Biomedical subjects
Publications and source records attributed to R Capper.
We report a case of upper airway obstruction following high-pressure water jet injury to the pharynx incurred from a car wash jet. Injuries from high-pressure water jets are relatively rare and, to the best of our knowledge, airway obstruction as a result has not been reported. Since this unusual injury may be associated with life-threatening complications, it must be promptly recognized and treated.
Otoplasty surgery carries a high satisfaction rate for participants (96%). Surgeons are more critical of the results of otoplasty than the participants or parents (92% satisfied). There is no statistical difference in qualitative results with different surgical techniques when comparing the published data. Data on otoplasty surgery is numerous, but quantitative assessment of surgical outcome is rare. The authors propose the measurement of cephaloauricular distance to allow comparison between studies.
Spontaneous perforation of the oesophagus is an uncommon condition that almost invariably affects the thoracic oesophagus. We present an unusual case of perforation of the cervical oesophagus, in which an unsuspected ingested foreign body was ultimately found to be responsible.
Otitis media with effusion (OME) is characterized by the accumulation of a viscous fluid rich in mucins in the middle ear cleft. There is increasing evidence that this fluid is the result of an inflammatory reaction and that nitric oxide (NO) is an important mediator in this reaction. The goblet cell line HT29-MTX produces principally MUC5AC, an important mucin in middle ear effusions, and thus is a good model for the study of mucus-secreting epithelia. Confluent cell cultures were trypsinized, subcultured and incubated with isosorbide dinitrate (ISDN), a NO donor, for 0.5, 1 and 2 h at a concentration of 1 mm and in concentrations of 0.01, 0.1, 0.5, 1 and 2 mm for 1 h. Experiments were performed four times. Mucin production was detected by a slot blot ELISA assay, using a monoclonal mouse antibody to human MUC5AC mucin. Statistical significance was tested using a one-way analysis of variance. NO donation by ISDN caused a consistent rise in mucin production above control. Maximal mucin production of 35% above control occurred at 1 h with 1 mm ISDN. Mucin production increased from 12% above control with 0.1 mm ISDN dinitrate to 45% above baseline with 2 mm ISDN. NO donation by ISDN results in an increase in mucus production, which is both dose and time related. This adds further evidence to an inflammatory model for mucus secretion in OME.
Poor quality sleep and sleep-related hypoxia have been described in children awaiting (adeno)tonsillectomy even in the absence of a history which would suggest such problems. However, restless sleep has also been commonly reported in children from a normal population. It has not been shown whether an increasing frequency of tonsillitis is associated with deterioration in sleep quality. This study directly compares sleep quality in three groups of children: (1) a normal population; (2) children from a normal population who have tonsillitis but are not awaiting tonsillectomy; and (3) children awaiting tonsillectomy for recurrent tonsillitis. A questionnaire was completed by the parents and the answers compared using the chi2 and Spearman's rank correlation tests. The results show that children awaiting tonsillectomy have poorer sleep quality than their normal peers. However, there is no dose-response effect between deteriorating sleep quality and increasing frequency of tonsillitis.
Tonsillectomy is the second most common operation undertaken in children in the United Kingdom, but the rate at which tonsillectomy is performed varies greatly across the Health Authorities. The reasons for the variation appear to be related to differences in local medical practice rather than differences in regional morbidity. This study was undertaken to compare the factors used to diagnose tonsillitis in children, the indications for tonsillectomy and the expected benefits of tonsillectomy in children by general practitioners, paediatricians and otolaryngologists. There was poor correlation between general practitioners, paediatricians and otolaryngologists in all study objectives. There appears to be no consistent clinical pathway by which children with recurrent tonsillitis are managed. The wide variation in tonsillectomy rates across the United Kingdom will probably continue until the decision-making process of doctors involved in the treatment of children with recurrent tonsillitis is better understood.
Little evidence exists from randomized controlled trials to support the role of tonsillectomy in children with recurrent tonsillitis. Despite this, parents report a great change for the better in their children following the operation. Previous trials vary in their inclusion criteria, both in terms of the definition of tonsillitis and in the frequency of sore throats required before entry into the study is permitted. The aims of this study are to define tonsillitis from the perspective of parents whose children are awaiting tonsillectomy for recurrent sore throats, and to determine whether such parents have a better understanding of the difference between tonsillitis and other sore throats than parents of children from a normal population control group. These aims demonstrate whether parents who request tonsillectomy for their children do so on the basis of a recognized clinical problem. We report that parents can clearly identify a sore throat illness that they call tonsillitis and which is differentiated from other sore throats by different symptom complexes. The parental history is important in the assessment of a child prior to tonsillectomy. The views of parents whose children have recurrent tonsillitis must be further investigated if the difference between randomised controlled trial results and parents' opinions regarding the benefit of tonsillectomy is to be understood.
Previous reports have suggested that the incidence of tonsillectomy, and/or tonsillitis in children, is influenced by factors such as parental smoking, maternal health and previous parental tonsillectomy. The reports have considered single factors and have not considered the possible confounding effect of the factors upon one another. Previous studies have not investigated the influence of social class. This paper uses the background of a large case-control trial of children awaiting tonsillectomy for recurrent tonsillitis, and a normal control group to study the influence of parental smoking, parental surgical history, parental tonsillectomy, family atopy and social class upon the reported incidence of sore throats and tonsillitis. A multivariate analysis is used. The paper shows that parental smoking, previous parental surgery and social class have no effect upon the number of sore throat episodes. A history of parental tonsillectomy and a family history of atopy are both significant predictive factors for the number of reported sore throats and episodes of tonsillitis in children.
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Day-case surgery has been urged on the National Health Service by the Audit Commission in the last decade despite concerns about safety. A questionnaire was posted to the parents of 109 children who had recently undergone day-case adenoidectomy, addressing parental concerns and opinions. Eighty per cent of the questionnaires were returned. A high level of satisfaction with day-case adenoidectomy was expressed by the parents. All the children were observed for six hours after surgery prior to discharge. One child was visited at home by his general practitioner in the first 24 hours of discharge but there were no serious post-operative complications and none of the children required re-admission to hospital. Day-case adenoidectomy is safe, very acceptable to parents and does not result in a greatly increased workload for general practitioners.
We have studied thirteen patients to assess the efficacy of uvulopalatopharyngoplasty on snoring and on oxygen desaturation during sleep. Pre- and post-operative overnight pulse oximetry studies were performed and the patients were divided into snorers and those with obstructive sleep apnoea on the basis of the preoperative test. Uvulopalatopharyngoplasty did not result in a significant change in the number of oxygen saturation dips in either snorers or those with the obstructive sleep apnoea syndrome. Subjectively, 85% (11/13) of patients reported good or excellent improvement in snoring following surgery.
A case is reported of oat cell carcinoma of the lung presenting with unusual sites of metastasis to the orofacial region. Distant metastases are common in oat cell carcinoma but a literature review did not reveal any reports of metastases either to the hard palate or to medial canthus of the eye.