PubMed Health⌕ Search

Biomedical subjects

I M Smith

Publications and source records attributed to I M Smith.

At least 19 recordsLinked to original sources
PubMed1992

A conservative approach to the management of otitis media with effusion in cleft palate children.

Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic. There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes. A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.

Adolescent↗
PubMed1992

A comparison of facial grading systems.

There have been several attempts at establishing a grading system to estimate the severity of a facial palsy. This study compares the validity and consistency of all the leading systems. The results indicate that the systems are comparable and overall none had the advantage over the others. Interobserver variation had a significant effect on the consistency of the systems used, but experience of the observer was not a significant factor. The simplest classification studied was the House-Brackman system which is recommended.

Facial Paralysis↗
PubMed1992

Routine nasopharyngeal biopsy in adult secretory otitis media.

This study was to determine whether routine examination under anaesthesia and nasopharyngeal biopsy in adults presenting with deafness due to secretory otitis media (SOM) is necessary for detection of nasopharyngeal malignancy. Two patient groups were studied. The first comprised 72 adults with SOM. Of these patients, 3 had nasopharyngeal tumours, 2 of whom also had cervical lymphadenopathy. The prevalence of malignancy in patients with SOM but no other suspicious signs was 1/72 (1.4%). The second group comprised 66 patients receiving treatment for nasopharyngeal neoplasms. In this group, 8 patients had SOM at presentation, 7 of whom had other features suspicious of malignancy. SOM as the sole presenting feature of nasopharyngeal malignancy was 1/66 (1.5%). EUA and biopsy of the nasopharynx is a cost effective investigation which continues to be indicated in adults presenting with deafness due to SOM.

Adolescent↗
PubMed1992

Triple therapy for advanced squamous cell cancer of the head and neck.

This study presents the results of treatment for Stage III and IV squamous cell carcinoma of the head and neck at the Princess Alexandra Hospital and Queensland Radium Institute, Brisbane. Patients were treated using a programme of sequential chemotherapy, surgery and radiotherapy. Between 1980 and 1988, 116 patients commenced the programme and 85 completed the treatment as planned. The Price-Hill regimen of chemotherapy was used until 1986 after which time it was replaced by cisplatin/5-fluorouracil (5FU). Two courses were usually given achieving an overall response rate of 36% (12% complete response). Cisplatin/5FU produced an overall response rate of 56% compared with 24% for the Price-Hill regimen. Radical surgical resections were performed using a free flap reconstruction in the majority of patients. Radiotherapy fields usually covered the primary site and both cervical lymph node areas to a dose of 50-60 Gy in 5-6 weeks. The lengthy treatment was generally well tolerated although there were two chemotherapy and two perioperative deaths. The overall actuarial survival for the 85 patients completing the triple therapy was 60%. These patients were analysed in more detail for possible prognostic factors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Effect of giving enrofloxacin in the diet to pigs experimentally infected with Actinobacillus pleuropneumoniae.

Three groups of 16 pigs were exposed individually when four weeks old to intranasal infection with 10(8.9) viable Actinobacillus pleuropneumoniae (serovar 3, strain 2/(10P2); a fourth group was kept in isolation from the others as uninfected controls. Seven days later the 62 surviving animals were killed and necropsied. The organism had caused typical, mainly subacute disease in 12 of the 16 unmedicated animals but in only two of the 16 which had had continuous access to a diet containing 150ppm of enrofloxacin from four hours before exposure to infection, and in six of the 16 given 32 ppm enrofloxacin. However, only 150 ppm enrofloxacin produced marked control of the infection in terms of reduced average severity of thoracic lesions and much reduced prevalence of the organism in the lung at necropsy, and the mean weight gain (1.55 kg) and feed conversion efficiency (2.08) of this infected group over seven days were similar to those of the unmedicated, uninfected controls (1.67 kg and 2.25). The infected but untreated group on average produced detectable antibody seven days after infection whereas in the infected and medicated groups a specific response against serovar 3 was absent.

4-Quinolones↗
PubMed1991

Facial weakness. A comparison of clinical and photographic methods of observation.

The search for an internationally acceptable facial grading system has resulted in an assessment of existing methods by several investigators. These studies were based on observations of video film taken of patients with varying degrees of facial malfunction. Although the grading systems were evaluated, the use of videotape has never been compared with clinical examination and its suitability for this type of work is, therefore, unknown. We used nine facial grading systems to compare the results of clinical observation with those of photographic methods of presentation. The latter included videotape, photographic slides, and a combination of the two. The correlation between clinical examination findings and findings of any of the photographic methods was poor, suggesting the need for a standard form of presentation when grading patients. The most consistent results were found with either clinical examination or photographic slides; videotape was the least reliable.

Data Interpretation, Statistical↗
PubMed1991

Sleep patterns in rural elders: demographic, health, and psychobehavioral correlates.

Altered sleep patterns, including changes in bedtime, sleep latency, total sleep time, and arising time, have been reported to occur with increasing age. We examine self-reported sleep patterns in a geographically-defined population (n = 3097) of persons aged 65 years and older. Sleep patterns were characterized according to demographic variables, clinical conditions, and physical, psychological, and social functioning. Sleep latency and total hours of sleep increased with age, and older respondents went to bed earlier. The percentage of respondents who reported feeling rested in the morning decreased with age. Women went to bed later, had longer sleep latency, and fewer hours of sleep than men, and were less likely to report feeling rested than men. Sleep patterns were also related to educational attainment, self-perceived health status, physical functional status, psychotropic drug use, alcohol use, depressive symptoms, life satisfaction, and social and recreational activity level. This population study suggests that sleep problems among the elderly are sometimes associated with treatable health conditions and modifiable behavioral and environmental characteristics.

Age Factors↗
PubMed1991

Lateral cephalometric analysis of children with otitis media with effusion: a comparison with age and sex matched controls.

Previous reports from this department have established significant differences in the morphology of the nasopharynx between patients with otitis media with effusion (OME) and normal controls. This study has used lateral cephalometric analysis to investigate these differences in greater detail. Skeletal and soft tissue measurements were recorded in 50 patients with bilateral OME and were compared with 50 age and sex matched normal controls. Various points were plotted enabling 23 different linear dimensions and three angles in and around the nasopharynx to be compared. The results show significant differences between the two groups in the skeletal and soft tissue dimensions of the nasopharynx. The children with OME have a smaller nasopharynx with a suggestion that this may be due to a difference both in the rate and timing of growth.

Aging↗
PubMed1991

Secretory otitis media: a review of management by consultant otolaryngologists.

A questionnaire concerning various aspects of secretory otitis media was completed by a random sample of Consultant Otolaryngologists in the United Kingdom. The replies to questions associated with the management of this condition are presented. The results suggest only a moderate degree of agreement between Consultants in many areas of management and these findings are discussed in the light of current research.

Child↗
PubMed1990

Papillary adenocarcinoma of the middle ear.

A case of papillary adenocarcinoma of the middle ear is presented. The patient had an unusually short history of otalgia, aural discharge and facial palsy, and, at presentation the tumour was too large for surgical resection to be a feasible option. The management of this rare tumour is discussed and the relevant literature reviewed.

Adenocarcinoma, Papillary↗
PubMed1990

Contact hypersensitivity in patients with chronic otitis externa.

Thirty-seven patients with chronic otitis externa were investigated for contact hypersensitivity to 49 agents using standardized patch testing. Positive reactions were found in 22 (58%) patients. This incidence is higher than the 40% found in the only previous similar study and is within the range of 32-72% found in patients with contact dermatitis. The average age of subjects showing sensitivity was 56.7 years compared with 34.9 years for those with negative tests. This significant age difference suggests that contact hypersensitivity is not an aetiological factor in the younger patient. There was no significant difference in the duration of otitis externa between those with positive and negative tests. This feature has not been previously examined or reported. Neomycin was the commonest sensitizing agent, sensitization occurring in 12 (32%) patients.

Adolescent↗
PubMed1990

A modified screening protocol for the diagnosis of acoustic neuromas.

In many centres the diagnosis of acoustic neuromas relies on a preliminary screening protocol. The current method is a combination of caloric tests, tomography of the internal auditory meati and brain stem evoked response audiometry (BSERA) with 2 positive results indicating the need for further investigation. This protocol, although sensitive lacks specificity and results in a high incidence of normal CT air meatograms. As this procedure is associated with a significant morbidity, we have devised a 'weighted' system of scoring to avoid subjecting large numbers of normal patients to CT air meatography. The proposed system has been derived from screening 61 patients with unilateral sensorineural hearing loss, 24 of whom had an acoustic neuroma. This method reduced the false positive rate of CT air meatography from 68%, using the 2 out of 3 criteria, to 18%, whilst the false negative incidence remained at 8%.

Audiometry, Evoked Response↗
PubMed1990

Post-discharge care planning and rehabilitation of the elderly surgical patient.

Successful discharge planning, home care, and rehabilitation for surgical patients can be very satisfying. However, everyone involved should be aware that it can also be frustrating when, despite careful plans and organization, everything falls apart, often because the patient's disease course is different from that expected or the patient or family are not satisfied with the services. There are multiple other reasons for plans to fail, but with experience the failures should become less frequent. All too often in life we take success for granted and weigh failures twice as much. The danger of this type of thinking becomes especially important in discharge planning--successfully discharged patients may be "invisible" but the failures are back very quickly. Everyone involved in discharge planning should be made aware of the successes in order to prevent "burn out." Certain predictable complications can often be prevented or rapidly reversed, and rehabilitation is achieved by a team of varied health care providers. A home visit is often very helpful before discharge of an elderly surgical patient.

Aged↗
PubMed1990

Use of monoclonal antibodies for classifying Actinobacillus (Haemophilus) pleuropneumoniae.

The serological typing (by enzyme-linked immunosorbent assay) of 119 isolates of Actinobacillus (Haemophilus) pleuropneumoniae (representing in varying numbers the 12 serovars of this taxon) by monoclonal antibodies derived from the reference strains of serovars 1 to 5 in general correlated reasonably with the serotype previously established for these strains by conventional procedures employing polyclonal antisera. However, where there were reasonable numbers of isolates representing a given serovar to provide a decision, there was no instance where the correlation between the monoclonal and the polyclonal antibody was in complete accord. In addition, some of the differences between monoclonal and polyclonal antibody binding with some isolates suggest that the distribution of the serotype-specific antigens within the taxon may be even more complex than has previously been supposed.

Actinobacillus↗
PubMed1989

CT air meatography: review of side effects in 60 patients.

Sixty patients investigated for a suspected acoustic neuroma were questioned on the side effects of CT air meatography, a minimum of three months following the procedure. Twelve per cent of patients found the procedure itself so painful that a repeat examination would only be contemplated under general anaesthesia. Only 20 per cent of patients were asymptomatic after the procedure while 28 per cent of patients required bed rest for 24 hours or more (average 4.4 +/- 2.8 days). Sixty-two per cent of patients took three days or longer to return to normal health. The duration and frequency of side effects is greater than previously reported, and emphasizes the need for full investigation of these patients prior to CT air meatography.

Air↗