Biomedical subjects
Publications and source records attributed to G E Murty.
Tracheostomy self care at home can be a problem for some patients. The Nottingham System attributes a competence ratio to each patient. Those liable to develop problems can be identified early and the appropriate support provided. The Nottingham System is described.
Internal jugular phlebectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children. The clinicopathology, aetiology and management are discussed. Bilateral doppler ultrasonography is the diagnostic investigation of choice and should be performed in all suspected cases. Conservative management of the bilateral case is recommended.
The first case of an inhaled Montgomery Safe T-tube plug is reported. Both the surgeon and the patient should be aware of this possible complication and regular inspection of the plug is recommended. More than one plug should be provided with each T-tube.
Cervical cystic metastases are uncommon, originating predominantly from an oropharyngeal primary. Pre-operative differentiation from a branchial cyst can prove difficult. Three cases which presented clinically as branchial cysts but were subsequently found to be cystic metastases are described, and the literature is reviewed. Endoscopy, ipsilateral tonsillectomy and blind biopsies of Waldeyer's ring, combined with excision of the cervical lesion are recommended in patients over 40 years old.
Recordings by combined glottography of vocal cord movements in patients with a vocal cord palsy were compared with a control group. In paralysis of the vocal cord the open quotient (OQ) is increased and the speed quotient (SQ) decreased. This system may have potential in the diagnosis and continued assessment of laryngeal abnormalities as well as providing a permanent objective record in medico-legal cases.
The frequencies of the HLA-A, B, C, DR, DQ antigens and of several other genetic markers in biopsy proved and well characterised patients with Wegener's granulomatosis were compared with control frequencies of the region. A highly significant increase in HLA-DR1 was found. The percentage combined frequency of DR1-DQw1 was significantly higher in patients than in the controls. Interestingly, association with the red cell enzyme GLOI and complement locus C4B was also seen. As both of these markers are either linked or within the major histocompatibility complex region (MHC) this is further evidence for the involvement of chromosome 6 in the pathogenesis of Wegener's granulomatosis. To understand the pathology of the disease fully molecular genetic studies of the MHC region are warranted.
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Tracheo-oesophageal puncture for voice restoration is now established as a common procedure in the postlaryngectomy patient. We present what we believe to be the first recorded case of osteomyelitic cervical cord compression following this technique. This is a potentially fatal complication, but diagnosis and active surgical intervention can result in recovery of full neurological function.
This study assesses the effect a paralysed cord has on the intensity of coughing. The air flow pattern during coughing of 10 patients with a vocal cord palsy was compared with a control group, using a computerized pneumotachograph system. There was no significant difference in the value of the peak air flow but the time taken to reach the maximum value was prolonged in the vocal cord palsy group. This non-invasive test may aid diagnosis of vocal cord palsies but the laterality of the lesion cannot be predicted from the airflow pattern alone.
This study investigates the relationship between frequency and the open quotient (OQ) and speed quotient (SQ) values of combined glottography. Simultaneous electroglottography and photoglottography were performed on 20 healthy male subjects. Regression analysis showed that neither OQ nor SQ was dependent upon frequency. The technique is therefore still valid despite the inability to control this variable.
This study investigates the relationship between intensity and the open quotient (OQ) and speed quotient (SQ) values of combined glottography. Simultaneous electroglottography and photoglottography were performed on 20 healthy male subjects at intensities of 55 and 65 dB. Paired t-test statistical analysis showed that the open quotient varies inversely and the speed quotient directly with the intensity. When reporting findings it is therefore necessary to state the intensity at which the results were obtained.
This study investigates by combined glottography the effect of the anatomical changes of ageing on laryngeal movement during the vibratory cycle. 10 adult males less than 25 years of age were compared to 10 males over 60 years of age. The speed quotient was increased in the elderly group; thus, ageing in the larynx results in a slowing of the opening of the vocal folds. This may account for the different voice quality in the elderly. The clinician must consider the subject's age when interpreting speed quotient values.
Previous reports of an association between HLA tissue type and Wegener's granulomatosis are contradictory. By using for the first time a highly sensitive restriction fragment-length polymorphism (RFLP) analysis in addition to standard microcytotoxicity assays, the largest series yet investigated (41 patients) was tissue typed. No association was found between any specific HLA antigen and Wegener's granulomatosis. Although the condition appears to be immunologically mediated, this study indicates that the HLA antigens do not have a major role.
The exact role or even the necessity for a functioning larynx in the production of an efficient cough is unknown. This study compares the cough intensity of 10 laryngectomees with a control group of 10 individuals with a larynx. There is no significant difference in the peak flow but the time taken to reach the peak flow is prolonged in the laryngectomees. The supramaximal expiratory flow is thus absent. The larynx is not essential for coughing although the different pattern may be less efficient. This simple test may have diagnostic value in assessing the larynx.
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It has recently been suggested that combined electroglottography and photoglottography may aid diagnosis and assessment of treatment of laryngeal pathology. The ability to record and analyse such traces was previously restricted to voice research laboratories. A simple, less expensive, system for use in the outpatient clinic is described. A preliminary study on 10 normal subjects produced results comparable to that of voice research laboratories. The clinical potential is discussed. This may represent a valued addition to the armamentarium of the clinician.