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Biomedical subjects

B Kotecha

Publications and source records attributed to B Kotecha.

15 recordsLinked to original sources
PubMed2000

A cephalometric comparison of subjects with snoring and obstructive sleep apnoea.

This prospective study analysed the upright lateral cephalometric radiographs of 115 dentate, Caucasian males. Forty-five subjects exhibited proven obstructive sleep apnoea (OSA), 46 were simple snorers, and the remaining 24 subjects, who had no history of respiratory disease and did not snore, acted as controls. Radiographs were traced and digitized, and comparisons were made of the dento-skeletal, soft tissue, and oropharyngeal features of the three groups. Differences were also sought between the snoring and OSA subjects. Of the hard tissue measurements, only the cranial base angle and mandibular body length showed significant inter-group differences (P < 0.001 and P < 0.05, respectively). When the airway and associated structures were examined, both snorers and OSA subjects exhibited narrower airways, reduced oropharyngeal areas, shorter and thicker soft palates, and larger tongues than their control counterparts. Comparison of the two sleep disordered breathing groups showed no differences in any of the skeletal or dental variables examined. However in OSA subjects, the soft palate was larger and thicker (P < 0.05), both lingual and oropharyngeal areas were increased (P < 0.01 and P < 0.05, respectively) and the hyoid was further from the mandibular plane (P < 0.05). Thus, whilst the dento-skeletal patterns of snorers resembled those of subjects with OSA, some differences in soft tissue and hyoid orientation were apparent. There was not, however, a recognizable gradation in size of the airway and its associated structures from control through snoring to OSA subjects. This suggests that there may be a cephalometrically recognizable predisposition towards the development of sleep disordered breathing, but that this is only one facet of the condition.

Adult↗
PubMed1999

Myringoplasty: a prospective audit study.

Seventy-three surgeons participated in a prospective audit of myringoplasty. They returned data on 1070 individual patients. Up to 12 months follow-up information was obtained. The mean number of myringoplasties performed per consultant in 1 year (1995) was 14.7 (95% confidence intervals (CI) 12.1 17.2). The main indication for performing the operation was to achieve an intact tympanic membrane. The mean graft take rate was 82.2%. When hearing improvement was the main indication for surgery it was improved in 67%. The use, or not, of an antibiotic had no significant influence on the graft take rate or the complication rate. Most complications reported were minor in nature.

Ear Diseases↗
PubMed1999

Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA).

This prospective clinical study examined the alterations in airway and hyoid position in response to mandibular advancement in subjects with mild and moderate obstructive sleep apnoea (OSA). Pairs of supine lateral skull radiographs were obtained for 13 female and 45 male, dentate Caucasians. In the first film, the teeth were in maximal intercuspation, while in the second the mandible was postured forwards into a position of maximum comfortable protrusion. Radiographs were traced and digitized, and the alterations in the pharyngeal airway and position of the hyoid were examined. Males and females were analysed separately. In males only, correlations were sought between the changes in hyoid and airway parameters, and the initial and differential radiographic measurements. In males, mean mandibular protrusion at the tip of the lower incisor was 5.3 mm, increasing its distance from the posterior pharyngeal wall by 6.9 mm (or 9 per cent). Movement of the hyoid showed extreme inter-subject variability, both in the amount and direction. In relation to the protruded lower jaw, the hyoid became closer to the gonion by 6.9 mm and to the mandibular plane by 4.3 mm. With respect to the upper face, a 1.3-mm upward and 1.1-mm forward repositioning was seen. The percentage alterations in airway dimensions matched or bettered the mandibular advancement. The minimum distances behind the soft palate and tongue improved by 1.0 and 0.8 mm, respectively. Despite their smaller faces, females frequently showed greater responses to mandibular protrusion than males. No cephalometric features could be identified which might indicate a favourable response of the airway to mandibular protrusion. Larger increments of hyoid movement were associated with an improved airway response, but the strength of the correlations was generally low.

Adult↗
PubMed1998

Laser Assisted Uvulopalatoplasty: an objective evaluation of the technique and results.

The operation of Laser Assisted Uvulopalatoplasty (LAUP) as described by Kamami is now becoming more commonly used in the treatment of snoring and obstructive sleep apnoea. The authors have treated 95 snoring patients, varying the lengths of the soft palate incisions and percentage of uvula excised. All operations were carried out under general anaesthesia using a CO2 laser. Pilot studies showed incisions that are 25% of the distance between the free edge of the soft palate to the hard palate junction and excision of 50% of the uvula give good results with minimal complications. A further study using these parameters was conducted and postoperative evaluation including polysomnography confirmed this procedure to be effective in reducing snoring levels both subjectively and objectively.

Adult↗
PubMed1996

Management of epistaxis: a national survey.

A survey to assess variations in management and outcome of patients admitted with epistaxis was conducted. A questionnaire was sent to all consultant otolaryngologists working at NHS hospitals in England and Wales requesting information about management of patients admitted with epistaxis over a 3 month period. Data analysis of information provided by 102 consultants for a total of 933 patients was performed. The average number of patients admitted with epistaxis over a period of 3 months per consultant was 10.2. More than 70% of the patients were aged 60 years or over. Approximately 75% of the patients required nasal packing; the most common pack used was BIPP (Bismuth Iodine Paraffin Paste). Of the patients, 5.6% required general anaesthesia, with less than 1% requiring formal arterial ligation. The mean duration of stay in hospital was 2.9 days. Few complications were reported. Patients admitted with epistaxis were generally managed conservatively, with very few requiring surgical intervention. There was remarkable consensus in various aspects of management of patients admitted with epistaxis.

Adult↗
PubMed1994

Ototoxicity in vitro: effects of neomycin, gentamicin, dihydrostreptomycin, amikacin, spectinomycin, neamine, spermine and poly-L-lysine.

The effects that the aminoglycoside-aminocyclitol antibiotics amikacin, dihydrostreptomycin, gentamicin, neomycin, and spectinomycin, the neomycin fragment neamine, and the polybasic compounds spermine and poly-L-lysine, have on outer hair cells in cochlear cultures prepared from the early post-natal mouse have been assessed using both scanning and transmission electron microscopy (SEM and TEM). The antibiotics were used at concentrations ranging from 0.25-1.0 mM, spermine from 10 microM to 3.0 mM, and poly-L-lysine from 0.05-2 microM. Qualitative assessment of apical surface damage allows the antibiotics to be ranked in the following order: neomycin > gentamicin > dihydrostreptomycin > amikacin > neamine > spectinomycin. At a concentration of 1 mM spectinomycin is essentially non-toxic and the effects of neamine are marginal. Poly-L-lysine and spermine also cause surface damage, with poly-L-lysine being substantially more toxic than any of the antibiotics, and spermine ranking, on the basis of SEM observations, between dihydrostreptomycin and amikacin. TEM indicates that although all toxic compounds cause damage to the apical surface of the hair cell, only neomycin, poly-L-lysine and spermine induce the formation of whorls of tightly packed membrane resembling myelin within the apical surface lesions to any great extent. Apical-surface changes induced by dihydrostreptomycin and amikacin are simply large distensions of the cell filled with cytoplasmic organelles of normal appearance. Although the effects of the aminoglycoside antibiotics are largely limited to the apical surface of the cell, poly-L-lysine induces complete necrosis of the cell, and spermine causes a dramatic increase in cytoplasmic electron density and condensation of the nuclear chromatin.

Amikacin↗
PubMed1993

Ribavirin treatment for juvenile respiratory papillomatosis.

Juvenile respiratory papillomatosis involving the tracheo-bronchial tree imposes a significant management problem and is sometimes life threatening. The mainstay of treatment is repeated vapourization with a CO2 laser. To date, adjunctive medical treatments have been of limited value. A tracheostomized child with extensive laryngo-tracheo-bronchial papillomatosis who has required bronchoscopic lasering at two-weekly intervals for three years was treated with ribavirin, a broad spectrum anti-viral agent. The drug was administered in nebulized form using a small particle aerosol generator (S.P.A.G.) to the lower respiratory tract (6 gm/150 ml over nine hours) on three consecutive nights every two weeks over seven weeks and also administered orally (15 mg/kg/day). Endoscopic assessments were made every two weeks. At 14 days the papillomata were regressing and far less lasering was required. No further lasering was required up to 56 days. One month after stopping the ribavirin, however, a few sessile papillomata in the tracheo-bronchial tree had recurred and were treated with the laser. No adverse reactions were encountered. During the treatment period there was a significant reduction in the frequency of therapeutic endoscopies. This promising response requires further evaluation to define the role of ribavirin in the treatment of juvenile respiratory papillomatosis.

Administration, Oral↗
PubMed1992

Salivary duct carcinoma: report of a case and review of the literature.

Salivary duct carcinoma is a rare primary tumour of the salivary glands arising most frequently in the parotid gland. It has a male preponderance and occurs most often in patients over the age of 50 years. Its distinctive histological features include dilated ducts containing cells arranged in cribriform, papillary or solid patterns often with central necrosis and reminiscent of intraduct carcinoma of the breast. These features are associated with an obvious invasive component. It is an aggressive neoplasm and may metastasize widely, causing death in a high proportion of cases.

Carcinoma↗
PubMed1992

Orbital cellulitis.

Orbital cellulitis is an emergency. It may cause blindness and progress to life-threatening sequelae such as brain abscess, meningitis and cavernous sinus thrombosis. Successful management is dependent upon urgent referral and immediate treatment. Although isolated eyelid erythema and swelling usually indicate primary infection anterior to the orbital septum, they may also be the first signs of an underlying frontal or ethmoidal sinusitis. The condition always requires emergency referral to both an ophthalmologist and otorhinolaryngologist.

Adult↗
PubMed1991

Carcinoid tumour of the larynx: a case report and clinico-pathological review.

Carcinoid tumour of the larynx is a rare condition but one that is being increasingly recognised. We report the case of a 66 year old lady with an advanced malignant laryngeal carcinoid, metastasizing to the regional lymph nodes, thyroid and submandibular glands. Surgery is the treatment of choice in this condition--radiotherapy and chemotherapy being ineffective. Prognosis is poor, and most patients eventually die of distant metastases. The clinical, biochemical and histological findings are reviewed.

Aged↗
PubMed1991

Pain relief after tonsillectomy in adults: intramuscular diclofenac and papaveretum compared.

A wide variety of surgical and pharmacological methods have been described in an attempt to reduce pain after tonsillectomy, with conflicting results. Opiates are still widely used, despite unwanted side-effects. Recently the non-steroidal anti-inflammatory drugs have been shown to be effective against a variety of post-operative pains. Diclofenac is effective in both children and adults in the relief of pain after tonsillectomy when administered rectally, but absorption is variable, and suppositories are not widely accepted in the UK. The present double-blind study compared a single intramuscular dose of diclofenac with papaveretum in adults undergoing tonsillectomy. Post-operatively, the patients who received diclofenac had less pain and started drinking significantly sooner than the control group. There were no undesirable side-effects. Intramuscular diclofenac is superior to papaveretum in the relief of pain in adults undergoing tonsillectomy.

Adolescent↗
PubMed1990

The management of epistaxis in accident and emergency departments: a survey of current practice.

A short questionnaire on the subject of the management of epistaxis was sent to forty accident & emergency departments in two NHS regions. Thirty replies were received (response of 75%). It was found that all departments were involved in the initial management of epistaxis, but the extent of that involvement varied considerably. One of the most obvious factors contributing towards the degree of involvement was the liaison between the accident & emergency and the ENT departments. Three departments never referred patients to the ENT department for follow-up. Nine departments performed their own nasal cautery, but half of these did not use any form of local anaesthesia. Twenty-seven departments used various forms of nasal packing but, of these, two-thirds did not use any form of local anaesthesia. Twenty-three departments allowed patients to go home with a nasal pack in situ. The results of this survey are discussed and a guideline to the management of epistaxis in an accident & emergency setting is suggested.

Anesthesia, Local↗
PubMed1990

Upper airway obstruction secondary to anticoagulant induced haemorrhage necessitating a tracheostomy.

The incidence of major haemorrhagic complications from oral anticoagulants is between 4.4% and 8.2%. Life-threatening haemorrhage is usually either intracranial or gastro-intestinal, but haemorrhage into the upper airways is a distinctly uncommon occurrence. We report the case of an elderly lady who developed an anticoagulant induced haemorrhage into the parapharyngeal area resulting in upper airway obstruction and necessitating an emergency tracheostomy.

Aged↗
PubMed1983

Expression of differentiation markers by chick embryo neuroretinal cells in vivo and in culture.

Several markers of chick neuroretinal differentiation were monitored in vivo and in culture. All increase markedly between 7 and 20 days of embryonic development in vivo. In vitro, endogenous GABA levels decrease almost immediately, while other neuronal markers increase as in vivo for 2 to 5 days before declining (choline acetyltransferase, acetyl cholinesterase, glutamic acid decarboxylase). Neuronal cell surface markers (binding sites for tetanus toxin, alpha-bungarotoxin, muscimol), however, reach maximal levels only after 8 days in vitro. Glial markers such as carbonic anhydrase and hydrocortisone-induced glutamine synthetase activities are also expressed only transiently in culture.

Acetylcholinesterase↗