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Biomedical subjects

J G Fraser

Publications and source records attributed to J G Fraser.

At least 19 recordsLinked to original sources
PubMed1994

The hyoid syndrome: a pain in the neck.

This paper reports on 13 patients with a pain syndrome arising from the region of the greater cornu of the hyoid bone. It is often missed and yet is readily treatable. The syndrome causes pain on swallowing in the region of the hyoid which may radiate to the ear, face and lower jaw or may be felt also in the pharynx. Treatment by an injection of a mixture of depomedrone and one per cent lignocaine is very effective. The underlying pathology is discussed and it is suggested that in some cases the pain and discomfort experienced by patients may be due to tenosynovitis of the intermediate tendon of the digastric muscle. Greater recognition of this relatively common condition would not only result in more effective treatment but would also avoid unnecessary investigation and surgery.

Adult↗
PubMed1992

Positional audiometry in the diagnosis of perilymphatic fistula.

Fifty-eight cases with a presumptive clinical diagnosis of perilymphatic fistula (PLF) are described with the results of a positional audiometric test designed to detect the presence of air in the cochlea. All patients underwent tympanotomy and observations of the middle ear are recorded together with the results of treatment. A definite leak was found in 33 cases and none in 25, but grafting of the round and oval window was performed in all but 10 cases. Pure-tone audiometry was performed before and after a 30-minute period of positioning the patient horizontally with the affected ear uppermost. A change in audiometric thresholds was noted in the group where a presumptive diagnosis of PLF was made, including some of those not found to have leaks at operation. However these changes were not observed in the positional tests of a group of 22 patients with hearing losses attributable to other causes. Also, an abnormal air-bone gap was noted in the PLF group compared with the other group. Although the original two-frequency criteria of earlier studies applied to the positional test did not predict the operative findings (leak or no leak), new data on frequency specific changes are presented. It is possible that fistulas at the oval window may be associated with positional threshold change at 500 Hz, and those at the round window with changes at 8 kHz.

Audiometry, Pure-Tone↗
PubMed1989

Induction VBM plus radiotherapy, versus radiotherapy alone for advanced head and neck cancer: long-term results.

Between 1978 and 1981, 85 patients with advanced squamous cell carcinoma of the head and neck were randomized to receive induction VBM followed by radiotherapy, or radiotherapy alone. The shortest follow-up is thus 6 years. The median survival of patients receiving induction chemotherapy was 46 weeks, that of the radiotherapy group alone was 75 weeks. As the two groups were not balanced despite randomization, multivariate methods (GLIM) were used to identify significant prognostic factors. These were: response to radiotherapy (P less than 0.001), nodal status (P less than 0.001), age (P less than 0.01), and histological grade (P less than 0.01). Neither treatment with, nor response to, chemotherapy had a significant effect on survival.

Adult↗
PubMed1989

UCH/RNID single channel cochlear implant: surgical technique.

In a series of thirty patients who received single-channel cochlear implants a simple standard operative procedure has been developed. No life-threatening complication and no wound breakdown occurred. The only problems encountered during surgery were related to the position or obliteration of the round window niche. The commonest reason for removing the implant was device failure; this was caused by a single defective electronic component. No further failures have occurred since this was modified. The second commonest reason for failure was related to the position of the implant, both cases occurred early in the series and the operative technique was altered to prevent further episodes. The infection rate has been low, partly because a simple postaural incision does not put the local blood supply to the skin at risk. Synkinetic facial nerve stimulation seems difficult to predict and may be hard to avoid until more is known about its aetiology.

Cochlear Implants↗
PubMed1989

UCH/RNID single channel extracochlear implant: results in thirty profoundly deafened adults.

The University College Hospital/Royal National Institute for the Deaf (UCH/RNID) Cochlear Implant Programme has now given single channel extracochlear implants to forty profoundly deafened adults. Audiological, psychophysical, speech perceptual and subjective results for the first thirty cases are described. The main findings can be summarised as follows: 1. Users of the single channel extracochlear implant gained considerable improvements in their lipreading and communication ability, as assessed by both objective testing and by the patients' own reports. All acquired useful awareness of environmental sounds and an improvement in their quality of life; some also showed improvements in their own speech. A small number were capable of some open-set speech discrimination without lipreading. 2. Extracochlear implantation was not found to destroy residual hearing, although it did cause slight deterioration in hearing thresholds in some cases. 3. Our results so far suggest that patients deafened by meningitis are likely to obtain less benefit from a single channel cochlear implant than those deafened by other causes. Better results were also achieved by younger, more recently deafened patients and those who were good lipreaders. Despite the emergence of these trends we have not yet found a reliable way to predict benefit from an implant on the basis of preoperative variables. 4. Self-reported measures of the benefits of the implant correlated well with the objective test results, but also revealed important information that was not available from the objective tests. In particular, they showed that the improvement in lipreading provided by the implant was reduced in noisy conditions.

Acoustic Stimulation↗
PubMed1986

The UCH/RNID cochlear implant programme: patient selection.

After an initial postal questionnaire, patients undergo a series of tests and assessments designed to establish their suitability for implantation. The following criteria should be met: Total or profound post-lingual hearing loss. Sufficient age to give informed consent. General good health. Psychological stability. Unable to benefit from hearing aids. Free from middle ear or mastoid disease. Detailed medical, audiometric, vestibular and psychological investigations are performed, as well as acute electrical stimulation of the cochlea, and a hearing aid trial in those subjects with some measurable hearing. Fifty-two applicants have so far been assessed and of these 14 have been found to be suitable for implantation and seven have received implants.

Cochlear Implants↗
PubMed1983

Sequential chemotherapy and radiotherapy in advanced head and neck cancer.

Eighty-six previously untreated patients with advanced squamous-cell carcinoma of the head and neck were entered into a prospective randomised controlled trial to evaluate whether the addition of a kinetically based chemotherapy regimen before and after radiotherapy would improve survival compared with radiotherapy alone. Survival at 30 months showed there was no evidence that the addition of chemotherapy to radiotherapy improved survival and that the chance of obtaining a significant result in favour of adjuvant chemotherapy was remote. We make a strong plea that all chemotherapy regimens for the treatment of squamous-cell carcinoma of the head and neck regions should be subjected to controlled prospective trials before they are widely adopted.

Adult↗
PubMed1983

Language development in a group of very low-birth-weight children whose postauricular myogenic response was tested in infancy.

A new instrument for the detection of the postauricular myogenic (PAM) response was used to test the hearing of 106 infants weighing less than or equal to 1,500 g when they were aged 1 to 21 months. Eighty-eight infants showed a positive response at 60 dB hearing level (HL) (normal). The other 18 did not respond; four were found to have sensory neural hearing loss and another six had conductive loss due to secretory otitis media. Of the 106 children, 90 aged 2 years or more (mean 27 months) were living in the United Kingdom, and their language development was assessed. It was normal in 67/75 children whose PAM response had been normal in infancy. The remaining eight children with normal PAM responses in infancy, had language delay. All eight children had problems that were thought to account for the delay, including three with mental retardation, three with cerebral palsy, and two whose families did not speak English. Language development was normal in 11/15 children tested whose PAM responses had been found to be abnormal, including all six whose secretory otitis media had been diagnosed and treated at the time of the PAM test. Delay in language development was found in 3/4 children with sensory neural hearing loss who were available for testing and in one child with overall developmental delay. It is concluded that a positive PAM response at 60 dB HL in infancy indicated hearing adequate for the development of normal speech in otherwise normal children among a group of infants at high risk of hearing loss.

Child, Preschool↗
PubMed1981

Stress radiography in acute ligamentous injuries of the knee.

Stress radiography was performed on 60 acute ligamentous injuries of the knee under general anaesthesia using a simple standard technique. Laxity on angular stress in extension was evident when the posterior cruciate ligament was torn in association with a collateral capsular tear. The same test repeated in 20-30 degrees of flexion was abnormal when the collateral capsule alone was abnormal when the collateral capsule alone was torn and laxity always exceeded 5 degrees. Where both cruciate ligaments were torn the laxity exceeded 10 degrees. Lateral stress radiographs in the presence of an isolated capsular tear demonstrated rotatory laxity with a glide rarely exceeding 10 mm. The addition of a torn anterior cruciate ligament resulted in sagittal laxity greater than 7 mm and a tear of the posterior cruciate ligament, irrespective of the associated pathology, resulted in a laxity exceeding 12 mm.

Humans↗
PubMed1981

The management of acute ligamentous injuries of the knee; experience with 116 patients.

One hundred and eighteen acute complete ligamentous injuries of the knee in 100 males and 16 females presented in the years 1974 to 1976. Stress analysis under anaesthesia was considered an important step in the clinical evaluation, while radiological evidence of articular fractures justified a high index of suspicion with ligamentous lesions. Eighty-eight of the injuries were treated by early operative repair of all damaged structures. The remaining knees were considered on preselected criteria, to be suitable for conservative treatment. At review twelve months following injury, 73% of the knees were considered to have good results. In general, late review showed no deterioration in stability, but an increasing proportion had pain. Unsatisfactory results were due to combined cruciate and collateral ligament instability.

Female↗