Biomedical subjects

D A Bowdler

Publications and source records attributed to D A Bowdler.

33 records · Page 2Linked to original sources

PubMed1993

Jugular bulb phlebectasia.

Phlebectasia of the internal jugular vein (IJV) is a rare venous anomaly that usually presents in young children as a soft cystic swelling in the neck and represents a pathologically enlarged vein. We present a case of jugular bulb phlebectasia in a 4-year-old boy. He presented with a blue pulsatile swelling arising from the floor of the left middle ear cleft. The venous phase of digital subtraction vertebral arteriography (DSVA) and computerised axial tomography (CT) with contrast confirmed a diagnosis of phlebectasia of the lateral sinus and proximal part of the left IJV, with a complete bony defect in the floor of the middle ear. The child did not have any neck symptoms or signs. No active treatment was required. To our knowledge, this is the first case of jugular bulb phlebectasia presenting in the middle ear.

Angiography, Digital Subtraction↗

PubMed1991

Solitary keratoacanthoma of the nasal vestibule.

Keratoacanthomas are lesions which rarely present to Otorhinolaryngologists; however they must be considered in the differential diagnosis of any rapidly growing lesion in the head and neck. We report a case of a keratoacanthoma of the nasal vestibule which caused clinical and histopathological difficulties in diagnosis. Keratoacanthomas and the treatment options are discussed.

Adult↗

PubMed1991

Interpretation of maxillary sinus radiographs in children.

Nasal symptoms are a frequent cause of referral to paediatric ENT clinics. It is the policy of our unit to view sinus radiographs without a report at the initial clinic attendance. This study demonstrates there is no statistically significant difference in the interpretation of the radiographs between two ENT surgeons and a radiologist although there was a tendency for the radiologist to have a greater specificity. This finding may have financial implications. In addition a clear sinus radiograph is shown to be a significant negative finding.

Adolescent↗

PubMed1991

Verrucous carcinoma of the maxillary antrum.

Verrucous carcinoma is a rare variant of squamous cell carcinoma which occurs most frequently in the oral cavity and larynx. In this article we describe a patient with verrucous carcinoma of the maxillary antrum, and present a review of the literature.

Aged↗

PubMed1991

Disposition and tumour concentrations of platinum in hypoalbuminaemic patients after treatment with cisplatin for cancer of the head and neck.

1 Platinum concentrations in the tumour reached a peak of 3.8 +/- 1.5 micrograms g-1 wet weight tissue at the end of an 8 h intravenous infusion of cisplatin. The tumour concentrations of platinum were higher than the corresponding plasma concentrations (2.5 +/- 0.9 micrograms ml-1) and declined more slowly. 2 Patients with squamous carcinoma of the head and neck had a significantly shorter median survival time if they had low plasma albumin concentrations (less than 40 g l(-1) compared with patients in the normal range, 133 days and 768 days respectively (P less than 0.05) after treatment with cisplatin. 3 No changes in the pharmacokinetics of platinum were detected to account for this poor response of hypoalbuminaemic patients, but plasma albumin concentration was found to be negatively correlated with the first order elimination rate constant. 4 The cumulative urinary excretion of platinum in the first 24 h was not altered by lowered plasma albumin. 5 The concentration of platinum in the tumour did not correlate with the survival time of the patient, but was found to be correlated with the volume of distribution in the post-distributive phase.

Adult↗

PubMed1989

The management of pseudohypacusis in school-age children.

Pseudohypacusis is a condition in which there is an apparent hearing loss in the absence of clinical or audiological evidence; indeed, audiological assessment for inconsistencies is the mainstay of diagnosis. It is easier to diagnose in children than in adults, due to a child's inability to produce consistently similar results on repeat tests. We have reviewed 15 children with pseudohypacusis, who had an average loss in the right ear of 57 dB, and of 59 dB in the left ear when tested by pure tone audiometry. Eight children were diagnosed by clinical impression and inconsistent pure tone audiograms but in order to confirm the diagnosis in the other seven children further testing with a speech audiogram was necessary and proved sufficient to establish the diagnosis in all cases. The hearing of all 15 children resolved spontaneously at between 2 and 70 months, when treated by careful monitoring and supportive therapy, and none of the children needed psychiatric referral.

Audiometry, Pure-Tone↗

PubMed1987

Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum).

Carcinoma is a rare but recognized complication of posterior pharyngeal pulsion (Zenker's diverticulum). Such diverticula merit radiological and endoscopic examination before operation. Surgery is preferred to radiotherapy in the treatment of carcinoma, the choice of operation resting between one-stage diverticulectomy for cancer confined to the body of the sac and pharyngolaryngectomy for more extensive lesions.

Aged↗

PubMed1987

Surgical management of posterior pharyngeal pulsion diverticula: inversion versus one-stage excision.

At present one-stage excision of the posterior pharyngeal pulsion diverticulum is the most popular method of treatment in the UK and the USA. We have reviewed 53 patients who have presented to this unit between 1968 and 1986, to compare the results of different surgical techniques. Of these, 21 underwent excision and myotomy, 20 inversion and myotomy, and 9 myotomy alone. The results show that the mortality for the whole group was 4 per cent, but there were no deaths in either the inversion or myotomy group. The excision group had a complication rate of 52 per cent, compared with 30 per cent for inversion, and also had more major problems such as fistula. Median hospital stay was shorter for inversion than for excision, at 7 and 10 days respectively. In summary we believe that inversion of the posterior pharyngeal pulsion diverticula is now the surgical treatment of choice.

Aged↗

PubMed1987

Subglottic stenosis in children: a conservative approach.

Subglottic stenosis may be either congenital or acquired and is one of the commonest causes of acute and chronic airways obstruction in neonates and infants. Most acquired stenoses result from perinatal intubation. The management of these lesions remains controversial, particularly regarding the timing of surgical intervention. At Alder Hey Children's Hospital a series of 33 patients with subglottic stenosis have been reviewed. A conservative approach, employing long-term tracheotomy as the mainstay of treatment, has achieved a success rate of 72.7%, and only 3 patients have so far needed corrective surgery (9%), of which 1 has been decannulated to date. One patient (3%) died of bronchopulmonary dysplasia. We believe that, where close follow-up is possible, a conservative approach is the method of choice.

Follow-Up Studies↗

PubMed1986

Internal jugular phlebectasia.

Varicose veins are a common venous anomaly, but rarer varieties also occur including phlebectasia, which is an abnormal dilatation of an isolated vein. Phlebectasia may affect any vein and is usually asymptomatic. When the internal jugular vein is involved, it presents as a cervical swelling that closely mimics the signs of either a pharyngocoele or a laryngocoele and, due to its rarity, is frequently misdiagnosed. A review of the English literature demonstrates that the diagnosis has generally been confirmed either by invasive contrast radiographic techniques, or surgical exploration, though many authors had made a tentative clinical diagnosis prior to surgical confirmation. No treatment is indicated for this benign self-limiting condition, except for the few patients who complain of symptoms and require surgical removal of the affected vein, and therefore, if a diagnosis cannot be made with certainty from the clinical features, investigations should be as non-invasive as possible, employing either a CAT scan or Digital Subtraction Angiography, though the latter is not yet universally available.

Child↗

PubMed1985