Biomedical subjects
Publications and source records attributed to A L Pahor.
The Birmingham Mummy is of a warrior, 25-35 years of age, from the Graeco-Roman period. He was struck from the front by an arrow, which penetrated the soft tissues of the neck to some depth and lodged in the right infratemporal fossa. It is suggested that the wound became infected and that muscle spasm induced the torticollis which was not fully corrected on mummification.
We present a patient with a lipoma of the deep lobe of the parotid gland. Despite the common occurrence of this tumour in other regions of the body, we believe that this is only the second report in the literature of a lipoma in this location. We believe that these tumours are easily dealt with by simple enucleation, and that superficial parotidectomy should be reserved for tumours deep to the facial nerve.
The middle ear mucociliary system has been shown to play an important role in clearing middle ear effusions. There is conflicting epidemiological evidence, however, as to whether exposure to tobacco smoke plays a significant role in persistence of middle ear effusion in patients with otherwise normal mucociliary function. Samples of middle ear mucosa from 33 patients with persistent otitis media with effusion (OME) were taken at myringotomy, together with corresponding nasal brushings. The aim of this study was to observe the mean ear ciliary beat frequency (CBF) and to compare it with nasal ciliary activity. Nasal brushings were collected from 33 age and sex matched non-smoking controls with no history of nasal atopy or topical nasal treatment. Ear CBF in OME was significantly reduced in comparison to paired nasal samples (p < 0.001). Ear CBF in adult OME patients who smoked or in children who were passive smokers was significantly less than in patients who were not exposed to cigarette smoke (p < 0.01). This study indicates that impaired ciliary function due to tobacco smoke exposure is an aetiological factor in persistent OME.
The ultrastructural details of normal middle ear mucosa have been reported in detail in the literature. This study was aimed at investigating the superficial structure of middle ear epithelium with the scanning electron microscope in patients with persistent otitis media with effusion (OME) and chronic suppurative otitis media (CSOM), especially in the light of the authors' recent findings regarding decreased ciliary beat frequency (CBF) in patients exposed to tobacco smoke. Mucosal biopsies were taken from the anterior mesotympanum in four patients with OME and another four patients with CSOM. There was no significant abnormality of cellular surface structure in patients with chronic middle ear disease. Furthermore, no significant difference was observed between smoke exposed and nonsmoke exposed patients. It is concluded that the effect of tobacco smoke on CBF is functional and not related to any anatomical abnormality observed by scanning electron microscopy (SEM).
A case of carcinoma of the lung with a metastasis on the tongue is presented. The case is of interest because, although primary carcinomas of the tongue are fairly common accounting for 50 per cent of all oral carcinomas, metastatic tumour represents only one per cent of all malignant tumours of the oral cavity and of these only 0.2 per cent metastasize to the tongue.
The assessment of children with suspected stenosis of the posterior choanae and the subglottis can be arbitrary and subjective. A study was therefore undertaken to assess the normal size of both posterior choanae and subglottis in normal children and ascertain their relationship. The size of the posterior choanae in 72 children ranged from 3-9.3 mm (3-5.5 mm when less than one year old, and 6.1-9.3 mm when older than one year). The two sides were of equal size in 51 children (p < 0.001), in 16 children the right side was larger than the left (p < 0.01), and in 5 children the left was larger than the right side. The subglottic size in 52 children ranged between 4.2-9.3 mm (1.2-5.5 mm when less than one year old, and 6.1-9.3 mm, when older than one year). The size of the subglottis was of equal size or within 1.0 mm of the average size of the two posterior choanae in 41 children (p < 0.001), and of different sizes in 11 children. Accurate and objective assessment of either area can therefore be made by measuring and comparing the two sizes in the same child.
Persistence of the stapedial artery is rare. A case is presented in which the stapedial artery was found over the footplate during stapes surgery. The technical problems encountered are discussed. A wire prosthesis has previously been used in the presence of a persistent stapedial artery and we describe the use of an all Teflon prosthesis. A subsequent CT scan demonstrated the vessel in the middle ear. An outline of the embryology of the stapedial artery is given and the literature reviewed.
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Seventy patients with nasal polyps were studied. Forty-seven of these had pre-operative sinus radiographs and all seventy patients had antral washouts at the time of nasal polypectomy. One hundred and seventeen antral aspirates were sent for culture and microscopy. The naked eye appearance of aspirates were turbid in 34 patients. Bacteria were cultured from 15 of the specimens in 10 patients. It was concluded that antral washout should be recommended in all patients who have nasal polypectomy and that there is no need for sinus radiographs in those patients who have uncomplicated nasal polyps.
Ceruminous glands should no longer be regarded as purely apocrine glands, but as apoeccrine glands with both apocrine and eccrine modes of secretion. We present two cases of pleomorphic adenoma of ceruminous glands, among the rarest of such tumours. The use of such terms as 'ceruminoma' and 'hidradenoma' should finally be abandoned, and 'ceruminous gland tumour' used instead as a generic term. Classification should be based on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic carcinoma and adenocarcinoma), with the addition of benign eccrine cylindroma and syringocystadenoma papilliferum; the inclusion of mucoepidermoid carcinoma should await full validation. Wide local excision is necessary for all tumours, with only follow-up for histologically benign neoplasms. Malignant tumours need early aggressive surgery and radiotherapy. If marginal invasion cannot be assessed histologically, then adenoma and adenocarcinoma cannot be distinguished and we suggest that the tumour be reported as 'of uncertain malignant potential'. Long-term studies are needed to confirm or refute the view that all ceruminous gland tumours are potentially malignant.
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Leiomyosarcoma of the larynx is extremely rare. A patient with respiratory obstruction due to such a tumour is presented. This was originally misdiagnosed as hysteria. The treatment of choice was an emergency laryngectomy.
Terminal duct carcinoma of salivary glands is an uncommon, histologically distinctive, low grade malignant neoplasm arising from the intercalated salivary duct. We present a case arising eight years after removal of a parotid tumour reported as a pleomorphic adenoma. We describe the clinico-pathological features of the present tumour, illustrate the difficulties that may be encountered in differentiating it from other salivary gland tumours, and discuss the possible significance of the previous tumour.
The facial nerve is commonly involved in neural sarcoidosis, but there is only one reported case in which bilateral facial paralysis was the sole manifestation of sarcoidosis. We report a case of sarcoidosis presenting with bilateral facial paralysis as the only sign. The pathology, clinical presentation, pathophysiology and diagnosis of sarcoidosis has been discussed.
Two cases of vagal neurilemmoma are presented and are added to the 64 such cases previously reported. Current management is discussed, with emphasis on diagnostic procedures, which include preoperative CT scanning and exploration of the neck, with careful definition of the tumor under general anesthesia. The operative techniques used are discussed. Attention is also drawn to severe transient bradycardia that may occur during removal of these tumors.