Sweet Shop Sialagogues: A Sour Solution to Sialolithiasis.

Historically, boiled sweets have been recommended by ear, nose, and throat surgeons for their sialagogue effect in patients with sialolithiasis. This study presents an in vivo analysis of boiled sweets and solutions to determine sialagogue superiority. Six high-street boiled sweets (lemon sherbets, rhubarb sweets, mint humbugs, Werther's Original® (August Storck, Germany), Fox's Glacier Fruits® (Fox's Confectionery, Braunstone, Leicester, United Kingdom), and Chupa Chups® lollipops (Perfetti Van Melle, Breda, Netherlands)) and two solutions (malt vinegar and lemon juice) were compared to two controls (no sweet and inert plastic) in two healthy participants. Malt vinegar and lemon juice produced the highest salivary flow. The best-performing boiled sweets were Chupa Chups lollipops and lemon sherbet. Substances with the highest concentrations of citric or lactic acid were the best sialagogues. This pilot study provides a proof of concept for further investigation in this cohort of patients.

The pressure effects of different commercially available beverages on food boluses in vitro.

PURPOSE: Acute oesophageal food impaction is a common and potentially life-threatening condition. Effervescent agents have been used to manage these patients. To date, there have not been any studies comparing the differences in commercially available beverages in relieving food bolus impaction. The aim of this study was to design an in vitro system where the pressure changes generated by different commercially available beverages could be compared in the presence of different food items. METHODS: A closed in vitro system was designed using a flask and manometer. Different food items [potato, beef, chicken, and no food item (control)] and different beverages (Coca-Cola®, lemonade, 7 Up Free, Prosecco and water) were inserted into this system in turn. For each food item and beverage, pressure changes (cmH2O) were recorded over a 3-min period. RESULTS: Comparing the different food items, the potato appeared to cause the greatest increases in pressure over most time points with all beverages except Coca-Cola® and water. Between the beverages, the lemonade and Prosecco seemed to generate the greatest pressure changes; lemonade generating higher (but non-significant) pressures than the Prosecco with the potato and control. CONCLUSION: Our study demonstrates that, in vitro, amongst the beverages, lemonade and Prosecco generated the greatest increases in pressure, whilst potatoes generated a greater reaction than the other food items. These findings need to be studied in further detail and, if deemed clinically relevant, may prompt further investigation for their use in the clinical setting.

Can fluorescence spectrometry be used as a surrogate for the Biochemical Oxygen Demand (BOD) test in water quality assessment? An example from South West England.

The fluorescence intensities of tryptophan-like, tyrosine-like and humic-like materials were determined using excitation-emission-matrices (EEMs) for a wide range of samples including natural surface waters, sewage and industrial effluents and waters that have experienced known pollution events from the South West of England (n=469). Fluorescence intensities reported in arbitrary fluorescence units (AFU) were correlated with standard five day Biochemical Oxygen Demand (BOD(5)) values which were used as an indicator of the amount of biodegradable organic material present. Tryptophan-like fluorescence, which has been found to relate to the activity of the biological community, showed the strongest correlation with BOD(5). Fluorescence analysis of the tryptophan-like peak (excitation/emission wavelength region 275/340 nm) is found to provide an accurate indication of the presence, and relative proportions of bioavailable organic material present (natural or anthropogenic). It therefore provides an insight relating to its oxygen depleting potential. Thus fluorescence spectroscopy is recommended as a portable or laboratory tool for the determination of the presence of biodegradable organic matter with intrinsic oxidising potential in natural waters. The novel application of Geographically Weighted Regression (GWR) to the data illustrates that strong local relationships exist between the two parameters and that site specific character may be a strong factor in the strength of the tryptophan-like fluorescence/BOD(5) relationship.

Tonsillectomy and biopsy for asymptomatic asymmetric tonsillar enlargement: are we right?

OBJECTIVE: The aim of this study was to evaluate the incidence of malignancy in patients with clinically asymmetrical tonsils and who are otherwise asymptomatic. DESIGN: Retrospective review of our experience based on case note review, carried out in a district general hospital setting during a period of two years. MATERIAL AND METHODS: 142 patients who had undergone tonsillectomy and biosy were included in the study. Histological studies of all these patients obtained and correlated with the clinical findings. RESULTS: None of the patients with asymmetric enlargement of tonsils but are otherwise asymptomatic had shown histological evidence of malignancy. However all the 3 patients with associated suspicious symptoms in the presence of asymmetric tonsils were diagnosed as having tonsillar malignancy. CONCLUSION: Tonsillar asymmetry in the absence of other associated risk factors may not indicate malignancy and a period of watchful waiting is considered appropriate prior to any surgical intervention.

Accuracy of finger-tip palpated tracheostomy tube cuff pressure readings among otolaryngologists.

The tracheal mucosa is very a delicate structure, and pressure-ischaemia problems following the use of cuffed tracheostomy tubes are well documented. Iatrogenic tracheal stenosis is one of the consequences of mucosal ischaemia and is very difficult to treat. In this study the accuracy of finger-tip tested tracheostomy tube cuff inflation pressure, as judged by consultants and non-consultants, was assessed by comparison with manometric pressure readings. The estimated pressure readings from the consultant group were more accurate than those from the non-consultant group, but a high standard deviation and very big difference between low and high readings in both these groups showed the real extent of the problem. Participants who performed 10 or more tracheostomies a year obtained more accurate results. No definite correlation was observed between the readings and the experience of the participants in otolaryngology or the size of the tube used. The authors recommend that instrumental monitoring of cuff pressure be considered good practice among junior otolaryngologists.

Diphtheria: the patch remains.

This study analysed the number of patients admitted with diphtheria to a teaching hospital in the state of Assam in India over a period of five years and compared the disease characteristics and management with outcomes and incidences of diphtheria reported in the literature. It was a retrospective analysis of data elicited from clinical records of patients admitted to hospital. A total of 101 admissions were recorded during a five-year period between March 1997 to March 2002, mostly with pharyngeal diphtheria (90 per cent). The majority of patients had no history of immunization (70 per cent). Significant presenting features were a tonsillar patch, sore throat, respiratory distress and fever. All patients were treated with anti-diphtheritic serum and intravenous antibiotics. Steroids were given to 81 per cent of patients and tracheostomy was carried out in 10 per cent of cases. The mortality was 16 per cent. Diphtheria of the respiratory tract remains a potentially fatal disease commonly presenting with membranous pharyngitis. Early diagnosis and treatment with anti-diphtheritic serum and antibiotics remain the cornerstone of treatment. Inadequate immunization cover is deemed responsible for the continued menace of diphtheria.

Intractable paroxysmal sneezing.

Intractable paroxysmal sneezing is a rare disease primarily affecting teenage girls. We present the case of a 12-year-old girl who demonstrated the classical features of intractable paroxysmal sneezing of psychogenic origin. Most of the reported cases are psychogenic in origin, but a number of other conditions may cause intractable paraoxysmal sneeze. Apart from a detailed history, clinical examination and relevant investigations, topical nasal anaesthesia should be tried for control of symptoms--that will help to differentiate psychogenic sneezing from organic sneezing. A timely diagnosis can avoid unnecessary medical trials, parental anxiety and poor school performance, as most of the patients are very young.