Biomedical subjects
Publications and source records attributed to R W Slack.
Verrucous carcinoma is a rare type of squamous cell carcinoma which is most often seen in the oral cavity and larynx. This paper describes a case of verrucous carcinoma of the maxillary antrum, a site in which this tumour has been described on only two previous occasions in the English language literature.
The diagnosis of submandibular lumps is usually straightforward, using a combination of history, examination and simple investigation. Most will turn out to be submandibular salivary gland enlargement or lymph node swellings. We present a case in which conventional investigation failed to help in the diagnosis, and was eventually found to be what we believe is the first capillary haemangioma described in the anterior belly of the digastric muscle.
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In a retrospective study of 96 patients 16 different histological features were examined in 100 aural polyps to see whether some or any could be used to predict the presence or absence of a cholesteatoma underlying the polyp. The patients were divided into those who had cholesteatoma and those who did not, so that discriminatory features were identified. These were combined to make an overall prediction of the probability of a cholesteatoma in the middle ear. The results showed that any polyp that (i) was composed of raw granulation tissue and (ii) contained keratin as flakes or masses had a 70-80% probability of being associated with an underlying cholesteatoma. In contrast, when a polyp (i) was composed of a fibrous core, (ii) had a covering epithelium, and (iii) contained glands and lymphoid aggregates, there was a 70-80% probability of cholesteatoma being absent. This scoring system can be used to help surgeons decide whether surgical exploration of the mastoid should be undertaken.
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Displaced fractured noses are usually manipulated under general anesthetic. The appearances of fractured noses were assessed and the airways measured by rhinomanometry before and after nasal manipulation in 29 patients. Seventeen received a local anaesthetic (LA) and 12 a general anaesthetic (GA) for the manipulation. Patients were generally pleased with the outcome and there were no significant differences between results in the 2 groups. Bony manipulation did not affect the nasal airway. Local anaesthesia was acceptable to all but one patient. The benefits, including those of cost and safety, of local anaesthetic for manipulation of almost all fractured noses are discussed.
We have presented two cases of gastric atony complicating the gastric 'pull-up' procedure in pharyngo-laryngo-oesophagectomy.
Twenty-seven patients with an initial diagnosis of otitis externa, untreated for the previous 2 weeks, were treated with weekly aural suction toilet and a choice of three topical drops. Two contained combinations of antibiotics and steroids, one of which also contained an anti-fungal agent. The third was boric acid in spirit. The patients were assessed at weekly intervals until a remission was established. From this study it would appear that antibiotic-based drops confer no real advantage over boric acid in spirit.
Despite the huge advances in clinical audiology over the past few decades, tuning fork tests are still used extensively in the diagnosis of hearing loss. This study investigates the usefulness, reliability and accuracy of tuning fork tests in a group of children involved in a prospective study of glue ear, and shows them to be of dubious value.
Otorrhoea is a troublesome complication of middle ear ventilation tubes. This investigation of children with various ventilation tubes shows that the incidence of this complication varies with the type of tube used. In particular, Paparella type 2 tubes are associated with a higher rate of otorrhoea, and should be reserved for use when long-term ventilation is necessary.
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Little is known about the pathological changes in the cochlea of preterm infants which might be responsible for the hearing loss which the infants are at risk of developing. This study looks at the cochleas of 5 preterm infants who died at ages up to 2 weeks using light and electronmicroscopic techniques, and shows changes in the inner hair cell population in association with intracochlear clot which may be responsible for subsequent hearing loss.
The earpits-deafness syndrome is a rare autosomal dominant condition. This report documents 4 families and describes the characteristic radiological features of both the inner and the middle-ear lesions. Prospects for surgical intervention are discussed.
Fine needle aspiration cytology is a useful technique in the management of patients with masses in the head and neck, which is usually performed in co-operation with a specialized cytopathologist. It has not until recently been an investigation used frequently by British otolaryngologists. This study shows that an aspiration cytology service may be run with the aid of a general histopathologist and demonstrates that it is a valuable aid to diagnosis even without the services of a specialized cytopathologist.
Grommets have been used as a treatment for middle-ear effusions since their introduction by Armstrong in 1954. However, it is now accepted that the presence of a grommet in a tympanic membrane is associated with the development of tympanosclerosis in that membrane. Furthermore, it has been shown that this is a progressive phenomenon and that the incidence increases with time to as much as 65 per cent at 3 to 4 years after grommet insertion (Mawson and Fagan, 1972; Tos and Poulsen, 1976). Initially it was suggested that the development of tympanosclerosis might be due to the middle ear disease rather than to the grommet (McKinnon, 1971). However, most recent studies have found that, in bilateral cases of effusion, tympanosclerosis develops more frequently in ears with a grommet than in those without (Brown, Richards and Ambegaokar, 1978; Lildholt, 1979). This prospective study was designed to show the development of tympanosclerosis in the tympanic membrane of children treated for bilateral middle-ear effusions and to elicit any factors from the clinical history and operative technique which might be associated with the pathogenesis of the complication.
We have investigated the distensibility of the lower limb arteries by an ultrasonic technique following vasectomy. Vasectomy accelerates the development of atherosclerosis in animals and this has been attributed to an immunological mechanism. Immunological changes are common in men following this operation, but epidemiological surveys have failed to reveal evidence of an increase in arterial disease. We have studied distensibility at the posterior tibial arteries by Laplace transform analysis of Doppler waveforms in 49 vasectomised men and 33 controls. Statistical analysis of each subject's higher (less distensible) value showed reduced distensibility in the vasectomised group (P = 0.006). This result lends support to the possibility that vasectomy may accelerate the development of peripheral arterial disease in man.
The Cancer Register for the South-West Region of England has been used to examine the survival rate of men with carcinoma of the breast, and a comparison has been made with carcinoma of the breast in women. For all men with carcinoma of the breast the prognosis is worse than for all women, but comparing the prognosis by clinical stage, the difference between men and women is small. However, the survival rate in men under 65 years of age is appreciably better than for men over 65, and for older men the survival rate is considerably less than for women over 65.