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Biomedical subjects

P Q Montgomery

Publications and source records attributed to P Q Montgomery.

17 recordsLinked to original sources
PubMed2005

Meta-analysis of the timing of haemorrhage after tonsillectomy: an important factor in determining the safety of performing tonsillectomy as a day case procedure.

OBJECTIVES: To perform a meta-analysis of studies of the timing of primary tonsillectomy haemorrhage. In particular to compare the difference in risk between 0-8 and 8-24 h; that is whether overnight inpatient tonsillectomy is required. DESIGN: Medline search of all tonsillectomy studies to perform a meta-analysis of the timing of primary haemorrhages. SETTING: Literature-based study. PARTICIPANTS: All adult and paediatric tonsillectomy studies giving the absolute number and timing of all primary haemorrhages. MAIN OUTCOME MEASURES: The overall incidence of haemorrhage occurring between 0-8 and 8-24 h. The overall incidence of haemorrhage for each of the first 24 h after operation. Compare risk of a bleed occurring 0-8, 8-24 and >24 h where data were available. RESULTS: From a 1.4% overall risk of a primary haemorrhage only one in 14 occur after 8 h, i.e. 0.1% (95% CI=0.08-0.16%). A total of 833 patients would require to be kept overnight in order to identify one case of bleeding after 8 h. CONCLUSIONS: Little benefit was conferred from overnight admission from the point of view of monitoring for primary haemorrhage. A case can be made for either day-case tonsillectomy (hospital stay over the period in which 93% of primary haemorrhages would occur) or the 'belt-and-braces' approach of a 1-week stay (during which all haemorrhages would occur) but current 24-h admission appears illogical.

Adult↗
PubMed1998

Intralaryngotracheal thyroid--ectopic thyroid or invasive carcinoma?

Intralaryngotracheal thyroid is a rare clinical condition with only about 125 cases described so far in the literature. We present an unusual case of intralaryngotracheal thyroid which had many clinical features of malignancy and yet appeared benign on histology. As in this case, well-differentiated thyroid cancer can present with locally aggressive clinical features and can pose a dilemma in management if treatment decisions are guided solely by histological features.

Adult↗
PubMed1997

Infectious pseudomonas subglottic stenosis occurring in a patient with acquired immunodeficiency syndrome.

Pseudomonas aeruginosa is emerging as an increasingly common opportunistic infective agent in the immunocompromised human immunodeficiency virus (HIV) positive patient (Kielhofner et al., 1992). Improvements in the prevention and treatment of opportunistic infections in HIV and acquired immunodeficiency syndrome (AIDS) has led to longer life expectancy (Graham et al., 1992), and this has changed the incidence of Pseudomonas aeruginosa infection in this population (Baron and Hollander, 1993). We present a case of a patient with AIDS who developed a fulminant Pseudomonas aeruginosa stenosing subglottic infection. We are unaware of any previous reports of this particular manifestation of Pseudomonas aeruginosa infection.

AIDS-Related Opportunistic Infections↗
PubMed1996

Early diagnosis of Wegener's granulomatosis presenting with facial nerve palsy.

Wegener's granulomatosis is a multi-system disease characterized by granuloma formation and a necrotizing vasculitis. It classically presents with involvement of the upper and lower respiratory and renal systems. However locoregional disease is common and may include otological manifestations. Facial nerve palsy has been reported during the course of the disease process but it is extremely rare for it to be the presenting feature. Previously reported cases have involved a protracted diagnostic process including exploratory tympanotomy, mastoidectomy and facial nerve decompression. We report a case of Wegener's granulomatosis which presented with a facial nerve palsy. An early diagnosis was achieved by measurement of the erythrocyte sedimentation rate (ESR), followed by serological assay of cytoplasmic anti-neutrophil cytoplasmic antibody (cANCA). Histological examination of nasal mucosal biopsies confirmed granuloma formation consistent with a diagnosis of Wegener's granulomatosis. This allowed early treatment with immunosuppressive therapy and avoided unnecessary and potentially hazardous middle ear surgery.

Aged↗
PubMed1996

Paraffinoma revisited: a post-operative condition following rhinoplasty nasal packing.

Paraffin impregnated tulle is frequently used as a post-operative dressing after surgical repair of wounds, on skin-donor sites and in packing of tissue cavities. Historically, paraffin has been injected into various sites of the body and paraffinoma is a well-described complication. Despite this, nasal packing with paraffin gauze is still common after rhinoplasty. We report a case of paraffinoma occurring after rhinoplasty and discuss the avoidance of this rare but serious complication and suggest silicon mesh as an alternative dressing.

Adult↗
PubMed1996

Invasive candidiasis of a late presentation laryngeal chondroradionecrosis.

Laryngeal chondroradionecrosis is an unusual condition which may present many years after the initial radiotherapy. We present a case of late onset chondroradionecrosis which was complicated by invasive candidiasis of the arytenoid cartilages which had themselves been extruded through the laryngeal mucosa.

Adult↗
PubMed1995

Microbiological features and pathogenesis of peritonsillar abscesses.

Samples of pus aspirated from 53 peritonsillar abscesses were examined in detail for aerobic and anaerobic bacteria, and the microbiological results correlated with clinical data in 44 cases. In 45 samples (85%) cultures were positive: 7 yielded organisms consistent with an aerobic infection, mainly Lancefield group A beta-haemolytic streptococci (5/7), and 38 yielded organisms consistent with an anaerobic infection. The anaerobic infections were usually mixed, but in two cases Fusobacterium necrophorum was isolated in pure culture. Peptostreptococcus micros and Streptococcus milleri were the predominant isolates in this group. Direct Gram stain smear and gas-liquid chromatography were useful indicators of the type of infection present. Samples from ten patients (18.9%) grew one or more beta-lactamase-producing isolates. Of the 25 patients prescribed antibiotics by their general practitioners prior to admission, 18 received one or more beta-lactam antibiotics. Most cases of peritonsillar abscess were due to mixed anaerobic infections, Lancefield group A beta-haemolytic streptococci playing a central role in only a minority of cases. In light of these findings and the possibility of infection with beta-lactamase-producing isolates, it is suggested that the first-line antibiotic therapy in this group of patients should include a chemotherapeutic agent directed against anaerobic bacteria.

Adolescent↗
PubMed1993

Acute pneumonitis caused by low density barium sulphate aspiration.

The aspiration of contrast medium during the investigation of swallowing disorders is a well recognized hazard. It is therefore essential that the contrast medium administered is non-irritant to the lungs. A case is presented to illustrate the problems associated with the aspiration of a relatively non-irritant contrast medium.

Acute Disease↗
PubMed1993

Eye protection in ear, nose and throat surgery.

The aim of this study was to quantify the risk of blood splashes to the conjunctiva during ear, nose and throat surgery. Two hundred and sixty consecutive operations by three surgeons were assessed for contamination of safety glasses and other factors. We found that 15 per cent of operations resulted in blood droplet contamination of safety glasses. In 92 per cent of these, contaminations were on the exterior of the glasses and eight per cent were on both sides. We concluded that about one and a half per cent of operations would result in droplet contamination of the conjunctiva and that safety spectacles reduced the risk by a factor of about 10. This study generally concurs with that of previous research in the areas of general and orthopaedic surgery and necropsies. We substantiate the need for eye protection for all ear, nose and throat procedures. Spectacles do provide a reasonable degree of protection but where absolute protection is needed i.e. in high risk groups, goggles should be used in preference to safety spectacles.

Blood-Borne Pathogens↗
PubMed1992

Nasal teeth.

Ectopic and supernumerary teeth occur in a wide variety of sites. Those that have been reported include the mandibular condyle, coronoid process, orbit, palate, nasal cavity and the maxillary antrum. Eruption of teeth into these sites is rare, and easily overlooked. We present two cases in which eruption of teeth into the nose and paranasal sinuses was associated with significant morbidity and show how this was relieved by appropriate surgery.

Adult↗
PubMed1990

Ultrastructure of human fetal trachea. A morphological study of the luminal and glandular epithelia at the mid-trimester.

Twenty two mid-trimester human fetal tracheae were processed for light microscopy and scanning, transmission and freeze-fracture replication electron microscopy. The tracheal pseudostratified columnar epithelium was found to be composed of four cell types: ciliated in various stages of development, non-ciliated, basal and degenerating cells. The ratio of ciliated to non-ciliated cells was approximately one-to-one. The non-ciliated cells were of two morphological sub-types. Of these, the vast majority contained characteristic secretory granules, approximately 0.5 microns diameter, found in abundance within the apical region of the cell cytoplasm. The second sub-type of the non-ciliated cell, the well differentiated goblet cell, was observed very infrequently. The relatively large number of non-ciliated cells in the fetal tracheal epithelium suggests a transition stage to the adult where the ratio of ciliated to non-ciliated cells is near 5-to-1. The nature of the first type of the non-ciliated cells, which have not been studied in depth previously, remains obscure. Their probable secretory function is discussed and comparisons are made with previously reported cell types showing similar features, in fetal or adult material from the distal airways of animal and human tissues. Approximately 15 to 20% of the epithelial cells show signs of degeneration. The probable causes of this degenerative process are discussed. Other cell types such as brush cells, endocrine and wandering lymphocytes were not observed. Well-differentiated muco-serous glands were observed within the tela submucosa.

Cilia↗