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Biomedical subjects

J C Shotton

Publications and source records attributed to J C Shotton.

14 recordsLinked to original sources
PubMed1996

An unusual foreign body migrating from pharynx to mediastinum.

A case of a swallowed foreign body migrating from the pharynx into the soft tissues of the neck is presented, whose management was complicated by its undetected migration to the superior mediastinum occurring between radiological localization in the neck three days prior to exploration and its attempted removal. A median sternotomy was then required to retrieve the object. Radiological guidance with regard to the localization of a foreign body in the neck can only be relied on when performed immediately prior to surgical removal.

Foreign-Body Migration↗
PubMed1993

A new technique using cultured epithelial sheets for the management of epistaxis associated with hereditary haemorrhagic telangiectasia.

A new technique for the treatment of severe epistaxis associated with hereditary haemorrhagic telangiectasia is described. The nasal septum and inferior turbinates, surgically denuded of respiratory epithelium, were grafted using autografts of cultured epithelial sheets derived from buccal epithelium. All patients upon whom this technique has been used have shown considerable lessening in the frequency and severity of their epistaxes although two patients received grafts on two occasions, in each case approximately three months apart. It is postulated that a nasal lining of stratified squamous epithelium is likely to be more resistant to trauma than the normal respiratory type, and this is supported by the observation that bleeds very seldom occur from the oral cavity in this syndrome.

Cells, Cultured↗
PubMed1993

Lateral temporal bone resection for extensive pinnal malignancy. Has anything changed in forty years?

This paper offers an account of the contemporary surgical approach to advanced tumours of the external ear based on a series of 11 patients. There were eight squamous, two basal cell carcinomas and one mucoepidermoid tumour. The traditional method of excision was slightly modified by performing microsurgical dissection of the lateral part of the temporal bone rather than chisel osteotomies, and then including it en bloc with the involved soft tissues. The defect was then closed using a scalp or myocutaneous flap and this combination of otological and reconstructive expertise has proved satisfactory. Four patients are alive with no evidence of disease a mean of 4.2 (range 1.0-7.0) years from surgery: two patients who remained free of disease have subsequently died of unrelated conditions 12 and 24 months post-operatively, and in three cases death from recurrent disease occurred a mean of 1.4 (range 0.9-2.1) years after our surgery. There were two post-operative deaths. Based on the actuarial survival of 36 per cent and a successful disease clearance rate of 54 per cent, our conclusion is that the outlook of this condition has not dramatically improved since the original descriptions of the management of this problem first appeared, although intervention remains justifiable because of the potential curability and relief of symptoms.

Aged↗
PubMed1993

Extra-pharyngeal neck pathology complicating pharyngeal pouch surgery.

One case each of: (1) low grade thyroid lymphoma; (2) supraclavicular and para-oesophageal metastasis of a uterine adenocarcinoma; and (3) recurrent multinodular goitre have been encountered in very intimate relationship with the neck of a pharyngeal pouch within the tracheo-oesophageal gutter raising the possibility that the two conditions were interrelated. The practical importance of these cases is that a surgeon excising a pouch from the neck ought to be able to resect a thyroid lobe should it prove necessary, and occasionally endoscopic diverticulotomy is the only reasonable option.

Aged↗
PubMed1992

Multiple ganglioneuroma of the neck.

A case of multiple ganglioneuroma arising along the entire length of the cervical sympathetic chain of one side of the neck is described. This is a distinctly unusual site and distribution of the disease and computed tomography proved invaluable to demonstrate its extent, in addition to excluding involvement of more caudal regions.

Child↗
PubMed1992

Clinical and vestibulometric status following labyrinthectomy or vestibular nerve section for Menière's disease.

A clinical and vestibulometric comparison of 10 patients following labyrinthectomy, 5 following vestibular nerve section, and 10 control subjects was undertaken in order to evaluate the long-term effectiveness of these procedures. Testing was performed a mean of 8.5 years after surgery. Vestibulometry assessed time constants, gain, and phase advance of the vestibulo-ocular reflex (VOR) in both horizontal and vertical planes of head movement. Loss of the anticipated increase in phase advance in the vertical VOR of the labyrinthectomy group, significantly different from the vestibular nerve section group (P less than 0.05 and P less than 0.01 for each direction of rotation), suggests that posterior and superior semicircular canal function remains intact following per-meatal labyrinthectomy. Although stabilometry suggested that balance in the labyrinthectomy group was poorer than in the two other groups (P less than 0.025 without optic fixation), clinical assessment demonstrated excellent functional results. Per-meatal labyrinthectomy remains a safe and effective procedure for the relief of vestibular symptoms, although vestibular nerve section may provide more complete removal of contributory end-organ function.

Aged↗
PubMed1991

The infratemporal fossa approach for adenoid cystic carcinoma of the skull base and nasopharynx.

The infratemporal fossa approach to the skull base is an established method of treating neoplasms of this region. The type C variation has proved an effective means of removing adenoid cystic carcinoma invading the infratemporal fossa and skull base from the nasopharynx. A classification of these tumors is proposed, the surgical technique is described, and the results are given in this article.

Adult↗
PubMed1989

Temporal bone venous anomaly of surgical significance.

Variability in the size of the dural sinuses and jugular bulb is not uncommon and usually manifests as a high jugular bulb encroaching upon the floor of the middle ear. A rarer entity is the superior and medial extension of the jugular bulb into the bone of the posterior wall of the internal auditory meatus. We report a case where this anomaly was encountered during acoustic neuroma surgery making exposure of the fundus of the internal auditory meatus technically impossible. The possibility of a communication with the superior petrosal sinus is discussed.

Female↗
PubMed1989

Persisting nystagmus following vestibular nerve section for Menière's disease.

Unilateral vestibular nerve section (VNS) creates a state of acute dysequilibrium which resolves by a process of central compensation. This disturbance resolves quickly and central compensation is complete generally within a month with resolution of symptoms and signs. The course of central compensation following VNS will be similar to that seen after labyrinthectomy because the detachment of hemi-labyrinthine input that is achieved by both will be identical. Six patients are presented who have undergone VNS at least 2.7 years ago (Average 3.5 years); all of them have persisting spontaneous peripheral type horizontal jerk nystagmus, present with optic fixation in five. This is obvious clinically and was confirmed in each case by agreement of three independent observers and has been recorded by electronystagmography (ENG). They are free from marked vestibular symptoms. The explanations of mechanisms involved in central compensation are discussed with respect to this previously unrecorded clinical observation.

Adult↗
PubMed1989

Leiomyosarcoma of a lower limb presenting with multiple cranial nerve palsies.

Leiomyosarcoma is a relatively uncommon soft tissue sarcoma usually presenting as a mass at the primary site. It arises in the retroperitoneal region, in the cutaneous or subcutaneous tissue of the extremities or, less commonly, from a large vein. A case is described where a patient presented with unilateral third, fourth, and sixth cranial, and ophthalmic division of trigeminal nerve palsies in whom biopsy of a longstanding lower limb mass demonstrated leiomyosarcoma. The presentation of this type of pathology has not been described previously.

Abducens Nerve↗
PubMed1988

Malignant triton tumour of the palate--a case report.

The malignant Triton tumour is a malignant schwannoma with rhabdomyoblastic differentiation. This is the first report of this type of rare, aggressive sarcoma arising in the maxilla and only the third report of this type of pathology arising outside the context of von Recklinghausen's disease. Aspects of clinical and histopathological diagnosis are mentioned.

Adult↗
PubMed1988

Stab wounds of the neck--observations on management.

Seventeen stab wounds to the cervical region presenting over a 3 year period are described. Clinical assessment, appropriate investigations and surgical management are discussed. Examination of the oral cavity for the presence of blood or displacement of the lateral oropharyngeal wall by an expanding haematoma, assessment of air bubbling from a wound, particularly on coughing, chest and lower cranial nerve examination are all required. Blind probing or attempted clamping of a bleeding vessel in a neck wound is not recommended. The use of urgent angiography in stab wounds high in the neck behind and above the angle of the mandible is recommended. Primary repair is optimal for all laryngotracheal, pharyngo-oesophageal and significant neurological injuries.

Adolescent↗