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Biomedical subjects

J E Osborne

Publications and source records attributed to J E Osborne.

At least 37 records · Page 2Linked to original sources
PubMed1999

Tracheal ring herniation following percutaneous dilatational tracheostomy and its resection under endoscopic control.

A 76-year-old patient had an elective percutaneous dilatational tracheostomy (PDT) under endoscopic control in the intensive care unit. Twelve days later when her general condition improved, two attempts at decannulation failed due to upper airway obstruction above the tracheostomy site. Bronchoscopy showed herniation of the anterior tracheal wall above the tracheostomy tube occluding 80 per cent of the lumen. The herniated anterior segment was elevated and partially resected under endoscopic guidance. The patient made a full recovery and was decannulated on the first post-operative day. Pitfalls and possible complications of PDT are discussed.

Aged↗
PubMed1999

False negative clinical diagnoses of malignant melanoma.

The false negative rate for the clinical diagnosis (FNR) for malignant melanoma is reported to be of the order of 20-50%. The aim of this study was to investigate possible predictor variables for FNR, with particular reference to the features and score of the seven-point check-list within the total population (778) of histologically proved malignant melanomas presenting in Leicestershire between 1982 and 1996. The FNR was 18.5%. The check-list would have failed as a referral indication in only 0.8-1. 1% of the lesions. The major check-list features occurred more commonly than the minor features, excepting size >/= 7 mm, confirming the diagnostic importance of the major criteria. The FNR was unaffected by age or sex. More rarely involved sites had higher rates (31-42%), and the face was a particularly difficult diagnostic site. Clinical features of lesions associated with a higher FNR were lack of irregular pigmentation and shape, altered sensation, the presence of inflammation and size < 7 mm. The FNR was inversely related to the total score and major feature score, but directly related to the minor score. The minor features, in addition to the major features, are potentially valuable in avoiding false negative diagnoses and we suggest their retention as part of the check-list. There was only one patient, in whom the diagnosis of melanoma was initially missed and who was not biopsied on presentation to hospital, who re-presented after 1 year. However, the study illustrates the importance of avoiding a false negative diagnosis as there was marked delay in the excision of such lesions.

Adult↗
PubMed1999

A new acoustic method of differentiating palatal from non-palatal snoring.

Palatal snoring produces explosive peaks of sound at very low frequency (approximately 20 Hz). Using a digital sound trace a ratio of peak amplitude to root mean square amplitude can be calculated. This Peak Factor Ratio is significantly higher for palatal snores than non-palatal snores (P < 0.01). This acoustic method will be useful for selecting patients for palatal surgery as it is non-invasive and could be used in a home monitor.

Acoustics↗
PubMed1999

Palatal snoring identified by acoustic crest factor analysis.

The differentiation of palatal from non-palatal snoring is very important for ENT surgeons trying to determine whether palatal surgery would be curative. At present sleep nasendoscopy is the accepted method. Palatal vibration produces marked modulation of sound loudness at low frequency (below approximately 100 Hz). We calculate a crest factor for the sound waveform (ratio of peak to root mean square (rms) value in any given epoch), as a measure of the degree of modulation. Free-field snore sounds were recorded from 11 supine adult patients under intravenous sedation (midazolam), using a digital tape recorder. Recordings were transferred to a PC (sampling frequency 11 kHz), and analysed using code written by us. Direct visual confirmation of the site of snoring was gained from simultaneous sleep nasendoscopy, taken as the gold standard. In six patients the dominant site was the soft palate. The non-palatal group (five patients) comprised one epiglottic, two hypopharyngeal and two tongue base snorers. The crest factor was found to be significantly higher for palatal snorers (p < 0.01, Student-t or Mann-Whitney tests). Furthermore, palatal could be distinguished from non-palatal snorers on the basis of crest factor alone in all 11 cases, making this a promising non-invasive diagnostic technique.

Acoustics↗
PubMed1998

The effect of the introduction of a pigmented lesion clinic on the interval between referral by family practitioner and attendance at hospital.

The value of pigmented lesion clinics (PLCs) for the early detection and treatment of malignant melanoma has been questioned. We have examined the effect of the introduction of a PLC on the referral interval between patients with melanoma presenting to their general practitioner (GP) and their attendance at hospital. The case notes of all patients presenting with melanoma in Leicestershire between 1984 and 1994 were reviewed. There was a significant initial reduction in the mean referral interval following the introduction of the PLC from 27.9 days (SEM = 6.6) in 1984 to 11.3 (2.3) days in 1987 (P < 0.01). However, the referral interval gradually rose over the following 7 years to a mean of 20.4 (4.4) days in 1994, which was not significantly better than the 1985/86 level. The increase in the referral interval was due to a greater percentage of melanomas being referred to clinics other than the PLC. Only 48% of melanomas were referred to the PLC in 1994 compared with 70% in 1987. We also reviewed the referral letters for those patients presenting in 1991 and 1994, and decided, on the basis of the content of the letter, whether the GP had suspected the diagnosis of melanoma. More than 50% of the melanomas were correctly diagnosed by the GP, but only half of these were then appropriately referred to the PLC. We believe that PLCs are of value in the early diagnosis and treatment of melanoma, but only if they are appropriately utilized by GPs.

England↗
PubMed1997

Is the KTP laser effective in tonsillectomy?

Thirty-eight patients underwent a randomized double-blind trial using the KTP laser for tonsillectomy on one tonsil and standard dissection tonsillectomy on the other tonsil. Blood loss was less on the laser side. However, pain though initially slightly less on the laser side (days 1 and 2 post-operation) was worse on the laser side at 2 weeks due to delayed healing of the tonsillar bed. There were no primary or reactionary haemorrhages but a 15% incidence of secondary haemorrhage on the laser side.

Adult↗
PubMed1994

An evaluation of the revised seven-point checklist for the early diagnosis of cutaneous malignant melanoma.

The seven-point checklist has been widely advocated as a sensitive screening test for malignant melanoma. A number of groups have questioned the sensitivity of this system, especially in the detection of early lesions. We have assessed the sensitivity and specificity of the revised seven-point checklist when applied to lesions seen in our department over a 26-month period and compared it with the American ABCDE evaluation system. All melanomas (n = 65) were detected using the revised seven-point checklist and all were found to have at least one of the three major criteria defined by that system. Five (7.7%) melanomas were not picked up by the ABCDE checklist. Of 100 randomly selected patients who attended the clinic during the same period, with clinically diagnosed benign pigmented lesions, 63 had at least one major feature of the revised seven-point checklist. Forty (62%) of the melanomas, compared with only (4%) of the benign lesions, had more than one major feature. This study confirms the sensitivity of the revised seven-point checklist in the diagnosis of cutaneous malignant melanoma.

Dermatology↗
PubMed1993

Further experience of public education for the early diagnosis of malignant melanoma in Leicestershire.

Publicity campaigns alerting the public to the need for early attention to malignant melanoma (MM) were conducted in Leicestershire, England during the summers of 1987, 1988 and 1989. There was a marked, and statistically significant, rise in the number of referrals with good prognosis MMs in the period immediately after the first campaign. In the 2 subsequent years, despite further publicity campaigns, the number of MMs diagnosed per week remained lower than the postpublicity peak of 1986/87. The postpublicity rise was less marked in 1987/88 and 1988/89. In the next year (1989/90), in which there was no publicity campaign, the total number of MMs seen was higher than in 1988/89. Numbers of MMs seen per week remained relatively steady throughout the year. There was again no publicity in 1990/91, and the total number of MMs diagnosed was about the same as in the previous year. There was a rise in the number of MMs seen per week in what would have been the postpublicity period of this year. The initial results would be consistent with the initial postpublicity rise in numbers of MMs seen being made up of lesions seen 'early', that is, in 1986/87 and 1987/88. Since these lesions were seen earlier than they would have been had there been no publicity, the number of MMs seen in 1988/89 was lower than it would otherwise have been and the publicity effort appeared to have less effect. By 1989/90 and 1990/91 this effect seems to have been wearing off. It may be that, at least in low MM incidence areas like the UK, it is better to pulse public education for the early diagnosis of melanoma rather than to use annual or continuous campaigns. However, longer-term experience, and the pooling of data between centres will be necessary to test this conclusion.

Age Factors↗
PubMed1990

The initial effects on workload and outcome of a public education campaign on early diagnosis and treatment of malignant melanoma in Leicestershire.

We report our experience of the initial effects of a publicity campaign directed at early presentation of malignant melanoma in Leicestershire. The campaign resulted in a dramatic increase in workload and, at the pigmented lesion clinic, the numbers of new patients rose from 12.3 to 54.5 per clinic. There was a large rise in the number of new melanomas presenting in Leicestershire: from 1.02 per week before the campaign to 1.88 per week in the immediate post-publicity period. This was statistically significant (P less than 0.001). Although there was also an apparently encouraging rise in the percentage of thinner 'good prognosis' tumours, it was not possible to isolate this statistically from a pre-existing trend.

Dermatology↗
PubMed1990

A double-blind, randomized, prospective trial of a topical antiseptic versus a topical antibiotic in the treatment of otorrhoea.

The clinical efficacy was assessed of a topical antiseptic (aluminium acetate) and a topical antibiotic (gentamicin sulphate) for the initial treatment of otorrhoea. Evidence of resistant organisms developing to either treatments after 9 and 21 days was also examined. 139 affected ears were entered into the trial and of these, 102 (74%) completed the study. Improvement in the otorrhoea occurred in 68% of ears treated with gentamicin and 67% of ears treated with aluminium acetate, with no significant difference between the two treatments. No resistant organisms to aluminium acetate were encountered. Twelve gentamicin-treated ears had gentamicin-resistant organisms at presentation and one patient developed a gentamicin-resistant Pseudomonas during treatment. We therefore recommend a topical antiseptic such as aluminium acetate rather than a topical antibiotic in the initial treatment of otorrhoea on the grounds of cost, avoidance of resistance and toxicity.

Acetates↗
PubMed1990

Do patients with otitis externa produce biochemically different cerumen?

As polyunsaturated fatty acids have better antibacterial properties than saturated fatty acids, the cerumen of seven patients with recurrent otitis externa and seven unaffected subjects was analysed to determine their ratio. There was no significant difference in either the overall ratio of unsaturated/saturated fatty acids or in the amounts of the individual fatty acids from the cerumen of either group.

Cerumen↗
PubMed1990

Endaural meatoplasty for mastoid cavities.

Obtaining an adequate meatoplasty when performing mastoid surgery via an endaural approach is not always easy. This paper reviews the different types of meatoplasty available and describes a transposition flap of pretragal skin which can be used to provide a meatoplasty for mastoid cavities, acquired stenosis or congenital stenosis.

Ear, External↗
PubMed1988

Pharyngeal diverticula: is a positive family history unusual or of consequence?

The aetiology of pharyngeal diverticula is unclear. There are only a few case reports of pharyngeal pouches occurring in families in the literature and the importance of inheritance has been relegated to 'other proposed aetiological factors' in a recent paper. We studied the incidence of a family history in all patients diagnosed as having pharyngeal pouches between 1980 and 1985 in the Leeds/Bradford area. Of 32 people questioned, 7 had died leaving no relative to provide the information. Five patients (20%) recorded a positive family history and 20 patients (80%) a negative history. This finding is of relevance to the controversy surrounding cricopharyngeal myotomy in combination with pouch excision. If these patients have a congenitally weak posterior pharyngeal wall then they may have a greater risk of recurrence without a simultaneous myotomy.

Adult↗
PubMed1988

The swallowed foreign body: is it in the nasopharynx?

Children with a history of a suspected swallowed radio-opaque foreign body should undergo radiographic examination of the nasopharynx even in the absence of symptoms and signs. Failure to identify and remove an object at this site can result in potentially fatal consequences.

Child↗