RESUMO
Intratracheal thyroid is a rare condition. It presents with symptoms of tracheal obstruction and may mimic adult onset asthma. We present a case and discuss the difficulties in diagnosis and management.
Assuntos
Coristoma/diagnóstico , Glândula Tireoide , Doenças da Traqueia/diagnóstico , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Coristoma/patologia , Coristoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Traqueia/patologia , Traqueia/cirurgia , Doenças da Traqueia/patologia , Doenças da Traqueia/cirurgia , UltrassonografiaRESUMO
An unusual case of a patient presenting with myringitis bullosa haemorrhagica (MBH), who subsequently developed acute otitis media and meningo-encephalitis, is described. The aetiology of MBH is discussed, and recommendations for the management of patients with acute otitis are made.
Assuntos
Meningoencefalite/complicações , Meningoencefalite/diagnóstico , Otite Média/etiologia , Membrana Timpânica/patologia , Doença Aguda , Adulto , Vesícula/etiologia , Vesícula/patologia , Feminino , Humanos , Mycoplasma pneumoniae/patogenicidade , Otite Média/patologia , Tomografia Computadorizada por Raios XRESUMO
We describe a simple preoperative procedure that we have found of great benefit in submandibular gland excision.
Assuntos
Glândula Submandibular/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Tampões Cirúrgicos , Administração Sublingual , HumanosRESUMO
This study aims to investigate the facilities available in Accident and Emergency (A&E) departments and the education of casualty officers in the treatment of epistaxis in the UK. Fifty departments were chosen at random and a telephone survey undertaken. The results show a paucity of facilities and inadequate training of A&E officers in a majority of departments. Recommendations for treatment standards are made.
Assuntos
Tratamento de Emergência , Epistaxe/terapia , Protocolos Clínicos , Educação Médica Continuada , Serviço Hospitalar de Emergência , Pesquisas sobre Atenção à Saúde , Humanos , Corpo Clínico Hospitalar/educaçãoRESUMO
A case of a solitary fibrous tumour arising in the deep soft tissues of the neck is reported. This rare tumour has not previously been described in this site. We discuss the clinical presentation and pathological features.
Assuntos
Fibroma/patologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Tecidos Moles/patologia , Feminino , Fibroma/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Neoplasias de Tecidos Moles/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The transplantation of large numbers of three- to five-hair minigrafts has superseded the use of traditional punch grafts in hair restoration surgery. The minigrafts are usually designed and cut in a square or rectangular shape for implantation into the recipient slits. Transplanting a large number of these grafts into the recipient slits can lead to a high frequency of complications, especially in cases in which there is a need for dense packing of grafts. The complications include excess graft compression resulting in extrusion or retraction into the slit. This in turn can lead to piggybacking or insertion of two grafts per slit with the resultant effect of cyst formation, cobblestoning, and hypertrophic scar formation. OBJECTIVE: To develop an optimal shape of minigrafts to match the recipient slits. METHODS: The authors have calculated the optimum geometric configuration for a minigraft in a linear slit and have developed the correct cutting instrument and preparation technique for its production. This rhomboid minigraft design maximizes the graft stability in the slit and therefore its survival, and also minimizes the risk of complications. RESULTS: The described technique shows that the transplanted rhomboid minigrafts remain well anchored in the recipient slits and results in an excellent clinical outcome. CONCLUSION: The rhomboid minigrafting technique (1.5 x 1.5 mm in size) seems to accommodate the grafts better into the recipient slits than the standard shape rectangular minigrafts. It thereby better facilitates the insertion of the grafts in the slits and reduces the frequency of graft extrusion as well as graft compression.
Assuntos
Alopecia/cirurgia , Cabelo/transplante , Couro Cabeludo/cirurgia , Adulto , Sobrevivência de Enxerto , Humanos , Masculino , Transplante de Pele/métodosRESUMO
Relapsing polychondritis is a rare multisystem disorder of unknown etiology characterized by recurrent inflammation and degeneration of cartilage and connective tissue. Laryngotracheobronchial complications are the most severe manifestations of the disease and present the most challenging management decisions. We present four cases of relapsing polychondritis with laryngotracheobronchial manifestations that illustrate the clinical features and review the treatment options.
Assuntos
Broncopatias/etiologia , Doenças da Laringe/etiologia , Policondrite Recidivante/complicações , Doenças da Traqueia/etiologia , Adulto , Obstrução das Vias Respiratórias/etiologia , Anti-Inflamatórios/uso terapêutico , Dióxido de Carbono , Edema/etiologia , Eritema/etiologia , Feminino , Humanos , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/cirurgia , Mucosa Laríngea/patologia , Terapia a Laser , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Policondrite Recidivante/fisiopatologia , Prednisolona/uso terapêutico , Doenças da Traqueia/tratamento farmacológico , Doenças da Traqueia/cirurgia , Estenose Traqueal/etiologiaRESUMO
The endoscopic approach to the fronto-ethmoidal recess (FER) in the treatment of chronic frontal sinus disease is now widely accepted. The Lothrop procedure was first described in 1914, but was largely replaced with more invasive open frontal sinus procedures until the advent of the rigid Hopkins' rod, since when it has enjoyed renewed popularity. We describe a modification of this technique which allows both transnasal endoscopic and external direct visualization of the FER and frontal sinus and a direct approach to the anterior buttress (or "nasofrontal beak") which allows its quick and simple removal.
Assuntos
Endoscopia , Sinusite Frontal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Otolaringologia/métodosRESUMO
Giant cell reparative granuloma (GCRG) is a rare nonneoplastic proliferative lesion of unknown etiology. It most commonly occurs in the mandible, but also occurs in other bones of the facial skeleton and cranial vault. Two cases of GCRG arising from the maxilla are presented. Histological and radiological features, and the pertinent literature on the subject are reviewed.
Assuntos
Granuloma de Células Gigantes/patologia , Doenças Maxilares/patologia , Idoso , Movimento Celular , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
A percutaneous connector system has been developed for use in neural prosthetic applications. It is based on a skin-penetrating, bone-anchored titanium pedestal, housing an II-channel electrode array. Initial applications for the system are in audiology and as such, the proposed fixture site is in the temporal bone. The titanium pedestal is based on existing design features of the EPI Bioglass implant, developed by University College London (UCL), and the Brånemark System, employed by Nobel Biocare AB. The electrode array, consisting of platinum wires in a silicone carrier, can be custom designed to suit the application. The design features of the connector system are reviewed. Animal studies have been used to assess soft tissue reactions and the osseointegration of the pedestal. The histological data are presented. The pedestal, electrode array and the mating external connector are currently undergoing mechanical and electrical testing. The percutaneous connector system will undergo clinical trials, initially in the study of tinnitus (employing stimulation via an extracochlear electrode), and as part of a cochlear implant system (using a multichannel intracochlear electrode array and digital signal processing techniques.
Assuntos
Implantes Cocleares/normas , Osseointegração , Animais , Fenômenos Biomecânicos , Eletricidade , Desenho de Equipamento , Humanos , Teste de MateriaisRESUMO
It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the 'gold standard', but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis. A newer technique to reduce snoring caused by palatal flutter by using a neodymnium:yttrium aluminum garnet laser to stiffen the soft palate has been introduced recently by another unit. We show that this procedure can be carried out using a CO2 laser, and present the initial results of the first 29 patients operated on at The Royal National Throat, Nose and Ear Hospital.
Assuntos
Terapia a Laser , Palato/cirurgia , Síndromes da Apneia do Sono/cirurgia , Ronco/cirurgia , Dióxido de Carbono , Feminino , Humanos , Masculino , Projetos Piloto , Resultado do Tratamento , Úvula/cirurgiaRESUMO
The case of an elderly male with Shy-Drager syndrome is presented. His presentation to the Sleep Clinic for assessment of snoring illustrates bilateral abductor vocal fold palsy as a rare presentation of the syndrome. This case emphasizes the need for thorough investigation of all patients with sleep-related breathing disorders with video and sound recordings prior to anaesthesia and surgery.
Assuntos
Síndrome de Shy-Drager/complicações , Síndromes da Apneia do Sono/etiologia , Ronco/etiologia , Paralisia das Pregas Vocais/etiologia , Idoso , Humanos , Masculino , Síndrome de Shy-Drager/diagnósticoRESUMO
A simple, safe and effective procedure for improving the diagnostic accuracy of nasopharyngoscopy is described. It is most useful for the exposure of the hypopharynx, especially in the elderly patient.
Assuntos
Hipofaringe/patologia , Doenças Faríngeas/diagnóstico , Manobra de Valsalva , Idoso , Endoscopia , HumanosRESUMO
Post-operative nasal medications are commonly used following routine septal or turbinate surgery but their efficacy in removing blood clots, improving the sensation of a patent airway and promoting healing are unknown. This prospective randomized trial of patients undergoing septal and/or turbinate surgery assessed the efficacy of three commonly used nasal medicines, 0.5 per cent ephedrine hydrochloride nasal drops, betamethasone sodium phosphate (Betnosol) nose drops and alkaline nasal douches, in producing the sensation of a patent airway in the 14 days following surgery. Ninety-seven patients were randomized into the three treatment groups and a control group who received no nasal medication. Patients assessed their nasal patency by means of a visual analogue scale (VAS) and any complications of treatment were recorded. Statistical analysis of the 76 complete sets of results using the Mann-Whitney U-test showed that there was a significant difference in the distribution of all of the treatments for each of the time intervals (p < 0.05). Glass rank biserial correlation coefficients were all small (rg < 0.085) but the most significant differences were between ephedrine and the control group at two hours, two, seven and 10 days (0.02, 0.054, 0.057, 0.085 respectively), alkaline nasal douches being most significant at four and 14 days (0.06 and 0.0722 respectively).
Assuntos
Álcalis , Betametasona/análogos & derivados , Efedrina/administração & dosagem , Obstrução Nasal/tratamento farmacológico , Septo Nasal/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Conchas Nasais/cirurgia , Vasoconstritores/administração & dosagem , Adolescente , Adulto , Idoso , Betametasona/administração & dosagem , Feminino , Humanos , Instilação de Medicamentos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
This randomised prospective trial compared the efficacy of sodium bicarbonate and hydrogen peroxide ear drops in clearing a blocked tympanostomy tube. Tympanostomy tubes, 110 in number, obstructed with blood or inspissated secretions were randomised into treatment and control groups. Details of the operative procedure were retrospectively collected from the patients notes. The patients were reviewed after 2 weeks for both clinical and tympanometric evidence of clearance of the tube and evidence of complications of the drops. There was no significant therapeutic advantage between the two drops (P > 0.9), but in both treatment arms there was a significant therapeutic advantage over a period of observation (P < 0.05 in both groups). Otorrhoea and pain on instilling the drops occurred with equal incidence in both treatment groups. As obstruction of tympanostomy tubes is a common occurrence which often prompts surgical reventilation, there is great potential for cost savings if conservative treatment can be used effectively. The treatments for obstructed tympanostomy tubes are reviewed and methods of prevention of this common occurrence are discussed.
Assuntos
Peróxido de Hidrogênio/uso terapêutico , Ventilação da Orelha Média/instrumentação , Bicarbonato de Sódio/uso terapêutico , Testes de Impedância Acústica , Administração Tópica , Adolescente , Adulto , Criança , Pré-Escolar , Meato Acústico Externo/patologia , Falha de Equipamento , Feminino , Seguimentos , Migração de Corpo Estranho/etiologia , Humanos , Peróxido de Hidrogênio/administração & dosagem , Peróxido de Hidrogênio/efeitos adversos , Lactente , Masculino , Pessoa de Meia-Idade , Otite Média com Derrame/tratamento farmacológico , Estudos Prospectivos , Estudos Retrospectivos , Bicarbonato de Sódio/administração & dosagem , Bicarbonato de Sódio/efeitos adversos , Membrana Timpânica/patologiaRESUMO
Atomizers working on the Venturi principle are used by otolaryngology departments in the UK to spray cocaine and other local anaesthetic and vasoconstricting solutions into the nasal cavities. These devices are rarely cleaned, nor is the cocaine in the reservoir changed between patients. This study aimed to assess the risk of cross-infection with such an atomizer of the Down's design. Nutrient broth from a sterile atomizer was sprayed into the nasal cavities of 12 healthy volunteers on three occasions, the tip of the nozzle was withdrawn between sprays into the right nostril, but not between sprays into the left. On each occasion the tip of the nozzle, a nutrient broth rinse of the inner tube of the nozzle and the residue of broth in the reservoir of the atomizer were cultured and the colonies compared with those from a nasal swab collected previously. The results show transmisson of bacteria from the nasal vestibule on to the tip, into the nozzle and into the reservoir of the atomizer. Examination of the minimum inhibitory concentration values of 10% cocaine with and without Nipasept preservative indicated poor antibacterial properties. We conclude that the use of an atomizer on more than one patient poses a risk of cross-infection, and recommend their replacement with a single-use disposable nasal atomizer.
Assuntos
Infecção Hospitalar/transmissão , Contaminação de Equipamentos , Nebulizadores e Vaporizadores , Administração Intranasal , Adulto , Cocaína/administração & dosagem , Cocaína/farmacologia , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/microbiologia , Nebulizadores e Vaporizadores/normas , Nebulizadores e Vaporizadores/estatística & dados numéricos , Ambulatório Hospitalar , Risco , Staphylococcus/efeitos dos fármacos , Staphylococcus/isolamento & purificação , EsterilizaçãoRESUMO
A patient suffering from persistent hoarseness was eventually shown to have laryngeal leishmaniasis. The incubation period for the disease must have been at least 16 years, following infection in Southern Europe. Mucosal leishmaniasis is rare in the Eastern hemisphere, and laryngeal leishmaniasis has not previously been reported in the UK. Previous Mediterranean cases have run a similar chronic course and have caused diagnostic difficulty, in particular being mistaken for malignancy. Treatment with aminosidine was ineffective, but the patient responded to liposomal amphotericin.
Assuntos
Doenças da Laringe/patologia , Leishmaniose/patologia , Anfotericina B/uso terapêutico , Animais , Feminino , Humanos , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/parasitologia , Laringe/parasitologia , Leishmaniose/tratamento farmacológico , Leishmaniose/parasitologia , Pessoa de Meia-Idade , Mucosa/parasitologia , Fatores de TempoRESUMO
Five patients undergoing assessment for cochlear implantation have been found to have a nonorganic hearing loss (pseudohypacusis). This phenomenon has not been reported previously in this patient population. The cases are presented and the causes, detection, and management of this condition are discussed.
Assuntos
Implantes Cocleares , Perda Auditiva Funcional/diagnóstico , Adolescente , Adulto , Audiometria , Feminino , Perda Auditiva Funcional/etiologia , Perda Auditiva Funcional/terapia , Humanos , Masculino , Seleção de Pacientes , Cuidados Pré-Operatórios , Encaminhamento e ConsultaRESUMO
The combination of a narrow oesophageal lumen and a hypertonic pharyngo-oesophageal (P-E) segment following laryngectomy and secondary tracheo-oesophageal puncture (TEP) can cause obstruction of a voice prosthesis and consequently prevent phonation. The 'Allan Johnson' modification of the Bivona voice prosthesis incorporates a stainless steel slide and has been successfully used to remedy such a circumstance.