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Biomedical subjects

G W McGarry

Publications and source records attributed to G W McGarry.

At least 19 recordsLinked to original sources
PubMed2003

Audit-derived guidelines for training in endoscopic sinonasal surgery (ESS)--protecting patients during the learning curve.

The objective of the present study is to propose guidelines to ensure safe practice in teaching centres while allowing endoscopic sinonasal surgery (ESS) training to proceed. A prospective complications audit of ESS procedures was undertaken over a 5-year period (January 1996-December 2000). The results have been used to form specific guidelines for safe and effective ESS training. A total of 500 patients underwent ESS during the 5-year period. The senior author was the main surgeon in 55% of cases with the trainee observing or assisting. A supervised trainee was the main surgeon in 45% of cases. The overall complication rate was 1.2% (n = 6) (i.e. 0.7% for the 815 procedures performed). These were all minor complications. We encountered no major complications in 500 patients over the 5-year period. This audit shows that training need not compromise patient safety provided it is phased and structured. We propose appropriate phases and suggest the minimum requirements for units involved in ESS training.

Endoscopy↗
PubMed2003

Polyflex stent: is it radiopaque enough?

We report a case of tracheal stenosis in which a migrated Polyflex (Rusch AG, Germany) stent entered the right main bronchus but could not be identified on the chest radiograph. The stent was identified at bronchoscopy and removed under general anaesthesia. Polyflex stents are radiopaque but may not always show up on radiograph. We recommend reliance on clinical symptoms rather than imaging to diagnose migration. If stent migration is suspected then imaging should include thoracic inlet films that incorporate a lateral view.

Bronchi↗
PubMed2003

How frequent are accessory sinus ostia?

The frequency of accessory sinus ostia (ASO) has been estimated at between four and 50 per cent in the findings of studies designed for other purposes or from uncontrolled observations. The literature revealed no study specifically designed to determine the prevalence of ASO. We have carried out a prospective cohort study to measure the prevalence of ASO. The prevalence of ASO was determined in rhinology clinic patients and general ENT clinic controls. Overall ASO occurred in four per cent. Seven per cent of rhinology patients and two per cent of controls had ASO. Of the rhinology patients with rhinitis or sinusitis, eight per cent exhibited ASO. The overall prevalence in this study is lower than most quoted figures in the literature. There was increased prevalence of ASO in patients with rhinitis or sinusitis compared to controls. (p<0.05) This study should be regarded as a pilot study and further investigations of the relationship between ASO and nasal disease is merited.

Adolescent↗
PubMed2002

Benefit from endoscopic sinus surgery.

Benefit and satisfaction following endoscopic sinus surgery were assessed using the Glasgow Benefit Inventory (GBI) and a validated outcome satisfaction score. In total, 140 patients were invited to participate; 101 (71%) responded. ESS produces significant benefit as assessed by the GBI and satisfaction, and the benefit compares favourably with other otorhinolaryngological procedures. Greatest benefit was derived by patients undergoing surgery for polyp disease. Patients whose cardinal preoperative symptom was nasal obstruction or headache tended to report higher benefit. Co-existent asthma, allergic rhinitis or aspirin intolerance appeared not to result in a significant decrease in benefit after surgery, except in patients with non-polyp disease, who also have both aspirin intolerance and asthma. Also, for non-polyp disease, postoperative medication with nasal steroids or antihistamines does not appear to influence benefit.

Endoscopy↗
PubMed2001

Preliminary results of a pilot study investigating the potential of salivary cortisol measurements to detect occult adrenal suppression secondary to steroid nose drops.

Adrenocortical suppression is a well-known risk of systemic steroids, but is thought less likely to occur with topical intranasal corticosteroids. However, the UK Committee on the Safety of Medicines (UKCSM) has expressed concern about the possibility of this complication. We assessed the prevalence of adrenal suppression in patients with rhinitis using intranasal beclomethasone and betamethasone; and the potential value of salivary cortisol as a tool for detecting this complication. Sixty-six patients (38 men: 28 women; mean age 49.6[SD 16.0] years) were prospectively screened for adrenal insufficiency using clinical assessment and salivary cortisol measurements. Abnormalities at this initial screening were confirmed with a Short Synacthen Test (SST). No patient was clinically Cushingoid. All 22 beclomethasone users had normal salivary cortisols. Eleven (25%) of 44 patients using betamethasone had subnormal salivary cortisol levels (mean morning cortisol 2.8[SD 0.9]nmol/l) suggesting adrenal suppression, which was confirmed by an impaired SST in each case. The positive predictive value of salivary cortisol measurements was 100%. Only patients with abnormal salivary cortisols had a SST, so no comment can be made about sensitivity/specificity. Topical betamethasone may produce occult adrenal insufficiency and assessment of adrenal function is recommended in these patients. Measurement of salivary cortisol is a useful, non-invasive and economical test for monitoring patients using intranasal corticosteroids.

Administration, Intranasal↗
PubMed2001

One-stop neck lump clinic: phase 2 of audit. How are we doing?

Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one-stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.

Adolescent↗
PubMed2001

Most patients overdose on topical nasal corticosteroid drops: an accurate delivery device is required.

Otolaryngologists and general practitioners commonly prescribed intranasal corticosteroid drops for rhinitis. Compliance in real patients has not previously been studied, but is generally believed to be poor. Recent concerns over systemic adverse effects of topical corticosteroids have highlighted the risks of overdosing. Fifty patients, who were prescribed betamethasone, were prospectively studied for accuracy of compliance using a weighed dose study. Patients consistently administered inaccurate quantities of nasal corticosteroid drops, with a marked tendency to overdose up to four times the recommended daily dose (RDD) in some cases. The mean dose administered was 200 per cent of the RDD. Of the 50 patients, only seven (14 per cent) administered the correct dose. The introduction of metered-dose delivery systems should be considered to reduce the risk of inadvertent overdosing.

Administration, Intranasal↗
PubMed2001

The otologic T-tube: a cost effective dacryocystorhinostomy stent.

Endoscopic endonasal dacryocystorhinostomy (EDCR) has established itself as a popular means of relieving post-saccal obstruction of the naso-lacrimal ducts. Soft tissue stenosis of the rhinostomy is a significant cause of long-term failure. We describe the technique of using a standard otological T-tube as a cheap and easy self-retaining stent to ensure a patent rhinostomy following EDCR.

Cost-Benefit Analysis↗
PubMed2000

Fine-needle aspiration cytology of salivary gland: a review of 341 cases.

Three hundred and forty-one salivary gland fine-needle aspiration (FNA) cytology specimens taken over a 6-yr period were reviewed and correlated with clinical and/or histological findings. The aspirates were derived from parotid gland (212 cases), submandibular gland (124 cases), and minor salivary gland (5 cases). The major diagnostic categories were unsatisfactory (10 cases), normal (100 cases), sialadenitis (74 cases), cyst (34 cases), lipoma (5 cases), pleomorphic adenoma (55 cases), Warthin's tumor (36 cases), and malignancy (27 cases). The latter included 14 primary salivary neoplasms (4 lymphomas of mucosa-associated lymphoid tissue (MALT) type, 3 adenocarcinomas, 2 squamous carcinomas, 2 adenoid cystic cacinomas, and one case each of carcinoma ex pleomorphic adenoma, undifferentiated carcinoma, and high-grade mucoepidermoid carcinoma), and 13 metastases, 9 of which were derived from squamous carcinomas of head and neck origin. Clinicopathological review showed that 88 of 91 (97%) benign epithelial tumors and 27 of 31 (87%) malignant neoplasms with adequate FNA sampling were accurately diagnosed cytologically. False-negative results were caused by sampling error (7 cases), most notably in cystic tumors, or were due to misinterpretation of uncommon neoplasms (3 cases). The overall sensitivity, specificity, and accuracy were 92%, 100%, and 98%, respectively. FNA cytology provides accurate diagnosis of most salivary gland lesions and contributes to conservative management in many patients with nonneoplastic conditions.

Adenocarcinoma↗
PubMed2000

Patients with neck lumps: can they be managed in a 'one-stop' clinic setting?

The present government has stated its intentions to expand the application of "one-stop" assessments for out-patients. To decide if this is an appropriate strategy for managing patients with neck lumps, we prospectively assessed 110 patients referred to the Neck Lump Clinic of the Otolaryngology Department of a teaching hospital. Patients were assessed clinically and with immediately reported fine needle aspiration cytology (FNAC). The accuracy of immediately reported FNAC was later compared with a final report and histology, when available. A "one-stop" visit was defined as patients who were discharged, or placed on a waiting list, after a single consultation. Eight-three (76%) patients did not have to return to the outpatient department, of which 59 (54%) were discharged. No changes occurred from immediate to final FNAC reports. If certain criteria are met, patients with neck lumps can be successfully managed in a "one-stop" setting.

Adolescent↗
PubMed2000

The clinical value of septal perforation biopsy.

Biopsy from the edge of a septal perforation is performed to diagnose potentially significant aetiological conditions, including malignant pathology and Wegener's granulomatosis. However, it is common for the histological result to be undiagnostic and unhelpful in planning an individual patient's management. To clarify the role of septal perforation biopsy, we reviewed all biopsies performed on our patients over a 13-year period. Of the 65 biopsies performed, in 63 patients, none had a histological result which changed the clinical diagnosis made before biopsy. Forty-three patients had clinically benign perforations biopsied, and no histology other than chronic inflammation was obtained. In 16 patients with a clinical vasculitis, none had this diagnosis confirmed histologically. One positive biopsy was obtained from two patients with clinically malignant perforations yet both were treated for T-cell lymphoma. The subsequent management of all patients was based on their clinical diagnosis rather than their biopsy results. We suggest only clinically malignant perforations are worthwhile biopsying.

Adolescent↗
PubMed2000

Excision of nasopharyngeal angiofibroma facilitated by intra-operative 3D-image guidance.

The latest 3D-image guidance systems to assist surgeons have greatly improved over earlier models. We describe the use of an optical infra-red system to assist in the removal of a juvenile nasopharyngeal angiofibroma. The specific advantages of this system in pre-operative assessment, intra-operative evaluation and excision of the angiofibroma are discussed.

Adult↗
PubMed1999

A new bipolar diathermy probe for the outpatient management of adult acute epistaxis.

The findings of a prospective evaluation of the use of a newly-designed bipolar diathermy probe in the outpatient management of adult acute epistaxis are presented. Forty-four adult patients with acute epistaxis were treated with bipolar diathermy after identification of the bleeding point using a rod lens endoscope. The use of the nasal endoscope allowed diagnosis of the source of the bleeding point in all patients. In all 44 patients immediate control of the bleeding was achieved. The use of the bipolar probe obviated the need for hospital admission in 31 patients (70%). Three patients had recurrence of their epistaxis after treatment (7%). The number of patients requiring admission to hospital with epistaxis was significantly reduced using the new bipolar strategy. (4.4/month versus 1.2/month, P < 0.002)

Acute Disease↗
PubMed1997

The effect of microdebriders on tissue for histological diagnosis.

Microdebriders are an innovation in endonasal surgery which enable accurate and precise removal of tissue without damaging the surrounding mucosa. Concern has been expressed, however, that the instrument may render excised tissue unsuitable for histological diagnosis. This problem is further compounded by the fact that the Hummer (Stryker UK Ltd) microdebrider does not incorporate a mechanism for collecting specimens at the time of removal. Twenty-one patients with sinonasal polyposis underwent endoscopic sinus surgery using the microdebrider. Specimens were collected at the time of surgery via an in-line specimen trap. Simultaneous conventional biopsies of adjacent tissue were taken for comparison. The tissue was fixed in formalin then routinely processed to paraffin wax prior to staining with haematoxylin and eosin (H&E). A histological diagnosis was made in all 21 patients. A single unsuspected transitional cell papilloma was found. The remaining 20 specimens consisted of inflammatory nasal polypi. In two non-caseating granulomas were identified. Traumatic artefact was limited to the respiratory epithelium. The sub-epithelial tissue was unaffected and metaplastic epithelium appeared intact. The use of microdebriders does not preclude the submission of tissue for histological analysis. Tissue obtained has limited artefact and is suitable for pathological diagnosis.

Adult↗
PubMed1995

Idiopathic epistaxis, haemostasis and alcohol.

Recent studies have suggested a link between antiplatelet medications and alcohol in the aetiology of acute adult epistaxis. The possibility that adult epistaxis may be associated with alcohol induced platelet dysfunction has not previously been investigated. This study evaluated primary haemostasis in 50 adult patients with idiopathic epistaxis. A detailed alcohol history was recorded and the Simplate bleeding time device was used to test haemostatic function. Forty-six per cent of patients were found to have an abnormality of primary haemostasis. Prolongation of the bleeding time was significantly associated with a history of alcohol use. The effect of alcohol on the bleeding time duration was significant (P < 0.001) even at low levels of intake of between 1 and 10 units per week. Although prevalent in the study group (42%) the use of non-steroidal anti-inflammatory drugs did not confer a significant additional risk of increased bleeding time. These findings support the importance of alcohol induced haemostatic abnormalities in the aetiology of adult epistaxis.

Adult↗