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P Sheahan

Publications and source records attributed to P Sheahan.

16 recordsLinked to original sources
PubMed2006

Management of life-threatening airway obstruction caused by benign thyroid disease.

INTRODUCTION: Goitre presenting with acute, life-threatening airway compromise is an uncommon indication for thyroid surgery. The management of this critical condition is controversial. AIMS: To investigate the incidence of life-threatening airway compromise in patients with benign goitre, to investigate the predisposing factors, and to outline an optimal management policy for such critical cases. METHODS: Retrospective review of the medical records of patients presenting with life-threatening, acute airway compromise secondary to benign thyroid disease, treated by the senior author (CT) between July 1994 and July 2005. RESULTS: Of a total of 505 thyroid surgery procedures over the 11-year period, five patients with benign thyroid disease had presented with life-threatening, acute airway compromise. Three of the five patients had been thyrotoxic and two of these had received an iodine load prior to airway compromise. Immediate endotracheal intubation for airway control followed by admission to the intensive care unit had been the presentation in two patients. An incidental diagnosis of tracheal compression had been made from the computed tomography (CT) scan in two patients who had non-resolved obstructive airway disease. Emergency thyroidectomy had been performed in all five patients. Significant tracheomalacia had been noted in four patients. Following thyroidectomy, two patients had required tracheostomy and one had required tracheal stenting. CONCLUSION: Chronic obstructive airways disease, substernal extension and long-standing goitre are considered as risk factors for developing acute, life-threatening airway compromise in the presence of benign thyroid disease. A recent iodine load may lead to airway compromise in thyrotoxic patients. A CT scan is indicated in cases of unresponsive chronic obstructive airways disease to rule out substernal extension of non-palpable goitres. Life-threatening airway compromise secondary to benign goitres is best treated by endotracheal intubation if conservative measures fail, followed by emergency thyroidectomy. Following surgery, close observation is mandatory to exclude airway compromise due to tracheomalacia and laryngeal oedema.

Aged↗
PubMed2006

Acute epiglottitis in adults: a recent experience with 10 cases.

OBJECTIVES: Our objective was to examine the presentation, clinical course and management of acute epiglottitis in a recent series of adult patients. METHOD: All consecutive adults with acute epiglottitis or supraglottitis admitted to a tertiary referral centre over a recent six-month period were included in this retrospective study. The diagnosis of epiglottitis or supraglottitis was established by flexible nasolaryngoscopy. RESULTS: Ten patients were included. Two patients had concurrent acute tonsillitis and one had a peritonsillar abscess. Blood cultures were negative in all cases. Pathogens were isolated by throat swabs only in the two patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of cefotaxime and metronidazole was the most common antibiotic regimen used. CONCLUSION: The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.

Acute Disease↗
PubMed2006

Is intralesional cidofovir worthwhile in juvenile recurrent respiratory papillomatosis?

OBJECTIVE: To investigate the efficacy of intralesional cidofovir in the treatment of recurrent respiratory papillomatosis (RRP) in children. METHODS: Prospective observational study of four consecutive children with RRP treated at an academic tertiary children's hospital. Laryngo-bronchoscopy was performed at three- to five-weekly intervals. Photodocumentation was obtained and disease severity assessed using an anatomical RRP severity score. Surgical debulking of large papillomas was then performed, and cidofovir (5 mg/ml) injected into any remaining papillomas as well as submucosally at the sites of resected papillomas. The efficacy of cidofovir was assessed by the change in papilloma severity score over the course of the treatment. RESULTS: Complete disease remission was obtained in one patient, with a partial response seen in two others. One patient showed no significant response. The greatest beneficial effect was seen after the fourth cidofovir injection; however, two patients demonstrated a deterioration in severity scores after treatment was withheld at this point. Both responded well to further cidofovir injections. However, a clear plateau in the response to cidofovir was seen in all patients by the eighth injection. CONCLUSION: Intralesional cidofovir may help control papilloma regrowth and reduce disease severity in many children with RRP. In most cases, cidofovir would appear to be less efficacious in causing disease eradication. There appears to be little evidence to support prolonged treatment regimes (i.e. more than eight treatments).

Adjuvants, Pharmaceutic↗
PubMed2006

Successful ex utero intrapartum treatment (EXIT) procedure for congenital high airway obstruction syndrome (CHAOS) owing to a large oropharyngeal teratoma.

Large fetal neck masses can present a major challenge to securing an airway at birth, with associated risks of hypoxia, brain injury and death. The authors report a case of a giant oropharyngeal teratoma diagnosed in a fetus of 19 weeks gestation. The fetus was delivered by the ex utero intrapartum treatment procedure allowing sufficient time on placental support for bronchoscopy and tracheostomy to secure the airway. A multidisciplinary team approach combined with an accurate prenatal diagnosis obtained through fetal ultrasound was the key to a successful outcome. Unfortunately due to the large size of tumour and intracranial extension, the lesion was unresectable and the baby died 6 days after birth.

Adult↗
PubMed2005

Induction of nasal hyper-responsiveness by allergen challenge in allergic rhinitis: the role of afferent and efferent nerves.

BACKGROUND: Hyper-responsiveness of nasal secretory function and volume changes are features of allergic rhinitis (AR) that are mediated in part by neural mechanisms. The finding of nasal hyper-responsiveness in subjects with AR who are currently symptomatic, but not in those who are currently out of season and asymptomatic, suggests that induction of neural reflexes in allergic subjects occurs as a result of allergic inflammation. OBJECTIVES: To investigate whether allergen exposure in subjects with asymptomatic seasonal allergic rhinitis (SAR) may lead to induction of neural reflexes, and to investigate the components of the reflexes involved in this induction. METHODS: Asymptomatic subjects with (out-of-season) SAR underwent a nasal bradykinin challenge, before and 24 h after preceding ipsilateral (n = 11) and contralateral (n = 11) antigen challenge. Challenges were performed and nasal secretions collected using filter paper disks, and changes in nasal minimal cross-sectional area (A(min)) were measured using acoustic rhinometry. RESULTS: Preceding ipsilateral antigen challenge led to the induction of a contralateral secretory reflex (P = 0.01), which was absent in control experiments (P = 0.34). Ipsilateral secretion weights were also enhanced. Preceding contralateral antigen challenge also induced a contralateral secretory reflex (P = 0.03). Enhancement of the reduction in contralateral A(min) was also seen (P = 0.02). Ipsilateral responses were unchanged. CONCLUSIONS: Allergen exposure in asymptomatic allergic subjects leads to induction of neural reflexes, resulting in nasal hyper-responsiveness, which persists beyond the resolution of the acute allergic response. Our data suggest that the mechanisms of allergen-induced hyper-responsiveness involve both afferent and efferent components.

Adolescent↗
PubMed2004

Efficacy and pitfalls of fine needle aspiration in the diagnosis of neck masses.

BACKGROUND: Fine needle aspiration biopsy (FNAB) is now well established in the assessment of cervical masses. The purpose of the present study is to review the efficacy of this procedure, as well as to identify any pitfalls that may limit its usefulness. METHODS: One hundred and ninety aspirations of neck masses performed over a recent five-year period were reviewed. The definitive diagnosis of the mass was determined in each case by review of the patients' case notes. RESULTS: Thirty seven per cent of all neck lumps were malignant. The most common cause for a false-negative result, in the case of a carcinomatous mass when an adequate sample had been obtained, was a cystic neoplasm. One quarter of all cystic lateral cervical masses not considered suspicious for malignancy by FNAB turned out to be malignant. CONCLUSION: Repeating FNAB in cases where the original result is negative for carcinoma may increase the sensitivity of FNAB in the detection of cystic carcinomas.

Adenoma↗
PubMed2004

The ultrasonically activated scalpel versus bipolar diathermy for tonsillectomy: a prospective, randomized trial.

Among patients undergoing tonsillectomy, the ultrasonic scalpel has been reported to lead to less intraoperative blood loss than cold dissection, and less postoperative pain and faster recovery than monopolar electrocautery. However, the ultrasonic scalpel has not been compared with bipolar diathermy. The present study was a prospective, randomized, single-blind trial, comparing these two techniques with respect to postoperative pain. Twenty-one adults underwent tonsillectomy on one side using the ultrasonic scalpel, and on the other using bipolar diathermy. Pain scores were obtained on postoperative days 1, 2, 7 and week 3. There was no difference between the two treatments at any of the time points (P = 0.6047, 0.4018, 0.6047 and 0.5000, respectively). Inability to control bleeding with the ultrasonic scalpel resulted in the rescue use of an alternative technique of haemostasis in 14 cases. We conclude that the use of the ultrasonic scalpel in adult tonsillectomy is likely to be limited by its substantial costs and difficulties with haemostasis.

Adolescent↗
PubMed2004

Pearls and pitfalls in the management of branchial cyst.

INTRODUCTION: Although branchial cysts may present as asymptomatic swellings, about one-third present acutely due to inflammation. The use of fine-needle aspiration biopsy (FNAB) and computerized tomography (CT) is controversial. The treatment of inflamed cysts is also controversial. AIMS: To compare the findings of FNAB and CT between cases of branchial cysts presenting as an asymptomatic swelling, and those presenting acutely due to inflammation, and to examine the management of infected cysts. MATERIALS AND METHODS: Retrospective review of the medical records of 39 adult patients with histologically proven branchial cysts treated by the senior author (C.V.T.) between 1994 and 2003. RESULTS: Twenty-eight patients presented with an asymptomatic swelling. Eleven presented acutely with inflammation. A higher incidence of indeterminate fine needle aspirates and atypical CT features were found in the inflamed group. Initial treatment in the infected group consisted of intravenous antibiotics, followed by aspiration or surgical exploration in non-resolving cases. Interval excision after six weeks was performed in all inflamed cases without complication. CONCLUSIONS: FNAB is recommended in all cystic neck lumps to rule out malignancy, but may be inconclusive, especially in inflamed cysts. Inflamed cysts are best treated with intravenous antibiotics, with or without aspiration or incision and drainage, followed by interval excision.

Acute Disease↗
PubMed2003

Effect of tumour thickness and other factors on the risk of regional disease and treatment of the N0 neck in early oral squamous carcinoma.

A high occult metastatic rate and a high regional recurrence rate are reported among patients with early oral squamous carcinoma; however, considerable controversy exists regarding the merits of elective neck dissection in this group. The purpose of the present study was to examine the influence of various histological factors on the risk of occult neck disease, neck conversion and recurrence among 63 patients with stage I and II oral cancer. Tumour thickness (P = 0.0175) and size (P = 0.023) were both significantly predictive of outcome. Among tumours of a given thickness, those with infiltrative margins also showed a tendency towards a poorer outcome; however, this was not significant (P = 0.0768). Patients undergoing elective neck dissection with pathological evidence of cervical metastases or with subsequent neck recurrence had a better 3-year survival (55%) than those developing neck conversion after primary neck observation (20%). Our data would suggest considering tumours greater than 5 mm in thickness or with infiltrative margins as potential candidates for elective neck treatment.

Adult↗
PubMed2003

Cleft palate and otitis media with effusion: a review.

Otitis media with effusion is a common finding in children with cleft palate. However, although middle ear effusions have been reported to be almost universal among infants with cleft palate, less is known regarding the epidemiology, natural history, and outcome of middle ear disease among older children with cleft palate. Furthermore, considerable controversy surrounds the management of otitis media with effusion in these children: many authors have advocated a policy of early or scheduled ventilation tube insertion on account of the high incidence of hearing loss and speech difficulties; others have advocated a more conservative policy on account of the high incidence of complications from ventilation tubes and lack of evidence supporting a policy of early intervention. In the present paper, we review the epidemiology, aetiology, and natural history of middle ear disease in children with cleft palate. We also discuss the controversies involved in the management of these patients.

Child↗
PubMed2002

Sequelae of otitis media with effusion among children with cleft lip and/or cleft palate.

Otitis media with effusion (OME) is common among children with cleft palate, and may lead to such long-term consequences as hearing loss, tympanic membrane retraction, and chronic otitis media (COM). In total, 104 children with cleft lip and/or palate treated for OME at our institution were reviewed. Mean duration of follow-up was 6.9 years, and mean age at latest follow-up was 9.6 years. The incidence of COM was 19%, and the incidence of cholesteatoma was 1.9%. Ears showing such long-term sequelae of OME as hearing loss, tympanic membrane retraction, and chronic otitis media, were noted to have undergone a significantly greater number of ventilation tube insertions than ears not showing these sequalae. Our findings would suggest that a conservative approach to the management of OME in children with cleft palate is more likely to be beneficial in the long term.

Child↗
PubMed2001

T/NK cell non-Hodgkin's lymphoma of the sinonasal tract.

Non-Hodgkin's lymphoma of the sinonasal tract is now recognized as an important cause of destructive midfacial lesions formally designated as idiopathic inflammatory processes, and commonly treated with local radiotherapy in a bid to halt the destructive process. However, left untreated, the natural history of this disease remains largely unknown. We report a case which demonstrates the slow and apparently indolent natural course that these lymphomas, if left untreated, may display, before finally evolving into overwhelming and fatal disease. We also take the opportunity to present a brief synopsis of the evolution of our understanding of this condition and to review the modern literature on it.

Disease Progression↗
PubMed2001

Clinical features of newly presenting cases of chronic otitis media.

The clinical features of 58 consecutive patients presenting with a new case of chronic otitis media were prospectively collected over a 15-month period. Twenty-three ears had a keratin filled marginal or attic defect (14 with cholesteatoma), 20 had a self-clearing marginal or attic defect, and 21 had a central tympanic membrane perforation (including one cholesteatoma). Twenty patients (35 per cent) had an abnormal finding in the opposite ear. The patients' ages were dispersed over a wide range of age groups with a mean age of 34 years. Hearing loss was the most common presenting symptom (78 per cent), followed by otorrhoea (64 per cent). A significant proportion of patients denied any history of otorrhoea. Our findings should alert the clinician to suspecting a new case of COM in patients with hearing loss of any age, with, or without, a history of otorrhoea, regardless of their background ear history or the duration of their symptoms.

Adolescent↗
PubMed1988

Psychiatric disorders in adopted children: a controlled study.

The number of adopted children referred to a Canadian psychiatric service was found to be greater than warranted by their ratio in the community. They presented more with conduct disorders and less with anxiety disorders and were significantly more impaired than the controls.

Adolescent↗
PubMedDate not supplied

James and Sarah.

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Aged↗