A Study on Sorption of (226)Ra on Different Clay Matrices.

The sorption of radium 226 ((226)Ra) on different clay materials (bentonite, illite and a mixture of bentonite-illite) was studied. Clay materials are used in the construction of disposal pits for technically enhanced naturally occurring radioactive materials (TENORM) wastes (i.e., contaminated soil and sludge) generated by the oil and gas industry operations. Experimental conditions (pH, clay materials quantity, and activity concentrations of (226)Ra) were changed in order to determine the optimal state for adsorption of (226)Ra. The results showed that the concentration of adsorbed (226)Ra on clay materials increased with time to reach an equilibrium state after approximately 5 h. More than 95 % of the radium was adsorbed. The mixture of bentonite-illite (1/9) exhibited the greatest adsorption of radium under all experimental conditions.

A randomised controlled trial comparing Rapid Rhino Mannheim and Netcell series 5000 packs following routine nasal surgery.

OBJECTIVES: To determine whether there is a difference in discomfort between Netcell Series 5000 and Rapid Rhino Mannheim 8.0 cm (Cat. No. 800) packs used after routine nasal surgery, whilst in situ and during removal. This was tested in a single blind, randomised controlled trial at the ENT Department, Royal Devon & Exeter Hospital. PARTICIPANTS: Adults aged 16-65 undergoing nasal septal surgery and trimming of inferior turbinates. Patients were excluded if they were undergoing revision surgery, taking anticoagulants, or had a history of sino-nasal disease or trauma. Thirty nine entered and 32 completed the study. The intervention was a different nasal pack in each side of the nose, removed the morning after surgery. MAIN OUTCOMES MEASURES: Pain experienced by patients while packs are in situ and on removal as recorded on a standard unmarked 100 mm visual analogue scale. RESULTS: There was no difference in the pain scores whilst in situ. Rapid Rhino Mannheim was more painful on removal (difference = 10.6 mm, p < 0.001, Wilcoxon signed ranks test). CONCLUSIONS: Rapid Rhino Mannheim packs do not confer a benefit over Netcell Series 5000 packs after routine nasal surgery.

Air rifle pellet injury to the middle ear, a very rare occurence.

INTRODUCTION: Air rifle pellet injuries are relatively common. These injuries often involve the brain, eyes chest or abdomen. It is rare for ENT surgeons to be involved in the care of these patients. CASE REPORT: We present the case of a 38 year old man with a history of an air rifle pellet injury to the left ear. Presenting symptoms included bleeding per ear, otoalgia, hearing loss and tinnitus. Imaging and surgical exploration demonstrated a metallic pellet in the left petrous temporal bone, within the middle ear and a fracture of the anterior wall of the external auditory meatus with associated tiny metallic fragments. A further surgical exploration was required to remove a bony sequestrum of the anterior canal wall. CONCLUSION: The onset of pain and discharge a few months after the injury may imply the formation of a delayed sequestrum. The possibility of an implantation cholesteatoma should also be considered.

Functional endoscopic sinus surgery for chronic rhinosinusitis.

BACKGROUND: Rhinosinusitis is a well-recognised clinical syndrome affecting patients of all ages and gender. FESS has now become a well-established strategy, comprising several techniques, for the treatment of chronic rhinosinusitis refractory to medical treatment. OBJECTIVES: The aim of this review was to assess the effectiveness of functional endoscopic sinus surgery as a treatment for patients with chronic rhinosinusitis. SEARCH STRATEGY: The Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to January 2006) and EMBASE (1974 to January 2006) were searched. Reference lists were handsearched and experts in the field contacted to identify further studies. SELECTION CRITERIA: Randomised controlled trials. Inclusion criteria were any of the following criteria singly or in combination: patients with chronic rhinosinusitis diagnosed by a health professional; patients with sinusitis symptoms for more than 12 weeks; endoscopic evidence of sinusitis or radiological evidence of sinusitis. Exclusion criteria were immune suppression; cystic fibrosis; Wegener's disease; previous sinus surgery or sinonasal malignancy. DATA COLLECTION AND ANALYSIS: All studies meeting the inclusion criteria underwent validity assessment and the data were extracted independently by the two authors. Comparisons were:FESS versus medical treatmentFESS versus conventional sinus surgeryFESS + medical treatment versus medical treatmentFESS + medical treatment versus conventional sinus surgery + medical treatment MAIN RESULTS: The three included studies were randomised controlled trials. The evidence available does not demonstrate that FESS, as practiced in the included trials, is superior to medical treatment with or without sinus irrigation in patients with chronic rhinosinusitis. A middle meatal antrostomy fashioned by FESS was also not shown to be superior to an inferior meatal antrostomy formed by traditional sinus surgery techniques, although the small sample size in the study does not exclude a type II error. In one study there was a relapse rate of 2.4% in the FESS and sinus irrigation group compared to 5.6% in the sinus irrigation only group. The relapse rates were not mentioned in the other studies. There were no major complications such as orbital injury or cerebrospinal fluid leak reported in any of the included trials. AUTHORS' CONCLUSIONS: FESS as currently practiced is a safe surgical procedure. The limited evidence available suggests that FESS as practiced in the included trials does not confer additional benefit to that obtained by medical treatment (+/- sinus irrigation) in chronic rhinosinusitis. More randomised controlled trials comparing FESS with medical and other treatments, with long-term follow up, are required.

Fluorescence spectroscopy combined with 5-aminolevulinic acid-induced protoporphyrin IX fluorescence in detecting oral premalignancy.

BACKGROUND: Early detection of premalignant/malignant lesions in the oral cavity can certainly improve the patient's prognosis. This study presents fluorescence imaging with the topical application of 5-aminolevulinic as a way to improve detection of various oral tissue pathologies. This procedure depends mainly on comparing the intensity of red and green fluorescence emitted from tissues during examination. MATERIALS AND METHODS: Seventy-one patients who presented with clinically suspicious oral leukoplakia were recruited for this study. Each of the patients was required to have 5-aminolevulinic acid in the form of mouth rinse prior to fluorescence imaging. Following this a surgical biopsy was acquired from the exact examination site. The results of the fluorescence spectroscopy have been compared with histopathology. RESULTS: A Student's t-test was applied to test the viability of the ratio between red and green fluorescence. The red-to-green ratio was found to increase significantly when the lesion was identified as dysplastic or carcinoma in situ. By applying a threshold line to discriminate between normal and dysplastic lesions; a sensitivity of 83-90% and specificity of 79-89% were obtained. CONCLUSION: Fluorescence spectroscopy combined with 5-aminolevulinic acid-induced protoporphyrin IX was found as a valuable tool in the diagnosis of oral premalignancy. This technique offers the potential to be advantageous over other non-optical techniques in terms of providing real-time diagnosis, in situ monitoring, cost effectiveness and more tolerated by patient compared to surgical biopsy.

Photodynamic therapy down-regulates the invasion promoting factors in human oral cancer.

Squamous cell carcinomas of the head and neck are characterized by their high tendency for invasion and metastasis. Several studies have identified the roles of matrix metalloproteinases (MMPs), vascular endothelial growth factors (VEGF) and urokinase plasminogen activators (uPA) in this process. Photodynamic Therapy (PDT) is an emerging treatment currently in clinical practice for the treatment of early cancer. Here we evaluate, in vitro, the influence of PDT on the expression of these molecules. A series of human keratinocyte cell lines derived from human oral squamous cell carcinomas (OSCC) were used as the PDT 'targets' in this study. Each cell line was subjected to sublethal dose of PDT. Activity of MMP-2, MMP-9, MMP-13, uPA and VEGF were evaluated at protein levels using zymography and ELISA on culture medium. For uPA, a chromogenic assay was performed. Gelatin zymography results revealed that, in control medium, MMP-9 and MMP-2 were secreted in proform. MMP-2 was highly expressed by H376 cells while VB6 and UP cells relatively show similar MMP-2 with comparatively low expression. For MMP-9, the latent type was highly expressed by VB6 cells and only slightly by H376, while active-MMP-9 was expressed by VB6 cell line only. Following PDT, both active and latent MMP-2 and MMP-9 were down regulated by UP and VB6 cells (p<0.001), while H376 showed an increase in active-MMP-2. These observations were supported by ELISA. This study has demonstrated that, PDT causes the suppression of factors responsible for tumour invasion which may be of therapeutic value.

Orbital infections: five-year case series, literature review and guideline development.

BACKGROUND: Periorbital infections represent a spectrum of sepsis that carries potentially significant morbidity and mortality. Early recognition, systematic assessment and aggressive treatment of the condition are essential. METHODS: A retrospective five-year case note review on the management of periorbital infections was performed at a tertiary centre. A literature review on the management of periorbital infections was also undertaken. A multidisciplinary guideline on the management of periorbital infections was developed based on the findings of the case and literature reviews. RESULTS: The results of the retrospective case series correlate well with those of recent reports. CONCLUSION: The new multidisciplinary guideline has been finalised and approved for practice and future auditing.

From Inpatient Notes to Outpatient Followup: Enhancing the Rhinology Service in a Tertiary Centre through Student Led Projects.

Introduction. Medical students can use systems to help improve the quality of care in a unit. Following the review of care within the ENT department at a tertiary centre a number of quality improvement projects were put in place. Methods. The following interventions were established: (1) creation of an outpatient telephone enquiry clinic, (2) development of a rhinology database, (3) introduction of operative note templates, and (4) construction of electronic discharge summary templates (eDSTs). Discussion and Outcomes. (1) Consultant telephone inquiry clinics were successfully organised and showed high levels of patient satisfaction. (2) A database to collect patient reported outcome measures was piloted within rhinology outpatients; the results suggest that such a database would be simple to introduce and yield benefits for patients and the department. (3) Operative note templates for FESS procedures were implemented with a view to improving the continuity of care onto the ward; these have become well established and further steps to integrate these into routine care are being taken. (4) eDSTs specific to FESS and septorhinoplasty procedures were introduced with a view to increasing completion speed of templates and adherence to Royal College of Physician Guidance.

Radiological difficulties in the diagnosis of fibrous dysplasia of the sphenoid sinus and the cranial base.

Fibrous dysplasia is a benign disorder of bone. We present the case of a 26-year-old man with fibrous dysplasia of the sphenoid sinus and the cranial base. The presentation and management of this rare condition are discussed highlighting the potential for misdiagnosis with MRI.

Well-differentiated liposarcoma of the hypopharynx.

We present a case of well-differentiated liposarcoma of the hypopharynx in a 51-year-old male, with a review of the literature of this very rare condition.

Thyroglossal duct remnants.

Thyroglossal duct remnants presenting as a lump in the neck are usually called thyroglossal cysts. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone (Sistrunk's operation) is necessary to avoid recurrence. The authors have reviewed the histology of 61 consecutive specimens diagnosed preoperatively as thyroglossal cysts and have found that a true cyst exists in only 46 per cent of cases.

A simple assessment of quality of life in head and neck cancer patients; what can it tell us?

OBJECTIVE: A number of well validated quality of life (QoL) instruments are available. Head and neck cancer patients often find these exhaustive questionnaires too long or bothersome. The purpose of our study was to evaluate a patient self-reported very simple assessment of quality of life and to compare it with the well-validated European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaire. METHODS: A departmental simple questionnaire was designed consisting of 2 components: 1. A visual analogue scale; 2. A space for patients to enter up to 3 specific problems which prevent quality of life being better. These may be physical, emotional, social or practical problems. 112 patients attending the head and neck oncology clinic completed both questionnaires (half completed the simple questionnaire first and the other half the EORTC questionnaire first). RESULTS: There was a good correlation between the global health scores of the EORTC and the visual analogue scale of the simple questionnaire. There was poor correlation between specific domains in the EORTC questionnaire and the 3 comments mentioned by patients in the simple questionnaire. CONCLUSION: A simple patient assessment of quality of life can be used as a simple outcome tool in head and neck cancer data bases when specific details are not required.

The use of speech therapy in the treatment of globus pharyngeus patients. A randomised controlled trial.

INTRODUCTION: Globus sensation is a common condition accounting for about 4% of new referrals to an ENT clinic. A review of current theories on the cause of globus sensation concludes that no single aetiology is responsible. Wareing et al believed that globus sensation might in part be associated with excessive laryngeal and pharyngeal tension. The aim of this study was to substantiate in a controlled prospective manner the results of a non-controlled study by the same authors that certain speech therapy techniques improved globus symptoms. METHODS: 1. 36 patients with typical globus pharyngeus symptoms were randomised to treatment with speech therapy (Study group) and reassurance by nurse practitioner (Control group). The following data was collated for each patient: duration and type of globus symptoms (sense of a lump in the throat/throat irritation), severity of globus symptoms on a visual analogue scale, fibreoptic laryngoscopy, full blood count, barium swallow. 2. At the end of 3 months, patients in both groups marked on the visual analogue scale the severity of their symptoms. RESULTS: There was a significant improvement in the globus symptom scores in the speech therapy group compared to pre-intervention scores (p < 0.001, Wilcoxon rank test). There was also a significant improvement in globus symptoms in the speech therapy group compared to controls (p < 0.001, Mann-Whitney U test). CONCLUSION: Initial results suggest that patients with globus pharyngeus symptoms benefit from speech therapy.

Otoplasty for prominent ears in children. The technique adopted in the Portmann Institute.

The Otoplasty technique adopted in the Portmann Institute is a simple rapid technique that maintains the natural contours of the auricle with minimal risk of infection. The technique involves excision of a large ellipse of skin from the mastoid surface of the auricle and reflection of remaining skin to the edge of the helix. The subcutaneous and muscular tissues on the mastoid bone are excised and the mastoid surface of the auricular cartilage scored with monopolar diathermy. After haemostasis, the wound is closed using continuous long-term absorbable sutures. A dressing and bandage are applied and the child is monitored for 10 days. A head bandage is applied at night for one month with use of a sun-screen cream on the scar at daytime.

Schwannoma of the postcricoid region: report of a first case.

Schwannoma is one of the very rare benign tumours of the hypopharynx. It has to be distinguished from malignant tumours arising from this region. We report the management of a case of postcricoid schwannoma with a review of the literature.

Sinonasal malignancy: presentation and outcomes.

OBJECTIVE: We wanted to identify the presentation, diagnostic work-up and treatment outcomes of patients with sinonasal malignancy at Derriford Hospital, Plymouth, UK and compare these with the European Position Paper on Endoscopic Management of Tumours of the Nose, Paranasal Sinuses and Skull Base. MATERIALS AND METHODS: This was a retrospective audit of all patients diagnosed with sinonasal malignancy over a five-year period. The clinical records and picture archiving and communications system data of the patients were reviewed. RESULTS: Thirty patients with sinonasal malignancy were identified out of 570 head and neck cancer patients. The nasal cavity was the most common site for presentation, followed by the maxillary sinuses. Fifty per cent of patients had a squamous cell carcinoma and 27 per cent had a malignant melanoma. Half of the patients presented at stage IV of the cancer and 20 per cent at stage III. Thirty-seven per cent of patients underwent surgical management and only 20 per cent of the total patient group underwent endoscopic surgery. The mortality in our series was 30 per cent over the studied period. CONCLUSION: Late-stage presentation of sinonasal malignancy has resulted in increased patient mortality in our case series. Also, we found a high incidence of malignant melanoma with high recurrence and survival rates.

Cavernous sinus thrombosis secondary to contralateral sphenoid sinusitis: a diagnostic challenge.

OBJECTIVE: To report what we believe to be the first case in the English language literature of unilateral cavernous sinus thrombosis complicating contralateral sphenoid sinusitis. CASE REPORT: A 62-year-old man presented to his general practitioner with a severe, right-sided, temporal headache. He was diagnosed with temporal arteritis and treated with systemic steroids. After five days, he developed right proptosis, ophthalmoplegia and ptosis. He was referred to the neurologists. After an urgent computed tomography head scan and computed tomography angiogram, a diagnosis of carotido-cavernous fistula was made. However, this was subsequently excluded after a negative cerebral angiogram. A review of the scans enabled diagnosis of right cavernous sinus thrombosis secondary to left sphenoiditis. The patient was referred to the otolaryngology team. After an urgent endoscopic sphenoidotomy and medical treatment, all symptoms and signs improved dramatically. CONCLUSIONS: Sphenoiditis can lead to contralateral cavernous sinus thrombosis. Urgent surgical sphenoidotomy, with appropriate medical treatment, can be successful in this life-threatening complication.