Biomedical subjects
Publications and source records attributed to R C Herdman.
The use of a polymaleinate glass ionomer cement in 80 neuro-otology cases is described. It has proved of great value in translabyrinthine acoustic neuroma surgery, reducing the incidence of CSF fistula to nil. It is the method of choice for fixation of the Nucleus cochlear implant, and has many other applications in the field of otology and neuro-otology. It is easy to use and appears to have no side effects.
Five patients with upper aerodigestive tract pathology seen acutely in the Accident and Emergency department at St Mary's Hospital, London are presented. The value of the lateral soft tissue neck X-ray in their diagnosis is discussed.
OBJECTIVE: To assess the cost effectiveness of a periodic program of colorectal cancer screening in the elderly. DESIGN: A model was constructed of four strategies for the periodic screening of persons 65 to 85 years of age. The effect of each strategy on life expectancy and health care costs was estimated under assumptions that were uniformly unfavorable to screening. Cost and added years of life were discounted at 5% per year. Cost per year of life gained from screening was calculated for each screening strategy. DATA SOURCES: Assumptions used in the model were based on a review of pertinent studies; those studies with results more unfavorable to screening were given more weight. Strengths and weaknesses of studies are discussed. MAIN RESULTS: A program of annual fecal occult blood testing (FOBT) in the elderly would detect at least 17% of the expected cases of cancer and could cost $35,000 per year of life saved. Screening schedules that include periodic sigmoidoscopy would prevent more cases of cancer but could cost between $43,000 and $47,000 per year of life gained. These estimates are based on uncertain assumptions, but results were not extremely sensitive to further relaxation of the values of the most uncertain assumptions. In no case did the cost per year of life gained from annual FOBT exceed $55,000 or did the cost per year of life gained from FOBT with sigmoidoscopy every 5 years exceed $61,000. CONCLUSIONS: Although colorectal cancer screening is costly in the aggregate, its potential medical benefits make it a reasonably cost-effective preventive intervention for the elderly.
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The incidence and risks of conjunctival contamination with patients' blood during a range of otolaryngological surgical procedures was assessed. Risks were found to be highest in three groups of procedures; tracheostomy, operations preceded by local anaesthetic injections and procedures involving the use of the air drill. A simple and effective method of protection using spectacles with large plain lenses is presented.
Seven patients with fibrous obliteration of the ear canal due to long-standing otitis externa were seen at St Mary's Hospital during the past 10 years. Two patients underwent bilateral surgery making a total of 9 ear cases. Two patients developed early restenosis within 6 months of permeatal excision of the fibrous core and skin grafting, and one patient had late stenosis 4 years following postaural excision, meatoplasty and skin grafting. Two of these patients opted for revision surgery and a total of 6 patients (8 ear cases) underwent postaural excision with Körner flap canalplasty, enlargement of the bony ear canal and skin grafting. The average hearing gain was 25 dB in the speech frequencies and only one restenosis was seen at 3 years. This was successfully revised. Radical excisional surgery with a wide bony canalplasty is recommended in this condition.
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Over a 40 month period, 219 patients with AIDS were seen at St. Mary's Hospital, London. Kaposi's sarcoma, one of the criteria for diagnosing the syndrome, was the presenting feature in 62 patients. Eighty four patients developed Kaposi's sarcoma at some stage of their disease and the head and neck region was involved in 56 of them. Although Kaposi's sarcoma is rarely life threatening in AIDS, potential airway obstruction, pain or cosmetic disfigurement may justify treating the lesion. Whilst cutaneous tumours may be managed by using radiotherapy (16 Gray in four fractions over four days), this treatment produces a sever mucositis when used to treat mucosal disease; we, therefore use a combination of vincristine and bleomycin for this.
Between October 1984 and December 1987, 219 patients who fulfilled the criteria for Acquired Immune Deficiency Syndrome (AIDS), as set out by the Centers for Disease Control, Georgia, were seen at St. Mary's Hospital, London. The most common otolaryngological manifestations of the disease in these patients were oral candidiasis (60%), oesophageal candidiasis (16%), persistent generalized lymphadenopathy (27%) and Kaposi's sarcoma (26%). Our management of the patients is described.
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Obstetric decisions regarding extremely premature infants are based in part on their long-term prognosis. This review pools data from perinatal center reports to update mortality and morbidity trends for each subgroup of very low birth weight infants. Throughout the last 10 years, there has been steady and statistically significant improvement in neonatal mortality rates among inborn very low weight infants (1500 g or less). The most substantial improvement of the 1980s over the late 1970s is in the 750-1000-g birth weight group, in which today's infants have about a 70% chance of surviving if they have access to neonatal intensive care. Mortality in infants born weighing less than 750 g is still very high; overall about two-thirds die, but results are highly variable across centers, with several centers reporting 50-70% survival. The rate of serious long-term disability increases with decreasing birth weight, but within each birth weight group, the proportion of survivors who have serious handicaps has not changed significantly since the introduction of neonatal intensive care. For infants born between 1975-1985, 26% of surviving infants with birth weights below 800 g, 17% of survivors with birth weights between 750-1000 g, and 11% of survivors with birth weights between 1000-1500 g have major handicaps at 1 or 2 years of age. Because many very sick newborns who previously would have died are now surviving, an increasing rate of handicap might have been expected.
The case of 57-year-old woman is presented with a chondrosarcoma of the sphenoid. The main symptom was rapid loss of vision and in order to halt this the tumour was debulked. The literature relating to chondrosarcomas of the head and neck is reviewed. These rare tumours are not radio-sensitive and surgery represents the best form of treatment at the present time. The prognosis is poor.
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