Biomedical subjects
Publications and source records attributed to L H Durham.
A Groningen speaking valve was lodged in the oesophagus in a post-laryngectomy patient and was neglected for nine years. The patient presented with dysphagia. It was diagnosed and removed on rigid endoscopy. The procedure was complicated by a primary tear of the oesophagus, that was managed conservatively. The case has many interesting features, that are discussed below.
AIMS: Ultrasound is a highly effective imaging technique to determine salivary gland tumours and may help to identify many benign lesions. The aim of this study is to evaluate whether colour Doppler is able to further differentiate the malignant tumour. METHODS: Fifty-six patients with salivary gland lesions were prospectively assessed using ultrasound imaging with colour flow and power Doppler. The peak systolic velocity (PSV) was measured and the pulsatility index (PI) and resistive index (RI) calculations were performed on the pulsed wave traces. The real time ultrasound morphology and the Doppler information were correlated with the histology. RESULTS: In 18 of the 56 patients, no internal colour flow or power Doppler changes could be detected. The real time ultrasound morphology diagnosed benign disease with sensitivity of 89.7% with specificity of 57.1%. The positive predictive value was 93.6%. There were no significant differences in the colour Doppler appearances in terms of vessel type or intratumour distribution which could separate benign from malignant conditions. However, there was statistical discrimination for PI and RI values (P = 0.0006, P = 0.0002, respectively). No malignant lesions were seen when the PI was less than 1.8 and RI was less than 0.8. The PSV was elevated in several cases (> 50 cm per s) but there was no statistical correlation with malignancy. CONCLUSION: The risk of malignancy increases by a third when the colour Doppler demonstrates increased intratumour vascular resistance (RI > 0.8 and PI > 1.8), with positive predictive value of 97.3% (sensitivity 75.5%, specificity 85.7%).Bradley, M. J. (2000). Clinical Radiology55, 759-762.
We wished to estimate the percentage of children undergoing tonsil and adenoid surgery who would make suitable day cases. To achieve this a prospective study of 100 consecutive children admitted for the above surgery was undertaken. A medical and social history was obtained along with the parents' attitude to the possibility of day case tonsil and adenoid surgery. We found that 59% of our population would be eligible for day case surgery on the strict criteria we used. Reasons for failure were social in 26%, medical in 6% and both in 9%.
We present the development of a mechanical pressure probe which was constructed from items readily available to most university departments. The device is simple to operate and gives repeatable determinations. Its main use has been to measure the pressure thresholds for pain in the nasal mucosa.
To determine the relationship between subjective sensation of nasal patency and objective measurement of nasal inspiratory peak flow rate, a longitudinal study was conducted using healthy volunteers. Five healthy medical practitioners, one woman and 4 men, aged 24-34 years, made daily subjective estimations of their sensation of nasal patency on a 10-cm visual analogue scale. This was followed immediately by measurements of nasal inspiratory peak flow rate using a Youlten meter, repeated on at least 25 days per subject. Correlation coefficient and regression lines for subjective nasal patency on nasal inspiratory peak flow rate were calculated. One hundred and sixty nine sets of observations were made, range 25-44 per subject. Each subject showed strong evidence (P < 0.01) of positive correlation between subjective nasal patency score and nasal inspiratory peak flow rate. There was strong evidence (P < 0.001) that different regression lines are needed for different subjects, but no evidence that the lines are not parallel. Subjective sensation of nasal patency is strongly correlated with objective nasal patency, as measured by peak inspiratory flow rate. This relationship varies between individuals. Measurement of nasal inspiratory peak flow rate may be a valuable objective test of nasal patency, and is quick and simple to perform.
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The distribution of thermoreceptors within the nasal vestibule (that part of the nasal cavities lined with skin) and nasal cavum (that part of the nasal cavities lined with respiratory epithelium) was studied in 20 subjects. The distribution was compared with that of the malar skin adjacent to the nose. No thermoreceptors were located in the nasal cavum but the nasal vestibule contained a dense distribution of cold receptors (3.5 receptors per cm2) and warm receptors (3.2 receptors per cm2). The corresponding density of receptors in the malar skin was 2.7 receptors per cm2 and 2.6 receptors per cm2. The difference in distribution density between the nasal vestibule and the malar skin was significant (P less than 0.05). The implications of these findings are discussed.
A matched-pair parallel, group trial was carried out on 2 groups of 13 subjects (26 subjects in total), using 2% aqueous lignocaine to anaesthetize both the nasal vestibule and the nasal mucous membrane. Both groups had lignocaine infiltrated into the nasal vestibule and lignocaine applied topically to the nasal mucous membrane. The groups differed in the order in which the medication was given, one group having the infiltration first and the other group the topical application first. Local anaesthesia of the nasal vestibule caused a marked decrease in the nasal sensation of airflow (P less than 0.05) with no accompanying change in nasal resistance to airflow. Topical anaesthesia of the nasal mucous membrane had no effect on either nasal sensation of airflow or nasal resistance. The study demonstrates that the nasal vestibule is the dominant area for sensing nasal airflow. The nasal cavum (the major part of the nasal cavities that is lined by respiratory mucosa) appears to be unimportant as regards the sensation of nasal airflow. The clinical significance of the study is discussed with reference to other work, in this field.
A case of transsphenoidal meningohydroencephalocoele is presented. The clinical features and pathogenic factors are discussed briefly. An awareness of this condition should prevent attempted biopsy--which might otherwise prove disasterous. Air or contrast cisternography, with plain or computerised tomographic radiology, would seem to be the investigation of choice.
Otorhinolaryngological operations would be facilitated by the use of a safe, cheap, surgical adhesive. Though commercial fibrin glue is effective, it is both relatively expensive and, because it is prepared from pooled human blood, there has been concern that it carries the risk of transmitting viral disease, in particular hepatitis and acquired immune deficiency syndrome. We describe a rapid, cheap method of preparing sufficient fibrin glue, of adequate bonding power, from a small quantity of the patient's own blood, and therefore with no risk of contracting viral disease. Our method of preparation of fibrin glue promises to provide a valuable adjunct to otorhinolaryngological surgical practice.