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D A Nunez

Publications and source records attributed to D A Nunez.

At least 19 recordsLinked to original sources
PubMed2001

Combined risk factors contributing to cerebral venous thrombosis in a young woman.

Cerebral venous thrombosis is a rare condition affecting predominantly adolescents or young adults. The presentation is often non-specific, and delay in diagnosis is common. The otolaryngologist may be consulted about the radiological findings of lateral sinus thrombosis and mastoid changes. The association of congenital thrombophilia with unusual presentations of venous thrombosis, especially in young individuals is now well documented. We present a case of lateral and sagittal sinus thrombosis complicated by cerebral venous infarction in a girl with protein C deficiency and masked mastoiditis. Unusual forms of venous thrombosis, including cerebral venous thrombosis may develop in association with a single risk factor for thrombosis, but additional risk factors should be sought especially when thrombosis presents in very young individuals. This case draws attention to the multi-causal nature of cerebral venous thrombosis in young adults, and highlights the issue of masked mastoiditis. A coordinated approach by otolaryngological and haematological teams is recommended in such cases.

Adolescent↗
PubMed2000

Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy--a randomized trial.

OBJECTIVE: To determine the effect of the method of tonsillectomy on postoperative pain in pediatric patients. DESIGN: Prospective, randomized, single-blind, controlled clinical trial. SETTING: A university pediatric hospital in Aberdeen, Scotland. PATIENTS: A volunteer sample of 54 children, aged 3 to 12 years, with recurrent tonsillitis or symptomatic adenotonsillar hypertrophy. Two patients withdrew consent. INTERVENTIONS: Twenty-six children underwent a nonelectrical (ie, cold) dissection tonsillectomy with cold steel instruments, 5 of whom also had adenoidectomy by curettage. Monopolar diathermy forceps were used for tonsillar bed hemostasis. Twenty-four children had electrocautery (ie, hot) dissection tonsillectomy, 7 of whom underwent adenoidectomy by curettage without a suction coagulator. MAIN OUTCOME MEASURES: Postoperative analgesic consumption, time to regain normal diet and activity levels, and complications. RESULTS: Patients who underwent hot dissection tonsillectomy showed no difference in time to first drink or analgesic use within the first 24 postoperative hours compared with children undergoing cold nonelectrical dissection tonsillectomy. The hot dissection tonsillectomy group took 7.5 (95% confidence interval [CI], 1-14.1) more doses of analgesics than the cold dissection group over the next 12 days (P<.05). The hot dissection tonsillectomy group took 2.5 more days than the cold dissection tonsillectomy group to regain normal diet (P<.05). Thirteen children (54%; 95% CI, 34-74) in the hot dissection tonsillectomy group and 6 (23%; 95% CI, 7-39) in the cold dissection tonsillectomy group sought outpatient care for throat pain, otalgia, poor diet, pyrexia, and/or bleeding (P<.05). Throat pain delayed in onset or of prolonged duration affected 9 children (38%; 95% CI, 19-57) in the hot dissection tonsillectomy group as opposed to 3 children (12%; 95% CI, 0-24) in the cold dissection tonsillectomy group (P<.05). CONCLUSION: Hot dissection tonsillectomy increases morbidity in pediatric patients in the recovery period following hospital discharge.

Adenoidectomy↗
PubMed2000

A randomised clinical trial of turbinectomy for compensatory turbinate hypertrophy in patients with anterior septal deviations.

Turbinectomy is performed at the time of nasal septal surgery by many otolaryngologists. One reason given for this procedure is the presence of a hypertrophied contralateral inferior turbinate. A randomised trial was undertaken to evaluate the relief of nasal obstruction following contralateral turbinectomy with septal surgery. Patients presenting with nasal obstruction who had a unilateral septal deviation and contralateral inferior turbinate enlargement were prospectively randomized to contralateral turbinectomy or no turbinate surgery at the time of septal surgery. Questionnaires and active anterior rhinomanometry were used for evaluation. Twenty-six patients (mean age 31 years) demonstrated a reduction in subjective and objective measures of nasal obstruction (P < 0.05) 8 weeks after operation. There was no intergroup difference, the median total decongested nasal resistance postoperatively in the non-turbinectomized patients was 0.17 kPal-1 s and 0.21 kPal-1 s in the turbinectomized patients. Contralateral inferior turbinectomy does not add to the relief of nasal obstruction beyond that attained by septal surgery in these patients.

Adolescent↗
PubMed2000

A randomised controlled trial of the effect of regional nerve blocks on immediate post-tonsillectomy pain in adult patients.

Post-operative pain is the main cause of morbidity following tonsillectomy. The efficacy of glossopharyngeal and lesser palatine nerve blocks in controlling postoperative pain in adult patients was investigated prospectively. Patients 16 years and older admitted for elective tonsillectomy were randomised to one of three groups to receive a pre-incisional oropharyngeal injection of 0.5% bupivicaine, a 'dummy' injection of saline or no injection. Dissection tonsillectomy and general anaesthetic techniques were standardized. Postoperative pain was monitored for 24 h. ANOVA, chi2 and Fisher's exact test were used for intergroup comparisons. Ninety-two patients (72 women and 20 men), mean age 22 years were studied. Twenty-nine patients received 0.5% bupivicaine, 30 saline and 33 no pre-incisional injection. The overall mean pain scores of 2.1, 1.9 and 1.9 in the bupivicaine, saline and no injection groups were similar. Glossopharyngeal and lesser palatine 0.5% bupivicaine nerve blocks are not effective in reducing early post-tonsillectomy pain.

Adult↗
PubMed2000

Base of tongue varices associated with portal hypertension.

A symptomatic case of tongue base varices in a patient with portal hypertension secondary to liver cirrhosis is presented. There are no previously documented cases in the world literature. Oesophageal varices may not be the only source of expectorated blood in a patient with portal hypertension.

Aged↗
PubMed1999

Trends in the UK contribution to the otolaryngological literature.

Ten leading otolaryngological journals were reviewed with a view to detecting the UK contribution to the ENT literature from 1985 to 1994. From a total number of 12,293 publications studied 2414 (19.6%) papers were found to originate from British and Northern Irish otolaryngological departments, with the proportion of UK papers remaining at around 20% throughout the whole 10-year period. These papers were fully reviewed and the number of authors, paper type, names of authors and originating department recorded. Eleven departments were responsible for 50.2% of the total number of publications with the most prolific author being responsible for 2.5% (n = 60) of the total number of UK papers. Over the 10-year period, there has been a significant change towards the publication of more clinical research at the expense of pure laboratory research in these 10 journals (chi 2 P < 0.001). There has also been a move towards multiple authorship (three or more co-authors) over the same period with fewer single-author papers (P < 0.001).

Authorship↗
PubMed1998

Non-Hodgkin's lymphoma of the lacrimal sac and concomitant pansinusitis.

Paranasal sinus disease has an established propensity to breach anatomical barriers and present with orbital clinical features. Lacrimal sac lymphomas on the other hand are rare, usually present in males in the sixth decade and 50 per cent of cases have systemic lymphoma/leukaemia. Atypical presentations of lymphomas at this and other sites are reported in patients with acquired immunodeficiency syndrome (AIDS). The clinical features, investigations and treatment of a young human immunodeficiency virus (HIV) sero-negative woman with a non-Hodgkin's lymphoma localized to the lacrimal sac and presenting with a concomitant ipsilateral pansinusitis is described. The importance of submitting surgical material for pathological investigation is stressed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

A simple method for retaining the aural speculum.

In middle ear surgery via the permeatal approach, aural specula are frequently used to improve visualization of the operative field. Mechanical holders designed for retaining the aural speculum, are expensive and require sterilization for reuse. A simple technique for retaining the speculum which overcomes the drawbacks of a mechanical holder is described.

Bandages↗
PubMed1995

Do ventilated packs reduce post-operative eustachian tube dysfunction?

Nasal packing is associated with post-operative Eustachian tube dysfunction in patients undergoing nasal surgical procedures. The effect of cannulated nasal packs which may improve nasopharyngeal ventilation was investigated in a prospective randomized controlled trial. Adult elective patients without tympanometric evidence of pre-operative Eustachian tube dysfunction were recruited. All subjects underwent single or combined intranasal surgical procedures and were randomized to receive either bilateral cannulated or non-cannulated Merocel nasal packs. Middle ear pressures (MEP) were recorded pre-operatively and post-operatively before nasal pack removal. Left and right ear results were amalgamated for analysis and 40 adults, 20 in each group were analysed. There was no difference in pre-operative MEP, -15 dPa (median value) in both groups. Post-operatively the MEP changed in both groups P < 0.0001. There was no significant inter group difference in the post-operative median MEP, -85 dPa in the cannulated and -70 dPa in the control groups, (95% c.i. for the difference in the medians -25-55 dPa). Nasal surgery with post-operative packing leads to an objective reduction in MEP which is not altered by venting the packs.

Acoustic Impedance Tests↗
PubMed1994

Human papilloma viruses: a study of their prevalence in the normal larynx.

The association of human papilloma viruses (HPV) with laryngopharyngeal squamous cell carcinoma is under investigation. The suitability of control tissue in the reported series, invariably obtained from histologically normal tissue adjacent to a squamous cell carcinoma or from patients with benign laryngopharyngeal disease, is questionable. The present study determined the prevalence of HPV in a series of normal larynges. Twelve autopsy larynges were collected. DNA was obtained by SDS proteinase K digestion. Evidence of HPV infection was documented by the polymerase chain reaction using oligonucleotide primers complementary to sequences in the E6 region of HPV types 11, 16 and 18. Four female and eight male larynges, mean age 65 years (SD = 16 years) were collected 72 hours postmortem (median value). HPV type 11 was isolated from three specimens. A 25 per cent prevalence rate for HPV 11 was found. No other HPV types were isolated.

Adult↗
PubMed1994

Human papilloma viruses in the human hypopharynx.

The possible association of human papilloma viruses (HPV) with laryngopharyngeal squamous cell carcinoma is under investigation. Recent work suggests regional differences in the prevalence of HPV infection in the hypopharynx. The present study investigates the prevalence of HPV in tissue obtained from a series of piriform fossae. Piriform fossa epithelium was harvested from 12 autopsy cases free of local disease. DNA was obtained by SDS/Proteinase K digestion. Evidence of HPV infection was documented by the polymerase chain reaction using oligonucleotide primers complementary to sequences in the E6 region of HPV types 11, 16 and 18. All the specimens were positive for beta-globin. HPV11 was isolated from two patients. None were positive for HPV16 or HPV18. An 18% prevalence rate for HPV11 in the normal human hypopharynx was found.

Aged↗
PubMed1993

Otitis media.

Explore the source record for details and available documents.

Brain Abscess↗
PubMed1992

Hearing aids: family practitioner referral patterns.

This study aims to determine whether the implementation of a direct referral service in which family practitioners received feedback on the appropriateness of their patient selection had any impact on the referral pattern. Six months after the establishment of such a service to which general practitioners were requested to refer patients who satisfied the Hearing Aid Council and Therapist Technicians and Scientists in Audiology group criteria, 40 consecutive patients were analysed. 40 age matched controls referred concurrently to the routine ENT clinic for hearing aid provision were compared. In the 80 ears seen in each group, the number of perforations infected or otherwise were 2 and 7 respectively (P less than 0.01). Conductive hearing losses were more common in the control group (P less than 0.05). The degree of patient selection was higher than noted in the first 6 months of the service when the prevalence of perforations in the direct sample was 7%. It appears that the practice of selective referral has developed.

Aged↗
PubMed1992

Aetiological role of otolaryngological disease in paediatric intracranial abscess.

Recent reports suggest that congenital heart disease has supplanted otolaryngological disease as the major aetiological factor in the development of paediatric intracranial abscess. A survey of intracranial abscess identified from the records of the Information and Statistics Division of the Scottish Health Service Common Services Agency and the departmental records of the regional neurosurgical units in Scotland for the period 1981-1985 was undertaken to test this hypothesis. A total of 22 cases in individuals under the age of 16 years confirmed at surgery or autopsy were classified aetiologically on the basis of localization, clinical and investigative findings. Three were cardiogenic, four otogenic and three rhinosinugenic in origin; the others were due to miscellaneous causes. The mean(s.d.) age was 9(4.5) years. The overall mortality rate was 18%. Otolaryngological disease is the major aetiological factor in paediatric intracranial abscess in the UK.

Adolescent↗
PubMed1992

Bilateral vocal cord palsy: the alternative to tracheostomy.

Bilateral abductor vocal cord paralysis remains a difficult management problem for otolaryngologists. The techniques currently used fall into four main types: arytenoidectomy, cordectomy, cord lateralization and laryngeal re-innervation. These techniques invariably require a tracheostomy either prior to or at the time of the main procedure. A technique for managing patients without performing a tracheostomy which is as effective as the previously mentioned procedures and with no greater morbidity in terms of voice production was initially described by Ejnell, et al (1984). The results in three patients using this technique which involves vocal cord lateralization under endoscopic control confirms its ease and efficacy. All three patients were relieved of their presenting dyspnea and had satisfactory postoperative voice production. This appears to be an effective technique for the treatment of patients with bilateral abductor laryngeal paralysis which obviates the need for tracheostomy and its attendant complications.

Aged↗