Retrospective analysis of the risk of neoplasia associated with unilateral maxillary sinus opacification on computed tomography.

BACKGROUND: Unilateral maxillary sinus opacification on computed tomography may reflect an inflammatory or neoplastic process. The neoplasia risk is not clear in the literature. METHODS: In this retrospective study, computed tomography sinus scans performed over 12 months were screened for unilateral maxillary sinus opacification, and the rates of inflammatory and neoplastic diagnoses were calculated. RESULTS: Of 641 computed tomography sinus scans, the rate of unilateral maxillary sinus opacification was 9 per cent. Fifty-two cases were analysed. The risk of neoplasia was 2 per cent (inverted papilloma, n = 1). No cases of unilateral maxillary sinus opacification represented malignancy, but one case of lymphoma had an incidental finding of unilateral maxillary sinus opacification on the contralateral side. Patients with an antrochoanal polyp (n = 3), fungal disease (n = 1), inverted papilloma and lymphoma all had a unilateral nasal mass. CONCLUSION: Our neoplasia rate of 2 per cent was lower than previously reported. A unilateral mass was predictive of pathology that required operative management. Clinical findings, rather than simple findings of opacification on computed tomography, should drive the decision to perform biopsy.

Prospective, randomised, controlled trial comparing delivery of patient information for functional endoscopic sinus surgery via website versus printed leaflet.

OBJECTIVE: To compare the efficacy of two modes of delivery of information for patients undergoing functional endoscopic sinus surgery: website and printed leaflet. METHODS: A two-centre, prospective, single-blinded, randomised, controlled trial was conducted, comparing mode of information delivery. Adult patients were randomly allocated to receive pre-operative information regarding functional endoscopic sinus surgery, either via a website or a printed leaflet. Primary outcomes, measured by questionnaire, were: readability, usability and recall of complications. RESULTS: Fifty-eight patients were recruited. Fifty met the inclusion criteria, of which 40 were analysed in the study (20 patients per group), meeting the power criteria set. There were 18 male and 22 female patients, ranging in age from 21 to 76 years (mean, 47 years). Patients found both the printed leaflet and the website readable, and were satisfied with the usability of both modes. There were similar rates for recall of complications in both study arms. CONCLUSION: Patient information on functional endoscopic sinus surgery can be provided either as a printed leaflet or a website, with similar rates for usability, readability and recall of complications. These findings could help tailor the provision of pre-operative information for patients undergoing functional endoscopic sinus surgery, based on patient preference.

Ear injuries sustained by British service personnel subjected to blast trauma.

OBJECTIVES: To describe the pattern of ear injuries sustained by all British servicemen serving in Iraq and Afghanistan between 2006 and 2009; to identify all servicemen evacuated to the Royal Centre for Defence Medicine following blast injury; to ascertain how many underwent otological assessment; and to calculate the incidence of hearing loss. DESIGN AND SETTING: A retrospective analysis of data obtained from the Joint Theatre Trauma Registry and the Defence Analytical and Statistics Agency, together with audiometry records from the University Hospitals Birmingham National Health Service Trust. RESULTS: Ear damage was present in 5 per cent of all British servicemen sustaining battle injuries. Tympanic membrane rupture occurred in 8 per cent of personnel evacuated with blast injuries. In 2006, 1 per cent of servicemen sustaining blast injury underwent audiography; this figure rose to 13 per cent in 2009. Fifty-three per cent of these audiograms were abnormal. CONCLUSION: The incidence of tympanic membrane rupture was higher than that found in previous conflicts. Otological assessment prior to and following military deployment is required to determine the incidence of ear injury amongst British servicemen following blast trauma.

Pre-operative prediction of 'dry taps'.

OBJECTIVES: The treatment of children with 'glue ear' often presents surgeons with the question of whether or not to insert a grommet when myringotomy reveals no fluid in the middle ear. We present a study designed to assess which factors contribute to the presence of a 'dry tap'. DESIGN: We prospectively gathered data from a cohort of 280 children (504 myringotomies). The cohort included two subgroups, one received halothane and nitrous oxide anaesthesia, and the other received enflurane anaesthesia. SETTING: The ENT department of a district general hospital. PARTICIPANTS: Children (aged less than 17 years) requiring myringotomy. MAIN OUTCOME MEASURES: The presence of a 'glue' or dry tap at myringotomy was documented. We also recorded data on the following: pre- and post-induction tympanometry; age; season; anaesthetic type; and the delay from listing to actual operation. RESULTS: A non type B pre-induction tympanogram and delay to operation were strong indications of finding a dry tap at surgery. CONCLUSIONS: In our study population, the proportion of dry taps at myringotomy was 18 per cent. The presence of a dry tap was rarely due to the induction of anaesthesia. Multivariate analysis revealed that the combination of factors most likely to predict a dry tap were non type B tympanogram and delay to operation.

Osteochondroma of the cervical spine causing occipital nerve neuralgia. Case report.

Osteochondroma is a rare tumor of the cervical spine. The authors present a rare case of osteochondroma narrowing the C 1/2 foramen and causing occipital neuralgia. Complete removal of the tumor was performed with release of the pain. The literature is reviewed and etiology, diagnosis, treatment and differential diagnosis are discussed.

Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions.

OBJECTIVE: Significant numbers of patients experience intractable pain after brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment. METHODS: Forty-seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years (average follow-up period, 14 yr). RESULTS: Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up monitoring. Nine patients experienced major complications, including subdural hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more-accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. CONCLUSION: Central deafferentation pain that persists and becomes intractable among patients with traumatic cervical root avulsions has been difficult to treat in the past. Long-term follow-up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majority of individuals, with acceptable morbidity rates.

Frequency of pseudo-Gaucher cells in diagnostic bone marrow biopsies from patients with Ph-positive chronic myeloid leukaemia.

Pseudo-Gaucher cells (PGC) are a characteristic finding in Ph-positive CML, and prolongation of survival was observed when PGC were detected within the bone marrow. However, the conspicuous variation in the reported frequencies indicates the necessity for analysis of their natural occurrence in the bone marrow from untreated CML patients. A total of 833 diagnostic bone marrow biopsies from patients with Ph-positive CML were examined for PGC by 7 observers. Proof of PGC was based on systematic examination of Giemsa-stained slides with and without polarization at high magnification. Birefringence within the cytoplasm turned out to be highly specific for PGC. The risk of overlooking PGC was at least 80% when the number of these storing histiocytes was 70 per slide or less, and at least 50% when the total amount per slide was < or = 250. This high risk of failure explained the disagreement among the authors. An intensive investigation by at least two observers is mandatory if results are to be evaluated in research. Under the conditions used in this study, the natural frequency of PGC within the bone marrow from untreated patients with a Ph-positive CML is much higher than assumed to date, amounting to about 70%. On the basis of these findings, the prognostic importance of PGC in CML must be evaluated critically.

Relative role of B and T lymphocytes in pathogenesis of a murine herpes virus.

Pathogenesis of a murine herpes virus was investigated in inbred strains (BALB/c, CBA, AKR and C57BL/10) of mice. After intranasal inhalation, virus was found to replicate primarily in the lungs, followed by haematogenous spread to the target organs (adrenal glands and ganglia). AKR (H-2k) were found to be most susceptible to virus infection while CBA (H-2k) mice appeared to be relatively resistant. Infection of B-cell depleted BALB/c mice resulted in detection of lower lung virus titres in B-cell depleted animals as compared to normal intact mice. Moreover, 3 of 12 normal mice in untreated group died of virus infection while deaths did not occur in the B-cell depleted group. Results of T-cell subset depletion experiments in BALB/c mice revealed maximum mortality in the group depleted of both Lyt-2+ and L3T4+ subpopulations. Infectious virus titres were also higher in lungs of T-cell depleted animals.

Libido, hormone concentrations in blood plasma and semen characteristics in Holstein bulls.

Relationships among bull libido, serum hormone concentrations and semen characteristics were studied using 18 Holstein bulls that were 4 to 5 yr old. The hormones studied included testosterone, estradiol (E2), prolactin (PRL), LH and cortisol. Two ejaculates were collected three times per week from each bull during a 5-wk trial. During the last week of the trial, on a day semen was not collected, blood was collected from indwelling catheters every 15 min for 6 h to determine the hormonal profiles of each bull. On the following day, blood was sampled every 10 min before and after the time of semen collection. Libido factors were quantified, and semen volumes and sperm concentrations were recorded. The libido factors included reaction time to first service, latency time between the first and second semen collections, and duration of time the bull mounted the teaser prior to the first (TM1) and second (TM2) semen collection. Average reaction and latency times were correlated (r = .524; P = .026), as were TM1 and TM2 (r = .597; P = .015). Latency times were correlated with average TM2 (r = .669; P = .003). Average PRL concentrations were correlated with average latency times (r = .467; P = .05). Low libido bulls tended to have higher E2:testosterone ratios than did high libido bulls. Both PRL and cortisol concentrations increased at semen collection.

The effects of compounds related to gamma-aminobutyrate and benzodiazepine receptors on behavioural responses to anxiogenic stimuli in the rat: punished barpressing.

Rats were trained to press a bar for sucrose reward on a random-interval (RI) schedule and footshock punishment was then introduced for 3-min intrusion periods (signalled by a tone) on an independent RI schedule. Shock intensity was individually adjusted to produce stable intermediate levels of response suppression during the tone for each animal. Groups of animals were then allocated to a number of separate experiments in which they were systemically injected with anxiolytics (chlordiazepoxide HCl or sodium amylobarbitone), GABA antagonists (picrotoxin or bicuculline), the GABA (A) agonist muscimol, the GABA(B) agonist baclofen, an antagonist (RO 15-1788) at the benzodiazepine receptor and, an inverse agonist (FG 7142) at this receptor. The results showed that the alleviation of punishment-induced suppression of barpressing produced by chlordiazepoxide was blocked or partially blocked by RO 15-1788, picrotoxin and bicuculline but not by FG 7142; that picrotoxin (but not FG 7142) increased the suppression of responding by punishment; that neither muscimol nor baclofen affected responding on their own, but their combination weakly but reliably released punished responding from suppression; and that the anti-punishment effect of amylobarbitone was unaffected by either picrotoxin or bicuculline, though the barbiturate reversed the punishment-enhancing effect of picrotoxin. These results are discussed in the light of the hypothesis that anxiolytic behavioural effects are due to increased GABAergic inhibition.