Magical numbers and the treatment of nasal polyps.
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Biomedical subjects
Publications and source records attributed to A Drake-Lee.
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This study was designed to compare the differences in morphology of the mast cells from the adenoid in children with otitis media with effusion (OME) and those from children with recurrent tonsillitis. Tissue for electron microscopy was prepared in the standard manner and between three and 10 blocks were examined for each child. All the mast cells with nuclei were photographed and the condition of the granules noted. The number of electron dense granules in each cell was assessed on a scale between zero and 10. Sixteen unselected children with OME were compared with 19 children with recurrent tonsillitis. There were no obvious differences in the degree of degranulation between the two groups although there was more vacuolation than previously described in the normal nose but less than in those patients with perennial allergic rhinitis. Allergy and mast cell reactions do not seem to predispose to OME. It was concluded that the adenoids are not the ideal tissue in which to study normal mast cells.
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Nasal polyps are multifactorial in aetiology but are associated with respiratory diseases, particularly late onset asthma. Several members of a family may be affected with nasal polyps but there is little evidence for a genetic basis for this. Some evidence to support a genetic predisposition comes from the development of polyps in identical twins.
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We present a paper to highlight that the investigation of dysphagia by the standard methods of barium swallow and the now routinely used fibreoptic oesophagogastroscope may miss or inadequately assess pharyngeal and hypopharyngeal causes of dysphagia and to remind that if such a cause is suspected then rigid endoscopy is required to assess or exclude the pathology.
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Acute sinusitis is easy to diagnose and treat but the symptoms of chronic rhinosinusitis may be the presenting manifestation of systemic disease. A careful history and examination should precede radiological investigation since coincidental mucosal changes are frequent in the sinuses.