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Biomedical subjects

N Tolley

Publications and source records attributed to N Tolley.

12 recordsLinked to original sources
PubMed2007

Estimation of tracheostomy tube cuff pressure by pilot balloon palpation.

Two methods can be used to assess the intra-cuff pressure of tracheostomy tubes: digital palpation of the pilot balloon and use of a hand-held manometer. We conducted a telephone survey to determine the prevalence of both methods in intensive care units within 21 teaching hospitals across the United Kingdom. Forty-two per cent of the intensive care units surveyed used a protocol for monitoring cuff pressure with a manometer.A study to compare these two methods, using the manometer as the reference standard, was then carried out. The cuff pressure was correctly estimated in pre-inflated tracheostomy tubes, in a tracheal model, by 61 per cent of a cross-section of intensive care unit and otolaryngology staff.Using pilot balloon palpation is inaccurate and leaves a significant proportion of patients at risk of tracheal injury. We advocate the wider availability of hand-held pressure manometers in intensive care units and the institution of protocols for monitoring cuff pressure for any patient with a tracheostomy tube with an inflated cuff in situ.

Cross-Sectional Studies↗
PubMed2006

Temporary threshold shift due to recreational firearm use.

OBJECTIVE: To assess whether a temporary threshold shift occurred after recreational firearm use. DESIGN: An observational study of 25 subjects using ear protection in an indoor rifle range. Hearing was evaluated before and after shooting five rounds with a 0.22 calibre rifle over 10 minutes. A threshold shift of 5 dB was found to be statistically significant, while a shift of 10 dB was clinically significant. RESULTS: Twenty-four candidates had a statistically significant threshold shift, while 12 had a clinically significant threshold shift. Two subjects with previous industrial noise exposure had threshold shifts at more frequencies than other subjects. There was no significant preference for either ear. One subject showed no changes. CONCLUSION: This small study sheds some light on impulse noise behaviour in an indoor shooting range, but no definite conclusions can be drawn. The side of shooting did not influence threshold changes in either ear.

Adult↗
PubMed2005

Bilateral tension pneumothorax following rigid bronchoscopy: a report of an epignathus in a newborn delivered by the EXIT procedure with a fatal outcome.

We describe a case of a newborn baby with a prenatal diagnosis of an epignathus (oropharyngeal teratoma). With the potential for airway problems at birth, he was delivered by an elective EXIT (Extra Utero Intrapartum Treatment) procedure at 38 weeks of pregnancy. The airway was secured and rigid bronchoscopy performed. Initially he was stable, but developed cardiorespiratory difficulties 40 minutes after birth and died from a cardiac arrest 17 minutes later. Tension pneumothorax is a devastating complication that can occur with lower airway manipulation for anaesthesia and rigid bronchoscopy. The addition of positive pressure during mechanical ventilation converts the pneumothorax into a tension pneumothorax. The possibility of tension pneumothorax should be entertained in a mechanically ventilated patient whose ventilatory pressures are increasing, with diminishing cardiac output. A complicated case is presented, where the diagnosis was missed with a fatal outcome.

Bronchoscopy↗
PubMed1999

Investigation of variant Creutzfeldt-Jakob disease and other human prion diseases with tonsil biopsy samples.

BACKGROUND: Prion diseases are associated with the accumulation of an abnormal isoform of cellular prion protein (PrPSc), which is the principal constituent of prions. Prions replicate in lymphoreticular tissues before neuroinvasion, suggesting that lymphoreticular biopsy samples may allow early diagnosis by detection of PrPSc. Variant Creutzfeldt-Jakob disease (variant CJD) is difficult to distinguish from common psychiatric disorders in its early stages and definitive diagnosis has relied on neuropathology. We studied lymphoreticular tissues from a necropsy series and assessed tonsillar biopsy samples as a diagnostic investigation for human prion disease. METHODS: Lymphoreticular tissues (68 tonsils, 64 spleens, and 40 lymph nodes) were obtained at necropsy from patients affected by prion disease and from neurological and normal controls. Tonsil biopsy sampling was done on 20 patients with suspected prion disease. Tissues were analysed by western blot to detect and type PrPSc, by PrP immunohistochemistry, or both. FINDINGS: All lymphoreticular tissues obtained at necropsy from patients with neuropathologically confirmed variant CJD, but not from patients with other prion diseases or controls, were positive for PrPSc. In addition, PrPSc typing revealed a consistent pattern (designated type 4t) different from that seen in variant CJD brain (type 4) or in brain from other CJD subtypes (types 1-3). Tonsil biopsy tissue was positive in all eight patients with an adequate biopsy sample and whose subsequent course has confirmed, or is highly consistent with, a diagnosis of variant CJD and negative in all patients subsequently confirmed to have other diagnoses. INTERPRETATION: We found that if, in the appropriate clinical context, a tonsil biopsy sample was positive for PrPSc, variant CJD could be diagnosed, which obviates the need for a brain biopsy sample to be taken. Our results also show that variant CJD has a different pathogenesis to sporadic CJD.

Adolescent↗
PubMed1994

Wegener's granuloma--presenting as a unilateral parotid swelling.

Wegener's granuloma is a systemic necrotizing vasculitis which predominantly affects the upper and lower respiratory tracts and kidneys. The nose and paranasal sinuses are often the first or main sites to be affected. Equally ear involvement is common and a recognized early manifestation of the disease. Salivary gland involvement is rare and is usually part of more widespread systemic involvement. We present a 34-year-old female with a six-week history of hearing loss and a unilateral parotid swelling. One year previously she was diagnosed as having myalgic encephalomyelitis following a long period of post-viral malaise. The case points to the difficulties encountered when Wegener's granuloma presents in an unusual and varied way. A high index of suspicion coupled with early diagnosis and treatment is essential. The patient made a good recovery.

Adult↗
PubMed1994

Lipoma of the left tonsillar fossa.

Lipomas are common benign connective tissue tumours composed of adult adipose tissue. They are relatively rare in the upper aerodigestive tract, although they occur with considerable frequency in other areas, particularly in the subcutaneous tissues of the neck. Although there are several reports of this tumour occurring in the oropharynx, there is no recorded case of a lipoma of the tonsillar fossa. An 83-year-old man with a left tonsillar fossa lipoma is presented. Clinical presentation, management and a literature review are discussed.

Aged↗
PubMed1994

Aspergillosis of the larynx.

Primary infection of the larynx with Aspergillus spp. is rare. It is more commonly seen as part of a wider infection involving the respiratory system in an immunocompromised host. In noncompromised patients laryngeal aspergillosis may represent colonization rather than invasion requiring no systemic anti-fungal treatment. The diagnosis is important as the presenting symptoms are suggestive of malignant laryngeal disease. We present a 62-year-old man with a short history of hoarseness. Direct laryngoscopy and biopsy confirmed the diagnosis of aspergillosis. Clinical presentation, diagnosis and the important pathological characteristics of this infection are discussed.

Aspergillosis↗
PubMed1993

Euthanasia: a comparison of the lived experience of Chinese and Australian palliative care nurses.

This paper reports on a study which investigated whether nurses from Eastern and Western cultures hold differing definitions of euthanasia and different perspectives of the effect of their attitudes to euthanasia on professional relationships with patients and colleagues. The focus of the study was the lived experience of Chinese and Australian nurses working in palliative care. The results indicate that there were differences between these two groups in their definitions of euthanasia. Lived experience obtained from both groups revealed conflict with patients and colleagues, and a lack of opportunity to discuss the ethical issue of euthanasia in the workplace.

Adult↗
PubMed1991

Comparison of cocaine alone or with adrenaline on nasal mucosal blood flow.

Cocaine is commonly used in ENT practice for its vasoconstrictor and anaesthetic properties. It is sometimes combined with adrenaline. The laser Doppler Flowmeter was used to compare the effect of 5 per cent cocaine alone or with adrenaline (1 in 1,000) on nasal mucosal blood flow. The results show an average fall in blood flow of 76.7 per cent for cocaine with adrenaline, compared to 61.2 per cent with cocaine alone. The difference is significant (P less than 0.05). The time taken for the blood flow to fall was an average of 131 s and 160 s respectively. These differences are not significant.

Adult↗
PubMed1991

The effect of ice packs upon nasal mucosal blood flow.

The effect on nasal mucosal blood flow of ice packs on the forehead and ice packs within the mouth was investigated in 16 healthy subjects. The laser Doppler flowmeter was used to record changes in blood flow to the inferior turbinate, as measured by change in the flux. Ice packs within the mouth produced a significant decrease in nasal mucosal blood flow (p less than 0.05). The average fall was 23% (SEM 5.9) compared with the control measurements. No significant change was recorded following the application of ice packs to the forehead. The results of this study question the scientific rationale behind the use of forehead ice packs in clinical practice.

Adult↗