Biomedical subjects
Publications and source records attributed to A R Nicolaides.
A patient with sudden onset pulsatile tinnitus resulting from a spontaneous carotico-cavernous fistula is presented. The case is discussed and illustrated to highlight the clinical features and natural history of a condition rarely seen by ENT surgeons.
This case report describes the rare complication of an adenocarcinoma developing in a colonic interposition graft 20 years following surgical resection of a postcricoid squamous carcinoma. A free jejunal graft was used for further oesophageal reconstruction following resection of the colonic graft.
An unusual incident of aspiration of a silver tracheostomy tube obturator is described. Common sense advice to patients performing home tracheostomy care may help avoid similar occurrences in the future.
Vertigo induced by aural suction was abolished by maintaining a constant temperature in the mastoid cavity during the procedure. This was achieved using humidified air at 38 degrees C at the wider end of the aural speculum. The cavity temperature fell by a maximum of 0.2 degrees C (average) in 24 patients, none of whom experienced rotatary vertigo despite prolonged suction. This contrasted with a maximum temperature drop of 8.9 degrees C (average) in the same group of patients, 18 of whom then suffered vertigo and nystagmus, when the cavity temperature was not controlled during suction.
A case of adenosquamous carcinoma of the thyroid gland is presented. This rare form of cancer behaves in an aggressive manner similar to anaplastic carcinoma and is characterized histologically by the intimate blending of the squamous and glandular elements. The prognostic significance of identifying areas of malignant squamous epithelium within papillary carcinoma as opposed to the much more common benign squamous metaplasia, is highlighted. The pathogenesis, differential diagnosis and management of the condition are discussed.
Suction toilet of mastoid cavities leads to unpleasant vertigo in many patients. We have shown that suction causes cooling within the cavity, in a series of 20 patients. This is of the same order of magnitude as a cold air caloric, showing the temperature drop to be an important factor. The relevant physical principles are examined. During suction a flow of cold, dry room air replaces the warm, moist cavity air, causing cooling both directly and by vaporization of water. Introducing humidified air at near body temperature should eliminate these effects and a study is being set up to evaluate the potential clinical applications of the method in the ENT Outpatient Department.