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Table of Contents
ABSTRACTS
Year : 1998  |  Volume : 1  |  Issue : 1  |  Page : 69-74

Abstracts from selected journals


Date of Web Publication16-Jun-2020

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DOI: 10.4103/1319-8491.286861

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How to cite this article:
. Abstracts from selected journals. Saudi J Otorhinolaryngol Head Neck Surg 1998;1:69-74

How to cite this URL:
. Abstracts from selected journals. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 1998 [cited 2022 Nov 30];1:69-74. Available from: https://www.sjohns.org/text.asp?1998/1/1/69/286861




  Use of Glycopyrrolate in the Treatment of Meniere’s Disease Top


Storper.Ian S.; Spitzer,Jaclyn B.; Scanlan,Mark. Lamigoscope 1998;108:1442-45.

Obicctives’Hypothesis: The objective of lliis study lo determine whether Glycopyrrolatc is useful as a fibular suppressant in patients with Meniere’s disease. Tlic tested hypotheses were that glycopyrrolatc would decrease the perception of dizziness measured by tlic Dizziness Handicap Inventory in patients with Meniere’s disease and that placebo would cause no such decrease. Siudv Design: Randomized, prospective. Method: Thirty- seven subjects with a diagnosis of Meniere’s disease were administered either 2 mg of glycopyrrolatc or placebo twice daily as needed for vertigo. All were also administered the regimen of 1500 mg sodium/dav diet and diuretic. Tlic following indices were examined: Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire, Beck Depression Inventory, hearing examination, and electronystgamographv. After 4 to 6 weeks of the drug regimen. Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire and Beck Depression Scale were reexamined. Paired t tests were performed to verify the significance of improvement before and after treatment. Results: Subjects who received glycopyrrolatc had statistically significant reduction in Dizziness Handicap Inventory, Beck Depression Score and Modified Somatic Perception Score. In the placebo group, no improvement in any index was found. Conclusions: The hypothesis that glycopyrrolatc is a useful vestibular suppressant in patients with Meniere’s disease was statistically verified. Author.


  The Evidence for Allergic Pathophysiology in Allergic Fungal Sinusitis Top


Manning, Scott C.; Holman, Marie. Laryngoscope 1998; 108:1485-96.

Controversy continues over whether allergic fungal sinusitis represents a true allergy; an infection, or a point somewhere along a spectrum between allergy and infection. The present study describes two experiments that add weight to the argument that allergic fungal sinusitis (AFS) is truly an immunologically mediated hypersensitivity and not a form of infection. In the first experiment, eight patients with Bipolaris culture-positive AFS were prospectively evaluated with Bipolaris antigen skin testing and with inhibition radioallergosorbent (RAST) and enzyme-linked immunosorbent assay (ELISA) for Bipolaris-specific IgE and IgG antibodies. The Bipolaris AFS cases were compared with 10 control patients with no history of AFS. All eight AFS cases demonstrated positive skin testing to Bipolaris and in addition, all tested positive by RAST and ELISA for IgE and IgG Bipolaris antibodies, respectively. In the control group one patient had positive skin test, ELISA and RAST and one additional patient had a positive ELISA only. Good correlation was noted between skin test, RAST and ELISA results. In the second experiment, sinus mucosa from 14 AFS patients and 10 control patients with other forms of surgical sinus disease was analyzed by immunohistocytochemistry for the eosinophilic inflammatory mediators major basic protein (MBP) and eosinophil derived neurotoxin (EDN) and the neutrophil mediator neutrophil elastase. All AFS cases demonstrated evidence of eosinophilic mediator release,, and MBP and EDN predominated over neutrophil elastase. In the control group eosinophil and neutrophil mediator release in sinus mucosa was equal. The two experiments support the concept that AFS is an antigen-triggered, IgE- and IgG-mcdiated hypersensitivty response with a late-phase inflammatory reaction involving release of eosinophilic mediators.


  Prospective Randomized Comparative, Study of Tracheoesophageal Voice Prosthesis: Blom- Singer Versus Provox Top


Delsupehe, Kathelijne; Zink, Inge; Lejaegere, Marylin;

Delaere, Pierre.Laryngoscope 1998; 108: 1561-65.

Objective: Compare the most commonly used types of tracheoesophageal voice prostheses, Blom-Singer and Provox. Study Design: Prospective study of 113 prostheses placed in 52 patients randomly selected to receive Blom-Singer and Provox. Methods: Postoperative voice was recorded at 1 and 4 months after valve placement. Survival time of the prosthesis and four objective voice parameters were analyzed. Eight judges rated all recordings in a random order for six subjective voice parameters. Subgroup analysis for primary versus secondary placements and type or procedure performed. In addition, patients were asked for their subjective assessment. Results: Overall, Blom-Singer and Provox orostheses give very similar voice quality, lifetime, and patient satisfaction. Cleaning management is somewhat better for Provox, but there is a trend toward better overall voice quality for the Blom-Singcr prosthesis. In subgroup analysis secondarily placed prostheses score somewhat better than primary placements, and patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial pharyngectomy. Conclusions: Given the equal and good results in terms of voicc quality, other factors (e.g. costs, surgcry-rclatcd factors, maintenance , patients preference) should be taken into account when deciding which type of tracheoesophageal voicc prosthesis to use.


  Revision Surgery For Chronic Otitis Media: A Learning Experience. Report on 389 cases with a long-term follow up. Top


Veldman, Jan E.; Braunius, Weibel W. Ann Otol Rhinol Laryngol 1998;107:486-491,

The objective of this study was to evaluate, during a long-term follow up period, the results of revision surgery for chronic otitis media with or without cholesteatoma. Intact canal wall and wall down procedures were performed. The surgical history of eveny patient was assessed before the operation. A dry, relatively safe, and disease free ear was created in 90% of the reported cars of (N=389). The recurrence rate of cholesteatoma was 5% for the total group. Reperforations of the tympanic membrane occurred in 10%, and persistent or recurrent otorhea was present in 10% of the cases. The functional hearing results were quite satisfactory. A residual air-bone gap of <30 dB was reached in 70% of cases after revision tymanoplasty only (N=41). Revision mastoidectomy with revision tympanoplasty as a one stage procedure led subsequently to, in 76% of intact canal wall procedures (N=113) and 55% of canal wall down procedures (N=90%), to residual air-bone gap of <30 dB.


  Examining The safety Of Nasogastric Tube Placement After Endoscopic Sinus Surgery Top


Bhattacharyya, Neil; Gopal,Harsha,V. Ann Otol Rhinol Laryngol 1998;107:662-4

Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of the anterior skull base fractures. The fovea cthmoidalis and sphenoid sinus arc often exposed after endoscopic sinus surgery, so (hat these fractures are potentially placcd in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea cthmoidalis and sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy , standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ctlmioidalis and sphenoid sinus roof. No penetration of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the I6F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetration occurred in if, and 11 sides for the 18F and 16F tubes, respectively. Tlic sphenoid sinus was easily entered even in the prcscncc or an intact middle turbinate. These data suggest that although intracranial penetration during nasogastricintubation after endoscopic sinus surgery is an unlikely event., there is a non-negligible risk of such an injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.


  Electroporation Therapy Cf Head And Neck cancer. Top


Panje, William R.; Hier,Michael P.; Garman,Guy R.; Harrell, Erin.; Goldman, Andrew.; Bloch,Isac. Ann Otol Rhinol Laryngol 1998; 107: 779-785.

The purpose of this paper is to introduce the concept of electroporation therapy and present our results from using this new tcclmique combined with intralesional bleomycin in head and neck cancer patients. Elcctroporation therapy is a technique wherein liigh- voltagc electric impulses delivered into a neoplasm transiently increase cell membrane permeability to large molecules, including cytotoxic agents. In this phase I/IT study, extremely low-dose bleomycin sulfate were electroporated into head and neck malignant neoplasms in 10 patients. Tumour responses included 2 nonrcspondcrs, 3 partial responders, and 5 complete responders, with a mean follow-up of 40 weeks. We conclude that this tcclmique offers promising possibilities in the local treatment of head and neck cancer.


  Antibiotic treatment of patients with mucosal thickening in the paranasal sinuses, and validation of cut-off points in sinus CT. Top


Lindbaek, Morten; Kaastad, Esben; Dolvik, Sverre; Johnsen, Ulf; Laerum, Even; Hjortdah, Per. Rhinology 1998; 36: 7-11.

We compare the efficacy of penicillin V and amoxycillin treatment with placebo in 70 adult patients from Norwegian family practice with a clinical diagnosis of acute sinusitis and mucosal thickening on CT, but without fluid level or total opacification. The study was randomi7xd and double-blind. Three different outcomes were evaluated; subjective status after 10 days treatment , difference in clinical score between day 0 and day 10, and duration of the illness episode. Amoxycillin and penicillin V gave no better response to treatment than placebo, evaluated by all three outcome measures The median duration of sinusitis episode was 10 days in amoxycillin-and placebo groups and 13 days in penicillin group. Inpatients with a clinical diagnosis of acute sinusitis, fluid level and total opacification on CT are good criteria to differentiate between groups of patients that need or do not need antibiotic treatment.


  Association of rhinoscleroma with rhinosporidosis. Top


Al- serhani A wad M.;Al Qahtani,Ali S.;Arafa,Maha. Rhinology 1998;36:43-45.

Rhhioscleroma caused by the bacillus Klebsiella rhinoscleromatis and rhinosporidiosis caused by the fungus Rhinosporidum seebri are rare, specific nasal infections. both of which have a certain geographical distribution. To the best of our knowledge no association between them have been reported in international literature. We have documented such an association in two male Indian patients aged-32 and 27 years, respectively-both presenting with unilateral blood-stained discharge and nasal blockage. They showed strawberry- like polypoidal masses, and histological examination confirmed (lie diagnosis. Klebsiella rhinoscleromatis was cultures twice in the first case. The patients were treated with complete excision and a long course of septrin, for which Klebsiella rhinoscleromatis is sensitive. The purpose of this paper is to report the first association of these two granulomatous infections, to show the impact of immigration on the differential diagnosis, and to review the literature.


  Effect cf psendoephedrine on nasal airflow in patients with nasal congestion associated with common cold Top


SuhairS.M. Jawad, R. Eccles. Rhinology 1998; 36:73-76. Common Cold Centre, Cardiff University, Wales, United Kingdom

SUMMARY:

The aim of this study was to investigate the efficacy of Pseudoephcdrinc as a nasal decongestant. Patients with nasal congestion associated with common cold receivedtwo doses of medication separated by 4 hours, either 60mg pseudoephedrine (n = 20), or placebo (n = 20).

Unilateral nasal airflow was measured over a 7hour period to record the spontaneous changes in nasal airflow association with the nasal cycle.Minimum (F MIN)and maximum (F MAX) unilateral nasal airflows were defined as the minimum and maximum nasal airflows values for each nasal passage recorded during the 7 hour period of the study. There was no significant difference in F MAX between the two treatment groups yet there was a significant difference in F MIN (p < 0.05). No differencein total nasal airflow (T NAf) between treatment group was found either before or after treatment(p > 0-05). The results demonstrate that (T NAF -is not sensitive a measure of decongestion as F MIN. The findings of this study show that pseudoephedtine had no effect on the decongestion phase of the nasal cycle, but did significantly limit the congestion phase. The decongestant action may be explained by the Sympathomimetic supplementing the natural sympathetic nervous activity to the nasal blood vessels.


  Nasal nitric oxide and its relationship to nasal symptoms, smoking and nasal nitrate Top


Anna-Carin Olin (1), Johan Hellgren (2), Goran Karlsson (2,3) Goran Ljungkvist (1), Kerstin Nolkrantz (1), Kjell Toren (1,3)

  1. Section of Occupational Medicine, Sahlgrcnska University Hospital, Gotcborg, Sweden.
  2. Section of Otorliinotaryngology and Head-Neck Surgery, Sahlgrcnska University Hospital, Gotcborg, Sweden.
  3. Section of Respiratory Medicine and Allergology, Sahlgrcnska University Hospital, Gotcborg, Sweden. Rhinology 1998; 36: 117-121.


Summary:

Nitric oxide (NO) is produced in tlie nasal mucosa and in tlie paranasal sinuses. Increased nasal NO concentrations have been found in patients with asthma and/or rhinitis, and nasal NO has been suggested to be a marker of nasal inflammation. Measuring tlie stable end products of NO, nitrate and nitrite in nasal lavagege fluid have been proposed as an indirect method for measuring NO concentration. The aim of this study was to measure nasal NO concentration, and to find out its relationsliip to nasal nitrate concentration and clinical parameters. 73 paper-mill workers were investigated with nasal and exhaled NO, nitrate in nasal lavage fluid and were given a respiratoiy questionnaire. Nasal air was sampled directly from a nasal mask and NO concentration was measured with a chemiluminesccnce analyser. Exhaled NO was measured with the subjects breathing tidal volumes and wearing nose clips. Tlie nitric oxide metabolites were analysed as nitrate, after reduction of nitrite to nitrate.

Smokers had lower nasal NO concentration (264 ppb) as compared to NO concentrations of 340ppb among non- smokers (p-0.02). There was no statistically significant relationship between nasal NO concentration and nitrate in nasal lavage fluid or nasal symptoms. Nasal NO concentration was significantly related to FVC (p-0.047) and there was a relationsliip with borderline statistical significance (p=0.06) to FEV I.

In conclusion, wc found no relationship between nitrate in nasal lavage and nasal NO, and. neither of these were correlated to nasal symptoms or to nasal PIF. Nasal NO was significantly lower among smokers.

Further controlled studies 011 subjects with rliinitis arc needed, to evaluate the relation between nasal NO and nasal inflammation. In addition, there is also a need to develop methods Tor measuring nasal NO that minimise contamination from sinuses.


  The usefulness of computed tomography in the diagnosis of impacted fish bones in the oesophagus Top


Ken-lchi Watanabc, M.D., Toshihiko Kikuchi. M.D., Yukio Katori. M.D., Hiroko Fujiwara. M.D., Rciji Sugita, M.D., Tomonori Takasaka, M.D., Sho Hashimoto. M.D.

J Laryngol Otol 1998; 112: 360-364.

Abstract

The usefulness of computed tomography (CT) in the diagnosis of fish bone impaction in the oesophagus was evaluated. Thirty-two patients were examined by plain X-ray followed by direct ocsophagoscopy for suspected fish bone impaction. Among 25 cases in which fish bones were actually removed, foreign bodies were not clearly demonstrated by plain X-ray in 14 cases (56 per cent). Eleven eases underwent CT prior to tlic oesophagoscopic examination. Fish bones were clearly demonstrated by CT in all patients. CT also clearly visualized secondarily- induced inflammatory changes in the neighbouring structures, In order to confirm this result, we made a simulation model of oesophageal fish bone impaction, using fish bones of three different species surrounded by a water bag. In comparison with plain X-ray, CT depicted a superior image of fine fish bones and provides extremely useful information for the management of impacted fish bones in tlic oesophagus.


  Limmmunoglobulin- and complement-coated bacteria in pus from Peritonsillar Abscesses Top


Nurkus Lilja, Simo Raisanent, Lars-Eric Stcnfors. J LaTyngol Otol 1998;112:634-638.

Abstract:

Fifty-five samples of pus were collcctcd from 51 acute, non-perforated, two spontaneously ruptured recurrent peritonsillar abscesses {35 males and 18 females; median age 18 years) and analysed regarding (i) aerobic and anaerobic bacteria (standard culturing), (ii) morphology of bacteria and inflammatory cclls (direct microscopy of acridinc orange-stained material), and (iii) tlic percentage or bacteria coatcd with immunoglobulins IgG, secretary IgA (SIgA) and IgM and complement clcavageproduct C3b (immunofluorescence assay). Seventy-one per cent of the abscesses harboured a mixed bacterial flora of various aerobes and anaerobes. In none of the cases with a single bacterial species (27 per cent) could immunoglobulin- or complement-coated bacteria be found. In abscesses with a mixed flora, 18 per Cent harboured IgG-coatcd. 15 per cent SIgA-coatcd, five per cent IgM-coatcd and cent C3b-coatcd bacteria respectively. All pus samples contained inflammatory cells in abundance but tlicy were mostly deformed and only occasionally could intracellular bacteria be rccognizcd. Insufficient imnumoglobulin-coating or bactcria might be an important actiopathogcnic factor in the development of apcritonsillar abccss. Bactericide in the abscesses is accomplished chiefly by protcctivc mechanisms not dependent on antigen recognition by antibodies.


  Laser assisted uvulopalatoplasty.- six and eighteen month results Top


Michael J. Wareing. F.R.C.S., B.Sc., Vincent P. Callanan, F.R.C.S.I., F.R.C.S., David B. Mitchell, F.R.C.S., F.R.C.S.I. J Laryngol Otol 1998;112:639-641.

Abstract

Our ongoing evaluation of the results of laser assisted uvulopalatoplasty (LAUP) for snoring is presented. Follow-up between 18 and 24 months post-treatment completion, of patients with a successful result at six months, reveals that 22 pcr cent of these patients suffer failure of snoring control between these two evaluation points. This equates to an overall success rate at this time of 55 per cent.

LAUP, like other surgical remedies for snoring, has a continued relapse rate. This must be considered when counselling patients.


  The epiglottis and obstructive sleep apnoea syndrome Top


Frank J. Catalafumo, M.D., Avishay Golz, M.D., S. Thomas Wcstennan, M.D., Lianc M. Gilbert, M.A., Henry Z. Joachims, M.D., David Goldcnbcrg, M.D. J Laryngol Otol 1998; 112: 940-943.

Abstract:

Obstructive sleep apnoea syndrome (OSAS) is causcd by obstruction or narrowing of the airway at various levels. The repair or one site only will not alleviate tlic syndrome if there arc obstructions in other sites. Epiglottis prolapse during inspiration is an unusual causc of airway obstruction and a rare causc of OS A. Twelve cases of OSAS due to an abnormal epiglottis arc presented. We present our approach to the diagnosis using fibre-optic examination or the hypopharynx, and our trcauuent using endoscopic carbon dioxide laser partial cpiglottidcctomy. We round in our scries that in 11.5 per cent of patients who failed the uvulopalatopharyngoplasty procedure, the reason was a narrow airway at the hypopharyngeal level causcd bv an abnormal epiglottis. It is our suggestion that in these cases a laser partial epigolotidectomy should be performed the results of this study slow thst partial epiglottidectomy can increase the cure rate of patients with obstruction sleep apnoea syndrome by 10-15 per cent.


  Changes in the clinical presentation of chronic otitis media from the 1970s to the 1990s Top


Eero Vartiainen, M.D.

J Laryngol Otol 1998; 112: 1034-1037.

Abstract

Clinical features of 1123 patients with chronic otitis media referred to a Finnish university hospital for surgical treatment over a 20-year period were analyzed. The number of patients declined by 48 per cent from the period 1976-1985 to 1986-1995. Tlic decline was evident in all age groups but the proportion of children increased significantly from 14 per cent in 1976-1985 to 20 per cent in 1986-1995 A male predominance was noted witli the exception of patients with sequelae of otitis media in whom the sex distribution was equal. In cholcsteatomatous ears, no significant change occurred in the type or size of cholesteatomas or in the incidence of ossicular destruction. Likewise, no significant change was noted in the size of perforations or in the incidence of ossicular destruction in patients with dry eardrum perforations. However, hearing levels of patients treated 1976-1985 were significantly worse than those of patients 1986-1995. Severe complications causcd by the disease were rare during both periods.


  The Effect of Nasal Surgery on Snoring Top


Ibrahim Elshcrif, FRCSI, DLO, and Sayed Nascr Hussein, DLO. Am J Rhinol 1998;12:77-79.

Abstract:

Patients with nasal obstruction often have associated snoring, it is uncertain whether surgery, which relieves the nasal obstruction, will also relieve the snoring. We have reviewed 96 patients who complain of both nasal stniclion and snoring and who underwent nasal surgery. snoring was completely relieved in 48 patients (50, %) was less loud in a further 38 patients (40%), unchanged in 8 patients, and and louder in 2. Patients who had nasal polypectomy as part of their nasal rgery obtained the greatest snoring relief. The relationship between nasal obstructionand snoring is complex and the alteration of airflow patterns after nasal surgery is postulated to be important in influencing snoring relief. This study suggests that,when snoring and nasal obstruction coexist, nasal surgery should be considered as the first line of as the first line of surgica treatment.


  Usefulness of patient symptoms and Nasal Endoscopy in uw Diagnosis of Chronic Sinusitis Top


Kristina W. Rosbe, MD., and Kim R. Jones, M.D., Ph.D

Am J Rhinol 1998;12:167-171.

Abstract

The diagnosis of clironic sinusitis can bc difficult due to the variety and lack of specificity of present symptoms, Sinus CT scanning ,s present! conES most sensitive and specific diagnostic method, but is expensive. In order to determine whether a combination ot patient symptoms and nasal endoscopy could bc used to predict which patients would have CT evidence of chronic sinusitis, we conducted a prospective study in which 92 consecutive patients refened for chronic sinusitis were required to fill out a questionnaire detailing their symptoms. Their responses were then con-elated with subsequent findings on nasal endoscopy and CT scanning. Briefly, we found that patients with headache or facial pain as their chief complaint were less likely to have evidence of sinusitis than patients whose chief complaint was nasal obstruction or postnasal drip. Also, nasal endoscopy was shown to be moderately sensitive and highly specific in predicting results of CT scanning.


  Antimicrobial Resistance in Bacterial Chronic Sinusitis Top


John Hsu, M.D., M.B.A., Donald C. Lanza, M-D., and David W. Kennedy, M.D. Am J Rhinol 1998;12:243-248.

Abstract:

Recent reports describe the emergence of antimicrobial resistant bactcria in acute sinusitis and an increased incidence of enteric gram negative bacilli in chronic sinustls. Tlic objectvc of this cross sectional study is to identify tlic emergent resistance patterns in bacterial chronic sinusitis. Specifically, Uiis article seeks to characterize the bacteriology of outpatient chronic sinusitis, then to compare the antimicrobial susccptiblitics of the bacterial isolates with standard eultue data from a tertiary care ccnter. Between March and August, 1994, 113 new outpatients presented with chronic sinusitis at a major teaching institution. Of these patients 34 underwent endoscopically guided aerobic culture of the paranasal sinuses and nasal cavities. Of the 48 total cultures , there were 43 postive cultures yielding72 isoiatcs.Thirty-eight cultures had two. or fewer isolates; four cultures had three isolates, and one culture grew out normal flora. Ti c mo I frequently isolatedorganisms were coagulase negative Staphylococcus (SCN), 20 (28%). Pseudomelia negative Mapry staphylococcus aureus 9 13%) Within the limited sample size for each isolate Staphylococcus coagulase negative, Pseudomonas and demonstrated higher antimicrobial resistance compared to the medical center’s corrsponding nonurinary isolates. Additionally, three of six patients with Pscudomonas aeruginosa (50%) had a quinolonc resistcnt strain. These preliminary data suggest that both an increased incidence of antimicrobial resistance and of cnteric gram negative bacilli may exist in these outpatient, tertiary care center patients with chronic nacterial sinusitis.


  Comprehensive Management of Allergic Fungal Sinusitis Top


Bradley F. Marple, M.D., and Richard L. Mabry, M.D.

Am J Rhinol 1998;12:263-268.

Abstract:

In little more than a decade, allergic fungal sinusitis has gone from a medical curiosity to one of the more perplexing problems to challenge tlie otorhinolaryn- gologist. These patients are typically immunocompetent adolescents or young adults with pansinusitis (unilateral and bilateral) and polyposis, atopy, and characteristicradiographic findings. Allergic mucin contained within tlie sinuses demonstrates numerous eosinophils and Charcot-Leyden crystals, and fungal stains show the presence of noninvasive liyphae. Fungal cultures may or may not be positive. Wc have found tlie following approach to allergic fungal sinusitis to be most effective: 1) Adequate preoperative evaluation and medical preparation; 2) Meticulous exenterative surgery; 3) Closely supervised immunotherapy with relevant fungal and non-fungal antigens; 4) Medical management including topical and systemic corticosteroids as needed; 5) Irrigation and self-cleansing by tlie patient; and 6) Close clinical follow-up with endoscopically guided debridement when necessary.


  A Comparison of conservative, radical and laser palatal Surgery for snoring. Top


B.F.O’Reilly and D.C. Simpson

Basildon Hospital and Stobhill NHS Trust, Glasgow U.K.

J R Coll Surg Edinb 1998:43: 194-195.

Reports of snoring are common among servicemen in tlie armed forces. Continuous positive airway pressure (CPAP) usually an inappropriate modality for servicemen, butsurgery, although requested, is very painful. In an attempt to reduce the pain, a laser has been used to perform uvulopalatopharyngoplasty and the more conservative uvulopalatoplasty has been performed. Before proceeding to a randomized trial, this retrospective study was performed by questionnaire comparing these operations with conventional uvulopalatopharyngoplasty. Fifty-two completed replies from 63 patients were analyzed. The results have to be interpreted with caution because of the small sample size, however, the results in the three groups were similar. The study suggests thai each operation works well, but that any reduction in pain from performing uvulopalatoplasty or by using a laser is likely to be small. Tlie study also found that tlie incidence of dryness as a complication is much higher than previously estimated.


  Surgical treatment of thyroid cancer-. the Singapore General Hospital Experience. Top


R. Sima and K.C.Soo

Department of General Surgery, Singapore General Hospital, Singapore.

J R Coll Surg Edinb 1998: 43: 239-243.

Patients with differentiated thyroid cancers generally have a good prognosis. Tliis should be considered when deciding the extent of surgical resection. Radical surgery, however, may be appropriate in tlie control of locally advanced disease. The audit of 149 cases of thyroid cancer treated in the Department of General Surgery. Singapore General Hospital between October 1988 and June 1994 is presented. Particular attention is drawn to eight patients who underwent radical surgery. There were 11 (74.5%) women and 38 (25.5%) men. Tlie median age was 45 years (range 12 to 83 years) and 80.5% of the cancers were papillary carcinomas, 14.8% follicular, 2.7% medullary and 2.0% anaplastic. Total or near total thyroidectomy was the most common procedure for primary disease for about 75% of patients. Eight patients (5.4%) underwent radical surgery-four laryngectomy, one partial pharyngectomy and median strenotomy-for tumour clearance. Morbidity included: wound complications in 2%; hypocalcaemia, transient in 16.8% and permanent 3.4%: and hoarseness of voice in 8.1%. with 4.7% having proved recurrent laryngeal nerve palsy. All three patients with anaplastic tliyorid cancer died within three montlis. Of tlie eight who underwent radical surgery, three (37.5%) are alive and disease-free at median follow up of 20 montlis. In a correctly selected group of patients with locally invasive differentiated thyroid cancer, aggressive surgery is appropriate, with acceptable morbidity and mortality.






 

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Use of Glycopyrr...
The Evidence for...
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Revision Surgery...
Examining The sa...
Electroporation ...
Antibiotic treat...
Association of r...
Effect cf psendo...
Nasal nitric oxi...
The usefulness o...
Limmmunoglobulin...
Laser assisted u...
The epiglottis a...
Changes in the c...
The Effect of Na...
Usefulness of pa...
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Comprehensive Ma...
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