Biomedical subjects
Publications and source records attributed to J M Pickles.
To date there are only two recorded cases of patients with coexistent pleomorphic adenoma and myotonic dystrophy in the literature. We present two further cases, describe the general features of myotonic dystrophy and discuss the theory of a direct association between these two conditions.
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This is the first reported case of a laryngocoele developing after laryngeal trauma. A 26-year-old man sustained a shotgun injury to his larynx. A large number of shotgun pellets was removed from his left vestibular fold. He subsequently developed a left-sided laryngocoele, probably due to fibrosis around the neck of the saccule. The laryngocoele was removed by an external approach.
A randomized prospective study was performed on 101 children undergoing dissection tonsillectomy in two different sequences. In the 'pause' sequence, a period of inactivity lasting 1.5 min ('hemostatic pause') with the Boyle-Davis gag relaxed and the fossae packed with gauze swabs was implemented after the tonsils were excised. Hemorrhage was controlled exclusively by ligatures. The duration of tonsillectomy and the number of ligatures used were accurately recorded. The procedure was identical in the 'no pause' group but the pause period was omitted. No reactionary haemorrhage occurred. There was no significant difference in the operating time between the two groups, but the mean number of ligatures required was significantly reduced in the 'pause' sequence. We conclude that 'hemostatic pause' in tonsillectomy reduces the amount of ligatures needed for satisfactory hemostasis.
A prospective study of otitis externa in the district of South Bedfordshire was undertaken between October 1990 and January 1991. Patients were referred untreated by general practitioners; self-referred patients with external otitis were also included. A detailed history was taken, the severity of the condition assessed, aural toilet performed, bacteriology swabs taken and the patient treated according to department protocol. 48 patients were included in the study; a similar number of age and sex-matched controls without otitis externa were randomly selected from the ENT outpatient clinics for comparison. Regular swimming emerged as a significant factor in the aetiology of otitis externa. The commonest organism cultured was Pseudomonas aeruginosa and this accounted for the most severe cases seen.
A prospective study of 169 patients with hearing loss as their main symptom, referred to the ENT Clinic by General Practitioners, is reported. The study aimed to assess the safety of prescribing hearing aids by Physiological Measurement Technicians from the Audiology Department without medical supervision. The General Practitioners' referral letter and patients' histories were analysed to see if all cases of middle ear disease would be picked up from this information alone. In this study, 31 patients had otoscopic evidence of chronic otitis media, active or inactive, only 14 (45.2%) of whom were identifiable from the referral letters. Of the 8 cases of active inflammatory ear disease, 3 were not mentioned in the referral letter. No asymptomatic cholesteatoma was found in the study population. At present all patients are reviewed by ENT medical staff prior to prescription of a hearing-aid; we feel this should continue.
Non-tuberculous retropharyngeal abscesses in adults are usually secondary to pharyngeal or oesophageal perforation, or sepsis in the throat or sinuses. Mediastinitis may follow, and broad-spectrum antibiotics and surgical drainage are required. The management of neck wounds must include adequate radiology where there is a risk of retained foreign body, and careful exploration, under general anaesthetic in many cases, is necessary. In the case reported here, retention of a foreign body in a neck wound led to the development of an unusual retropharyngeal abscess.
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