Computer imaging and patient satisfaction in rhinoplasty surgery.

The measurement and achievement of improved patient benefit following a particular medical or surgical intervention has become an increasingly relevant part of the provision of effective healthcare. We have retrospectively analysed patient satisfaction in 56 patients following rhinoplasty via the Glasgow Benefit Inventory (GBI), 25 of whom underwent pre-operative computer imaging planning. We have also audited patient reaction to this technique via a concurrent questionnaire in those subjects who underwent imaging, and correlated this with overall patient outcome. Patient satisfaction with cosmetic rhinoplasty following computer imaging was significantly improved compared to those patients who did not receive imaging.

Maxillary myxoma: a rare midfacial mass in a child.

The case of a maxillary myxoma in a 13-month-old child is presented. This case highlights the difficulties associated with managing such cases. The tumour was found at operation to be unencapsulated and infiltrative. This was contrary to the preoperative CT scan findings and necessitated a change from a sublabial to a lateral rhinotomy approach. This case illustrates a potential pitfall of CT scanning in such cases: it is likely that a MRI scan would have demonstrated the invasive nature of this tumour. To the authors' knowledge this is the second youngest reported case of maxillary myxoma in the literature.

Direct interaction in T-cells between thetaPKC and the tyrosine kinase p59fyn.

The protein kinase C (PKC) family has been clearly implicated in T-cell activation as have several nonreceptor protein-tyrosine kinases associated with the T-cell receptor, including p59fyn. This report demonstrates that thetaPKC and p59fyn specifically interact in vitro, in the yeast two-hybrid system, and in T-cells. Further indications of direct interaction are that p59fyn potentiates thetaPKC catalytic activity and that thetaPKC is a substrate for tyrosine phosphorylation by p59fyn. This interaction may account for the localization of thetaPKC following T-cell activation, pharmacological disruption of which results in specific cell-signaling defects. The demonstration of a physical interaction between a PKC and a protein-tyrosine kinase expands the class of PKC-anchoring proteins (receptors for activated C kinases (RACKs)) and demonstrates a direct connection between these two major T-cell-signaling pathways.

Continuous nasal positive airway pressure with a mouth leak: effect on nasal mucosal blood flux and nasal geometry.

BACKGROUND: Obstructive sleep apnoea is a common condition. Treatment with nasal continuous positive airway pressure (CPAP), while effective and safe, causes nasal congestion and stuffiness in some patients. The hypothesis that this study aimed to test was that nasal CPAP with a mouth leak and subsequent unidirectional airflow across the nasal mucosa causes an increase in nasal mucosal blood flux and a fall in both nasal volume and minimal cross sectional area. A secondary aim was to study if this could be prevented by humidifying the air inspired with nasal CPAP. METHODS: Nasal CPAP was applied to eight normal subjects who kept their mouths open until they had expired 500 litres. The effect of this on nasal mucosal blood flux and nasal geometry was studied with and without humidification using a laser Doppler blood flowmeter and acoustic rhinometer. In addition, nasal mucosal blood flux was measured in four of the eight subjects before and after nasal CPAP with the mouth closed. RESULTS: Nasal CPAP using room air with the mouth closed did not result in any change in nasal mucosal blood flux; with a mouth leak nasal CPAP using room air was associated with a 65% increase in nasal mucosal blood flux. There was no change in nasal geometry. Nasal CPAP using humidified air with a mouth leak did not cause any change in nasal mucosal blood flux or nasal geometry. CONCLUSION: Nasal CPAP used with an open mouth leads to an increase in nasal mucosal blood flux. This can be prevented by humidifying the air inspired with nasal CPAP.

Parotid duct stenosis: interventional radiology to the rescue.

Recurrent parotid sialadenitis due to isolated parotid duct stenosis is an uncommon condition and poses a difficult management problem. Conventional surgical practice carries with it a potentially high morbidity for what is a benign condition. We present three cases where parotid duct stenosis has been treated by balloon dilatation and propose that this is a safe, quick and repeatable method for dealing with this problem.

Intranasal salbutamol has no effect on mucociliary clearance in normal subjects.

Normal mucociliary clearance is essential for the healthy function of the upper and lower airways. Restoring normal clearance times in the presence of chronic disease would be a helpful adjunct in treating these patients. This double-blind placebo-controlled trial in 37 normal subjects compared topical salbutamol against placebo on nasal mucociliary clearance. Clearance rates were measured using the sacharine clearance technique and 34 patients completed the study. There was no effect of treatment, sex, order of treatment or period (interval between treatments) on mucociliary times. There was a weak positive correlation with age and there was a trend towards increased clearance times with salbutamol although this did not reach significance (P = 0.226). The results show that topical salbutamol appears to have no effect on nasal mucociliary clearance times in vivo in normal subjects.

The diagnosis of inflammatory sinonasal disease.

A prospective study was carried out on 25 consecutive patients referred to an outpatient clinic at The Royal National Throat, Nose and Ear Hospital, with a medical letter suggestive of sinusitis, to test the hypothesis that the diagnosis of inflammatory sinus disease could be made simply and accurately by employing systematic nasal endoscopy and a series of plain sinus X-rays. The study compared the diagnostic yields of the history, rigid nasal endoscopy and plain sinus films with computed tomography. All the investigations were performed on the same day. The interobserver variability between consultant ENT surgeon, senior registrar and registrar were compared. With heightened concern over the radiation exposure patients are receiving for medical investigations, the radiation exposure was determined for a selected group of patients. This study demonstrated that in the diagnosis of inflammatory sinonasal disease the clinical assessment correlated with the CT findings in over 90 per cent of cases. This accuracy was dependent on the experience of the clinician in using rigid nasal endoscopy. Interobserver variability ranged from 71 to 90.4 per cent in the correct diagnosis of underlying sinus disease. Close agreement was seen with the interpretation of CT scans. The concordance rate between plain films and CT scans was 87 per cent when reported by a consultant radiologist. This is in close agreement with previously reported studies. The average radiation exposure of coronal CT scanning was 218 times the dose for plain sinus X-rays.

Rhabdomyoma of the larynx: a rare cause of stridor.

Rhabdomyomas of the larynx are rare tumours. In the literature to date 18 cases have been reported. They usually present with slowly progressive symptoms typical of their benign nature. We present a case that has many atypical features for an 'adult' type rhabdomyoma and discuss the relevant associated literature.

Vocal fold palsy: a re-evaluation of investigations.

With easier access to more sophisticated imaging techniques, the investigation of vocal fold palsy is reassessed. A questionnaire was sent to all ENT surgeons in the UK to establish which imaging techniques are available to ENT departments and which tests are currently requested during the investigation of vocal fold palsy. An extensive literature review established the aetiology of vocal fold palsy and the sensitivity and specificity of radiological investigations. A simple protocol is proposed which would be suitable to implement in the majority of ENT departments in the UK.

Characterization of the precursor for Manduca sexta diuretic hormone Mas-DH.

We have isolated a cDNA clone encoding a precursor form of the diuretic hormone from the tobacco hornworm Manduca sexta (Mas-DH). Translation of the cDNA revealed a 138-amino acid precursor consisting of the Mas-DH amino acid sequence bounded by dibasic amino acid processing sites, a putative signal sequence, and additional peptide sequence on either side of the Mas-DH coding sequence. The region of the precursor upstream of the mature Mas-DH sequence shows limited (28%) homology to the cryptic region of the ovine corticotropin-releasing factor precursor. The Mas-DH RNA is 1.5-1.6 kilobases long; it is present in both the heads and bodies of adult and larval insects. In prewandering fifth stadium larvae, Mas-DH mRNA is expressed in brain, nerve cord, gut, and Malpighian tubules, but not in the fat body. There is a single genomic copy of the Mas-DH gene; the message is multiply spliced.

Community care workers in rural southern Illinois: job satisfaction and implications for employee retention.

This study examined factors related to community care worker job satisfaction, as a method of assessing problems related to employee turnover, based on data collected from 393 community care workers who worked with elderly clients from the 13 southernmost rural counties in Illinois in 1987. Results suggested that the majority of workers were satisfied with their job; however, there was a difference in the mean scores of those employed for more than one year and those employed for less than one year (those employed for longer than one year had significantly lower satisfaction scores than those employed for less than one year). Although only 19 individuals indicated they were intending to quit within the year, 88 respondents answered "no opinion." Reasons given why new employees quit were: low wages, no benefits, no raises or promotions, cannot cope with the elderly, do not like the elderly, or not well-suited for this type of work. Also, many of the workers responded that people quit because the job was not what they expected, they did not give it a chance, they did not receive the proper training, and that the job was too stressful or frustrating. Recommendations made on the basis of these study data include the development of a new job hierarchy (which will increase the probability of being promoted) and more detailed pre-service training program which covers in detail what new employees can expect from the job. Health education training programs are recommended as a major tool for reducing the problem of employee turnover by helping the worker manage the high levels of stress experienced on the job.