Search PubMed⌕ Search

Biomedical subjects

C A Milford

Publications and source records attributed to C A Milford.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of quality of life and psychiatric morbidity in patients with malignant tumours of the skull base.

In general, patients with malignant tumours of the skull base have a poor prognosis. Treatment may have a disfiguring physical and disabling mental effect on patients. To evaluate the effect of treatment on physical and mental quality of life in patients with skull base malignancy, we conducted a cross-sectional patient survey of 18 patients treated for such tumours, using the University of Washington (version 4) quality of life questionnaire and the hospital anxiety and depression scale. The total quality of life score (median value) was 980 (550-1125). Patients with anterior skull base malignancy scored lower than those with lateral skull base malignancy (p=0.003). In general, the worst individual domain scores were: mood (64 per cent); activity (69 per cent); and, specifically for patients with anterior skull base malignancy, taste (54 per cent, p=0.004) and anxiety (60 per cent, p=0.034). One-third of skull base cancer patients were at risk of suffering from mental distress and psychiatric morbidity (indicated as a score of more than seven on the hospital anxiety and depression scale).

Adult↗
PubMed1999

Trigeminal neurinoma presenting with trismus.

We describe a patient with trigeminal neurinoma whose main presenting symptom was trismus. This has not previously been reported in the literature. We review the previously described symptoms and signs of trigeminal neurinoma.

Cranial Nerve Neoplasms↗
PubMed1998

Fibrous dysplasia and ossifying fibroma of the paranasal sinuses.

Fibro-osseous lesions involving the paranasal sinuses, the mid-face and anterior skull base are uncommon. In addition, there appears to be no clear pathological or clinical classification that embraces the variety of lesions that exhibit such diverse pathological and clinical behaviour, yet may still be referred to as a fibro-osseous lesion. The diagnosis of fibrous dysplasia and ossifying fibroma is made on a combination of clinical, radiological and pathological criteria. This paper emphasizes the clinical and pathological differences between fibrous dysplasia and ossifying fibroma. The more aggressive clinical behaviour of the latter is highlighted and a more radical surgical approach is recommended. In contradistinction, fibrous dysplasia can exhibit a more benign behaviour and radical surgery is not always justified. A clinicopathological distinction between these two conditions is important from a management perspective despite the fact that they both may be encompassed under the 'umbrella' term fibro-osseous lesion.

Adolescent↗
PubMed1996

MRI in the detection of acoustic neuromas--a suggested protocol for screening.

Magnetic resonance imaging (MRI) is the definitive investigation in the detection of an acoustic neuroma and its use is becoming increasingly widespread for this purpose. In the Oxford region, this facility has been available for 3 years, resulting in the scanning of the internal auditory meati and cerebellopontine angles of 892 patients and the detection of 38 acoustic neuromas. Based on our use of this investigation over this time period, we have attempted to rationalize our entry protocol for screening by limiting the availability of the test to those patients up to 70 years of age presenting with unilateral audiovestibular symptoms in the absence of significant neurological symptoms or signs, with an average difference in hearing threshold of 15 dB between normal and symptomatic ears or unilateral tinnitus with normal hearing. By following these entry criteria, we would hope to maximize the available resources.

Adult↗
PubMed1994

Outcome following discharge from an ENT out-patient clinic: patient and general practitioner satisfaction.

Fifty consecutive patients discharged from clinic were assessed by questionnaire at the time of discharge and 6 months later. Each patient's practitioner (GP) was sent a questionnaire at 6 months. On discharge, 12.5% of patients would have preferred another appointment and 7.5% were unhappy at being discharged. After 6 months 14% would have preferred ENT follow-up. Twenty-six per cent of patients said they saw their GP within 6 months of discharge with symptoms related to their initial ENT complaint. From the GP questionnaire the proportion was 31.5%. General practitioners were happy to manage the patients themselves and only one patient was seen again in the ENT department within 6 months. In no case did the GP feel discharge to be premature. Pre-reading of notes leading to an increase in the proportion of patients discharged from ENT clinics does not result in more discharges being premature or inappropriate. The majority of patients and general practitioners are happy for ongoing medical care to be continued without further ENT appointments if the nature of the condition and its long-term management is explained clearly.

Aged↗
PubMed1993

Isolated sphenoid sinusitis due to Pseudallescheria boydii.

A case of sphenoid sinusitis due to Pseudallescheria boydii is described in a 52-year-old non-immunocompromised woman. Treatment should always involve surgical drainage, and antifungal chemotherapy may be of benefit if there is histological evidence of invasion of surrounding tissue. For P. boydii infection miconazole should be the agent of choice, rather than amphotericin B. For this reason it is important to obtain culture and histological examination of sinus contents if fungal infection is suspected.

Female↗
PubMed1993

Out-patient management by junior staff: the value of consultant supervision.

The effect of consultant supervision on management of patients by junior staff was assessed. Supervision was exercised by pre-reading the notes with the consultant at the start of the clinic. The principle finding was that less patients were brought back for another appointment. For new patients, the proportion fell from 40% to 19%, and for follow-up patients it fell from 49.5% to 29%. The overall rate fell from 46% to 23.5%. This has major implications with respect to use of resources and, in the unit studied, this change would make available 38 extra clinic appointments for each registrar per month. The study also raises issues regarding the use of out-patient clinics for post-graduate training and consultant supervision of patient management in general.

Education, Medical, Graduate↗
PubMed1993

The role of CT imaging in the management of chronic suppurative otitis media.

CT imaging of the temporal bone is highly predictive of the presence of cholesteatoma but its value in the routine management of cholesteatoma has not been assessed. We aimed to establish the indications for CT imaging in CSOM by a prospective study of patients suspected of having cholesteatoma. The patients were assessed clinically and a management plan chosen; this was later adjusted, if indicated, on the basis of radiological findings. Surgical findings were recorded and correlation with CT appearances evaluated. Twenty patients completed the study. CT altered the management plan in 10 and was considered helpful in a further 6. We recommend its routine use in children, medically unfit patients, only or better hearing ears, patients in whom the tympanic membrane cannot be adequately visualized, patients who have had previous mastoid surgery whose operative records are available and patients with intratemporal or intracranial complications of disease.

Adolescent↗
PubMed1993

MRI as a single screening procedure for acoustic neuroma: a cost effective protocol.

Magnetic resonance imaging (MRI) is accepted as the 'gold standard' in diagnosing acoustic neuromas. Limited availability and perceived high costs have prevented clinicians from using it as a first-line investigation. A prospective study was set up in a specially designated screening session to audit the cost effectiveness and accuracy of audiovestibular investigations compared to MRI. Ninety-nine patients with asymmetrical audiovestibular symptoms or signs were investigated. Of these 54 evoked response audiometry tests, and 39 calorics were either not performed or were inconclusive. One patient refused to enter the MRI machine. All others received an unequivocal report after MRI and four tumours (three intracanalicular) were detected. The total cost of the audiovestibular protocol was 12,545 pounds compared to 12,900 pounds for the MRI protocol, which is a diagnostic and well-tolerated procedure. This study shows that MRI can be cost effective, as well as accurate, when used as a single screening procedure for acoustic neuromas.

Adult↗
PubMed1991

Management of verrucous carcinoma of the larynx.

Eight patients with a verrucous carcinoma of the larynx have been seen at the Charing Cross Hospital between 1970 and 1985. Seven patients were treated by primary radiotherapy and one by primary endoscopic laser excision. Four of those treated with radiotherapy developed recurrent disease which was treated by radical surgery in three and by endoscopic laser excision in one. The place of radiotherapy in the management of this condition requires further evaluation in view of the high rate of recurrence. Endoscopic laser excision may be a reasonable alternative to more radical surgery in this highly differentiated neoplasm.

Adult↗
PubMed1991

[Calcium alginate as a nasal pack].

Alginates are highly absorbent, gel-forming materials with haemostatic properties. The aim of this study was to compare calcium alginate to Telfa as a postoperative nasal pack in a prospective randomised clinical trial. Eighty two patients entered the trial. There were 55 males and 27 females whose ages ranged from 13 to 74 years (mean 34.7 years). Immediate postoperative bleeding was controlled in all cases irrespective of the pack used. There was no difference in the incidence of postoperative complications between the two groups. Calcium alginate is a safe and effective alternative to Telfa as a postoperative nasal pack.

Adolescent↗
PubMed1990

Long-term safety and efficacy study of intranasal ipratropium bromide.

Forty patients presenting with watery rhinorrhoea as their main complaint were entered in an open trial of long-term intranasal ipratropium bromide. Fourteen of these (35 per cent) found it to be beneficial and completed one year of treatment. Side-effects were seen in 28 patients (70 per cent) but these were local and mild in nature. All resolved during the trial as patients adjusted the dosage to individual severity and frequency of symptoms. No significant systemic effects were noted during the course of therapy. Ipratropium is a useful drug in the treatment of watery rhinorrhoea and appears safe for long-term use.

Administration, Intranasal↗
PubMed1990

Multiple submucosal out-fractures of interior turbinates.

Nasal obstruction caused by the inferior turbinate is a common clinical problem. There are many surgical procedures which attempt to relieve it, but all of them have associated difficulties. We describe, for the first time, a new method, namely multiple submucosal out-fractures of the inferior turbinates, which is both effective and free from serious complication.

Humans↗