for 4 h appears equally as effective as a post-nasal pack left for 24 h and reduces the discomfort and subsequent risks related to overnight post-nasal packing.

Adenoidectomy↗
PubMed2001

Endoscopic repair of unilateral choanal atresia with the KTP laser: a one stage procedure.

This paper, describes the endoscopic repair of unilateral choanal atresia with the KTP laser, a one-stage procedure, with no requirement for stenting. Three patients are presented with unilateral choanal atresia, aged six, nine and 38-years-old. The procedure combines the excellent endoscopic visualization, with the good haemostatic and penetrating properties of the KTP laser. Follow up was between 12 months and four years with all choanae remaining patent, no dilatation was required. No surgical complications were noted.

Adult↗
PubMed2001

Peri-orbital surgical emphysema following functional endoscopic sinus surgery, during extubation.

We present a case of peri-orbital surgical emphysema following functional endoscopic sinus surgery (FESS), due to extubation with simultaneous manual inhalation with a closed expiratory valve. This complication has not been previously reported in association with general anaesthetic and FESS. Patients undergoing FESS are advised against nose blowing. However, we recommend that the anaesthetist working with a surgeon who performs FESS should also be warned not to use manual inhalation with a closed expiratory valve while extubating, as this can cause peri-orbital surgical emphysema.

Aged↗
PubMed2001

Sebaceous carcinoma of the nasal vestibule.

Sebaceous carcinoma is a rare disease arising from holocrine adnexal components of the skin. Fewer than 400 cases have been reported worldwide and only about 19 are from the nose. We present a sebaceous cancer of the nasal vestibule in a patient who, with adequate excision, is disease-free after two years.

Humans↗
PubMed1998

A precricoid swelling in a patient treated with Teflon injection in the vocal fold after idiopathic left vocal fold palsy.

Vocal fold palsy is a cause of dysphonia. Due to incomplete glottic closure during phonation, patients with a unilateral vocal fold palsy present with a weak and breathy voice and recurrent aspiration. To lessen the clinical manifestations of unilateral vocal fold palsy, polytetrafluoroethylene (Teflon) paste is one agent which has been injected into the paraglottic region, thus causing the vocal fold to move more medially. One of the complications associated with Teflon paste injection is migration of the paste into the surrounding tissues. We present a patient with idiopathic left vocal fold palsy who underwent Teflon injection to the vocal fold and subsequently developed a precricoid nodule, mimicking a cartilaginous swelling.

Aged↗
PubMed1997

Complications of palatoplasty for snoring or sleep apnoea.

A questionnaire was sent to consultant Otolaryngologists (483) throughout the UK to identify any mortality associated with uvulopalatoplasty and other forms of palatoplasties for snoring and/or obstructive sleep apnoea. The response rate was 76.8 per cent (371). Six intra- and post-operative deaths were reported and four were known to have obstructive sleep apnoea. Life-threatening morbidity occurred in at least seven patients (three known apnoeic), two required immediate tracheostomy and two were managed in the intensive care unit. This suggests that the apnoeic patients undergoing palatoplasties experienced significant mortality and morbidity. Pre-operative sleep study should be performed in all snoring patients to identify the apnoeic subgroup. Continuous positive airway pressure, management of excessive obesity, elective tracheostomy and other strategies should be first considered before palatoplasties in these patients.

Humans↗
PubMed1996

Cowpox infection of the nose.

A case of cowpox infection presenting as a necrotising cellulitis of the nasal tip and vestibule is reported. Diagnosis was established by identification of the pox virus particles from tissue culture of the nasal biopsy using electronic microscopy and the characteristic lesions on chorio-allantoic membrane produced by the virus. Cowpox of the external nose and transmission of the infection from a dog have not to our knowledge been reported previously.

Adult↗
PubMed1992

Long-term results of Goode's tympanostomy tubes in children.

The results of a retrospective study of the complications of middle ear ventilation by Goode's T-tubes in children are presented. 248 T-tubes were inserted into 119 patients. 16.9% progressed to spontaneous extrusion with a mean period of ventilation approaching 20 months. 54.9% of patients experienced otorrhoea which was found to be significantly more common in those ears with a mucoid effusion at the time of T-tube insertion. 21.1% of ears developed a persistent perforation where spontaneous extrusion had occurred or the T-tubes had been removed. Perforation also occurred more frequently in those with otorrhoea.

Child↗
PubMed1992

Tuberculosis of the nasopharynx: clinicopathological features.

The clinicopathological features of 10 adult patients with nasopharyngeal tuberculosis (TB) are presented. 9 patients had no evidence of chest or systemic disease. 7 patients presented with cervical lymphadenopathy, and only 4 had nasal symptoms. Examination of the nasopharynx showed no abnormality in 2 patients, lymphoid hyperplasia in 4 patients, and a tumour-like mass in 4 patients. These findings suggest that nasopharyngeal TB may occur more frequently as part of an isolated upper respiratory tract infection than as secondary to pulmonary infection. The nasopharynx may be a portal of entry for tubercle bacilli in patients who develop cervical lymphadenitis. Involvement of the nasopharynx by TB may be underdiagnosed because it does not produce obvious symptoms or physical signs in all cases.

Adult↗
PubMed1991

A study of the complications of grommet insertion for secretory otitis media in the presence of nasopharyngeal carcinoma.

Accepted treatment of secretory otitis media, in the presence of nasopharyngeal carcinoma treated with radiotherapy, includes the insertion of a grommet. This study analyses the incidence of otorrhoea following this treatment as compared to a control group. Results show that persistent otorrhoea occurred frequently (68%) in the study group and was refractory to antibiotic therapy. Alternative methods of management of the secretory otitis, such as a hearing aid, should be considered to avoid the complications of grommet insertion in this group of patients.

Adult↗
PubMed1991

Nasopharyngeal carcinoma: modes of presentation.

Nasopharyngeal carcinoma (NPC) is a common malignancy among the southern Chinese people and has a poor prognosis. The aim of this study was to describe in detail the presentation of NPC as found between 1984 and 1988 at Prince of Wales Hospital, Hong Kong. Our study confirmed that patients present with an advanced stage of malignancy; 70% were stage III to V. Eighty-two percent of patients were between 21 and 60 years of age. The symptoms often suggested benign disease and most patients would delay seeking treatment for at least 5 months. We recommend inspection of the nasopharynx with flexible nasoendoscopy for all persons in high-risk areas on a regular basis and advise a policy of active health education for both physicians and the general population to reduce the stage of NPC at first presentation.

Adolescent↗
PubMed1990

Antibiotic/steroid ear drop preparations: a cost-effective approach to their use.

Otorrhoea is a common otological complaint reflecting infection in the outer and/or middle ear. Guidelines as to which antibiotic/steroid ear drop preparation to use in a treatment regime are few and no studies comparing the different types of preparation are available. This paper reviews the antibiotic/steroid ear drop preparations used by consultant surgeons and general practitioners and presents a two fold rationale for deciding which preparation to use, based on microbial sensitivity and cost.

Anti-Bacterial Agents↗
PubMed1990

Maintenance of serum calcium after total thyroparathyroidectomy.

We have studied calcium regulation in 11 consecutive patients undergoing radical surgery for upper aerodigestive tract malignancy. Eight patients received postoperative parenteral nutrition including calcium (19 mmol/day) and tri-iodothyronine (30 micrograms/day) supplementation. Three patients received enteral nutrition with calcium (70 mmol/day), 1.25 dihydroxycholecalciferol (1 microgram) and thyroxine (150 micrograms/day) via a nasogastric tube. Mean (SEM) corrected calcium fell from 2.42 (0.013) to 2.03 (0.036) mmol/l after 24 h (P less than 0.01). Replacement therapy generally maintained the serum calcium above 2.0 mmol/l. However, values were associated with only one episode of tetany. Phosphate increased from 1.10 (0.05) to 1.79 (0.11) mmol/l, 7-9 days postoperatively (P less than 0.001). Tubular calcium reabsorption fell and urinary calcium excretion rose, consistent with loss of parathyroid hormone (PTH) action on the distal nephron. However, the renal leak of calcium can be considerably reduced by concomitant salt depletion. This enhances proximal tubular sodium and calcium reabsorption thereby limiting calcium delivery to the distal nephron. This offsets the consequences of the loss of PTH which normally regulates distal calcium reabsorption.

Absorption↗
PubMed1990

Nasopharyngeal carcinoma. An analysis of 100 Chinese patients.

Clinical manifestations in the first 100 patients with nasopharyngeal carcinoma to attend the ENT outpatient clinic at the Prince of Wales Hospital, Hong Kong, commencing in February 1986, are presented. All tumours were non-keratinising or anaplastic carcinomas, World Health Organisation types 2 and 3. Cervical lymphadenopathy was the commonest presenting complaint (43%), followed by nasal symptoms (32%) and aural symptoms (18%). On clinical examination 73% had cervical lymph node metastases, and 72% of patients were in stages III-V at presentation. Trivialisation of the symptoms by the patient and delay by the referring physician contributed to lateness of diagnosis.

Adolescent↗
PubMed1990

Nasopharyngeal carcinoma: methods of presentation.

The forms of presentation of NPC, as related to the signs and symptoms of the disease, were studied in 215 patients over a 2-year period. A neck mass was the most common presenting symptom. Seventy percent of the patients were in Ho's stages III to V. This evidence emphasizes the need for earlier diagnosis to improve the prognosis of the disease. This earlier diagnosis could be achieved by increasing the awareness of both the patient and the clinician, particularly in countries where the incidence of NPC is high.

Adolescent↗