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Biomedical subjects

S N Dutt

Publications and source records attributed to S N Dutt.

At least 19 recordsLinked to original sources
PubMed2003

Anterior inferior cerebellar artery syndrome: fact or fiction.

A prospective analysis of patients referred by Otolaryngologists from a tertiary hospital for detailed assessment of the posterior cranial fossa was undertaken. The objectives were to evaluate radiological characteristics of the anterior inferior cerebellar artery (AICA) within the cerebellopontine angle (CPA) and the internal auditory canal (IAC), and to correlate these characteristics with ipsilateral auditory symptoms. Three hundred and thirty-two consecutive adult patients who presented with unilateral auditory symptoms were studied. All patients were referred by the Department of Otolaryngology at City Hospital, Birmingham, from October 1999 to October 2001. Magnetic resonance imaging (MRI) with three-dimensional Fourier Transformation Constructive Interference in Steady State (3D FT-CISS) was the imaging strategy used to investigate each patient. Six hundred and sixty-four sides were studied and the AICA loop was identified in all patients. Using a simple anatomical classification to type the loops: there were 412 type I loops (within the CPA), 202 type II loops (at the porus acousticus, extending up to 50% of IAC) and 50 type III loops (extending beyond 50% of IAC). There was a statistically significant association with unilateral hearing loss and type II and III AICA loops (P = 0.016 and P = 0.006 respectively). An association between the presence of a large diameter vascular loop in the CPA and unilateral auditory symptoms was not found to be significant (P > 0.05).

Adult↗
PubMed2003

Iatrogenic perforation in endoscopic stapling diverticulotomy for pharyngeal pouches.

In pharyngeal pouch surgery, the relatively new technique of endoscopic stapling diverticulotomy has a number of advantages over more traditional surgical treatments, such as Dohlman's procedure and open pouch excision, and now seems to be the procedure of choice. However, a number of iatrogenic perforations and deaths have been reported with this procedure. We present three cases of iatrogenic perforations occurring during endoscopic stapling of a pharyngeal pouch by different surgeons in our unit, and review the management, causes and prevention of this potentially life-threatening complication.

Aged↗
PubMed2002

A retrospective review of pharyngeal pouch surgery in 56 patients.

We retrospectively reviewed 56 consecutive patients treated surgically for a pharyngeal pouch at our institution between 1989-1999 (10 years). Various surgical procedures were performed including endoscopic stapling (20), external excision (23), Dohlman's procedure (9), pouch inversion (3), cricopharyngeal myotomy only (3), and pouch suspension (1). There were 12 patients (18%) with complications and one mortality (2%). Four patients (7%) had a recurrence with 2 requiring further surgery. Over the latter 3 years, endoscopic stapling has emerged as the primary procedure for pharyngeal pouch surgery in our unit; with the advantages of an earlier commencement of diet and earlier hospital discharge. However, results were not as good as for external excisions. Furthermore, there were difficulties with 3 cases that commenced as endoscopic stapling procedures but had to he converted to external excisions due to inaccessibility in one case and iatrogenic perforations in two cases. As with any new technique, problems may occur and a learning curve has been appreciated in our unit. Surgeons must he prepared, with informed consent, to convert to an external approach should difficulties arise during endoscopic stapling. Elderly and frail patients who are at risk from a general anaesthetic may benefit from endoscopic stapling. External excision of pharyngeal pouches may be more appropriate in the young, the medically fit, and when malignancy is a concern.

Adult↗
PubMed2001

Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate.

Tegmen plate defects causing cerebrospinal fluid (CSF) leaks and brain hernias have conventionally been repaired using soft tissue grafts by a transmastoid approach. A review of the literature reveals that the results of transmastoid repairs have been less than satisfactory. We present here four patients with spontaneous CSF otorrhoea who had tegmen defects repaired using the middle cranial fossa approach. An autologous bone pate slab mixed with fibrin glue with additional temporalis fascia reinforcement was used for the repairs. All four patients had uneventful postoperative periods and have had no subsequent CSF leak (follow-up range: 1-3 years). We believe that the middle cranial fossa approach is more effective than the transmastoid approach for the repair of CSF leaks and brain hernias through tegmen plate defects. An important additional benefit is hearing preservation. We also recommend the use of bone pate along with soft tissue for the repair in order to achieve a secure seal. Bone pate can effectively seal multiple defects in the tegmen plate without any risk of migration.

Adult↗
PubMed2001

The aetiology of nasopharyngeal carcinoma.

Nasopharyngeal carcinoma is a disease with a remarkable racial and geographical distribution. In most parts of the world it is a rare condition and in only a handful of places does this low risk profile alter. These include the Southern Chinese, Eskimos and other Arctic natives, inhabitants of South-East Asia and also the populations of North Africa and Kuwait.

Adolescent↗
PubMed2001

Transcanal atticoaditotomy and transcortical mastoidectomy for cholesteatoma: the Farrior-Olaizola technique revisited.

Conservative mastoid surgery in the management of middle ear cholesteatoma has been a subject of controversy for decades. Proponents of the combined-approach tympanoplasty for cholesteatoma do not entirely support the conservative approach in children, especially in the hands of an inexperienced surgeon. We describe here our experience with a modified technique of conservative mastoid surgery involving an atticoaditotomy and a separate simple mastoidectomy with lateral attic wall reconstruction (modified Farrior technique) that can be relatively safely used in the majority of cases of chronic squamous otitis media, even in children. This was a prospective analysis of the therapeutic effects and benefits of the technique used in 103 cases of cholesteatoma at Staffordshire General Hospital from 1991 to 1997. The follow-up was between 3 and 9 years. The study group consisted of 55 male patients and 48 female patients, including 28 children less than 16 years of age. The age ranges were 9 to 61 years in male patients and 10 to 48 years in female patients. After an audiological assessment, all patients underwent the described mastoid procedure, and some of them required revision surgery, mostly for a second look or for ossiculoplasty. The chief outcome measures used were complete eradication of disease, incidence of disease recurrence, and restoration of hearing. The steps of the procedure, its pros and cons, and the results of the series are presented. Also discussed is an overview of the literature pertaining to intact-canal wall mastoid surgery. Of the 103 patients, only 3 had a recurrence of disease, and 9 patients showed no hearing improvement. We conclude that this modified technique has several advantages over the previously described mastoidectomy procedures. It is a relatively simple and effective technique that can be performed even in children.

Adolescent↗
PubMed2001

Mandibular advancement prosthesis: first-line alternative to surgery in snoring.

Mandibular advancement prosthesis (MAP) is infrequently used in the UK at present for snoring. First-line measures include dietary and weight modification for those that require it. Where such measures are unlikely to be useful or have already failed, surgery is sometimes utilized as a second-line treatment modality. We evaluate the use of MAP as an adjunct to first-line measures, with emphasis on efficacy, side-effects and patient compliance. Case notes of 30 snorers were reviewed and followed up with a questionnaire. Despite being useful in alleviating snoring, the prosthesis was poorly tolerated. Side-effects include increased salivation, temporomandibular joint pain, intra-oral and myofacial discomfort. Patients who persevered with the prosthesis found the early side-effects resolved after a few weeks and snoring reduced. MAP can be used in the initial management of snorers but patients need to be educated and encouraged, especially in the first few weeks.

Humans↗
PubMed2001

Minimum dataset for recording myringotomy and ventilation tube insertion.

A minimum dataset for recording of findings during myringotomy and ventilation tube insertion for cases of otitis media with effusion is presented. With increasing pressures on surgeons to audit existing practices and hence improve standards of health care, it is appropriate to produce such a set of guidelines for a surgery that is frequently performed world-wide. We believe that the data presented is not too exhaustive and can be readily incorporated into the operative notes.

Data Collection↗
PubMed2001

Maffucci's syndrome: clinical and radiological features of a rare condition.

Maffucci's syndrome is a rare congenital non-inherited condition, characterized by multiple enchondromata, cutaneous haemangiomata and more recently spindle-cell haemangioma-endotheliomata. It is associated with an increased risk of malignancy including intracranial chondrosarcomas. Early diagnosis is crucial; screening patients with Ollier's disease is recommended. The treatment of choice for these intracranial cartilaginous tumours is complete surgical excision but this is often difficult to achieve due to difficult access and relationships with neurovascular structures. An alternative treatment is proton-beam therapy. We report a case of Maffucci's syndrome; illustrating the typical clinical and radiological features as well as the known complications of the condition.

Enchondromatosis↗
PubMed2000

Antrochoanal polyp presenting with obstructive sleep apnoea and cachexia.

A rare presentation of an antrochoanal polyp is reported. A 14-year-old boy presented with obstructive sleep apnoea and subnormal growth velocity for height and weight over a 1-year period. Examination revealed a post-nasal mass which following removal was confirmed histopathologically as an antrochoanal polyp. Relief of the airway obstruction was promptly followed by catch-up growth and subsequent normal growth velocities. The possible mechanisms underlying the cachexia are explored including the possible association with the obstructive sleep apnoea.

Adolescent↗
PubMed2000

Total decompression of facial nerve for Melkersson-Rosenthal syndrome.

Melkersson-Rosenthal syndrome (MRS) is a rare condition characterized by recurrent facial paralysis in addition to various orofacial manifestations. The condition appears to be a granulomatous disorder causing oedema and inflammation of the soft tissues of the face, lips, oral cavity and particularly, the facial nerve. There is general agreement that the symptoms and signs resolve spontaneously, aided perhaps by an empirical course of oral steroids. However, in some patients the condition may be progressive, leading to disfiguring facial synkinesis and increasing residual paralysis. There is anecdotal evidence in the literature to suggest that surgical decompression of the facial nerve in its entire intratemporal course may prevent further attacks of facial paralysis and its sequelae. We present here our experience with surgical decompression of the facial nerve in a 27-year-old woman with MRS who had sufferent recurrent left-sided facial palsy since the age of four. A review of the literature pertaining to facial nerve decompression for Melkersson-Rosenthal syndrome is presented.

Adult↗
PubMed2000

Chronic cerebrospinal fluid leak into skull base causing intramedullary osteolysis.

We present the rare case of a 74-year-old woman with extensive intramedullary osteolysis of the petroclival skull base straddling both sides of the basi-occiput and basi-sphenoid. She presented with clinical features of recurrent spontaneous cerebrospinal fluid (CSF) otorrhoea despite three previous attempts at repair of the CSF leak. Recent advances in imaging techniques enable accurate radiological diagnosis of skull base lesions. We performed T1- and T2-weighted magnetic resonance (MR) images, a fluid attenuated inversion recovery (FLAIR) sequence MR, and a diffusion scan to study the characteristics of the skull base pathology. This revealed extensive osteolysis, with cystic spaces within the clivus and the petrous pyramid extending also to the basi-occiput. The leak was sealed using the technique of subtotal petrosectomy with obliteration of the eustachian tube and blind pit closure of the ear canal. The patient has been followed up for six months with no recurrence of symptoms.

Aged↗
PubMed2000

Desmoplastic fibroma of the temporal bone.

An unusual case of a desmoplastic fibroma of the temporal bone is presented. Although classified benign, this intraosseous lesion exhibits local aggressiveness and has a high potential for recurrence. This rare condition occurs predominantly in the mandible and in the long bones and is seldom seen in the calvarium. Here we add another case to the previously described eight in the skull and this is the fourth such case reported in the temporal bone. The clinical features, radiology, histopathology and the therapeutic considerations of this lesion in a 72-year-old female are discussed. In addition, a literature review of all the cases affecting the skull bones is presented.

Aged↗
PubMed2000

Intraductal papilloma of the submandibular gland.

Salivary tissue intraductal papillomas are rare, benign tumours that predominantly affect minor salivary glands. We report a case of an intraductal papilloma arising in the unusual site of the submandibular gland. The tumour was completely excised and recurrence is not expected. A brief review of this histologically distinct lesion is presented.

Aged↗
PubMed1999

Spindle-cell variant of intralingual lipoma--report of a case with literature review.

A true lipoma is a rare lesion in the oral cavity. A histologically distinct variant is the spindle-cell variety, which is an innocuous lesion that can simulate a myxoid liposarcoma. We report a case of intra-oral spindle-cell lipoma in a 42-year-old female and have reviewed the literature pertaining to this unusual histopathological entity. Awareness of the condition is essential for both clinicians and pathologists to avoid any misinterpretation of the benign nature of this condition.

Adult↗