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Biomedical subjects

I J Mackenzie

Publications and source records attributed to I J Mackenzie.

At least 19 recordsLinked to original sources
PubMed2006

Detection of hearing impairment and handicap in Paget's disease of bone using a simple scoring system: a case control study.

Paget's disease of bone is known to be associated with hearing loss but there are limited data on the prevalence of hearing impairment and handicap in people with Paget's disease. Previous published population studies have used patient-completed questionnaires or review of GP records, none have included audiometry. 80 Paget's subjects were selected at random from a hospital database, 75 (94%) entered the study and were matched by age and gender with 76 controls. All participants completed a screening questionnaire for hearing handicap, the HHIE-S; a questionnaire on perception of hearing-related handicap, noise exposure, hearing aids and GP consultations regarding hearing; and audiometry. The results show significant problems from hearing loss in people with Paget's disease of bone. Paget's patients were significantly more likely to perceive hearing handicap (P=0.0001), 41% Paget's patients rated themselves moderate-severe compared to none of the controls. Paget's patients were significantly more likely to report difficulties such as hearing normal speech, watching TV or hearing over background noise (all P=0.0001). They were more likely to consult their GP due to hearing problems (P=0.004) or tinnitus (P=0.0001), or use a hearing aid (P=0.0001). Audiometry confirmed higher rates of deafness in Paget's patients. 41/75 Paget's patients compared to 19/76 controls had at least 40 decibels hearing loss (dBHL) (P=0.0001). The HHIE-S proved to be an effective screening tool. A score of greater than 8 increased the odds ratio of detecting moderate hearing impairment (>40 dBHL) in people with Paget's disease by 5.1. The specificity of HHIE-S >8 as a screening tool to select for audiometry appears good, 1/46 (2%) of Paget's patients would have proved to have normal hearing thresholds. The sensitivity is better with worse hearing loss, 7/16 Paget's patients with moderate loss (>40 dBHL) and 2/25 with severe-profound loss (>60 dBHL) would have been missed. In conclusion, 55% unselected Paget's patients have at least moderate levels of hearing loss, compared to 25% of age and gender matched controls. Paget's patients and controls under-reported hearing problems, many of which can be ameliorated. Screening for hearing problems in Paget's disease of bone can be done using the HHIE-S.

Aged↗
PubMed2003

Posture changes in diabetes mellitus.

The weight distribution and postural sway was measured in diabetic subjects with, and without, neuropathy, and then compared with age and sex matched non-diabetic subjects using a cheap and highly portable sway plate - SwayWeigh. The SwayWeigh was found to be very practical and the results obtained confirmed the increased postural sway in the absence of proprioceptive information in neuropathy subjects. The study shows that peripheral neuropathy increases the postural sway especially in the absence of visual clues but this did not result in postural strategies causing significant limb load asymmetry.

Aged↗
PubMed1996

Randomised controlled trial of treatment of chronic suppurative otitis media in Kenyan schoolchildren.

BACKGROUND: The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions. METHODS: We enrolled 524 children with CSOM, aged 5-15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups. FINDINGS: By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42-59) of children who received dry mopping with antibiotics, compared with 22% (14-31) of those who received dry mopping alone and 22% (9-35) of controls. Similar differences were recorded by the 8-week and 12-week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10-21) in the dry-mopping plus antibiotics group, 13% (5-20) in the dry-mopping alone group, and 13% (3-23) in the control group. The proportion with resolution in the dry-mopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times. INTERPRETATION: Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries.

Administration, Topical↗
PubMed1990

Management of the parotid pleomorphic adenoma, the problem of exposing tumour tissue at operation. The logical pursuit of treatment policies.

The objective of treatment of a parotid pleomorphic adenoma is to remove all tumour cells with minimal short- and long-term morbidity and minimal recurrence rates. If an enucleation is carried out, the facial nerve may be put at risk and tumour fragments will inevitably be left in the wound. Most surgeons suggest that after enucleation, radiotherapy must be given to reduce the recurrence rate to an acceptable level. If during a formal superficial parotidectomy the tumour capsule is visualised, the objective of removing the tumour with an intact cuff of normal tissue has failed and the operation has in effect become an enucleation. This paper defines the problem and discusses its management.

Adenoma, Pleomorphic↗
PubMed1988

Embryonal rhabdomyosarcoma of the sphenoid sinus.

Rhabdomyosarcoma is a diagnostic and therapeutic problem in the management of childhood tumours. A case of embryonal rhabdomyosarcoma affecting the sphenoid sinus and involving the cavernous sinus is presented. It has become evident that modern combined modality therapy, including surgery when required, radiation and adjuvant multi-drug chemotherapy offers the best chance of survival.

Child↗
PubMed1988

Transphenoidal meningohydroencephalocoele.

A case of transsphenoidal meningohydroencephalocoele is presented. The clinical features and pathogenic factors are discussed briefly. An awareness of this condition should prevent attempted biopsy--which might otherwise prove disasterous. Air or contrast cisternography, with plain or computerised tomographic radiology, would seem to be the investigation of choice.

Adult↗
PubMed1985

The extrusion rate of grommets.

A prospective study was performed to determine the factors influencing the extrusion rate of tympanostomy tubes. Nine hundred thirty-nine tubes were inserted in 589 patients and the extrusion of these tubes was reviewed up to a period of 27 months. The eight tubes used in the survey were the Shepard, Exmoor, Bobbin, Armstrong, Paparella, Shah, Arrow, and collar button. These tubes were inserted in strict rotation, the operator using the designated tube. The position, type of incision, presence of fluid, quality of tympanic membrane, and degree of difficulty of insertion were all recorded at operation. The sex, age, side of operation, and any simultaneous operative procedures were also recorded. The patients were reviewed the day after operation and then every 3 months thereafter until the tube was extruded. A definite pattern was identified for the extrusion of each type of tube. At one end of the spectrum, Exmoor and Shepard tubes were, for the most part, extruded between 6 and 9 months after insertion, while at the other end, most of the collar button tubes were still functioning at 18 months. The design of the tube was the only factor found to be a significant determinant of the extrusion of the tube, although the experience of the surgeon affected the extrusion rate of the Arrow tube. The different dimensions of the Exmoor and collar button tubes are examined and compared.

Equipment Design↗
PubMed1984

Recurrent pleomorphic adenomas of the parotid gland.

In this retrospective study of 19 cases of recurrent pleomorphic adenoma of the parotid gland, all 19 patients underwent primary surgery elsewhere, namely, lumpectomy in five cases and superficial parotidectomy in 14 cases. The age at which those patients with recurrence had originally been seen was significantly earlier than those seen in our series of cases of primary surgery for pleomorphic adenoma. If the primary operation had been a parotidectomy, the average time interval between the first and second operation was 7.7 years; however, if it had been a lumpectomy, it was ten months. Implantability of the tumor and inadequate surgery were reasons for tumor recurrence. The suggested treatment of recurrence is total parotidectomy with preservation of the facial nerve. Revision surgery has been successful in all cases with no further recurrences, except in two cases in which multiple operations had already been performed.

Adenoma, Pleomorphic↗
PubMed1984

Open v closed reduction of the fractured nose.

A stepwise study of nasal fractures includes an initial investigation that was carried out to discover why so many patients were awaiting rhinoplasty, which led us to find a 30% to 40% failure rate in nasal manipulation operations. We then studied the mechanics of nasal fracture by striking fresh cadaver noses. We found that if the nasal bones were deviated by more than half the bridge width, there was a concomitant C-shape fracture of the bony and cartilaginous septum. Two trials were performed, and patients with nasal deviation after trauma were allocated to either manipulation or manipulation plus excision of septal cartilage (closed or open reduction). Both trials were statistically significant, indicating that open reduction is the preferred treatment for patients with a deviation of more than half the bridge width of the nose.

Adult↗
PubMed1984

Carcinoma in situ of the larynx.

A series of 28 cases of carcinoma in situ of the larynx treated over the last 16 years is reviewed. The majority of the patients were treated with endolaryngeal stripping of the cords. In the few cases in which the treatment failed, early detection of disease was made and radiotherapy was successful in controlling the carcinoma. The use of radiotherapy is only advocated for selected cases because there is often difficulty in assessing a radiated larynx; radiotherapy may induce field changes, and if treatment fails, laryngectomy may have to be carried out as a salvage procedure.

Aged↗