Biomedical subjects
Publications and source records attributed to P Jani.
In some practices, otitis externa is treated with ear wick and patient is asked to remove it independently without re-attending clinic. * Although this method reduces workload on aural care services, it can be unhygienic and difficult to perform. * We propose a new design whereby the wick is tied to a string to facilitate its later removal. * Out of 18 patients treated with this method, only 4 opted to re-attend for further aural care.
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We present an unusual case of carcinoma of the piriform fossa, presenting with cutaneous metastases. These metastases are very rare, present in the late stages of disease, and are usually associated with distant metastases and poor prognosis. They often suggest aggressive disease. We believe that cutaneous metastases from a malignancy in the piriform fossa are more unusual than those from other sites of the head and neck.
Colonic carcinoma metastasis to the thyroid is rare. Here the authors present the case of an 81-year-old lady who presented with metastatic colonic adenocarcinoma in her thyroid gland. This case is unique as it is the first to demonstrate metastasis from the colon to the thyroid with no other site involvement. The use of cytokeratin immunohistochemical staining is reviewed along with the current perspectives on the concept of skip metastasis.
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Pierre Robin syndrome is a rare condition, first described by the French stomatologist, Pierre Robin in 1923. The severity of the syndrome varies widely, and associated upper airway obstruction is the most difficult problem to overcome. We present a case in which the airway was successfully managed with a modified naso-pharyngeal tube in addition to pulse oximetry. We also present a literature review discussing management of the airway in the Pierre Robin syndrome. The simple technique presented allows earlier patient discharge with home monitoring equipment.
We report our experience in the out-patient triage of 100 patients presenting with a lump in the neck. The out-patient visit consisted of a general history and examination, assessment of the upper air and food passages and, where indicated, ultrasound and core needle biopsy of the lump. Other investigations were performed as appropriate. One hundred neck lump patients were seen in a 9 month period. Ninety-six of these lumps were diagnosed on an out-patient basis, only four requiring admission for formal excision biopsy. Among the diagnoses were eleven lymphomas, nine parotid neoplasms, nine lymph node metastases, five thyroglossal cysts, and four branchial cysts. Almost half the patients seen had either a reactive lymphadenopathy, or no abnormality. The establishment of a tissue diagnosis on an out-patient basis allowed appropriate referrals to be made and management plans to be formulated. The theoretical risk of seeding of malignant cells in the needle tract is acknowledged and discussed.
Plummer-Vinson (Paterson, Brown-Kelly) syndrome refers to the association of iron-deficiency anaemia with dysphagia secondary to a post-cricoid web. Only seven cases of Plummer-Vinson syndrome in children and adolescents between the ages of 14 and 19 have been reported in the world literature. We report a case of the syndrome occurring in a child of 14 years and provide a short review of the present knowledge concerning the symptom complex.
We report an unusual case of internal jugular vein thrombosis in a 57-year-old female, with the recently discovered factor V Leiden (FVR506Q) mutation. The molecular basis of this mutation is described, and the importance of screening for hereditary venous thrombotic states is emphasized.
Haemangiomas are the commonest benign tumours of the head and neck in childhood, but they are extremely rate on the palate. We report a case of a palatal haemangioma presenting with feeding difficulties in a young infant. Clinical diagnosis and pathological features are discussed and we suggest a classification which may help in the diagnosis of these cases.
The head impulse test is a simple clinical test comprising high acceleration head rotation. In the presence of a severe unilateral vestibular weakness the normal vestibulo-ocular reflex is replaced by a misalignment of the eye followed by a series of corrective saccades which are evident to the examiner. Previous reports have shown the high sensitivity of the head impulse test in detecting complete unilateral weakness, but indicate poor sensitivity for mild weaknesses. This prospective, blinded study examined the head impulse test in a general clinical population of balance disorder patients to examine the sensitivity and specificity of the test, and to determine the degree of vestibular weakness that is required before the test becomes positive. One hundred and fifty patients were examined and the head impulse test results were compared to results from bithermal caloric testing. Results show that the overall sensitivity of the head impulse test is 34% with a specificity of 100%. The test does not detect mild or moderate vestibular weaknesses but is very sensitive to the presence of a severe paresis (87.5%). Head impulse testing will not replace caloric testing but is a very useful adjunct to it.
Mice exercised to fatigue and exposed to herpes simplex virus type 1 (HSV-1) exhibit greater mortality than control mice. In this study, we examined lung macrophage resistance to HSV-1 after exercise in terms of both viral replication and interferon (IFN)-beta production. We utilized the reverse transcriptase-rapid polymerase chain reaction to measure the IFN-beta mRNA content in alveolar macrophages. IFN release was measured with a bioassay, and viral replication within the macrophage was assessed by plaque titration. Exercised (Ex) mice ran on a treadmill until fatigue while control (Con) mice remained in lanes above the treadmill. After exercise, alveolar macrophages were removed and incubated with HSV-1. Alveolar macrophage IFN-beta mRNA was greater in Ex than in Con mice. Culture supernatant from infected macrophages showed a higher degree of IFN release and a higher number of infectious viral particles in Ex vs. Con mice. It is likely that the increase in IFN-beta mRNA occurs in response to a higher degree of viral replication. These results suggest that macrophages from Ex mice are less resistant to infection with HSV-1.
BACKGROUND: The histologic grading of the deep invasive margin of oral squamous cell carcinoma recently has been shown to have prognostic value, but previous series have not been homogeneous enough to allow grading parameters to be assessed individually. METHODS: Forty-seven small lingual carcinomas limited to the lateral border of the tongue and treated by radiotherapy were graded histologically at their deep invasive front. Clinical and grading parameters were correlated by statistical tests performed by permutational techniques. RESULTS: Carcinoma recurred locally in 6 patients, and metastases developed in 19. Local recurrence correlated with Broders' grade (P = 0.0143), keratinization (P = 0.017) and pattern of invasion (P = 0.0195). Metastasis had a highly significant correlation with Broders' grade (P < 0.001), pattern of invasion (P < 0.001), and invasive front grading total score (P < 0.001). Seven of 8 carcinomas with diffuse infiltrating patterns metastasised, whereas only 4 of 25 with large islands or a broad infiltrating pattern metastasized. CONCLUSIONS: The usefulness of the deep invasive front grading system for small lingual carcinoma was demonstrated. The pattern of invasion was the component of the grading system that had the closest correlation with metastasis and recurrence in this type of carcinoma.
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A 79-year-old man with a diagnosis of myocardial infarction treated with streptokinase and heparin developed a large lingual haematoma, precipitating dysphagia and upper airway obstruction. Spontaneous haemorrhage into the tongue is a previously unreported but serious complication of thrombolytic therapy. Tracheal intubation was performed under local anaesthesia.
107 children undergoing transcranial craniofacial surgery in a paediatric hospital have been reviewed to assess the incidence and type of complications which arose. This represents the first 4 years' experience of the craniofacial team. There were no deaths or permanent adverse sequelae of surgery. A total of 53 complications were seen in 42 patients. In 9.3% of patients they were potentially life-threatening, serious in 12.1% and of a minor nature in 28%. The more serious complications were related either to haemorrhage and/or vasovagal shock at operation or to infection post-operatively. Infants undergoing monoblock frontofacial advancements and those with tracheostomies were at particular risk.