Biomedical subjects
Publications and source records attributed to A K Robson.
A case of papillary adenocarcinoma of the middle ear is presented. The patient had an unusually short history of otalgia, aural discharge and facial palsy, and, at presentation the tumour was too large for surgical resection to be a feasible option. The management of this rare tumour is discussed and the relevant literature reviewed.
A prospective trial was carried out to assess the relative efficiency of digital block and local infiltration as methods of anaesthesia when suturing lacerations of the digits. A standard technique and questionnaire were applied to a consecutive group of 62 patients attending the Accident Department of the Bristol Royal Infirmary. Digital block was found to be a more effective technique than local infiltration for anaesthetising digital lacerations.
Secondary chondrosarcomas are rare tumours, which can develop in up to 2% of patients with single osteochondromas. The rarity of presentation of these tumours to the general surgeon can lead to difficulty and delay in diagnosis. We describe such a tumour presenting as an abdominal mass and discuss the appropriate investigations necessary to establish the diagnosis and plan subsequent management.
Between January 1980 and September 1988, 34 octogenarians underwent aortic aneurysm repair. There were 26 men and eight women with a median age of 83 years (range 80-88 years). Twenty underwent 'emergency' repair after presenting with pain and/or collapse: 11 with a retroperitoneal rupture, three with an intraperitoneal rupture and six with an expanding aneurysm. The mortality rate for this group was 35 per cent. During the same period 14 patients had an elective repair and there were no deaths within 30 days. The mean hospital stay for the elective group was 14.2 days compared with 17.0 days for survivors in the emergency group. There was no significant difference in terms of risk factors between those who developed postoperative complications and those who did not. These mortality rates compare favourably with our overall mortality results for elective (4.6 per cent) and emergency (31 per cent) surgery. Those patients over 80 years of age with infrarenal abdominal aortic aneurysms should not be refused surgery on the basis of age alone; each patient should be judged individually.
Acoustic neuromas may be resected either by a suboccipital craniectomy or translabyrinthine approach; the latter gives good access without unduly traumatising the brainstem, but can lead to a higher incidence of cerebrospinal fluid (CSF) leaks. The surgical management of these leaks can be difficult; we describe a transmastoid extracranial technique using pedicled sternomastoid muscle that has produced complete resolution of the leak in all cases managed in this way.
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We describe the use of a silicone septal button in the management of a patient who developed a large tracheo-oesophageal fistula following primary puncture as part of a total laryngectomy. The button was easily inserted, well tolerated and prevented leakage of solids into the trachea, allowing the patient to eat.
Inflammation in the nasal mucosa may lead to epiphora by causing edema around the orifice of the nasolacrimal duct. We present and discuss three cases where simple treatment of rhinitis led to the resolution of the presenting symptom of epiphora, avoiding the need for surgery. A randomized prospective trial of topical nasal corticosteroids in the management of epiphora associated with rhinitis is in progress.