Biomedical subjects
Publications and source records attributed to M S McCormick.
The larynx functions as a protective valve of the upper airway. An end-tracheostomy represents a risk factor for foreign body aspiration. We describe a case of tracheostomy stoma button aspiration, leading to recurrent chest infection and irreversible lung damage, necessitating a pneumonectomy. This is the first reported case of this kind. This case also emphasizes the importance of patient education and of stoma button design.
Fusobacterium necrophorum is implicated as an aetiological agent in a variety of necrotic diseases, such as Lemièrre's syndrome (LS) in humans. LS was initially described as septic thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection. Other primary sources of infection include parotitis, otitis media, sinusitis, odontogenic infection and mastoiditis. In the pre-antibiotic era LS carried a high mortality. This has been reduced as a result of the widespread use of antibiotics, but there is still a definite morbidity and mortality associated with infection with this virulent organism. We report three cases of complicated otitis media caused by Fusobacterium necrophorum. The patients were treated successively with intravenous metronidazole and surgery.
OBJECTIVE: Several cases of severe depression after tonsillectomy have been described in children, indicating psychological trauma after surgery and hospitalization. The actual prevalence of depressive symptoms after tonsillectomy is unknown and possibly underestimated. This study aims to quantify this problem by employing current diagnostic methods. METHODS: This is a prospective study of 159 children who underwent tonsillectomy in a major Pediatric University Hospital. All patients stayed in the hospital overnight. Parents were sent questionnaires based on diagnostic criteria for depression (ICD-10) 3 weeks postoperatively. Whenever the criteria for a depressive episode were met, a telephone interview with the parents followed 3 months after the operation. RESULTS: Some 89 questionnaires were returned (56%), revealing that 15 patients (17%), 4-16 years old, developed depressive symptomatology compared with a 4% prevalence of depression in the general child population and 10-20% in the pediatric hospital populations. No children had persisting symptoms 3 months later. CONCLUSIONS: These results suggest that post-tonsillectomy morbidity can occasionally manifest with depressive symptoms, usually resolving spontaneously. A high index of suspicion is required by the otolaryngologist, nurses and primary care physician for early diagnosis and referral of persisting cases to a specialist. Emphasis is given to a structured preoperative psychological preparation of pediatric patients.
Globus pharyngeus is a common complaint often referred to the ENT outpatient department. The precise nature of globus pharyngeus and its aetiology remains something of a mystery. There is no uniform policy of management of this condition. A postal questionnaire was sent to all UK-based ENT consultants registered with the British Association of Otorhinolaryngolgists-Head and Neck Surgeons (BAO-HNS). The aim of this study was to ascertain if there was a favoured management policy by the majority of consultants. Our results indicate that there is a lack of consensus in the investigation and management of globus pharyngeus. Fourteen per cent do not perform any investigations, but would prescribe antacid medication if clinically indicated. The remainder would investigate in a variety of ways. The most common investigation is rigid endoscopy which is performed by 61% of respondents, followed by barium swallow (56%). The combination of endoscopy and barium swallow is routinely performed by 17.5% of respondents.
Glossopharyngeal neuralgia is rare, typically idiopathic and treated with carbamazepine. Surgery to decompress or transect the glossopharyngeal nerve root may be performed if conservative management fails. We present a case following trauma to the neck with foreign body impaction. To our knowledge this is the first case of glossopharyngeal neuralgia due to neck trauma.
BACKGROUND: Carotid endarterectomy (CEA) is the most common surgical procedure performed for the treatment of symptomatic carotid stenosis greater than 70%. Among the recognised complications, such as stroke and myocardial infarction, is injury to cranial nerves. METHODS: We report the incidence and follow-up of cranial nerve injury in 269 patients who underwent carotid endarterectomy between January 1994 and December 1997 at the Royal Liverpool University Hospital. RESULTS: Fifteen cranial nerve injuries were documented (5.6%). Seven patients (2.6%) had unilateral vocal cord paralysis, nine (3.3%) hypoglossal palsy, two (0.7%) glossopharyngeal nerve injury and one (0.4%) facial nerve palsy (marginal mandibular nerve). All patients showed improvement within a few weeks and none had residual disability at the last follow-up (two weeks to 14 months). CONCLUSIONS: Patients manifesting symptoms of cranial nerve dysfunction should undergo a thorough otolaryngological evaluation and long-term follow-up. Most cranial nerve injuries are transient and result from trauma during dissection, retraction or carotid clamping. Knowledge of cranial nerve anatomy is essential if the surgeon is to avoid such injuries.
INTRODUCTION: Adenotonsillectomy usually cures obstructive sleep apnoea in otherwise healthy children. When children, with congenital cardiac pathology, suffer sleep hypoxaemia following their corrective cardiac surgery, they are referred to an otolaryngologist for adenotonsillectomy. Hardly any studies have been published to show how effective this operation is for these children. OBJECTIVE: To determine whether adenotonsillectomy significantly improves hypoxaemia in children with congenital cardiac pathology following corrective cardiac surgery. METHODS: Thirty children with sleep apnoea (aged 2-8 years) were recruited. Fifteen children with congenital cardiac pathology (Gp I) and 15 children who were otherwise healthy (Gp II). All children were assessed pre-operatively and at 1 and 3 months post-operatively with transcutaneous oxygen saturation monitoring. Tonsillar size, base oxygen saturation level, apnoeic episodes and snoring were recorded. Sleep apnoea and snoring was graded on a 5 point scale from I (no apnoea/snoring) to V (severe apnoea and snoring). RESULTS: All children had an initial sleep grade of IV or V. Tonsillar size did not appear to be a significant factor on sleep grade in Gp I and Gp II. The median base line oxygen saturation was 88 and 93%, respectively in Gp I and II pre-operatively and improved to 90.1 and 99.2%, post-operatively. Following surgery, snoring and sleep apnoea disappeared in group II. In group I, there was significant reduction in the number of apnoeic episodes at 3 months, but the majority of children were still snoring with hypoxaemic episodes. CONCLUSION: This study shows that adenotonsillectomy significantly reduces the apnoeic episodes in children with cardiac pathology but does not abolish it. At 3 months after surgery there was significant overall improvement in the baseline oxygen saturation.
OBJECTIVE: Owing to the increasing number of patients with acquired immunodeficiency syndrome and immunosuppressed transplant patients, disseminated Toxoplasma gondii has emerged as a potentially fatal pathogen. Common presentations include encephalitis, pneumonia, and myocarditis. The objective of this report is to describe the clinical course, histologic features, and outcome in two immunocompromised patients with disseminated toxoplasmosis presenting with parasitemia and panniculitis. MATERIALS AND METHODS: Two cases of disseminated toxoplasmosis presenting with parasitemia (patient 1) and panniculitis (patient 2) were retrieved from the clinical, surgical, and autopsy pathology archives of Vanderbilt University Medical Center, Nashville, Tenn. The histology and diagnostic approaches used are reported. Charts were reviewed for primary diagnosis, therapy protocols, clinical presentation of infection, and outcome. RESULTS: Patient 1 developed a clinically unexplained sepsis syndrome shortly after heart transplantation; T gondii parasitemia was diagnosed by examination of peripheral blood smears. The diagnosis was confirmed at autopsy. Patient 2 was a child undergoing induction chemotherapy for lymphoma who developed rapidly progressive neurologic deterioration accompanied by a maculopapular skin rash; T gondii panniculitis was diagnosed retrospectively when histologic examination was combined with immunohistochemistry. Autopsies performed in both cases confirmed widely disseminated infection. CONCLUSIONS: Disseminated toxoplasmosis should be considered in the differential diagnosis of immunocompromised patients with culture-negative sepsis syndrome, particularly if combined with neurologic, respiratory, or unexplained skin lesions. Examination of Wright's-stained peripheral blood smears or antitoxoplasma immunoperoxidase studies of skin biopsies may be diagnostic and allow rapid initiation of antibiotic therapy. Autopsy findings contributed to both of our cases by documenting the wide-spread heavy parasite burden and demonstrating numerous diagnostic T gondii cyst forms.
We describe our experience using the Provox voice prosthesis in patients undergoing free jejunal loop transfer following total pharyngo-laryngectomy. From our series and the few reports in the literature, the use of a voice prosthesis appears to be an effective method of speech rehabilitation in this group of patients.
Bay-leaf as a foreign body causing oesophageal obstruction has rarely been reported. We present two such cases, and review their management.
A controlled prospective study was performed on 429 consecutive children undergoing adenoidectomy, of which 263 were day-cases. Adenoidectomy was done alone, or in combination with other minor procedures. There was only one reactionary haemorrhage in each group, and these were early and easily recognized by the recovery staff. No other significant complication was seen. Adenoidectomy in children as a day-case procedure is safe and cost-effective.
This paper reports the results of a study to determine whether pulsed electromagnetic stimulation, applied over the mastoid bone, caused an improvement in the level of tinnitus in long-standing tinnitus sufferers. Fifty-eight patients from the Liverpool Tinnitus Association volunteered to take part in a double-blind placebo controlled trial. Active and placebo devices were randomly allocated to these patients on their first visit. At the end of one week of treatment, each patient noted whether their tinnitus had completely disappeared, was improved, unchanged or made worse by the treatment Forty-five per cent of the patients who completed the trial were improved by the active device, but only 9% by placebo (P = 0.0013, Mann-Whitney test). We suggest that electromagnetic stimulation may be an effective treatment in some tinnitus sufferers.
A cervical fistula from a 'congenital' cholesteatoma is described in a 70-year-old man. This was found to communicate with an extradural temporal lobe abscess. The presentation and management is described. No previous report of such a case has been found in a review of the literature.
The presentation and management of a two-year-old child with a severe spontaneous haemorrhage from the tonsil is reported. This was shown to be associated with an acute infection of the tonsil. It is suggested that early tonsillectomy be advised in patients with this symptom.
The present UICC classification of postcricoid cancer is based on directions of tumour spread which are uncommon and difficult to assess clinically. The classification takes no note of spread into the cervical oesophagus and fails to correlate staging with survival. The aim of this study was to assess the value of other criteria, including vocal cord paralysis and tumour length, in staging 157 patients with postcricoid cancer. Both vocal cord paralysis and tumour length could be assessed in most patients, and correlated with the mode of treatment. Generalized Linear Interactive Modelling (GLIM) identified vocal cord paralysis (P less than 0.001), performance status (P less than 0.025) and the interaction of length and histological grade (P less than 0.05) as significant predictors of survival. None of these variables is included in the current UICC classification.
This paper describes a series of 2447 patients with squamous carcinoma of the head and neck treated personally over 22 years; 276 patients with advanced untreatable disease and 498 with recurrent untreatable disease are analysed. The median survival for the first group was 13 weeks and for the second 11 weeks. The data fitted an exponential curve. Prognostic factors included general condition and N status for the first group, and site of the primary tumour, site of the recurrence and length of time to recurrence for the second group. However, these factors only explained 5% of the variance; the remaining 95% was unexplained, emphasizing the futility of stratification for prognostic factors, and the necessity for large trials. Using the above facts the number of patients required for a trial, and the length of the trial, can be worked out, and tables of these are given.
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