Conversion of percutaneous tracheostomy-a practical solution.
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Clinical Competence↗
Biomedical subjects
P A Williamson
Publications and source records attributed to P A Williamson.
Radiation induced sarcoma of the head and neck.
BACKGROUND: Radiation-induced sarcoma of the head and neck (RISHN) is a long-term complication of treatment. The rarity of this tumour is reflected in the very few series reported in the English language medical literature. The incidence of RISHN is, however, likely to increase due to progressive aging of the population combined with improved survival in head and neck cancer patients resulting from better treatment regimes. Diagnosis and management of this problem can be extremely challenging and the overall outlook has been reported to be very bleak. As survival data from isolated case reports cannot be expected to provide reliable information on outcome, we have reviewed 69 cases reported in the English medical literature since 1966 and pooled this information with our experience in treatment of RISHN. PATIENTS AND METHODS: Ten patients with features of a RISHN were treated at the Royal Marsden Hospital between 1944 and 1997. The features of RISHN, treatment, and outcome were analysed in these patients. Additionally, 61 eligible patients with RISHN reported in the literature between 1966 and 1997 were pooled with nine of our patients to form the RISHN group (n = 70). This group was then compared for survival with 124 patients with a diagnosis of head and neck sarcoma registered on the Head and Neck Sarcoma database at the Royal Marsden Hospital (SHN group). Lifetables were constructed using the Kaplan-Meier method and compared using the log-rank test. RESULTS: There was no site of predilection for RISHN, but malignant fibrous histiocytoma (MFH) was the commonest pathological diagnosis. The period of latency between initial radiation therapy and diagnosis of RISHN ranged from 9 to 45 years with a median of 17 years. Surgery was the mainstay of treatment and follow-up ranged from 6 months to 15 years with a median of 48 months. The actuarial five-year disease free survival in these patients was 60%. CONCLUSION: There is at present little or no prospect for effective prevention of RISHN and therefore, a high index of suspicion based on the patient's symptoms assumes great importance in the outcome of these patients. Although surgical management of RISHN is challenging because of the close proximity of the tumour to important regional structures and the technical difficulties of operating in an irradiated area, complete surgical excision appears to offer the best means for palliation and the only realistic chance for long-term survival.
Adolescent↗
Posterior tragal perichondrium harvesting for myringoplasty.
We present a modified harvesting approach for tragal perichondrium, used in tympanic membrane reconstruction. The technique described avoids amputation of the targus thereby facilitating dissection of the perichondrium from the cartilage as compared to the traditional method. The approach described is technically easier, and removes any potential for cosmetic deformity associated with tragal cartilage amputation and reimplantation. Furthermore, both the anterior tragal perichondrium and the temporalis fascia remain intact if further surgery is required. We recommend this approach for permeatal, tragal perichondrial grafting of small to medium sized tympanic membrane perforations.
Ear Cartilage↗
Methadone-related overdose deaths in South Australia, 1984-1994. How safe is methadone prescribing?
OBJECTIVE: To assess the safety of prescribing of methadone tablets and syrup in South Australia by investigating overdose deaths of patients using prescribed methadone and non-patients using illegally obtained methadone. DESIGN: Surveillance study of deaths related to methadone overdose, 1984-1994. DATA SOURCES: Coroner's Office and the Therapeutic Goods Section of the South Australian Health Commission. RESULTS: Per capita prescription of methadone tablets for chronic pain in South Australia was the highest in Australia in 1994. A large increase in deaths, due mainly to methadone tablets prescribed for chronic pain, occurred in 1993-1994. Illegal diversion of methadone to non-patients was responsible for half of the deaths during these two years. Deaths from overdoses of methadone syrup prescribed in maintenance therapy for drug dependence declined from 1984 to 1994. The relative risk for patient deaths due to methadone tablets versus methadone syrup was estimated to be 7.29 (95% confidence limits, 2.15-31.48). Psychotropic drug combinations were present in 86% of deaths. CONCLUSION: The methadone syrup program for drug dependence remains relatively safe. Our data raise concerns about prescribing methadone tablets for chronic pain. Better prescriber education and accountability, patient assessment and supervision and advice to patients about concurrent use of alcohol and benzodiazepines are needed.
Adult↗
Topical gentamicin-induced hearing loss: a mitochondrial ribosomal RNA study of genetic susceptibility.
Mitochondrial ribosomal RNA mutation has been shown to predispose affected individuals to aminoglycoside-induced hearing loss (AIHL). An A-to-G nucleotide substitution at the 1555 position within the 12S ribosomal RNA gene has been identified with a maternally inherited pattern in affected Asian pedigrees. The aim of this study was to identify the frequency of this DNA polymorphism in subjects who appear to show hypersensitivity to topical (middle ear) application of aminoglycoside. In this pilot study, 10 subjects with AIHL were recruited. Eight underwent vestibular ablative therapy with middle ear instillation of gentamicin for disabling vertigo, and two were treated with topical antibiotic drops for otitis media in the presence of a tympanic perforation. DNA samples were extracted, and polymerase chain reaction (PCR) technique was used for gene amplification and purification, searching for 1555 A-to-G substitution in the 12S ribosomal RNA gene. None of the subjects demonstrated this specific mutation.
Adult↗
Supraglottic transection: results of repair and functional outcome.
We present two cases of supraglottic transection, with concomitant neurotemesis of the superior laryngeal nerve. Both cases were repaired primarily and a temporary tracheostomy was used to protect the airway. In both cases subsequent decannulation was achieved within four weeks, following the initial injury. No long-term swallowing or voice disturbance was noted in either case. We recommend that in such cases it is unnecessary to repair the nerves directly, but that careful repair of the wound itself will achieve a functional result.
Adult↗
Punctate diathermy of the soft palate: a new approach in the surgical management of snoring.
We present our experiences in the surgical management of 21 snorers, utilizing a new approach designed to stiffen the palatal musculature, without compromising its function. This was achieved by using a punctate pattern of intrapalatal diathermy to achieve fibrosis within the palate and hence the requisite stiffening. The initial results of this procedure are encouraging showing a subjective improvement in snoring in 85.7 per cent of patients and an increase in sleeping in the same room as their partner every night, from 14.3 per cent pre-operatively to 57.1 per cent post-operatively.
Adult↗
Respiratory symptoms, immunological responses, and aeroallergen concentrations at a sawmill.
After identification of a case of extrinsic allergic alveolitis due to exposure to wood dust at a sawmill, all employees at the sawmill where he worked were studied with an occupational, environmental, and symptom questionnaire, spirometry, skin prick tests, and serum specific IgG measurements. Ninety five of current and 14 of 17 ex-sawmill workers were studied. As a basis for comparison, a group of 58 workers from a nearby light engineering factory were also studied. Few women (6) were employed and they were excluded from the analysis. Workers at the sawmill were stratified into high and low exposure groups depending on their place of work. This division was supported both by their subjective assessment of the dustiness of their environment and the results of personal dust samples. There were no significant differences between the three groups in age, height, smoking habits, exposure to other causes of extrinsic allergic alveolitis, forced expiratory volume in one second, forced vital capacity, atopic state, or cutaneous reactivity to moulds. In the high exposure group the prevalence of work related cough and nasal and eye symptoms was higher than in the low exposure and comparison groups. The prevalence of work related wheeze was similar in both the high exposure and comparison groups, but was lower in the low exposure group. The prevalences of chronic bronchitis and symptomatic bronchial hyper-reactivity were similar in the high and low exposure groups but were lower in the comparison group. Serum concentrations of specific IgG against extracts of sawdust and Trichoderma koningii were significantly higher in the high exposure group than in the other two groups. The prevalence of symptoms suggestive of extrinsic allergic alveolitis was 4.4% in the high exposure group, greater than in the low exposure group (0%), and the comparison group (1.9%). In conclusion extrinsic allergic alveolitis probably occurs in British sawmills, and among the exposed population its prevalence may be as high as that reported in Sweden. The allergen responsible is likely to be from mould growing on the wood and may be from Trichoderma koningii.
Adolescent↗
Emergency workload in otolaryngology.
A 6-month prospective audit of the otolaryngology emergency workload in a district general hospital was undertaken. A total of 742 cases was referred of whom 193 (26%) were children (< 16 years). The male to female ratio was equal, and 69% of cases were referred from the accident and emergency department. Although most conditions were minor enough to be managed in the ward treatment room and either discharged (40%) or followed up as outpatients (27%), more than one-quarter of patients (28%) needed management by a post-fellowship ENT surgeon. Of the patients, 31% (230/742) were admitted, of whom 107 (46%) required an operation under general anaesthesia. The consequent ENT emergency workload represented 24% of all new patient referrals, 20% of ENT ward admissions and 10% of ENT surgical procedures.
Adolescent↗
Blood carbonmonoxyhaemoglobin levels are chronically elevated in alcoholics treated for detoxification.
Self-reported daily consumption of cigarettes and ethanol was recorded from a group of 59 ethanol-dependent persons admitted to a detoxification clinic at 2000-2400 h and averaged 40 cigarettes per day and 320 g ethanol per day, respectively. In consequence, concentrations of blood COHb and ethanol were high. Mean values for COHb were 8.5 and 9.9% in men and women, respectively, while the corresponding levels for ethanol were 220 and 280 mg/100 ml. Blood acetate concentrations were also elevated and correlated negatively with mixed venous oxygenhaemoglobin concentrations. The mean carbonmonoxyhaemoglobin concentration at 0700 h was found to be approximately 65% of that on admission. Biochemical and haematological analysis, past medical history and current physical examination revealed a high degree of ethanol and/or cigarette-related pathology. Studies on lipid and lipoprotein metabolism in ethanol-dependent persons should take into account their simultaneous high cigarette abuse.
Acetates↗
Asymmetric neural control systems in human self-regulation.
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Arousal↗