On R. D. Laing: style, sorcery, alienation.
Explore the source record for details and available documents.
Attitude↗
Biomedical subjects
J M Heaton
Publications and source records attributed to J M Heaton.
Evaluation of the dizzy patient: experience from a multidisciplinary neurotology clinic.
In 1993 a multidisciplinary neurotology clinic was established at the Toronto Hospital, University of Toronto, where patients with symptoms of dizziness were assessed by both otolaryngologists and neurologists. The results from the first 400 patients seen in consultation are described. The disease pathologies identified in this patient population with dizziness showed some significant differences from other published series, which we believe reflects the specialized tertiary nature of referrals to this clinic. A model for the collaborative investigation of the dizzy patient is provided consistent with the current trend towards multidisciplinary approaches in medicine.
Adolescent↗
Speech assessment of patients using three types of indwelling tracheo-oesophageal voice prostheses.
A multidisciplinary prospective study compared speech acceptability between three types of indwelling tracheo-oesophageal voice prostheses. Twenty male laryngectomees took part over five years, using 42 prostheses. Speech was assessed on a discrete scale by trained and untrained personnel. The majority scored in the mid-range for each assessor. The kappa coefficient was used to test similarity between assessors, and for all pairings agreement was significant (p < 0.05). The speech and language therapist tended to give higher scores and the patient lower. A relationship was found between patients' ages categorized by decade and the surgeon's score alone. This relationship held for Groningen high resistance and Provox prostheses individually too (p < 0.05). The untrained assessed similarly to the professionals--humans are all voice listeners. The analysis suggests surgeons find tracheo-oesophageal speech in older patients better than in younger ones; or make more allowances for the elderly. There was a trend for Provox prostheses to produce the best scores.
Age Factors↗
In vivo measurements of indwelling tracheo-oesophageal prostheses in alaryngeal speech.
Over the last 5 years, detailed air pressure, flow and voice measurements have been made on indwelling tracheo-oesophageal speaking valves whilst inserted in patients, using specially designed apparatus. This study was set up to investigate the relationship between speech and in vivo parameters. In vivo pressure measurements were generally lower for Groningen low resistance than Groningen high resistance, while flow and voice measurements were higher. A plot of opening pressure against pressure at maximum flow for all valves suggested a straight line relationship. A graph of maximum voice against composite parameter score for all valves showed a cluster of points between the composite score of 0-15. The advances in knowledge about these valves should be of use in the design of improved valves.
Aged↗
Factors associated with positive bacteriological cultures of chronic middle ear effusions.
Pathogenic bacteria have been isolated from middle ear effusions in a number of studies. Our aim was to identify factors which predispose to patients having positive cultures. Over a 1-year period, prospective data were collected on patients admitted for myringotomy. Middle ear effusions were collected at the time of surgery using specially designed traps, and underwent microscopy and culture. Data on local weather parameters were obtained from the Meteorological Office in Edinburgh, UK and compared with the patterns of positive cultures. A higher proportion of cultures were positive in October, November and December and in February and May than in the other months of the years. We were not able to relate these variations to any of the meteorological data, with the possible exception of relative humidity, or to any other variable.
Adolescent↗
Trends in voice rehabilitation in the United Kingdom.
Three main basic forms of vocal rehabilitation are available for post-laryngectomy patients in this country: oesophageal, mechanical vibrator and valved speech. In Sheffield, we advocate the use of valved speech, and insertion of the prosthesis preferably at the time of laryngectomy. We studied current vocal rehabilitation trends in the United Kingdom by a random survey of 100 consultant otolaryngologists and present our findings here. While all forms of vocal rehabilitation are provided in the majority of centres, 20% of units involved in head and neck surgery do not have optimum levels of speech therapy involvement.
Humans↗
In vitro comparison of the Groningen high resistance, Groningen low resistance and Provox speaking valves.
This paper compares the physical parameters of the newer Groningen low resistance and Provox indwelling laryngectomy prostheses with the established and original Groningen device. In vitro pressure/flow profiles were determined, using specially designed apparatus, in 44 standard Groningen high resistance (GHR), 37 Groningen low resistance (GLR) and 19 Provox tracheo-oesophageal prostheses prior to insertion. GHR valves had significantly higher forward opening pressures than both the newer valves and the GHR was significantly higher than the Provox (p < 0.01: Mann-Whitney U-test). The mean forward resistance of GHR was significantly higher than that of both; the Provox valve was significantly lower than that of GLR (p < 0.0001: Mann-Whitney U-test). This may be of relevance with respect to patient acceptability, voice quality and effective duration of valve action.
Evaluation Studies as Topic↗
Acceptability and intelligibility of tracheoesophageal speech using the Groningen valve.
This prospective study was set up to investigate the acceptability and intelligibility of speech produced by a population of male patients who had undergone total laryngectomy for malignant disease in Sheffield. Each had been fitted with at least 1 Groningen tracheoesophageal prosthesis and their phonatory qualities were assessed by a team of 8 naive listeners. Speech quality assessed in terms of acceptability and intelligibility was found to be generally very high and compares favourably with that produced by a population of patients using the Blom-Singer prosthesis.
Aged↗
Indwelling tracheo-oesophageal voice prostheses post-laryngectomy in Sheffield, UK: a 6-year review.
The Groningen and Provox tracheo-oesophageal valve voice prostheses have been used in post-laryngectomy patients extensively in Sheffield since 1986 and 1990, respectively. To the present time a total of over 40 patients have made use of these devices, two thirds of whom underwent insertion at the time of laryngectomy. Prostheses were replaced under local or general anaesthesia if they were leaking or if phonation became increasingly difficult. Our experience with over 200 valves including the Groningen High Resistance, Groningen Low Resistance and Provox prostheses in this patient group is presented. We believe that the primary insertion of a low resistance prosthesis, either the Provox or Groningen Low Resistance device, is the method of choice in speech rehabilitation following laryngectomy.
Adult↗
Sensorineural hearing loss associated with birdshot retinochoroidopathy.
We treated a patient with birdshot retinochoroidopathy, an autoimmune eye disease. An autoimmune sensorineural hearing loss developed, probably due to endolymphatic hydrops. To our knowledge, the association of these two conditions has not been recorded previously.
Audiometry, Pure-Tone↗
The use of cortical bone grafts in ossiculoplasty. III: Audit of costs.
This paper describes the results of a comparative audit of the costs of using artificial prostheses and cortical bone. The costs of using a bone graft have been calculated by estimating the expenses incurred as a result of the additional time required for preparation of the grafts. The mean cost of preparing a graft was 29.10 pounds, while the mean cost of using a prosthesis was 65.01 pounds.
Bone Transplantation↗
Otorrhoea via ventilation tubes in adults and children.
A prospective investigation of 127 children and 41 adults undergoing ventilation tube (grommet) insertion has been carried out. One or more episodes of discharge via a ventilation tube occurred in 14% of the children and 27% of the adults during the in situ lifetime of the tube. So far, 44 of the children have undergone insertion of a second ventilation tube, and of these, 7% have had discharge from one or both tubes. In the paediatric group, discharge was more likely if the child had a history of atopy (Chi-squared, P < 0.03, multiple regression P < 0.03). No other risk factors were identified, but two patients with cholesteatoma were identified in the group with discharge via a tube. In patients with otorrhoea via a tube, which does not settle after removal of the tube, mastoid exploration should be considered.
Cerebrospinal Fluid Otorrhea↗
A comparison of performance of Shepard and Sheehy collar button ventilation tubes.
This study was designed to confirm the longer in situ life of the Sheehy collar button compared with the Shepard tube and to assess the complication rates associated with the two tubes. Cases of bilateral otitis media with effusion had a Shepard tube inserted in one ear and a Sheehy contralaterally. The insertion position was allocated randomly. The patients were then assessed at three-monthly intervals for two years. In 71 per cent of those in whom at least one tube had extruded, the Sheehy remained in situ longer. The antero-inferior tube remained longer than the postero-inferior whichever type was used. There was no significant difference between complication rates, or recurrence rates of middle ear effusion after tube extrusion, for the two types. We conclude that use of a Sheehy rather than a Shepard tube carries no increased risk of complications and the patient may require further surgery less often in total.
Adolescent↗
An assessment of the incidence of iron deficiency in paediatric otolaryngology inpatients.
The aims of this study were: to determine whether there is an increased incidence of iron deficiency in paediatric otolaryngology inpatients compared with other surgical controls; and to establish whether preoperative screening of haemoglobin level is warranted in such patients. Children aged 1-10 years admitted electively for ENT surgery or for general surgical procedures had blood taken for haemoglobin level, mean cell volume and serum ferritin. Their age, weight, socioeconomic class and ethnic background were recorded. A total of 100 patients entered the study, in a six-month period. The mean ages and weights for the two groups were statistically different, so allowance was made for this in calculations. Social class was not significantly different. No relationship could be established between haemoglobin level and ferritin level for individual patients. Multiple regression analysis for haemoglobin level, mean cell volume and for ferritin level showed that allowing for the age and weight differences these variables were not significantly different for the two groups. This study has therefore shown no increased incidence of iron deficiency in paediatric ENT inpatients. Each Department should formulate its own policy on pre-operative haemoglobin screening, based on local considerations.
Child↗
Waiting list initiatives: crisis management or targeting of resources?
To investigate the impact of a waiting list initiative on an ENT surgical waiting list, we have evaluated the outcome of the Tayside ENT Waiting List Initiative. Four hundred and forty-five patients were offered dates to come in during the initiative. Of these, 280 underwent surgery and 16 indicated that their operations were no longer necessary. The maximum wait for routine operations falling within the criteria for inclusion in the initiative was 28 months prior to the initiative can be effective in reducing waiting times for routine surgery. However, it is too early to describe the Tayside initiative as an unqualified success, as it remains to be seen whether or not the waiting list will lengthen again now that it is over.
Humans↗
Penicillium aurantiogriseum-induced, persistent renal histopathological changes in rats; an experimental model for Balkan endemic nephropathy competitive with ochratoxin A.
Renal histopathological changes in rats, caused by food partially moulded by a common fungus isolated from an area of nephropathy in Yugoslavia, were differentiated into acute and chronic responses. The acute response to a few days on the diet specifically involved necrosis and concomitant mitosis in proximal tubule cells. More protracted, continuous or intermittent administration of nephrotoxic mould led to a marked karyomegaly in the same corticomedullary region. The phenomenon is more prominent than that induced by treatment with ochratoxin A over a similar period, raising the question of the putative role of such mycotoxins in the etiology of chronic human renal disease.
Acute Disease↗
Acute histopathological changes produced by Penicillium aurantiogriseum nephrotoxin in the rat.
Shredded wheat moulded by an isolate of Penicillium aurantiogriseum elicited progressive histopathological changes at the rat renal cortico-medullary junction during 5 days of dosing, when incorporated into diet as a 20% component. The changes of acute tubular necrosis and regeneration were seen in the P3 segment of the nephron. In rats exposed to contaminated diet for 5 days the histopathological changes regressed in severity by about one-half within a further 4 days on normal diet and by 7 days the tubular epithelium was nearly normal. A partially purified fraction of an alcohol extract, selected by preparative high-voltage electrophoresis and anion exchange and notably rich in amino-compounds, was typically nephrotoxic when given in diet over 4 days. Acute marked tubular necrosis also occurred when the same fraction was given intraperitoneally over a similar period. The acute histological changes provide a rapid bioassay for this Penicillium nephrotoxicity and facilitate the search for the toxic metabolite(s). The cumulative expression of necrosis and repair over only a few days in tubular epithelium suggests that chronic exposure will elicit a more complex pathology which might serve as an experimental model for the idiopathic Balkan endemic nephropathy.
Animals↗
Tumefactive fibroinflammatory lesions of the head and neck.
The term 'tumefactive fibroinflammatory lesion' has been used to describe a fibrosclerosing disorder which has a locally destructive nature but is characterized by a benign histological appearance. We report five patients, over a five year period, with such a lesion. The clinical behaviour and surgical findings suggest the lesion to be an invasive malignancy. However, the histological appearance of an admixture of chronic inflammatory cells and fibrosis is consistent with a benign condition. We recommend surgical excision of the lesion as the mainstay of treatment; other studies report the use of steroids and radiotherapy.
Adult↗