Pediatric cochlear implantation: strategies to accommodate for head growth.

Accommodation for head growth presents one of several challenges unique to pediatric cochlear implantation. Given contemporary cochlear implant device designs, an electrode cable implanted at the age of 2 years must extend 2 to 3 cm as the head grows during childhood. In an initial study we found that model lead wires with redundant loops extended effectively when they were maintained within air-containing spaces such as the mastoid cavity or middle ear space. However, when looped leads traversed soft tissues overlying the parietal bone, they became embedded in fibrous tissue and did not extend. The present study evaluated three different configurations of expansile devices that were enclosed in polytetrafluoroethylene (PTFE) envelopes to deter fibrous ingrowth. This simple strategy was designed to ensure effective cable extension over cable pathlengths by protecting the redundant leads from any mechanically significant connective tissue ingrowth. Twelve such devices were implanted across the calvaria of four newly weaned piglets. Skull growth and changes in electrode dimensions were documented by sequential computed tomographic scans. At 3 months of age, cranial circumferences had increased substantially. Animals were then killed, the model cable extension appliances examined physically, and their implantation sites examined histologically. For all experimental devices, extension of redundant lead wires was satisfactory, and there was no mechanically significant invasion of fibrous connective tissue into the PTFE envelope. This indicates that enclosure of excess lead wire within a PTFE envelope may be an effective means of inhibiting fibrous ingrowth. This strategy should prove useful for ensuring effective electrode cable extension in cochlear implants applied in young children.

Can C.T. detect labyrinthine fistulae pre-operatively?

The aim of the study was to undertake a controlled prospective evaluation of high resolution computerized tomography in the pre-operative diagnosis of labyrinthine fistulae. Fifty consecutive patients with chronic suppurative otitis media were scanned prior to surgery, using a Siemens DRI scanner. The radiological predictions were then compared with the surgical findings. Five patients had labyrinthine erosions and these were predicted in 4 out of the 5 (80%). The one erosion that escaped radiological detection was less than 2 mm in length. The study shows that high resolution computerized tomography is a highly accurate method for demonstrating pre-operatively all but the smallest fistulae.

The inverted Schneiderian papilloma: a review and literature report of 43 new cases.

Inverted Schneiderian Papilloma remains a controversial nasal disease. Although a benign pathology it is associated with aggressive local destruction, recurrence after removal and malignancy. New information regarding aetiology may aid management which at present consists of surgical resection. The best method of resection is still undetermined. This paper describes 43 cases of Inverted Schneiderian Papilloma presenting to a tertiary referral centre and discusses the present knowledge surrounding the pathology and its treatment.

The surgical treatment of a pharyngeal pouch: inversion or excision?

Twenty eight patients with pharyngeal pouches were treated at the Radcliffe Infirmary, Oxford, between 1975 and 1985. Nineteen of these patients had the pouch excised and 9 patients had the pouch inverted. Preoperative and postoperative cine barium swallows were obtained on all patients. The results show pouch inversion to be an effective method of treatment with a low recurrence rate, and fewer complications compared with pouch excision. Inversion of a pharyngeal pouch with a cricopharyngeal myotomy is therefore recommended as a safe, satisfactory treatment.

Endoscopic stapling diverticulotomy of pharyngeal pouch.

Endoscopic diverticulotomy (Dohlman's procedure) is a well-established and effective alternative to external diverticulectomy in the treatment of pharyngeal pouch. The division of the common septum between the pouch and the oesophagus is usually performed either with electrocautery or with a laser. We describe a new technique of endoscopic diverticulotomy using a linear cutter stapling gun. This technique has the advantages of being quick and bloodless, avoiding the need for a nasogastric tube, permitting oral intake as early as the first postoperative day and allowing early discharge from hospital. It also has the theoretical advantage over the electrocautery or the laser technique of reducing the risk of fistula formation, mediastinitis and thermal injury to the recurrent laryngeal nerve.

Current practice in pharyngeal pouch surgery in England and Wales.

A survey of the current surgical practice for patients with a pharyngeal pouch was conducted among general surgeons, otolaryngologists and cardiothoracic surgeons in England and Wales. Our results show that while pouch excision remains the most common method used, endoscopic stapling diverticulotomy is rapidly being adopted. The reasons why this recently introduced technique is likely to become the definitive treatment of pharyngeal pouch are discussed.

The use of flexible nasoendoscopy in adults with acute epiglottitis.

Acute epiglottitis is a potentially fatal upper respiratory tract infection. In this paper, we describe the use of flexible nasoendoscopy, both in establishing the diagnosis and during the subsequent airway management of adults with acute epiglottitis.

Rationalization of peritonsillar abscess as an indication for tonsillectomy.

It has been widely held that peritonsillar abscess is a strong, if not absolute, indication for tonsillectomy, performed either immediately or after an interval of some weeks. A retrospective study of 48 patients is presented. It appears that age and the incidence of previous throat infections can be related to the likelihood of further problems and the need for operation.

Chondrosarcoma of the sphenoid--a case report and review.

The case of 57-year-old woman is presented with a chondrosarcoma of the sphenoid. The main symptom was rapid loss of vision and in order to halt this the tumour was debulked. The literature relating to chondrosarcomas of the head and neck is reviewed. These rare tumours are not radio-sensitive and surgery represents the best form of treatment at the present time. The prognosis is poor.

Hypohidrotic ectodermal dysplasia associated with squamous cell carcinoma of the trachea.

Hypohidrotic ectodermal dysplasia (HED) is a rare condition characterized by abnormalities to ectodermal derived tissues although other organs or systems are frequently involved. Patients with HED can have a number of symptoms that may lead them to present to the otolaryngologist. We present a case of a 37-year-old female with HED who initially presented with nasal obstruction but then very rapidly developed stridor due to a tracheal squamous cell carcinoma. We suggest a possible association between HED and carcinoma of the upper respiratory tract that has not previously been reported.

The role of endoscopic stapling diverticulotomy in recurrent pharyngeal pouch.

Endoscopic stapling diverticulotomy is an increasingly popular treatment option for pharyngeal pouch. It has been our treatment of choice for the condition for over three years. Of the over 50 cases treated using the technique, three were performed for recurrent pouches--two following previous endoscopic stapling diverticulotomy and one following previous external excision. We describe these three cases to highlight the advantages and effectiveness of the technique in recurrence cases.

Expression of the forkhead box transcription factor FOXP1 is associated with oestrogen receptor alpha, oestrogen receptor beta and improved survival in familial breast cancers.

BACKGROUND: The role of FOXP1 in sporadic breast cancers has been widely studied but its role in familial breast cancers is yet unexplored. AIMS: To investigate FOXP1 expression in different molecular subtypes of familial breast cancers and to correlate its expression with clinicopathological parameters, oestrogen receptors (ER) and survival. METHODS: Immunohistochemical staining for FOXP1 was performed in 126 familial breast carcinomas comprising 35 BRCA1, 34 BRCA2 and 57 BRCAX. RESULTS: Nuclear FOXP1 expression ranged from focal weak to widespread strong expression. Expression of FOXP1 was higher in familial breast cancers (54%) compared with sporadic cancers (46%) (p<0.001). There was a significant correlation between FOXP1 with ERalpha (p = 0.038) and ERbeta (p = 0.007) in familial breast cancers. FOXP1 was more highly expressed in familial breast cancers compared with sporadic cancers for luminal (p = 0.021) and basal (p<0.001), but not HER2 and null phenotypes (both p>0.05). The absence of FOXP1 expression was associated with a shorter relapse-free (p = 0.025) and overall survival (p = 0.009) in familial breast cancer. Negativity for FOXP1 was associated with a significantly worse overall survival in BRCA2 cancers (p = 0.021) and there was a non-significant separation of the survival curves for BRCA1 cancers (p = 0.183). No differences in survival were seen for BRCAX cancers (p = 0.762). CONCLUSION: Results suggest that FOXP1 demonstrates different expression patterns in familial breast cancers than sporadic tumours, even in tumours showing similar phenotypes. They also suggest a different role of FOXP1 as a tumour suppressor in familial tumours, which is unrelated to ER expression and may impact on therapeutic options.

Endoscopic stapling diverticulotomy for pharyngeal pouch.

Fifteen endoscopic stapling diverticulotomy procedures were performed on 14 patients. Our preliminary results show the technique to be fast. effective and safe. Most patients resumed oral intake within 6 h post-operatively and were discharged from hospital within 24 h. The technique has many advantages over both the external diverticulectomy and the traditional Dohlman's procedure. The short operating time and short hospital stay are an advantage. Our follow-up period was between 1 and 12 months. Long-term results require evaluation.