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Biomedical subjects

R P Rivron

Publications and source records attributed to R P Rivron.

16 recordsLinked to original sources
PubMed1992

Acute epiglottitis in adults: a potentially lethal cause of sore throat.

The diagnosis, management and outcome in 12 adults with acute epiglottitis was reviewed. Painful dysphagia was a universal symptom and respiratory distress affected eight patients, six of whom required urgent airway intervention. All patients received parenteral antibiotics, ten received steroids and four received adrenaline. Respiratory distress resolved in two patients given adrenaline and airway intervention was avoided. Indirect laryngoscopy is the investigation of choice and this is preferable to neck radiology. Two patients died and it is stressed that this condition must be distinguished from other more common causes of a severe sore throat. The patient should be managed in a unit with the facilities and expertise to effect acute airway intervention.

Acute Disease↗
PubMed1992

The effect of septal surgery on nasal symptoms.

Sixty patients scheduled for septal surgery were assessed preoperatively with regard to their symptoms of nasal obstruction, catarrh and facial pain. They were scored on a linear analogue scale and then re-assessed two months postoperatively. There was a highly significant improvement in scores for all three symptoms (p less than 0.005).

Adult↗
PubMed1991

Adult epiglottitis: is there a consensus on diagnosis and treatment?

Adult epiglottitis is a different disease from that seen in paediatric patients both in the clinical picture and management. This paper presents 6 cases of adult epiglottitis which resulted in 2 deaths despite 3 patients having airway intervention. After reviewing some of the larger published series of adult epiglottitis in an attempt to find a consensus on management, a number of recommendations can be made: (1) indirect laryngoscopy is an essential diagnostic step which is safe in the adult and is more reliable than a lateral neck radiograph; (2) bacteriology specimens play no part in acute management and antibiotics must be given empirically; (3) adrenaline may be of value in avoiding airway intervention; (4) airway intervention must be a clinical decision and the conditions for its successful outcome made as favourable as possible by realizing that all patients can rapidly develop life threatening respiratory obstruction. An 'intensive care' level of clinical monitoring and early involvement of experienced ENT and anaesthetic staff is recommended.

Acute Disease↗
PubMed1991

The Edinburgh FESS Trainer: a cadaver-based bench-top practice system for endoscopic ethmoidal surgery.

Functional endoscopic sinus surgery (FESS) requires cadaver-based practice to acquire the necessary technical expertise. To enable this to be undertaken as a bench-top activity the Edinburgh FESS Training system has been developed. This involves the en-bloc removal of the relevant parts of the nasal cavity and sinuses from cadavers and their embedding and mounting in a simulated head.

Cadaver↗
PubMed1991

The voluntary control of nasal airway resistance.

The effects of flaring and constricting the alar margins upon nasal airway resistance (NAR) were measured in 24 normal subjects. The median decrease in NAR on flaring was 21% whilst constricting increased NAR by a median of 67%, there being a high inter-subject variation. We feel these movements of the alar margin an important factor in controlling NAR.

Adolescent↗
PubMed1990

A double-blind, randomized, prospective trial of a topical antiseptic versus a topical antibiotic in the treatment of otorrhoea.

The clinical efficacy was assessed of a topical antiseptic (aluminium acetate) and a topical antibiotic (gentamicin sulphate) for the initial treatment of otorrhoea. Evidence of resistant organisms developing to either treatments after 9 and 21 days was also examined. 139 affected ears were entered into the trial and of these, 102 (74%) completed the study. Improvement in the otorrhoea occurred in 68% of ears treated with gentamicin and 67% of ears treated with aluminium acetate, with no significant difference between the two treatments. No resistant organisms to aluminium acetate were encountered. Twelve gentamicin-treated ears had gentamicin-resistant organisms at presentation and one patient developed a gentamicin-resistant Pseudomonas during treatment. We therefore recommend a topical antiseptic such as aluminium acetate rather than a topical antibiotic in the initial treatment of otorrhoea on the grounds of cost, avoidance of resistance and toxicity.

Acetates↗
PubMed1990

Cross-sectional area as a measure of nasal resistance.

The possibility of using cross-sectional area as a measure of nasal resistance was investigated with an equation based on hydraulic principles that link the area of a constriction in an airway to the pressure gradient and flow rate of air passing through it. Experiments with anatomical models of the nasal cavity confirmed the area of the nasal valve could be measured from simple pressure and flow data with a mean error of 3.5 mm2 (SD = 2.2). The software of a clinical rhinomanometer was then modified to incorporate this equation. Initial tests with a series of substitute airway constrictions of known area indicated the rhinomanometer could then use pressure and flow data to derive the area of each constriction with a mean error of 1.4 mm2 (SD = 0.9). Using this modification during rhinomanometry on 18 adults with subjectively clear nasal airways, a mean value for the narrowest area of the combined nasal cavities was found to be 48 mm2 (SD = 13.7) and results from 17 subjects complaining of nasal obstruction produced a mean narrowest area of 27 mm2 (SD = 11.8). Thus, this system can accurately derive area from data normally gathered from rhinomanometry and the value is constant over a range of pressure gradients and flow rates. The advantages of considering nasal obstruction in terms of area are discussed.

Airway Resistance↗
PubMed1989

Evaluation of recent experience in hypoglossal-facial nerve anastomosis in the treatment of facial palsy.

This evaluation of recent experience of hypoglossal-facial nerve anastomosis in ten patients who had undergone acoustic neuroma resection, indicates that this procedure may have a role to play in the treatment of this disfiguring condition. Facial symmetry at rest is satisfactory in the majority of patients, who suffered little long term deficit from the loss of their hypoglossal nerve. This procedure is ideally suited to otolaryngological practice.

Adult↗
PubMed1989

Bifid uvula: prevalence and association in otitis media with effusion in children admitted for routine otolaryngological operations.

Over a six month period, 709 children admitted for routine ENT operations were surveyed with regard to the presence of a bifid uvula as seen whilst under a general anaesthetic. The prevalence was found to be 7.5 per cent (53:709) which is higher than other published figures for a Caucasian population. There was a statistically significant male predominance (2.5:1). Comparison between those children found to have otitis media with effusion at operation and those having dry myringotomies, or operations not including myringotomy, revealed a similar prevalence of bifid uvula. Thus, this data does not support the hypothesis myringotomy, revealed a similar prevalence of bifid uvula. Thus, this data does not support the hypothesis that bifid uvula as a microform of cleft palate is associated with an increased incidence of otitis media with effusion.

Adenoidectomy↗
PubMed1988

ENT teaching.

All medical schools include undergraduate ENT teaching, but the time allocated is short and the acquisition of practical skills may suffer. Efficiency is essential, particularly with regard to those destined for general practice, where 10-30% of the workload concerns the upper respiratory tract. The students at the Leeds Medical School, during 1 academic year, were surveyed by questionnaire on various aspects of their ENT course. Criticisms and suggestions for improvement were also invited. The results suggested the lecture course should not change but the time spent in operating theatres could be reduced in favour of more time in the outpatient clinics with a greater emphasis on practical skills. This discussion was then extended to consider what an ENT course should include and whether it could be integrated, in some way, with postgraduate education.

Education, Medical, Graduate↗