Biomedical subjects
Publications and source records attributed to D W Skinner.
Obstruction of the laryngeal airway is a life threatening problem due normally to obstructive pathology within the upper aero-digestive tract. We describe four cases of laryngeal stridor (two adults and two children) of psychogenic origin, one of which required a tracheostomy. The literature is reviewed and the subsequent pattern of this disease documented on the basis of 28 patients previously described.
Explore the source record for details and available documents.
The presence of upper respiratory tract obstruction in patients with acromegaly has been described. The main sites for obstruction were previously thought to be laryngeal and oropharyngeal. This study reviews 65 patients with acromegaly and 27 patients with a prolactinoma treated by trans-ethmoidal hypophysectomy. The results confirmed a very high incidence of polyp formation and mucosal hypertrophy within both the sphenoid (88 per cent) and ethmoidal (62 per cent) sinuses of the acromegalic patients. The histological appearances of the mucosal hypertrophy and polyposis confirmed no specific features attributable to acromegaly. Patient age and serum H.G.H. level do not appear to be significant factors. These findings within the para-nasal sinuses have never previously been reported.
The long-term natural history of secretory otitis media and the changes induced in the middle ear following grommet insertion are of importance. We report the results 15 years following the unilateral insertion of a Shepard grommet and adenoidectomy for bilateral secretory otitis media. The results suggest that grommets do not protect against attic disease of late onset and induce atrophic scars which do not resolve. Grommets confer no long-term advantages to the hearing when used in the management of childhood secretory otitis media.
This paper deals with grommet induced tympanosclerosis. In the first part, patients from a controlled trial of the treatment of bilateral glue ear using unilateral grommet insertion are reviewed 15 years later. Tympanosclerosis due to grommet insertion is summated using computer graphics. Two areas of maximal tympanosclerosis are found, anteriorly and posteriorly midway between the annulus and the umbo. These maximal areas join inferiorly in the classical horse shoe shape. In an attempt to identify reasons for this distribution, the structure of the lamina propria is reviewed, and the changes that occur in tympanosclerosis considered. With this in mind, the tympanic membrane is modelled using finite element methodology to determine the areas of maximal shear stresses. These are found to be in the same position as tympanosclerosis. Such stresses would be increased by the weight of a grommet in situ. These stresses will damage the fibrils interconnecting between the fibrous layers of the lamina propria and this may lead to tympanosclerosis. This raises the question of whether a lighter grommet would decrease the incidence of grommet-induced tympanosclerosis.
The only cases of spontaneous tonsillar haemorrhage reported in the past have been associated with Infectious Mononucleosis. We report two cases in which Infectious Mononucleosis was not found as the cause of the haemorrhage.
Two cases of button-sized batteries found as foreign bodies, one in the ear and one in the nose, are presented. In both cases extensive local damage had followed delayed removal of the batteries. Urgent retrieval of such foreign bodies is stressed to avoid dangerous sequelae. The possible mechanisms of local tissue necrosis and subsequent complications are discussed.
Explore the source record for details and available documents.
Castleman's disease is an unusual cause of a neck mass; in only 6% of the cases reported in the literature is the disease primarily located in the neck. We present 2 cases of Castleman's disease restricted to the neck, who underwent successful surgical excision. We discuss the histopathology in the different forms of the disease and review the literature.