bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid measurement of insulin using the Abbott IMx: application to the management of insulinoma
Authors: Albright Suzanne V , McCart J Andrea , Libutti Steven K , Bartlett David L , Alexander H Richard , Sampson Maureen L , Ruddel Mark E , Remaley Alan T
Published: October 2002

Background: Patients with multiple endocrine neoplasia (type 1) often present with multiple pancreatic endocrine tumours, such as insulinomas. A major difficulty in the surgical treatment of such patients is identifying which tumours are functionally active and therefore need to be resected for a cure. The objective of this study was to develop a rapid insulin assay that could be used intraoperatively for identifying insulinomas from pancreatic aspirates.

Methods: By reducing the incubation time and by increasing the sample volume, a rapid insulin assay was developed on the IMx analyser. This was used to measure insulin from tissue aspirates collected from suspected insulinomas under ultrasound guidance.

Results: The rapid insulin assay ( y) could be performed in 14 min and showed a good correlation with the standard IMx ( x) insulin assay ( y=0·808 x+0·04; r2=0·986). Using the rapid insulin assay on pancreatic tissue aspirates, insulinomas could be readily distinguished from normal pancreatic tissue or from non-functional adenomas based on a marked increase in insulin content.

Conclusion: In summary, a new rapid assay for insulin is described that compares favourably to the standard IMx insulin assay and can potentially be used intraoperatively on pancreatic aspirates for identifying functionally active insulinomas.
Continuous glucose monitoring and haemoglobin A1c
Authors: Sharp Patrick , Rainbow Sandra
Published: October 2002

Background: Measurement of HbA1c is the standard test for assessment of glycaemic control in diabetic subjects. Using new glucose sensing technology we re-evaluated the significance of HbA1c in terms of the aspects of the blood profile it measures in patients with diabetes.

Methods: In a group of 27 patients with type 1 diabetes, interstitial fluid glucose concentrations were monitored for a mean of 2·6 days using the Continuous Glucose Monitoring SystemTM (MiniMed Inc, CA, USA). Results were correlated with an HbA1c measurement taken at the time of sensor insertion.

Results: Results were available in 25 subjects, two datasets being lost due to patient error. There was a correlation between mean sensor glucose value, and the HbA1c value ( r=0·59, P=0·002). The correlation with standard deviation of the readings was weaker (r=0·3, P=0·15). No other descriptor of the sensor glucose concentration correlated with HbA1c.

Conclusion: The mean interstitial glucose concentration recorded with the Continuous Glucose Monitoring System correlates with HbA1c level recorded at the time, but with no other marker of glucose control in diabetic subjects. These results have implications for the interpretation of HbA1c concentrations in type 1 diabetes.
Discrepancy between visual and spectrophotometric assessment of sample haemolysis
Authors: Hawkins Robert
Published: October 2002

Background: This study assessed the agreement between visual grading of sample haemolysis with automated haemolysis index (H index) measurement on the Roche 917 clinical chemistry analyser.

Methods: The H indices of 800 serum potassium samples and 800 EDTA plasma troponin I samples were compared with routine visual grading of sample haemolysis by technologists. Photographs of mild (haemoglobin 1 g/L), moderate (2·5 g/L) and severe (5 g/L) haemolysis were available for reference.

Results: For serum samples, the weighted kappa coefficient was 0·42 with an 8·0% haemolysis rate determined by visual inspection and 3·4% by H index. For EDTA-plasma samples, the weighted kappa coefficient was 0·35 with a 4·5% haemolysis rate determined by visual inspection and 7·9% by H index.

Conclusion: Visual assessment of sample haemolysis is unreliable and can give variable results depending on sample type. Laboratories should consider investigating sample haemolysis using automated haemolysis index measurement as an alternative to visual grading whenever it is available.
Macro-alkaline phosphatase due to IgG κ complex: demonstration with polyethylene glycol precipitation and immunofixation
Authors: Owen MC , Pike LS , George PM , Barclay ML , Florkowski CM
Published: October 2002

An otherwise unexplained, persistently elevated plasma alkaline phosphatase concentration in a 71-year-old woman was found to be attributable to the presence of macro-alkaline phosphatase using polyethylene glycol precipitation. Gel filtration showed two high MW peaks with masses of about 330 kDa and 560 kDa. The alkaline phosphatase (ALP) complex was characterized by immunoelectrophoresis as a complex with IgG with κ light chains.
Japanese familial hypercholesterolaemia with a 327insC mutation in the LDL receptor gene
Authors: Hirota Ryoji , Kubo Nobuhiko , Hikiji Kazumasa , Nakajima Kumiko , Hata Yoshiya , Sakurabayashi Ikunosuke
Published: October 2002

Mutations in the LDL receptor (LDLR) cause familial hypercholesterolaemia (FH) in an autosomal dominant manner. The condition frequently progresses to coronary atherosclerosis. We describe a patient with FH, but without ischaemic heart disease, who had a novel frameshift mutation (327insC) in exon 4 of the LDLR gene. This mutation introduced a premature termination codon (TGA, codon 158). The patient was a 59-year-old man who had presented with hypercholesterolaemia and a plasma total cholesterol (TC) concentration of 12·2 mmol/L at age 44 years. The mutation 327insC in this patient was heterozygous and hypercholesterolaemia was common within his family. Despite taking lipid-lowering medications (probucol and pravastatin) for more than 20 years, his TC concentration hardly fell below 7·8 mmol/L. However, neither the patient nor anyone else in his family developed characteristic symptoms of ischaemic heart disease or xanthoma. This patient was discovered by an intensive mutation survey among 22 unrelated Japanese with FH mainly in the Kanto area of Japan, suggesting a low incidence of the mutation in the area.
Limitations of Pneumovax® as a detection antigen in the measurement of serotype-specific antibodies by enzyme-linked immunosorbent assay
Authors: Huo ZM , Miles J , Riches PG , Harris T
Published: October 2002

Background: Measurement of antibody responses to polysaccharide antigens is regarded as an important assessment of an individual's ability to respond to carbohydrate antigens. The currently used assays for the measurement of pneumococcal-specific antibody use the multi-serotype vaccine Pneumovax® as the detection antigen.

Methods: An equal potency enzyme-linked immunosorbent assay (ELISA) system was used to compare the measurement of serotype-specific antibody with the multi-serotype assay.

Results: Our results show that the concentration of specific antibody to Pneumovax is not related to the concentration of antibody to the individual serotypes. Neither is any correlation found between the antibody concentrations to any of the three single serotypes investigated, to the mixture of the three serotypes or to Pneumovax.

Conclusion: We conclude that the measurement of the concentration of the specific antibody to the mixed serotypes present in Pneumovax has serious limitations when used to evaluate the protection acquired from Pneumovax immunization against any specific serotype.
Using Medline to achieve an evidence-based approach to diagnostic clinical biochemistry
Authors: Fielding Andrew M , Powell Anne
Published: October 2002

Medline is the US National Library of Medicine database that is used for searching the medical biochemistry literature. The database is structured using medical subject subheadings (MeSH terms) to classify the content of references; indexing is done manually using MeSH terms as key words. Searching the database effectively means finding the maximum number of relevant references together with the minimum number of irrelevant ones. This article is aimed at explaining the limitations of Medline and suggesting some solutions to key problems. The goal is that users can improve their literature search technique by employing a structured approach. As usual, asking relevant questions before starting a search is essential.
Screening for colorectal cancer
Authors: Starkey Bryan J
Published: October 2002

Colorectal cancer (CRC) causes 20 000 deaths per annum in the UK alone. Screening has been shown to reduce mortality but debate exists as to which approach to use. Direct visualization of the colorectum has the advantage that it detects lesions most effectively and is required at less frequent intervals, but the procedure is invasive and at present too costly for screening purposes. Faecal occult blood measurement, despite its limitations, is currently the recommended screening method, with follow-up of positive tests by colonoscopy or other visualization techniques. This strategy has been shown to reduce mortality from CRC by about 20% and screening trials directed towards individuals in the over 50 years age group are underway in the UK and elsewhere. Future developments in CRC screening include colorectal visualization by computed colonography - a less-invasive alternative to colonoscopy. Developments in stool analysis are also occurring. Examination of faecal samples for cellular products derived from neoplasms (e.g. calprotectin) may prove more sensitive and specific than faecal occult blood measurements. In addition, detection of altered DNA in faeces is being investigated by molecular biology techniques. Using a multi-target assay panel to detect point mutations and other neoplasia-associated DNA abnormalities may be an effective strategy for CRC screening in the future.
Hoarse voice resulting from premature ageing in Werner’s syndrome
Authors: Tsunoda Koichi , Takanosawa Minako , Kurikawa Yukiko , Nosaka Kenji , Niimi Seiji
Published: October 2002

Werner’s syndrome is characterized by clinical signs of premature ageing. A 42-year-old man presented with three-year history of hoarseness. Also noted were skin atrophy of the face and hands, ulcerations around the ankles, and a history of cataracts. A clinical diagnosis of Werner’s syndrome was made. Laryngoscopy revealed bowed vocal folds resulting in a spindle-shaped defect with glottal incompetence during phonation. Examination also revealed decreased maximum phonation time and vocal fatigue. At surgery, atrophy of the vocalis muscle was noted. Furthermore, degeneration of muscle fibres was noted in the temporalis muscle. The atrophic changes in the vocal folds that occur with ageing and result in an increased fundamental frequency were seen in this patient. The characteristic hoarseness of Werner’s syndrome appears to be the result of premature ageing of the vocal folds.
Pleomorphic adenoma of tongue base causing dysphagia and dysphasia
Authors: Yoshihara Toshio , Suzuki Saori
Published: October 2002

A case of an 87-year-old female with pleomorphic adenoma of the tongue base is reported, with a review of the literature. The tumour had enlarged gradually over a period of three years, causing dysphagia and dysphasia. Computed tomography and magnetic resonance imaging showed that the tumour was exophytic and occupy the oropharynx with little extension into the muscle tissue. The tumour was resected by CO2 laser. Histological examination revealed a benign pleomorphic adenoma that originated from the minor salivary gland of the tongue base.
Endoscopic stapling of pharyngeal pouches in patients from the Yorkshire region
Authors: Sood S. , Newbegin C. J. R.
Published: October 2002

The treatment of pharyngeal pouches by endoscopic stapling diverticulotomy has gained popularity over the last few years. We assessed the results of this technique in 44 patients by means of a clinical questionnaire and by reviewing case records. Thirty – six (82 per cent) patients commenced oral intake within 18 hours of the procedure and 37 (84 per cent) patients were discharged within 48 hours. Five patients had complications that included throat discomfort, a loose incisor tooth, shoulder pain, pharyngeal perforation and one mortality due to mediastinitis. Of the 37 patients that completed the questionnaire, nine (24 per cent) had some residual symptoms although only two (five per cent) felt that there had been no improvement at all following the stapling procedure. Thirty – five (95 per cent) of the patients stated that they would undergo the procedure again. It appears that pharyngeal pouches can be successfully treated by endoscopic stapling, with patients commencing oral intake within a few hours of surgery and having a short hospital stay. However, as there can be serious complications, we recommend that the procedure be performed by an experienced surgeon.
Optimum imaging for inverted papilloma
Authors: Savy Lloyd , Lloyd Glyn , Lund Valerie , Howard David
Published: October 2002

Inverted papilloma is the most common benign tumour of the nose and paranasal sinuses, and usually arises in the lateral wall of the nasal cavity and the middle meatus. The diagnosis is suggested on computed tomography (CT) when there is a mass continuous from the middle meatus into the adjacent maxillary antrum, through an expanded maxillary ostium. The mass may contain areas of high density or calcification, and there may be sclerosis of the wall of the affected sinus. The main advantage of magnetic resonance imaging (MRI) is in defining the extent of the tumour, and in differentiating it from adjacent inflammatory tissue, but there are no certain signal intensity or enhancement characteristics to help differentiate inverted papilloma from sinus malignancy. In the differential diagnosis, antro – choanal polyp, malignant sinus tumours and chronic rhinosinusitis and fungal disease need to be excluded. The combination of bone deformity and sclerosis with the typical antro – meatal mass suggests a slow – growing tumour such as inverted papilloma.
Duration of antibacterial effectiveness of gentamicin ear drops in external otitis
Authors: Colodner Raul , Keness Yoram , Rakover Yoseph , Smuskovitz Amnon , Rosen Gabriel
Published: October 2002

The recommendation of Anderson and Steele, for the use of ear drops four times a day, has not been changed since 1948. In order to re – evaluate the frequency of using ear drops, we examined the duration of the effectiveness of the antibacterial activity of gentamicin ear drops in external otitis. Seventeen patients (25 ears) with external otitis were studied. We took 18 samples from each ear at 0, 1, 2, 3, 6, 8, 10, 12 and 14 hours and measured the concentration of gentamicin on the wick and in the ear canal. We found that the concentration of gentamicin began to decrease only after 12 hours and a more significant decrease was detected after 14 hours of treatment. We have shown that the antibiotic used on the wick is effective for 12 hours. In conclusion, we recommend using ear drops twice a day on a wick as routine therapy for external otitis.
A concha bullosa crusher for use in endoscopic sinus surgery
Authors: Woolford T. J. , Jones N. S.
Published: October 2002

A concha bullosa may require surgical reduction to facilitate access to the middle meatus during endoscopic sinus surgery. Here we describe an original instrument which enables this procedure to be performed simply with minimal mucosal damage.
Vallecular cyst: report of four cases - one with co-existing laryngomalacia
Authors: Ku Albert
Published: October 2002

Congenital vallecular cysts are rare. In this report, four infants having vallecular cysts encountered over a six-year period from 1992 to 1997 were reviewed. All of them presented with upper aerodigestive tract symptoms. Marsupialization was performed in three of them and CO2 laser excision was performed in the fourth patient. There was no recurrence of the cyst in any patient. One of them also had co-existing laryngomalacia. The degree of airway collapse caused by laryngomalacia improved after cyst removal. The laryngomalacia resolved spontaneously. Cyst fluid culture was performed in one of the patients and yielded Staphylococcus aureus but there was no other definite indicator of infection. Staphylococcus aureus could also be isolated in the respiratory tract from two of the other patients.
Metastatic endometrial carcinoma of the neck
Authors: Siddiq M. A. , Bhudia S. K. , Gana P. , Patel J.
Published: October 2002

We report a case of metastatic endometrial carcinoma of the neck. A patient with a past medical history of squamous cell carcinoma of the larynx, breast carcinoma and endometrial carcinoma presented with a neck mass. Fine needle aspiration cytology (FNAC) showed this to be a poorly differentiated carcinoma with squamoid features and thus a potentially curative neck dissection was performed. Histology of the mass showed a clear cell endometrial carcinoma. Metastatic gynacecological malignancies to the head and neck are rare and this is the first reported case of metastatic endometrial carcinoma in the neck.
Microbiology of the middle meatus: a comparison between normal adults and children
Authors: Gordts Frans , Halewyck Stijn , Pierard Denis , Clement Peter A. R. , Kaufman Leonard
Published: October 2002

Middle meatal samples were obtained from 52 carefully selected healthy adults. In 75 per cent of the test subjects bacterial organisms were cultured. However, growth was often poor and the predominant species suggest a commensal flora: coagulase-negative staphylococci were retrieved from 35 per cent, Corynebacterium sp. from 23 per cent and Staphyloccus aureus from eight per cent of the adults. These data are very different from those previously obtained among children where – even in the absence of obvious ENT pathology – the most frequently cultured organisms were typical sinusitis pathogens: Haemophilus influenzae present in 40 per cent, Moraxella catarrhalis in 34 per cent and Streptococcus pneumoniae in 50 per cent of children. Furthermore, Streptococcus viridans and Neisseria sp., both organisms that might be able to inhibit colonization by some of the pathogens and found commonly among children, are virtually absent in healthy adults.
Improving the endoscopic view of the hypopharynx with anterior neck traction during the trumpet manoeuvre
Authors: Colquhoun-Flannery W. , Davis A. , Carruth J. A. S.
Published: October 2002

The postcricoid subsite is difficult to visualize on flexible laryngopharyngoscopy. The view can be improved with either auto-insufflation manoeuvres or anterior neck skin traction. In this study, the view of the hypopharynx was graded whilst anterior neck skin traction was applied during the trumpet manoeuvre; the latter involves the patient blowing on his finger as if blowing up a balloon. On auto-insufflation alone, the postcricoid site was demonstrated in 22/25 (88 per cent) of cases and the upper oesophageal sphincter (UOS) in two out of 25 (eight per cent). Of the 22 cases in whom only the postcricoid site was demonstrated, subsequent neck skin traction revealed the UOS in eight. Overall, the use of auto-insufflationsolely or in combination with traction resulted in UOS visualization in 40 per cent (10/25) of cases. The application of skin traction during trumpeting is easy to perform and should be used routinely.
Non-pseudomonal malignant otitis externa and jugular foramen syndrome secondary to cyclosporin-induced hypertrichosis in a diabetic renal transplant patient
Authors: Lancaster J. , Alderson D. J. , McCormick M.
Published: October 2002

We present the case of a 58-year-old diabetic renal transplant patient who developed a left jugular foramen syndrome, secondary to an ipsilateral staphylococcal malignant (necrotizing) otitis externa. This followed a protracted episode of uncomplicated otitis externa with no evidence of bone involvement on computed tomography (CT) scanning. Cyclosporin-induced hypertrichosis (excess hair growth) in his external auditory canal contributed greatly to the initial difficulty in managing his otitis externa. Following an initial successful treatment with prolonged intravenous antibiotics the patient relapsed with a secondary infection in the same anatomical site due to Candida parapsilosis. Despite further intensive treatment including antimicrobials, a subtotal petrosectomy and hyperbaric oxygen therapy he eventually succumbed to his disease.
Tubular expanded polytetrafluoroethylene implants in glottal and neoglottal insufficiency: implantation technique in an animal model
Authors: Tamplenizza Paolo , Acocella Fabio , Bolandrini Enrico
Published: October 2002

The problem of the therapy of glottal and neoglottal insufficiency is still unsolved. The surgical techniques and the materials employed up until now are not completely free from possible partial or total failures, early or late complications, or the need of a second operation. The objective of the study is to introduce a new thyroplasty technique of inserting tubular expanded polytetrafluoroethylene (e-PTFE) into the larynx of an animal model, with the purpose of using it next in human laryngeal tissue augmentation. Seven 30 kg pigs had tubular e-PTFE implanted under endoscopic control into a vocal fold or laryngeal vestibule. The implants were secured by suture to the thyroid cartilage. Short-term results demonstrate the ease and effectiveness of this mini-invasive implant surgical technique. Long-term follow-up is underway in anticipation of applying this technique to human laryngeal tissue augmentation.
Cavernous haemangioma of the internal auditory canal
Authors: Shaida A. M. , McFerran D. J. , da Cruz M. , Hardy D. G. , Moffat D. A.
Published: October 2002

Cavernous haemangiomas are rare lesions of the cerebello-pontine angle that can mimic the more commonly occurring vestibular schwannoma. A case report involving a patient with a cavernous haemangioma of the internal auditory canal (IAC) highlights this as a diagnostic possibility for lesions of the IAC by comparing and contrasting the clinical and radiological findings with the more commonly occurring vestibular nerve and facial schwannomas.

Symptoms such as hearing loss and facial paralysis that are disproportionate to the size of the lesion or fluctuate with hormonal changes such as those seen in pregnancy are suggestive of haemangioma. Radiological imaging demonstrating a lesion enchancing with gadolinium and containing areas of calcification is also suggestive of haemangioma. It is important to consider the possible diagnosis of haemangioma as early recognition of this entity may improve the chances of preserving the functional integrity of the facial nerve.
Juvenile xanthogranuloma of the nasal cavity
Authors: Saravanappa N. , Rashid A. M. F. , Thebe P. R. , Davies J. P.
Published: October 2002

Juvenile xanthogranuloma is a benign, normolipaemic, self-healing condition and a type of histiocytosis that occurs most frequently in infants and children. This condition usually presents with solitary or multiple cutaneous lesions and occasionally with visceral lesions. We report a case of juvenile xanthogranuloma occurring in the nasal cavity. We believe this is the first report, in the English literature, of juvenile xanthogranuloma occurring in this site.
Malignant odontogenic myxoma of the maxilla: case with cytogenetic confirmation
Authors: Pahl Stefan , Henn Wolfram , Binger Thomas , Stein Ute , Remberger Klaus
Published: October 2002

An odontogenic myxoma of the maxilla with an aggressive clinical course is presented. The tumour arose in a 53-year-old patient, recurred two times after extended maxillectomy and ultimately caused the patient’s death by uncontrollable local disease with infiltration of the cranial cavity.

Microscopically, the tumour showed histological features of a low grade malignant myxosarcoma with cellular areas, enhanced mitotic activity and nuclear pleomorphism. Cytogenetic analysis revealed an unexpectedly aberrant hypertetraploid chromosome complement, that was considered as incompatible with the usual karyotypic patterns of benign tumours.
Computed tomography evidence of dental restoration as aetiological factor for maxillary sinusitis
Authors: Connor S. E. J. , Chavda S. V. , Pahor A. L.
Published: October 2002

Maxillary sinusitis due to dental causes is usually secondary to periodontal disease or periapical infection and is commonly associated with mucosal thickening of the floor of the maxillary antrum. Computed tomography (CT) is currently the modality of choice for evaluating the extent of disease and any predisposing factors in patients with symptoms of chronic maxillary sinusitis, but it is unable to diagnose dental disease reliably. The presence of restorative dentistry is, however, easily seen at CT and is associated with both periapical and periodontal disease. We aimed to determine whether its presence at CT may predispose to maxillary sinusitis, and in particular to focal mucosal thickening of the sinus floor characteristic of dental origin.

Three hundred and thirty maxillary sinus CT images in 165 patients were reviewed for the presence of restorative dentistry in the adjacent teeth, focal maxillary sinus floor mucosal thickening, any maxillary sinus disease (including complete opacification, air fluid levels, diffuse mucosal thickening, focal mucosal thickening) and evidence of a rhinogenic aetiology (osteomeatal complex pathology, mucosal thickening in other sinuses).

One hundred and ninety two sinuses adjacent to restorative dentistry and 178 sinuses not adjacent to restorative dentistry were analysed. Focal floor thickening both with, and without, evidence of a rhinogenic aetiology, was significantly more common adjacent to restorative dentistry. Maxillary sinus disease overall was no more common adjacent to restorative dentistry.

This work demonstrated that the presence of restorative dentistry predisposes to focal mucosal thickening in the floor of the maxillary sinus and its presence should prompt clinical and radiographical assessment to exclude dental disease as a source of chronic maxillary sinusitis.
Retrospective review of augmentation rhinoplasties using autologous cartilage grafts
Authors: Bateman N. , Jones N. S.
Published: October 2002

The use of graft materials in rhinoplasty presents many challenges for the surgeon. There are a wide variety of alloplastic materials available for nasal augmentation but the graft material of choice remains autologous cartilage. It has considerable advantages over alloplasts. It does not induce an immune response and has a very much lower rate of infection or extrusion. It is also easily harvested and sculpted and is available in plentiful supply. We present a retrospective review of 103 patients who underwent augmentation rhinoplasty using autologous cartilage grafts with a mean follow-up time of three years six months. The revision rate over the follow-up period was 15.5 per cent (n = 16). The same surgeon’s revision rate for rhinoplasty without graft over the same period was four per cent in 311 cases. We conclude that while autologous cartilage remains the best graft material available there is a significantly higher revision rate than when no graft is required. This is primarily due to the unpredictable scarring associated with the graft in the medium term and the asymmetric nature of conchal cartilage.
Cerebellopontine angle lymphoma presenting as chronic mastoiditis
Authors: Hill Nicola , Little Brad , Vasan Nilesh , Giles Malcolm
Published: October 2002

Middle-ear tumours are not uncommonly mistaken for mastoiditis on presentation. We report a case of cerebellopontine angle non-Hodgkin’s B-cell lymphoma originally presenting as a middle-ear inflammatory process. In mastoiditis not resolving with conventional treatment it is important to look for an underlying cause.
Primary chordoma of the ethmoid sinus
Authors: Loughran S , Badia L. , Lund V.
Published: October 2002

Primary chordoma of the paranasal sinuses are extremely rare tumours, with only a small number of cases verified and published in the literature. It appears that only five of these cases involved the ethmoid sinuses either as a primary or by local invasion, and of these documented cases only one other has been found to solely involve the ethmoid sinus. We present a case of primary ethmoid sinus chordoma treated by wide local surgical excision and present a review of the literature with regard to prevalence and treatment rationale.
Congenital facial nerve agenesis
Authors: Jervis P. N. , Bull P. D.
Published: October 2002

We present a case of a seven-year-old child with a congenital facial palsy, diagnosed at birth, who subsequently developed a non-tuberculous mycobacterial (NTM) infection of the ipsilateral parotid gland. This required parotid exploration to treat the NTM disease with the intention of identifying and protecting the facial nerve to preserve any residual facial nerve function. At operation, thorough exploration revealed the complete absence of the nerve both at the stylomastoid foramen and more peripherally within the substance of the parotid gland. Exploration of the facial nerve for congenital facial paralysis is not normally indicated. Surgical treatment, if required, tends to involve the use of techniques such as cross facial nerve and free vascularized muscle grafting. To our knowledge this is the first reported case of complete congenital facial nerve agenesis, diagnosed incidentally during a surgical procedure for an unrelated condition.
Magnetic resonance imaging in the investigation of sensorineural hearing loss: is contrast enhancement still necessary?
Authors: Annesley-Williams D. J. , Laitt R. D. , Jenkins J. P. R. , Ramsden R. T. , Gillespie J. E.
Published: October 2002

High resolution T2-weighted magnetic resonance (MR) imaging has been proposed as a rapid, inexpensive means of investigating patients with sensorineural deafness, particularly to exclude vestibular schwannomas. Whether the accepted ‘gold standard’ of contrast-enhanced T1-weighted images can be omitted, however, remains controversial. Over a 22-month period the use of axial turbo-spin echo T2-weighted images (T2W) were prospectively compared with contrast-enhanced T1-weighted spin echo scans in the evaluation of 513 patients presenting with audiovestibular symptoms. A 2-D T2W turbo spin echo (TSE) sequence with 3 mm slices was used in 340 patients while a 3-D sequence with overlapping 1 mm slices was used in 173 patients. The T2-weighted image findings were documented and subsequently compared with contrast-enhanced images. With the 2-D sequence 24 patients (25 lesions) had internal auditory meatus (IAM)/cerebello-pontine angle (CPA) masses identified by contrast-enhanced T1-weighted images, all of which were seen on the T2-weighted TSE sequence; there was one false positive ‘mass’ on the T2-weighted scans and one false negative case of IAM dural enhancement on T1-weighted imaging; six were considered normal initially on the T2-weighted images although three were subtly abnormal in retrospect. With the 3-D sequence three acoustic neuromas were all identified correctly with no false positive and only one false negative result (labyrinthitis). The 2-D and 3-D images were judged technically inadequate for clinical assessment in 15 and nine per cent respectively. We conclude that mass lesions of the IAM/CPA can be reliably identified on T2W TSE imaging but labyrinthine lesions may be missed without contrast enhancement. This is of particular importance in planning the management of neurofibromatosis type 2. Non-neoplastic disorders of the inner ear are also likely to be missed.
Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft
Authors: Woolford T. J. , Jones N. S.
Published: October 2002

The surgical closure of a nasal septal perforation is recognized as being particularly challenging. A series of 11 consecutive patients who underwent closure of a septal perforation using a mucosal flap/composite conchal cartilage graft technique are reviewed, and the surgical technique described. The size of the perforation repaired varied, with eight cases being 2 cm or more in diameter. There was no significant graft donor site morbidity and complete perforation closure was achieved in eight cases after a mean observation time of 19.8 months. These results suggest that this is a suitable technique for closing nasal septal perforation.
Role of a home care team in paediatric day-case tonsillectomy
Authors: Shah C. , Shahab R. , Robb P. , Roy D.
Published: October 2002

The feasibility of paediatric day-case tonsillectomy (PDCT) depends on its safety and acceptance by parents and patients. The purpose of our retrospective study of paediatric day-case tonsillectomy was to review the role of the home care team (HCT) in improving the safety and acceptance of the procedure.

Between January 1997 and June 1999, 352 consecutive children underwent day-case tonsillectomy. The notes and HCT assessment sheets were reviewed for telephone calls made by HCT or by parents, home visit by HCT, types of complication and their outcome.

The primary haemorrhage rate was 0.6 per cent. The effective day-case rate was 97 per cent. The unplanned admission rate was three per cent. The HCT visited about 25 per cent of patients at home. We conclude that paediatric day-case tonsillectomy is associated with high morbidity and considerable parental anxiety that can be dealt with by timely reassurance, support and advice by a dedicated HCT.
‘Hairy polyp’ of the pharynx in association with an ipsilateral branchial sinus: evidence that the ‘hairy polyp’ is a second branchial arch malformation
Authors: Burns B. V. , Axon P. R. , Pahade A.
Published: October 2002

The pharyngeal ‘hairy polyp’, or ‘dermoid’ has caused considerable debate as to its origin since the original classification proposed by Arnold in 1870.1 This classification implies that the hairy polyp is either a teratoma or sequestration dermoid cyst. Many papers contest this view, in favour of a developmental malformation. We describe the first case of a hairy polyp in association with an ipsilateral branchial sinus as further supportive evidence of a developmental malformation of the second branchial arch.
Spontaneous recovery of profound post-meningitic hearing loss
Authors: Marx R. D. , Baer S. T
Published: October 2002

The timing of insertion of a cochlear implant (CI) in post-meningitic sensorineural hearing loss is, in spite of recent advances in the understanding of the pathogenesis of the condition, still controversial. The danger of labyrinthitis ossificans allows only a little time to decide whether to implant a CI or not. On the other hand the clinician needs to be certain that no residual hearing is present and whether or not the patient will benefit from conventional amplification. A well-documented case of early spontaneous recovery of a profound post-meningitic sensorineural hearing loss in a child is presented and the relevant literature reviewed.
Combined ‘trache-stent’: a useful option in the treatment of a complex case of subglottic stenosis
Authors: Morris D. P. , Malik T. , Rothera M. P.
Published: October 2002

The authors describe the adaptation of a Montgomery T-tube laryngo-tracheal stent to incorporate an uncuffed fenestrated Shiley tracheostomy tube in the management of a complex case of subglottic stenosis. The combined ‘ trache-stent’ provided a secure, unobstructed airway and optimal phonation. The presence of a removable inner tube facilitated cleaning and reduced patient anxiety regarding the perceived risks of stent obstruction with dried secretions.

The combined ‘ trache-stent’ was upsized at four weeks with minimal evidence of local granulation formation. The device was removed entirely six weeks later after direct laryngoscopy reconfirmed the above findings. Almost two years later the patient retains a good voice and airway using a simple fenestrated tracheostomy tube and speaking valve. The subglottic area is stable and the patient has returned to full-time employment.
Relapsing polychondritis associated with monoclonal gammopathy in a patient with myelodysplastic syndrome
Authors: Banerjee  , Morris  , Rothera  , Routledge
Published: October 2002

Relapsing polychondritis is a rare condition characterized by inflammation and subsequent degeneration of cartilages. Deformity of the pinna, nasal saddling and stridor due to involvement of the cartilages of the respiratory tract may lead to patients being referred to the otolaryngologist for initial assessment and further management. Recent observations have suggested that relapsing polychondritis may occur as a paraneoplastic phenomenon in cases of myelodysplasia. The case of a patient with relapsing polychondritis, myelodysplastic syndrome and a monoclonal gammopathy is presented. The authors highlight the apparent existence of this association and encourage otolaryngologists to consider such possible links when cases of relapsing polychondritis present to the outpatients department.
Extensive metastatic renal cell carcinoma presenting as facial nerve palsy
Authors: Kundu  , Eynon-Lewis  , Radcliffe
Published: October 2002

Metastatic lesions of the parotid gland are well described in the literature. Metastatic spread to the parotid from renal cell carcinoma is rare. We present the only reported case of facial nerve palsy caused by a metastasis to the parotid from a renal cell carcinoma.
Calcium oxalate granuloma of the nose of a chronically dialysed nephritic patient
Authors: Böör Andrej , Jurkovič Ivan , Friedmann Imrich , Benický Marian , Kočan Pavol
Published: October 2002

The patient was a 54-year-old woman who had been suffering from chronic tubulo-interstitial nephritis for about seven years, requiring haemodialysis. More recently, she developed a polypoid mass in the left nasal cavity causing discomfort on breathing and slight epistaxis. The tumour was of gritty consistency and measured 28 × 8 × 5 mm. Microscopy showed a lobulated almost cystic structure composed of granulation tissue with comparatively few plasma cells and many multinucleated giant cells lining the spaces filled with crystalline deposits of calcium oxalate.
Cervical paragangliomas: diagnosis, management and complications
Authors: Thabet M. Hossam , Kotob Hesham
Published: October 2002

Sixteen patients were diagnosed as suffering from cervical paragangliomas. Eleven patients (68.75 per cent) had twelve carotid paragangliomas (CPs), and five patients (31.25 per cent) had six vagal paragangliomas (VP). One CP (8.33 per cent) originated from paraganglia around the common carotid artery (CCA). Three cases of multiple paragangliomas are presented (18.75 per cent). In 80 per cent (4/5) of VP patients there was widening of the carotid bifurcation similar to that seen with CP. This widening occurred whenever the VP was large enough to grown in between the external carotid artery and internal carotid artery (ECA and ICA). Large VPs may displace the vessels either anterolaterally or anteromedially. Knowledge of the direction of the carotid displacement is essential to avoid intra-operative vascular injuries. Colour flow doppler ultrasound (CFD-US) was found to be a good non-invasive method for diagnosis of vascular neck swellings. It enabled the diagnosis of CP with 100 per cent accuracy, but it was not sufficient for diagnosis of high VP. A transcervical approach, cutting the digastric muscle and the styloid process with the attached ligaments and muscles, was sufficient for excision of most VP. However, midline mandibulotomy might be necessary with high VP. Vascular injuries occurred in 12.5 per cent (2/16) of patients. Superior laryngeal nerve and hypoglossal nerve paralysis occurred, respectively, in (2/11) and (1/11) of patients with CP. Vagal paralysis occurred in all patients with VP. Cerebrovascular accident and post-operative death occurred in one patient (6.26 per cent).
Plasma cell infiltration of the upper aerodigestive tract treated with radiation therapy
Authors: Fogarty Gerald , Turner Hugh , Corry June
Published: October 2002

A case of chronic, fluctuating plasma cell gingivostomatitis that progressed despite chemotherapy and surgery is reported. This is the first case reported of treatment with radiation therapy, and one of the few cases reported where the infiltrate has reached the larynx. After receiving low dose radiation therapy, via a conformal technique encompassing the respiratory mucosal lining from the base of tongue to carina, there has been symptomatic improvement.
Nitinol stent insertion for post-pneumonectomy syndrome
Authors: Harney Michael S. , Lacy Peter D. , O’Neill Shane , Walsh Michael
Published: October 2002

Post-pneumonectomy syndrome is an unusual condition, that can occur a variable period of time after a patient has had a pneumonectomy. Management of this syndrome has been described using a number of different techniques, often with considerable mortality. We present a case report where this condition was treated successfully by insertion of an expandable Nitinol stent. This is the first time this technique has been described to treat this condition, and we feel it may be the procedure of choice in managing these patients.
Long-term results of laser-assisted uvulopalatoplasty for snoring
Authors: Sharp H. R. , Mitchell D. B.
Published: October 2002

We present the ongoing results of the series of 53 consecutive patients who underwent laser-assisted uvulopalatoplasty (LAUP) for snoring at the Kent and Canterbury Hospital. Twenty-nine patients (55 per cent) were completely satisfied with their surgery 18 to 24 months following LAUP when previously questioned via telephone questionnaire.

We have followed up the 29 patients with a previously successful result at between 70 and 79 months following surgery. They underwent an average of 1.6 procedures. Twelve patients (22 per cent) continue to be completely satisfied at this late stage, and a further 12 (22 per cent) have some ongoing improvement in their snoring. Only three patients have indicated that a previously successful result has failed since the previous survey.

The failure rate of LAUP in the treatment of snoring is seen predominantly in the first two years following surgery, but some long-term subjective recurrence of snoring does occur.
Cowden’s disease: a rare cause of oral papillomatosis
Authors: Botma Marissa , Russell Derrick I. , Kell Robin A.
Published: October 2002

Cowden’s disease is a rare autosomal dominant condition with characteristic mucocutaneous papillomatous lesions. These lesions are mucocutaneous markers for increased risk of malignancies in the thyroid, breast and the gastrointestinal tract. We discuss the case of a 50-year-old female patient who presented with oral and cutaneous papillomoas and a past history of breast malignancy. Important management aspects of these patients are considered.
Applicability of the adult comorbidity evaluation – 27 and the Charlson indexes to assess comorbidity by notes extraction in a cohort of United Kingdom patients with head and neck cancer: a retrospective
study
Authors: Paleri V. , Wight R. G.
Published: October 2002

The term comorbidity stands for disease processes that co-exist and are not related to the index disease being studied. Comorbidity in cancer has been shown to be a major determinant in treatment selection and survival. Patients with head and neck cancer can have significant comorbidity owing to the high incidence of tobacco and alcohol abuse. No studies to date have addressed this problem in head and neck cancer patients in the United Kingdom. The applicability of the adult comorbidity evaluation – 27 index (ACE-27) and the Charlson index (CI) to assess the comorbidity burden by retrospective notes review is studied here. Retrospective data collection and completion of a comorbidity index in a United Kingdom setting is feasible. We conclude that the pre-assessment visit is a useful time to record comorbidity and as a significant amount of information required for grading relates to historical items, this is best done using a self-administered patient questionnaire.
An aberrant artery as a cause of massive bleeding following adenoidectomy
Authors: Windfuhr J. P.
Published: October 2002

Bleeding following adenoidectomy is a rare complication of this surgical procedure, and usually occurs in the first post-operative hours. In almost all cases it is related to adenoid remnants. Removal of these remnants under a second general anaesthetic is the treatment of choice. We report a case of massive bleeding three days following adenoidectomy related to the injury of an aberrant ascending pharyngeal artery during adenoidectomy performed elsewhere. Signs of manifest shock necessitated an immediate ligature of the external carotid artery and its individual branches. The post-operative course was uneventful. Two years later the boy underwent tonsillectomy without complications.
Immunocytochemical localization of lysozyme and lactoferrin attached to surface bacteria of the palatine tonsils during infectious mononucleosis
Authors: Stenfors Lars-Eric , Bye Helga-Marie , Räisänen Simo
Published: October 2002

Bacterial samples were obtained from the tonsillar surfaces of seven patients (four males, three females; median age 18 years, range 15 to 21 years) suffering from acute infectious mononucleosis with concomitant pharyngotonsillitis, and from five healthy controls. By using gold-labelled antiserum to human lysozyme and lactoferrin, micro-organisms on the tonsillar surfaces coated with these antibacterial substances could be identified by tracing the gold particles in the transmission electron microscope. In healthy individuals, most of the bacteria were coated with lysozyme and significantly more bacteria were coated with lysozyme than with lactoferrin (p < 0.01). In patients there was a non-significant reduction in lyoszyme-coating of the bacteria, whereas lactoferrin-coating was significantly increased (p < 0.01). Changes in the lysozyme and/or lactoferrin coating of the tonsillar surface bacteria on the palatine tonsils during infectious mononucleosis cannot explain the tendency to immense local bacterial colonization with commensals and proneness to bacterial penetration into the epithelial cells.
Fever and acquired torticollis in hospitalized children
Authors: Mezue W. C. , Taha Z. M. , Bashir E. M.
Published: October 2002

Acute torticollis due to non-traumatic atlanto-axial subluxation (AAS) is often seen in children presenting with inflammatory conditions of the upper respiratory tract and the neck. Grisel’s syndrome is the eponym given to this condition. These patients may present earlier in the disease process without evident subluxation. Thus, early recognition of the condition with prompt commencement of appropriate conservative treatment could halt the progression into Grisel’s syndrome. The purpose of this study is to address the importance of early recognition of inflammatory torticollis that can be treated successfully by conservative methods.

A retrospective review was made of the case files and radiological investigations of 13 children with fever and torticollis who were treated in the neurosurgery unit of Hamad General Hospital in Qatar, over a two-year period from July 1996 to July 1998. The children were aged between three and 12 years with a male to female ratio of 3:1. All patients arrived at the hospital within 48 hours of onset of torticollis and almost all had manifestations of upper respiratory tract or head and neck infections. Radiological examination by cervical spine X-rays, computerized tomography (CT) or magnetic resonance images (MRI) revealed that only three cases out of 13 had AAS. All patients underwent conservative treatment that included rest, neck collar, simple analgesics and antibiotics, where appropriate. A muscle relaxant was used in nine cases and Halter traction was applied to the three with AAS. All patients responded well to treatment and none required surgical intervention for AAS.

We conclude that the majority of children presenting acutely with inflammatory torticollis have rotational deformity only without AAS. Progression to the latter, i.e. Grisel’s syndrome, may be aborted should the diagnosis be made early and conservative treatment initiated in time. On the other hand, delay in diagnosis would deprive these children an opportunity of receiving effective conservative treatment.