bluuebunny/crossref_metadata_2025 huggingface dataset:
Biochemical markers of neonatal sepsis: value of procalcitonin in the emergency setting
Authors: Guibourdenche Jean , Bedu Antoine , Petzold Loïc , Marchand Martine , Mariani-Kurdjian Patricia , Hurtaud-Roux Marie-Françoise , Aujard Yannick , Porquet Dominique
Published: October 2002

Background We evaluated procalcitonin (PCT) assay in the emergency diagnosis of neonatal bacterial infection, especially in preterm infants, relative to C-reactive protein (CRP) and fibrinogen. Methods One hundred and twenty neonates (32 preterm), of whom 21 were infected, were tested. Results Concentrations of PCT, CRP and fibrinogen in uninfected infants were not affected by gestational age at birth. Concentrations of CRP and PCT increased rapidly during the first 24 h of life, while fibrinogen concentrations increased gradually from birth. All marker concentrations were significantly greater in neonates with bacterial infection. Receiver-operating characteristic analysis showed that optimum cut-off values for fibrinogen, CRP and PCT were 3.0 g/L, 7.5 mg/L and 2.5 µg/L respectively, for the diagnosis of sepsis at birth. Conclusions Determination of PCT is of value in excluding bacterial infection in neonates since it has a negative predictive value of 93%.
Evaluation of Kryptor cardiac troponin I immunoassay
Authors: Lefèvre Guillaume , Graïne Hanafi , Bakkouch Karim , Garbarz Eric , Marlin Ginette , Michel Pierre Louis , Capeau Jacqueline
Published: October 2002

Background and Methods: Cardiac troponin I (cTnI) is well recognized as a specific marker for myocardial infarction. A fully automated, random access, fluorescent immunoassay for cTnI was evaluated in comparison with an established assay (Stratus cTnI) using samples from healthy subjects and from patients with cardiac disease. Results: The detection and precision were acceptable, and no interference was observed from bilirubin, triglycerides, haemoglobin, rheumatoid factor, drugs (aspirin, dopamine, digoxin) or heparin. Results on the Kryptor cTnI assay correlated with those on the Stratus II cTnI assay. The optimum Kryptor cTnI concentration for acute myocardial infarction was 0.63 µg/L, with a sensitivity of 89% [95% confidence interval (CI): 75.9-96.3] and specificity of 98.9% (95% CI: 93.9-99.8). Conclusion: Kryptor cTnI immunoassay is suitable for use in the diagnosis of myocardial infarction.
Comparison of intact and 'whole molecule' parathyroid hormone assays in patients with histologically confirmed post-renal transplant osteodystrophy
Authors: Godber Ian M , Parker Cornelle R , Lawson Nigel , Hitch Tony , Porter Christine J , Roe Simon D , Cassidy Michael JD , Hosking David J
Published: October 2002

Background Fragments of parathyroid hormone (PTH) have been identified (amino acids 7-84) which may interfere with commercially available 'intact molecule' PTH assays. Novel assays which employ an antibody directed to the first seven amino acids of the N-terminus of PTH are thought to be free from cross-reactivity with the 7-84 fragments, and therefore measure true 'whole molecule' PTH. Transplant recipients (as well as those in end-stage renal failure) have been reported to have elevated levels of 'intact' in comparison with 'whole molecule' PTH.

Methods PTH concentrations were assessed in serum samples obtained from female renal transplant recipients previously classified as either having hyperparathyroid ( n = 14) or adynamic bone disease ( n = 14) by transiliac crest bone biopsy. PTH was measured as 'whole molecule' (Scantibodies 'whole molecule' PTH) and 'intact' (DPC Immulite 2000 intact PTH and Scantibodies total PTH).

Results Scantibodies 'whole molecule' PTH (all-subject mean 48·7 ng/L, ± 53·0) were significantly lower than DPC intact (83·5 ng/L, ± 88·1; P ≤0001) and Scantibodies total PTH (80·5 ng/L, ≤ 92·4; P ≤ 0·0001). However, the differences between the 'whole molecule' and 'intact' measurements were similar across the two patient groups, and reflected the lower reference range employed by the 'whole molecule' assay.

Conclusion The 'whole molecule' PTH assay was unable to discriminate between the two patient populations and provided very little additional clinical information to that obtained from the intact PTH assays.
Troponin for acute coronary syndromes: has NICE got it right?
Authors: Thomson JDR , MacKintosh AF , Barth JH
Published: October 2002

The guidelines on the use of glycoprotein IIb/IIIa inhibitors for acute coronary syndromes issued by the National Institute for Clinical Excellence (NICE) recommend that blood troponin is used to identify patients who might benefit from therapy. There are, however, a number of circumstances in which troponin results may be misleading. Firstly, the trials which comprise the evidence base for the therapeutic effect were only based on patients with documented coronary artery disease. Secondly, troponin is elevated in patients with heart failure and concentrations fall with appropriate treatment. Thirdly, there is no internationally accepted standard for troponin, and there are therefore important differences at the 'cut-off' values between the methods of different manufacturers. Fourthly, immunoassays suffer from interfering antibodies and at least 17 case reports have been published outlining false positive tests. It is important that the shortfalls of troponin tests in the diagnosis of acute coronary syndromes are widely recognized.
Cyclosporin: revisions in monitoring guidelines and review of current analytical methods
Authors: Andrews DJ , Cramb R
Published: October 2002

This article summarizes the main changes that have occurred in cyclosporin (ciclosporin) monitoring and measurement since the previous review in this journal. Cyclosporin has been reformulated to reduce variability in its absorption, leading to fewer post-transplant rejection episodes. Monitoring has mostly utilized the measurement of pre-dose blood levels of the drug, but more recently the potential benefit of using samples collected during the first few hours post-dose has been evaluated. Calculating the area under the cyclosporin concentration-time curve may be the ideal, but is not viable in the routine clinical situation and 2-h post-dose sampling seems likely to offer a practical clinical solution. Analytical methods based on high-performance liquid chromatography (HPLC) and immunoassay are available for the determination of whole blood cyclosporin concentrations. HPLC is specific but rarely used for routine monitoring, although HPLC-tandem mass spectrometry is making the technique more viable. New immunoassays have been introduced, but none are completely specific for the parent drug and all exhibit cross-reactivity towards cyclosporin metabolites. Immunoassays were originally designed for the lower cyclosporin concentrations seen in pre-dose samples, but are being evaluated and modified for determination of the higher concentrations seen 2 h post-dose.
Laboratory analyses for poisoned patients
Authors: Thomas SHL , Watson ID
Published: October 2002

Guidelines on the appropriate availability and use of laboratory analysis have been produced by the National Poisons Information Service and the Association of Clinical Biochemists and are published in this issue. These are intended to support the consistent and high quality investigation of the poisoned patient.
Schwannoma of the chorda tympani nerve
Authors: Browning S. T. , Phillipps J. J. , Williams N.
Published: October 2002

We report a case of schwannoma of the chorda tympani. This is a very rare benign tumour and only five other cases have been found in the literature. This is the first case to mimic a cholesteatoma presenting as a pearly tumour in the postero-superior segment of the drum with aural discharge and conductive deafness. Diagnosis is usually by biopsy and treatment is surgical with preservation of facial and auditory function. A summary of the other presentations of this tumour together with a review of the histopathology of the disease is presented.
Metastases from glomus jugulare tumours
Authors: Brewis C. , Bottrill I. D. , Wharton S. B. , Path  , Moffat
Published: October 2002

This review describes the features of glomus jugulare tumours with metastases. There were 100 sites of metastasis in the 53 cases previously reported. The sites of metastasis may be summarized as bone (33), lungs (23), lymph nodes (19), liver (nine) and other (16). Metastases presented up to 30 years after the initial treatment. The mean age of patients was 45 years and the sex ratio was approximately two females to one male, with no significant difference compared to non-metastatic tumours. There was a significantly higher incidence of pain and a significantly lower incidence of hearing loss at presentation compared to non-metastatic tumours. The commonest treatment was a combination of surgery and radiotherapy. The duration of symptoms before diagnosis was significantly shorter and the rates of persistent or recurrent local disease and death were significantly higher than for non-metastatic tumours. This review highlights the fact that glomus jugulare tumours are not always benign.
Indirect carotid cavernous fistula presenting as pulsatile tinnitus
Authors: Mohyuddin A.
Published: October 2002

This paper reports a case of spontaneous indirect carotid cavernous fistula that presented with pulsatile tinnitus, left-sided temporal headache and left-sided ptosis. The pulsatile tinnitus, its aetiology and investigation are discussed. The importance of pulsatile tinnitus is highlighted, with a discussion of carotidcavernous fistulas. This case illustrates that clinically silent cavernous sinus thrombosis can give rise to spontaneous indirect carotid cavernous fistula. Magnetic resonance imaging angiography was used in diagnosis. Treatment ranges from observation, as in our case, to transvenous endovascular techniques.
Incidental findings on magnetic resonance imaging screening for cerebellopontine angle tumours
Authors: Mirza S. , Malik T. H. , Ahmed A. , Willatt D. J. , Hughes D. G.
Published: October 2002

The otolaryngologist who requests magnetic resonance imaging (MRI) scans to exclude cerebellopontine angle (CPA) tumours may discover incidental pathologies. We retrospectively reviewed the results of 644 consecutive MRI screening scans with the aim of identifying findings other than CPA tumours. Two hundred and eighty-nine (45 per cent) scans featured one or more anomalies or abnormalities, including CPA tumour (23, four per cent), vascular loop (30, five per cent), basilar artery ectasia (13, two per cent), multiple high signal areas (135, 21 per cent), brain atrophy (52, eight per cent), sinus findings (56, nine per cent), middle ear/mastoid disease (34, five per cent), and a variety of other findings (39, six per cent) including clinically serious lesions (11, two per cent). The significance and management of these incidental findings is discussed. The majority were not clinically significant but the occasional presence of a serious incidental pathology should be borne in mind. Basilar artery ectasia and multiple high signal areas may be responsible for the symptoms investigated by MRI, and screening for cerebrovascular disease risk factors in such patients may be appropriate.
Total decompression of facial nerve for Melkersson-Rosenthal syndrome
Authors: Dutt Sunil N. , Mirza Showkat , Irving Richard , Donaldson Ivor
Published: October 2002

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.
Congenital malformations of the ear and cochlear implantation in children: review and temporal bone report of common cavity
Authors: Graham John M. , Phelps Peter D. , Michaels Leslie
Published: October 2002

The objective of this review is to analyze aspects of congenital malformation of the ear in relation to cochlear implantation in children. Having briefly described the in utero development of the ear and the classification of types of external, middle and inner ear malformation, five practical aspects of these malformations are discussed. It seems likely that the combination of bilateral profound sensorineural deafness with bilateral microtia severe enough to make a surgical approach to the cochlea difficult will be extremely uncommon. No such cases have been reported, although Klippel-Feil deformity seems the syndrome most likely to produce this set of circumstances.

Abnormalities in the intratympanic course of the facial nerve have been associated with cochlear malformation, emphasizing the benefit of intra-operative facial nerve monitoring, and a technique suggested for safely avoiding an abnormally placed nerve. Fistulae of cerebrospinal fluid (CSF) and perilymph can complicate surgery and are relatively common in common cavity and Mondini malformations. Strategies for facilitating surgery in the presence of ‘gushers’, for measuring the pressure of a gusher and for placement of the cochlear implant electrode array are reviewed, with reports of fluctuating levels of electric current when implants lie in dysplastic cochleas.

The relationship of implant performance to VIIIth nerve tissue in malformed cochleas is discussed, with a description of the histological findings in a common cavity cochlea. Techniques for identifying the absence of the cochlear nerve are reviewed. Stimulation of the facial nerve by cochlear implants has been described in cases of congenital malformation of the labyrinth but is relatively uncommon. Case reports of the benefit received by implanted children with congenital cochlear malformation have appeared since 1988. Most cases reported have not yet been followed for long enough to establish a clear picture of the outcome following cochlear implantationin such children; no centre has yet built up a large series of cases, but there have been two multicentre postal surveys. It seems likely that in cochlear malformation the range of potential outcomes in terms of hearing threshold and the development of speech perception and production will be similar to the range found in implanted children without cochlear dysplasia. However there is, as yet, no clear picture of the mean level of performance within this range.
Measurement of surface area in human mastoid air cell system
Authors: Park Moon Suh , Yoo Seong Hoon , Lee Dong Hoon
Published: October 2002

The total surface areas of human mastoid air cells were measured using digital CT scans. Using 24 normal ears, the lining of the mastoid air cells was digitally scanned, traced and analysed. The mean surface area of the mastoid air cell system was 167.0.cm2 and ranged from 74.78 to 330.01 cm2. The volume was also measured, the mean being 10.43.cm3 ranging from 6.25 to 20.52.cm3. The correlation coefficient between surface area and volume was 0.95. These results indicate that well pneumatized mastoid air cells serve to provide an extremely large surface area in the temporal bone which in normal mastoid air cells is proportional to the volume.
The complications of chronic otitis media: report of 93 cases
Authors: Osma Ustun , Cureoglu Sebahattin , Hosoglu Salih
Published: October 2002

The aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990–1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezold’s abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.
Middle-ear myoclonus
Authors: Zipfel Terrence E. , Kaza Srinivas R. , Greene J. Scott
Published: October 2002

Tinnitus produced by repetitive contraction of the middle-ear muscles is a rare condition. We present an interesting case of bilateral middle-ear myoclonus causing incapacitating tinnitus in a patient with multiple sclerosis. Otological examination demonstrated rhythmic involuntary movement of the tympanic membrane. These movements correlated with a rhythmic ‘rushing wind’ noise perceived by the patient. Oropharyngeal examination showed no evidence of palatal myoclonus. Impedance audiometry confirmed rhythmic change in the middle-ear volume. Medical management was unsuccessful. The patient’s tinnitus was subsequently cured with bilateral sectioning of the tensor tympani and stapedial tendons.
Herpes zoster oticus following mandibular block
Authors: Maini Sangeeta , Preece Mark
Published: October 2002

Although a few cases of facial palsy following mandibular nerve block and dental surgery have been described, it would appear that herpes zoster oticus following dental surgery has not been documented. It is possible that the latent virus may be activated by the mandibular nerve block and dental surgical interventions. Two cases of herpes zoster oticus, both following inferior alveolar nerve block anaesthesia for dental treatment are presented.
Amyloidosis of Waldeyer’s ring and larynx
Authors: Green K. M. J. , Morris D. P. , Pitt M. , Small M.
Published: October 2002

Amyloidosis of the upper aerodigestive tract is relatively rare. A case of localized amyloidosis involving all components of Waldeyer’s ring with added laryngeal involvement is described. This has not been previously reported. A literature review of this conditions is presented.
Imaging for endoscopic sinus surgery in adults
Authors: Lund Valerie J. , Savy Lloyd , Lloyd Glyn
Published: October 2002

Computerized tomography (CT) offers the gold standard in terms of imaging the extent of disease and the fine detailed anatomy, both pre-requisites to the safe practice of endoscopic sinus surgery. Neither plain X-rays nor magnetic resonance imaging (MRI) offer optimal information in this respect. A variety of protocols minimizing radiation dose to the lens whilst providing high quality images are presented together with a menu of anatomical features that require careful evaluation pre-operatively.
Adenoid cystic carcinoma of the tongue
Authors: Üstündaĝ Emre , Iseri Mete , Aydin O¨mer , Dal Hülya , Almaç Ahmet , Paksoy Nadir
Published: October 2002

Malignant tumours of the salivary glands in children are extremely rare. We present here a 12-year-old girl initially diagnosed as pleomorphic adenoma on fine needle aspiration biopsy, and adenoid cystic carcinoma (ACC) after the lesion was excised and examined by histopathology. A wide resection of the lesion and bilateral supraomyohyoid neck dissection was performed. To our knowledge this is one of the youngest patients with ACC of the minor salivary glands. Due to its benign histological appearance, the biological agressiveness of ACC is usually underestimated. Although fine needle aspiration cytology (FNAC) is very valuable in diagnosis, cytological variations of pleomorphic adenoma must be considered. ACC of the tongue in a young age group should be treated with wide resection and selective neck dissection if the tumour is localized in places where the risk of metastasis is increased and if there is a clinically palpable lymph node. In such cases the clinician should not avoid radical operations even in a young patient.
Isolated extramedullary plasmacytoma of the true vocal fold
Authors: Rakover Yoseph , Bennett Michael , David Rephael , Rosen Gabriel
Published: October 2002

We report a rare case of isolated extramedullary plasmacytoma (EMP) of the right true vocal fold in a 38-year-old male with a one-year history of hoarseness. Immunohistochemical staining of plasma cells in the tumour, showed over 90 per cent of them to be positive for kappa light chains. After two attempts at local surgical excision and recurrence within 10 months, the tumour was irradiated.

Only seven reported cases of isolated EMP of the true vocal fold are reported in the literature. The therapeutic options are discussed.
Idiopathic calcinosis of the tongue
Authors: Abdelkader M. , Johnston A. , Wilson K.
Published: October 2002

Idiopathic calcinosis of the tongue is very rare. We report a case of idiopathic calcinosis of the tongue in a 19-year-old female.
Penetrating neck injury: case report and evaluation of management
Authors: Tariq M. , Kalan A. , Surenthiran S. S. , Bhowmik A.
Published: October 2002

Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. There is no universally accepted specific approach to the management of patients with penetrating neck injuries, with some surgeons advocating mandatory neck exploration whilst others believe in selective surgical intervention.

We believe that an equal willingness for both conservative and surgical intervention as dictated by serial bedside evaluation with adequate radiological and endoscopic support can provide the clinician a safe and effective means of managing a potentially complex and lethal problem.
Management of acute surgical orbital haemorrhage: an otorhinolaryngological and ophthalmological perspective
Authors: Sharma Shanel , Wilcsek Geoffrey A. , Francis Ian C. , Lee Donald , Coroneo Minas T. , Harrison Henley , Wolf Gerald , Stammberger Heinz
Published: October 2002

This retrospective report describes the management and outcome of seven patients who suffered an acute surgical orbital haemorrhage (ASOH), secondary to a surgical procedure performed on either the sinuses, orbits or eyelids. All patients but one recovered their pre-operative vision. A management plan is outlined on how to assess and tackle this complication, so that the ENT surgeon may be better prepared to meet such an acute surgical emergency, should it arise.
Pleomorphic adenoma of the retropharyngeal space: a rare location
Authors: Tariq M. , Surenthiran S. S. , Kobbe A. E. R.
Published: October 2002

A case of an isolated pleomorphic adenoma of the retropharyngeal space is reported, this has not been documented previously in the literature. Attention is drawn to the wide spectrum of benign and malignant neoplasms that can potentially occur within this complex anatomical region. The importance of a systematic and logical approach to the management of such lesions is emphasized.
Plasma cell polyp of the vocal fold
Authors: Lee S. B. J. P. , Kundu S. , Salto-Tellez M.
Published: October 2002

Plasma cell polyps of the vocal fold (plasma cell granulomas) are rare inflammatory polyps of the larynx. They should be included in the clinical and histological differential diagnosis of laryngeal polyps. Histologically they are polyclonal aggregates of plasma cells. It is essential to distinguish them from monoclonal, neoplastic plasma cell proliferations. The treatment of choice is surgical resection, although radiotherapy, laser ablation, antibiotics and steroids have been used successfully. We present a case of plasma cell granuloma presenting as a vocal fold polyp, treated surgically.
Laser palatoplasty: evaluation of patient benefit using Glasgow benefit inventory
Authors: Banerjee A. , Dempster J. H.
Published: October 2002

Short-term results of laser palatoplasty have been encouraging. This study was undertaken to evaluate if there is a deterioration of benefit with time as seen in uvulopalatopharyngoplasty (UPPP). The Glasgow benefit inventory (GBI) was applied retrospectively by means of a postal questionnaire to measure the quality of benefit and to evaluate any deterioration in benefit with increasing post-operative time. Our results show that laser palatoplasty benefited 53 per cent of patients. With increasing postoperative time there was a decrease in the percentage of patients who felt the operation had made no difference, with a corresponding increase in the percentage of patients who felt worse. Although the number of patients who benefited remained fairly constant, there was deterioration in the quality of benefit in the first year, after which the benefit remained stable. This has implications in the pre-operative counselling of patients.
Bulbar presentations of myasthenia gravis in the elderly patient
Authors: Sharp H. R. , Degrip A. , Mitchell D. B. , Heller A.
Published: October 2002

We report on three cases of patients whose primary symptoms of myasthenia gravis were related to the upper aerodigestive tract. Symptoms had been present unrecognized in all patients for up to three years, and one patient subsequently developed a myasthenic crisis. We highlight the clinical features of myasthenia gravis to allow its prompt recognition in patients presenting to the ENT surgeon or physician.
First case of surgically corrected puberphonia
Authors: Pau H. , Murty G. E.
Published: October 2002

Puberphonia is predominantly a male condition which, normally affecting teenagers, may present in later life. It is defined as the failure to change from the high-pitched voice of the pre-adolescence to the lower pitched voice of adulthood. Patient previously reported have responded to voice therapy alone. We report the first surgically corrected case.
Extraskeletal Ewing’s sarcoma of the nose
Authors: Böör Andrej , Jurkovič Ivan , Friedmann Imrich , Plank Lukás , Kočan Pavol
Published: October 2002

A 20-year-old woman presented with nasal obstruction and slight epistaxis. The obstructing lesion was excised and microscopy showed a neoplasm composed of comparatively uniform undifferentiated cells forming solid nests. The cytoplasm of the cells was clear but poorly demarcated, partly vacuolated and contained much glycogen. Although widespread in the nasal mucosa, the cells did not penetrate into the underlying bone.

The cells expressed the MIC2 gene (using the CD99 marker). Electron microscopy showed simple cells with a small number of mitochondria, many glycogen particles; there were no neurosecretory granules present.

Early surgical treatment followed by chemo- and radiotherapy have greatly improved the prognosis of EWS: extraskeletal Ewing’s sarcoma (EWS/PNET).
Persistent foreign body sensation and pharyngeal pain due to retention of staples: an interesting sequelae of endoscopic stapling procedure
Authors: Arunachalam P. S. , Cameron D. S.
Published: October 2002

The surgical treatment of a pharyngeal pouch with endoscopic stapling diverticulotomy is a relatively new concept. Long-term results and complications are yet to be fully studied. We describe a patient who developed persistent pharyngeal pain and foreign body sensation due to retention of a clump of staples at the cricopharyngeal sphincter. This complication has not been reported before. This case highlights the need for repeat endoscopy rather than a barium swallow X-ray if the patients are symptomatic after stapling procedures.
Pott’s puffy tumour: an unusual presentation and management
Authors: Maheshwar  , Harris  , Al-Mokhthar  , Evans
Published: October 2002

Pott’s puffy tumour is a rare clinical entity in this era of antibiotics. It is usually seen as a complication of frontal sinusitis. This is the first report of Pott’s puffy tumour presenting as a complication of maxillary sinusitis. This is also the first reported case of Pott’s puffy tumour treated with debridement and gentamicin beads. We discuss the clinical presentation and successful treatment of this rare disease.
External carotid artery aneurysm in an infant presenting with oropharyngeal haemorrhage
Authors: Jarvis Sara , Parker Andrew
Published: October 2002

We report an unusual case of a mycotic external carotid artery aneurysm presenting in a nine-month-old infant. She presented with coryzal-like symptoms and oropharyngeal haemorrhage. This was thought initially to be due to acute tonsillitis. There was significant haemorrhage and reversible hypovolaemic arrest. A contrast computerised tomography scan (CT) confirmed the diagnosis of a mycotic external carotid artery aneurysm. This was subsequently successfully treated by percutaneous embolization with microcoil insertion.
Inflammatory pseudotumour in the submandibular region
Authors: Mathews  , Nicol  , Dingle
Published: October 2002

We present a rare case of inflammatory pseudotumour in the submandibular region. A review of the literature revealed that this is only the second case of inflammatory pseudotumour in the submandibular region to be reported. Clinical presentation and management of this condition are discussed.
Tissue engineering and ENT surgery
Authors: Patel Nimesh N. , Butler Peter E. M. , Buttery Lee , Polak Julia M. , Tolley Neil S.
Published: October 2002

Tissue engineering is the development of biological substitutes for the repair and regeneration of damaged tissues. We explain the principles of this emerging field of biotechology. The present and potential applications of tissue engineering technologies in ENT surgery are then reviewed.
Long-term follow-up after laser-induced endotracheal fire
Authors: Ilgner Justus , Falter Florian , Westhofen Martin
Published: October 2002

The objective of this presentation is to outline long-term complications and their management in contrast to acute measures after endotracheal laser-induced fire. This case focuses on a 56-year-old patient in whom an endotracheal fire occurred during CO2 laser surgery. Despite local swelling and evidence of acute lung injury, the patient was extubated the following day under single-shot cortisone and inhalation of dispersed adrenaline under assisted spontaneous breathing. Wound healing was assessed by regular flexible bronchoscopy and spirometry. Fourteen weeks after uneventful recovery, the patient presented with acute inspiratory stridor, related to a tracheal stenosis 2.5 cm distal to the glottic level. After tracheal end-to-end anastomosis, further follow-up was uneventful. Early extubation under ITU conditions avoided the need for tracheostomy and its sequelae. However, tracheal stenosis did not become apparent before week 14. While in acute management of laser-induced endotracheal fire a conservative approach was established successfully, the risk of further long-term complications implies the need for a prolonged follow-up regime even in cases of less extensive burns.
Vinegar treatment in the management of granular myringitis
Authors: Jung Hak Hyun , Cho Sung Dong , Yoo Chan Ki , Lim Hyun Ho , Chae Sung Won
Published: October 2002

To compare the therapeutic efficacy in the management of granular myringitis, 15 patients with chronic granular myringitis were treated with antibiotic ear drops that were used twice to four times a day, and another 15 patients were treated with daily irrigation of the external canal with dilute vinegar solution. All patients treated with dilute vinegar solution had resolution of their original otorrhoea within three weeks, whereas two-thirds of patients recovered within three weeks when treated with antibiotic ear drops. The disadvantages of dilute vinegar therapy were canal irritation with pain and dizziness. When the therapeutic efficacy was compared statistically, a dry ear was attained in the dilute vinegar-treated group at six weeks and six months in the antibiotic ear drop treated group (p<0.01). These results suggest that very low pH therapy using dilute vinegar solution is definitely effective in the management of granular myringitis.
Haemangioma of the frontal sinus
Authors: Harar R. P. S. , Wolfe K. Q. , Kumar S. , Gatland D. J.
Published: October 2002

A 71-year-old lady underwent successful excision of a haemangioma of the frontal sinus, via an osteoplastic flap approach. Haemangioma of the paranasal sinuses is an extreme rarity. A case is presented and the literature reviewed.
Primary nasopharyngeal tuberculosis in a patient with the complaint of snoring
Authors: Aktan Bülent , SelimoĞlu Erol , Üçüncü Harun , Sütbeyaz Yavuz
Published: October 2002

Isolated nasopharyngeal tuberculosis is a rare condition, even in endemic tuberculosis areas. The most common presentation of nasopharyngeal tuberculosis is with a cervical lymphadenopathy followed by nasal discharge or obstruction.

Here we present a 58-year-old patient with nasopharyngeal tuberculosis whose only complaint was snoring. Her oropharyngeal and anterior rhinoscopic examination was normal. On endoscopic examination, mucosal oedema and hyperaemia of the nasopharynx was observed. There was no cervical lymphadenopathy. The tuberculin skin test was positive and histopathological examination of the biopsy taken from posterior nasopharyngeal wall supported the diagnosis of tuberculosis. After anti-tuberculosis therapy, the snoring stopped and the nasopharyngeal examination was normal.
Common carotid artery dissection: A rare cause for cervical pain
Authors: Hirth Kristine , Sander Susanne , Hörmann Karl
Published: October 2002

Spontaneous dissections of extracranial carotid arteries occur most frequently in the internal carotid artery. In contrast, common carotid artery dissection (CCA) is a rare cause of cerebral ischaemia with only a few cases having been reported. We present the case of a 59-year-old male patient who was referred to our clinic with left cervical pain. The patient was otherwise asymptomatic. Magnetic resonance imaging (MRI) showed enhancement and double lumen in the left CCA without affecting the carotid bulb, internal carotid artery or aortic arch. We discuss the diagnostic and therapeutic management of the disease, focusing on its differentiation from other causes of cervical pain.
Myxofibrosarcoma of the sphenoid sinus
Authors: Lam Paul K. Y. , Trendell-Smith Nigel , Li Jimmy H. C. , Fan Y. W. , Yuen Anthony P. W.
Published: October 2002

Myxofibrosarcoma was originally described as the myxoid variant of malignant fibrous histiocytoma (MFH). It is uncommon in the head and neck region. We hereby report a case of myxofibrosarcoma in the sphenoid sinuses. The diagnostic and management difficulties are discussed. Close collaboration between surgeon, radiologist, histopathologist and clinical oncologist in making accurate diagnosis and appropriate management of this rare tumour are emphasized.
Results of type 1 tympanoplasty in children and parental perceptions of outcome of surgery
Authors: Sheahan Patrick , O’Dwyer Tadhg , Blayney Alexander
Published: October 2002

The goals of tympanoplasty in children include improvement in hearing, prevention of earinfections, and elimination of the need for water precautions. However, tympanoplasty in children is a controversial subject. In the present study the outcome of tympanoplasty in children is examined with regard to its success in achieving these goals and to the level of parental satisfaction with its outcome. Fifty-four children undergoing 62 tympanoplasties at our institution were included in the study. The surgical success rate was 72.5 per cent. Fifty per cent of parents reported that their child’s hearing had improved (p = 0.181 for association with surgical success), 78 per cent reported a decrease in ear infections (p = 0.023), 45 per cent reported their child to be participating in activities previously refrained from (p = 0.003), and 79 per cent of parents were satisfied with the overall surgical outcome (p < 0.001). Our findings show that successful tympanoplasty may confer benefits on children and may help guide parents’ expectations of the surgery.
The Glasgow benefit inventory in the evaluation of patient satisfaction with the bone-anchored hearing aid: quality of life issues
Authors: Dutt Sunil N. , McDermott Ann-Louise , Jelbert Anwen , Reid Andrew P. , Proops David W.
Published: October 2002

The Birmingham osseointegration programme began in 1988 and during the following 10 years there were a total of 351 bone-anchored hearing aid (BAHA) implantees. In the summer of 2000, a postal questionnaire study was undertaken to establish the impact of the bone-anchored hearing aid on all aspects of patients’ lives.

We used the Glasgow benefit inventory (GBI), which is a subjective patient orientated post-interventional questionnaire especially developed to evaluate any otorhinolaryngological surgery and therapy. It is maximally sensitive to any change in health status brought about by a specific event: in this case the provision of a BAHA.

A total of 312 bone-anchored hearing aid patients, who had used their aids for a minimum period of six months, were sent GBI questionnaires. Two hundred and twenty-seven questionnaires were returned and utilized in the study. The results revealed that the use of a bone-anchored hearing aid significantly enhanced general well being (patient benefit), improved the patient’s state of health (quality of life) and finally was considered a success by patients and their families.
A simple polymerase chain reaction assay for genotyping the retinal degeneration mutation (Pdebrd1) in FVB/N-derived transgenic mice
Authors: Giménez E. , Montoliu L.
Published: October 2002

FVB/N mice are one of the most common inbred strains for the generation of transgenic animals. This mouse strain is preferred for transgenesis because of its fertilized oocytes, which have unique pronuclei for microinjection, and its vigorous reproductive performance along with consistently large litter sizes. However, these inbred mice carry a retinal degeneration mutation caused by a proviral insertion into the Pdeb gene, encoding the β subunit of cGMP phosphodiesterase. This mutation ( Pdebrd1, formerly known as rd) results in postnatal rod photoreceptor degeneration and causes severe visual impairment, which may be relevant for behavioural and vision-related research. This deficit can be overcome by crossing these mice with other mouse strains carrying the wild-type allele at the Pdeb locus. We have devised a simple polymerase chain reaction (PCR)-based method for distinguishing between the mutant and the wild-type alleles, thus allowing the efficient monitoring of the Pdebrd1 mutation in FVB/N-derived transgenic mice prior to experimentation where visual deficit is expected to have an influence in the phenotype.
Development and validation of a sensitive ELISA for quantification of secretory IgA in rat saliva and faeces
Authors: Hau J. , Andersson E. , Carlsson H.-E.
Published: October 2002

Non-invasive measures of immunological markers are an attractive means of stress assessment in laboratory animals. Salivary IgA has been used successfully as a stress marker in the human, and several reports indicate the potential of secretory IgA as a non-invasive measure of stress in animals. The present paper describes the development of an ELISA using commercially available components for the quantification of rat IgA and validation of this assay for the quantification of rat secretory IgA in saliva and faeces. The concentration of IgA in rat saliva varied significantly between duplicate samples obtained from individual rats, and the viscosity and small total volume of rat saliva gave unsatisfactory results for IgA. Faecal IgA was present in high concentrations, and duplicate samples varied by only 2-3%. However, faecal IgA seemed less stable than IgA in other biological compartments, and this finding must be taken into consideration when using quantitative measurements of IgA as a marker of mucous humoral immune status.
Middle-latency auditory evoked potentials during induction of thiopentone anaesthesia in pigs
Authors: Martoft L. , Jensen E. W. , Rodriguez B. E. , Jørgensen P. F. , Forslid A. , Pedersen H. D.
Published: October 2002

A method is described for measuring middle-latency auditory evoked potentials (MLAEP) in consciously awake, non-sedated pigs during the induction of thiopentone anaesthesia (0.6 ml/kg, 2.5% thiopentone solution). It was done by using autoregressive modelling with an exogenous input (ARX). The ability to perceive pain during the induction was compared with (1) the changes in latencies and amplitudes of the MLAEP, (2) the change in a depth of anaesthesia index based on the ARX-model and (3) the change in the 95% spectral edge frequency. The pre-induction MLAEP was easily recordable and looked much like the one in man, dogs and rats. The temporal resolution in the ARX method was sufficiently high to describe the fast changes occurring during induction of thiopentone anaesthesia. As previously reported from studies in man, dogs and rats, induction of thiopentone anaesthesia resulted in significantly increased latencies and decreased amplitudes of the MLAEP trace as well as in a significantly reduced depth of anaesthesia index and spectral edge frequency. None of the changes, however, related well to the ability to react to a painful stimulus. Whether an ARX-based depth of anaesthesia index designed especially for pigs might be better than the present index (designed for man) for assessing depth of anaesthesia must await the results of further studies.
Policies, priorities, opportunities and barriers in mental health services: five years of the London managers survey
Authors: Peck Edward , Wigg Stefan
Published: October 2002

Since 1996, an annual survey of senior managers of mental health services in London has been undertaken in order to identify trends in their views of their task. This is the only longitudinal study in the current literature of the views of a group of health and social care managers in England. This paper first outlines the methods and the findings of the survey in 2000, drawing comparisons with data collected in 1998 and 1999 (and occasionally earlier). The discussion section draws out the central themes that emerge from the surveys: firstly, community mental health teams hold a central role in the mental health system; secondly, the development of trust between agencies is a complex challenge; thirdly, it appears that social care managers may be more committed to implementation of national policy than their health colleagues; fourthly, personal and organizational instability is a fact of life; and finally, the relationship between the promulgation of national policy and its adoption into local practice is not straightforward. The conclusion reflects on the potential implications of these findings for the future development of mental health services in England.
A retrospective study of neutropenia in HIV disease
Authors: Moore David A J , Sullivan Ann , Hilstead Paul , Gazzard Brian G
Published: October 2002

In aiming to define the characteristics of HIV-infected subjects developing neutropenia and describe the causes, features and effects of neutropenia we undertook a retrospective study in a dedicated HIV unit in London, UK. Two hundred and forty-four patients with documented neutropenia, defined as absolute neutrophil count (ANC) < 1000/mm 3, during a 12-month period were studied. First neutropenia occurred at a median CD4 count of 30 cells/mm 3. Low CD4 count was associated with longer episodes of neutropenia with a more profound nadir. Two thirds of episodes lasted less than 2 weeks. ANC nadir was < 500 cells/mm 3 in 45% of episodes. Infections were most frequent in patients with profound but brief neutropenic episodes. Neutropenia was generally mild, short-lived and associated with late-stage disease. However, profound neutropenia did develop suddenly in some patients with no prior history of neutropenia (in 13% first neutropenic ANC recorded was 500 cells/mm 3), and at CD4 count> 200 cells/mm 3. Most patients were receiving multiple myelosuppressive therapies. Infection was associated with brief, profound neutropenia.
Blood-borne virus infection: the occupational risks
Authors: Riddell L A , Sherrard J
Published: October 2002

Healthcare workers who are in contact with patients and/or clinical material are at continuous risk of acquiring blood-borne viral infections, in particular, infection with hepatitis B virus, hepatitis C virus and the human immunodeficiency virus (HIV). Prevention of occupational exposure is dependent on education. Prevention strategies include immunization, exposure avoidance by the use of universal precautions at all times, and post-exposure advice and prophylaxis. This article will review the risks to healthcare workers associated with exposure to hepatitis B, hepatitis C, and HIV. It will discuss post-exposure management in the United Kingdom (UK) and briefly outline the risks to patients from infected healthcare workers.
Asymptomatic gonorrhoea and chlamydial infection in a population-based and work-site based sample of men in Kilimanjaro, Tanzania
Authors: Klouman Elise , Masenga Elisante J , Sam Noel E , Klepp Knut-Inge
Published: October 2002

The aim of this study was to screen healthy rural and urban Tanzanian men for chlamydial infection and gonorrhoea, and determine the prevalence and the predictive value of urethral symptoms, signs and pyuria. In 2 cross-sectional surveys, 796 men were interviewed regarding symptoms and examined for signs of urethritis. Gonorrhoea was detected by culture/Gram-stained smears, Chlamydia trachomatis by antigen immunoassay, and pyuria by leukocyte esterase dipstick test. The prevalence of chlamydial infection, gonorrhoea and pyuria among rural men was 9.6%, 0.4%, and 12.7%, and among urban bar workers 7.4%, 8.1% and 6.3% respectively. Among all, 0.6% had urethral discharge confirmed by examination, while 2.6% reported urethral discharge and 7.4% dysuria. Among chlamydiainfected men, 59 (89%) of the 66 cases did not have urethritis symptoms or signs. Similarly, 24 (88%) of 28 men with gonorrhoea were asymptomatic. Treatment based on the urethral discharge sign, would have detected only one out of 92 cases with gonorrhoea and/or chlamydia in these populations.
Sexually transmitted infection as a risk factor for homosexual HIV transmission: a systematic review of epidemiological studies
Authors: Bonell C , Weatherburn P , Hickson F
Published: October 2002

Existing reviews suggest some sexually transmitted infections (STIs) are risk factors in heterosexual HIV transmission. This may not be so in homosexual HIV transmission, about which reviews make no specific conclusions. This paper reviews published studies which report on the relative risk of STIs in HIV seroconversion in homosexually-active men in order to examine this matter. Papers obtained via various searches were judged adequate if they were prospective cohort or cohort-nested case-control studies; used HIV seroconversion as the outcome; assessed STI exposure objectively; and controlled for potential confounding from age and sexual behaviour. Sixteen papers were obtained, of these 3 were judged adequate. Adequate papers reported little association. Inadequate papers were more likely to report association. Evidence from adequate studies does not suggest STIs are risk factors in homosexual HIV transmission. Some caution is needed in interpreting the results because of the paucity of adequate studies.