Biomedical subjects
Publications and source records attributed to J F Sharp.
A simple technique to improve the success rate of endoscopic stapling diverticulotomy of pharyngeal pouches is described. Equipment used is readily available. This technique can be used in difficult cases when the pouch cannot be visualised using a Weerda diverticuloscope. It reduces the need for conversion to an open surgical procedure with associated increased risk of complications.
The introduction of professional revalidation and clinical governance imposes an increasing requirement for clinicians to provide evidence of competence. This paper introduces a CUSUM (CUmulative SUM) mathematical tool for determining trend and applies the technique to 84 consecutive parotidectomies (superficial, partial or total/near total) performed by one surgeon (J.S.). Using this operation, the paper illustrates how attainment and maintenance of competence in the field of otolaryngological surgery may be demonstrated at differing levels of rigour. The role of the CUSUM in assessing a trainee's surgical progress is also explored.
Gustatory sweating of the external auditory canal is extremely rare. A clinical case, that is only the second in the English literature, is presented. The potential pathogenesis and its treatment options are discussed.
Chondroma, a benign tumour which is common at many sites in the body, has not been reported in the English literature in the bony external auditory canal. The first such case at this anatomical site is described and the pathogenesis is considered.
Explore the source record for details and available documents.
The origin and course of the carotid arterial system in the superior mediastinum and neck are remarkably constant. Although variations are rare, they can have important implications in certain clinical problems. In this report, a patient underwent free jejunal graft repair of a cervical oesophageal stricture caused by radiotherapy for a post-cricoid carcinoma. The common carotid artery on the side of the surgical approach was found to cross the midline to the other side of the neck, and created difficulties both with the procedure and future management. This has not been previously reported.
A post-operative survey of 291 children was conducted to assess morbidity found at home in the first five days post-tonsillectomy. Analgesic requirement (92.4 per cent), signs of distress (90.4 per cent), otalgia (69.1 per cent), halitosis (66.7 per cent) were common. Physical or behavioural changes (36.8 per cent) and secondary haemorrhage (8.9 per cent) were also prominent features. Nausea was reported in 59 children (20.3 per cent) and delayed return to a normal diet which in turn predisposed to secondary haemorrhage. Return to normal diet was independent of pain. General Practitioners were consulted by 60.6 per cent and more than half were prescribed drugs. The presence of an organized clot in the tonsillar fossa (3.45 per cent) post-operatively did not delay discharge from hospital and none of these patients re-presented with secondary haemorrhage. Based on their child's experience in this study, only one third of the parents approved of day-case tonsillectomy in principle, a finding which has implications for the instigation of day-case tonsillectomy procedures.
The anatomical location and relationships of the submandibular gland are well-known to most otolaryngologists and gross variations from the norm are rare. We report a case of an atypical submandibular gland located 2 cm below the mandible which presented as a painful neck swelling with non-diagnostic fine needle aspiration cytology. Using Doppler ultrasound the mass was noted to be closely located to the facial artery and vein and following the administration of oral lemon juice, the peak systolic velocity of a small artery within the mass rose from 8.5 cm/s to 16.4 cm/s, confirming the tissue's salivary nature. We review the literature on using Doppler ultrasound in this area of the neck and discuss realistic practical applications of the technique.
Explore the source record for details and available documents.
Uncontrolled epistaxis may require a long hospital stay, multiple blood transfusions and multiple arterial ligations. This case report highlights vertebro-carotid anastomosis as a rare cause of uncontrolled epistaxis. The importance of angiography in the identification of rare arterial anastomoses is stressed.
Malignant external otitis is classically associated with insulin-dependent diabetes mellitus probably due to generalized systemic immunodeficiency (Mowet and Baum, 1971). A unique case of malignant external otitis associated with Waldenstrom's macroglobulinaemia is presented.
The introduction of treatment protocols require audited prospective data. The use of X-rays in patients with simple nasal trauma is common but of limited value. A prospective audit of this practice and the implications of introducing a 'no X-ray' policy for these patients into the local casualty department are presented. Patients are spared radiation exposure and there are savings in patient throughput time and departmental costs. Casualty departments which have not already adopted such a policy are urged to do so. Where such a protocol is in use, audit to ensure adherence is encouraged.
One hundred elderly patients referred for hearing aids have been assessed with a view to setting up a direct hearing aid referral system, based upon the criteria laid down by the liaison group for Technicians, Therapists and Scientists in Audiology (TTSA). Sixty-three per cent of the patients could have been fitted with a hearing aid directly. Adequate prior wax removal, could increase this figure to 84%, with a reduction in the waiting time for a hearing aid of 6.1 months.
Freeze-thawed co-axially aligned skeletal muscle autografts provide a new concept in peripheral nerve repair, and are being investigated in the repair of mixed motor/sensory nerves. These grafts provide an orientated matrix of large basement membrane tubes through which regenerating axons can migrate and reinnervate the distal nerve. Using the buccal branch of the rat facial nerve as a model, we compared five freeze-thawed muscle autografts with five interposed nerve autografts. Some 300 days after grafting, the morphology of the distal nerve was evaluated. When the two groups were assessed morphometrically, it was found that nerve grafts showed a small but significant improvement over muscle grafts in respect of indices of the fibre maturation.
Inferior turbinectomy, often combined with septal surgery, is frequently performed in the surgical treatment of nasal obstruction. A patient with post-operative greater palatine anaesthesia occurring after this procedure prompted a study of the anatomy of the greater palatine nerve in the region of the inferior turbinate. Sixty-four lateral nasal walls were examined in cadavers. A dehiscence rate of 22% was noted, and in an additional 55% there was only a minimal bony covering to the nerve. Dehiscences occurred exclusively in the inferior meatus, anterior to the posterior bony end of the inferior turbinate. The narrow antero-posterior extent of the dehiscence, the hard dense lateral nasal wall bone and the lateral position of the nerve in the canal help to protect the nerve from surgical trauma during turbinate surgery.
Surgical closure of the anteriorly located tympanic membrane perforation can present a problem. The lack of anterior support for the graft frequently leads to graft failure if an underlay method is used whereas anterior blunting is a complication of onlay techniques in this situation. The experience with the Kerr flap, an underlay graft fashioned to include a tab of fascia which is placed laterally under the annulus and the anterior meatal skin, is presented. This method gave a 97.5 percent closure rate with no cases of anterior marginal blunting and a mean auditory threshold gain of 8.5 dB (95 percent confidence limits 5 to 11.9 dB, P less than 0.01) was achieved at the frequencies tested. The use of the Kerr flap is recommended when repairing the anteriorly placed tympanic membrane perforation.