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Biomedical subjects

H R Grant

Publications and source records attributed to H R Grant.

35 records · Page 2Linked to original sources
PubMed1993

Paranasal sinus disease in HIV antibody positive patients.

OBJECTIVE: To investigate the prevalence of radiologically-diagnosed paranasal sinus disease in HIV-1 seropositive patients. SUBJECTS AND SETTING: 476 patients admitted to a dedicated inpatient unit for HIV and AIDS at the Middlesex Hospital, London, between September 1988 and February 1992. DESIGN: Retrospective review of patients' case notes and radiological records. RESULTS: 30 patients (6.3%) had radiological evidence of paranasal sinus disease. At the time of admission, sinusitis was in the differential diagnosis in only 12 of the 30 patients; 13 patients were initially diagnosed as having meningitis. Pseudomonas aeruginosa was the causative organism in four patients, all of whom had advanced HIV disease. All four responded to appropriate antibiotics but had early relapse of infection. CONCLUSIONS: Sinusitis is an important and under-recognised cause of morbidity in patients with HIV disease.

Adult↗
PubMed1992

The effect of palate repair on otitis media with effusion.

Cleft palate in children is very frequently associated with otitis media with effusion. In this prospective study of 150 cleft palate children aged between 2 and 18 months, the prevalence of otitis media with effusion at myringotomy before palate repair was 92 percent. Otoscopic and tympanometric follow-up assessments for 140 children indicate that there is minimal improvement in middle ear status after palate repair. The condition is persistent in 70 percent of children up to 4 years of age. Furthermore, there is no evidence that age at repair or type of cleft is influential. These findings have implications for otologic management of cleft palate children. Early routine unilateral ventilation to ensure adequate hearing but minimize the morbidity of ventilation tubes is advocated.

Cleft Palate↗
PubMed1991

Mastoid obliteration with the temporoparietal fascia flap.

Obliteration of persistently discharging open mastoid cavities is one surgical option to achieve a dry ear. All the currently described techniques involve the use of random pattern local tissue flaps or free grafts. Ten patients have undergone obliteration procedures using the vascularized temporoparietal fascia flap. This resulted in rapid epithelialization by six weeks in seven out of 10 cases. The remaining three patients have persistent non healed areas over the medial attic wall, but are not troubled by otorrhoea. The indications, technique and complications of mastoid obliteration by this axial pattern flap are described.

Adolescent↗
PubMed1990

Mandibular reconstruction using vascularised fibula.

The osteocutaneous fibula flap has been used to reconstruct large segments of mandible in cases following ablation for cancer or radionecrosis. The bone can be cut to the appropriate shape and the fasciocutaneous flap may be used simultaneously to provide oral cavity lining or skin cover. The technique is described and its successful use in seven patients is reported with details of the complications encountered.

Adult↗
PubMed1989

Primary composite squamous cell carcinoma and large cell neuroendocrine carcinoma of the hypopharynx.

Neuroendocrine carcinomas are rare neoplasms of the larynx and hypopharynx. Tumours composed of both neuroendocrine and squamous cell elements are very rare. We report a case of a primary hypopharyngeal carcinoma composed of both squamous cell and large cell neuroendocrine carcinoma and discuss the treatment of this patient and management of neuroendocrine carcinomas of the larynx and hypopharynx.

Carcinoma↗
PubMed1989

Resection of the extra cranial carotid artery in head and neck cancer.

Carotid artery resection and reconstruction by unreversed autogenous saphenous vein grafting was undertaken in six patients undergoing extensive resection for malignancy over a four-year period. There were two deaths within 30 days of operation: one from secondary hemorrhage and one from bronchopneumonia. One patient died at six months and one at three months from recurrence, one died at 12 months from recurrence and one died free of disease at 10 months from aspiration. Vascular complications in three patients included a single TIA at 14 days, graft thrombosis with hemiplegia and a secondary hemorrhage from the graft requiring graft ligature with a subsequent normal neurological status. Malignant involvement of the extracranial carotid artery is associated with poor survival. Treatment by carotid artery resection and grafting should be considered in such cases, particularly where the pharynx or oral cavity are not entered.

Aged↗
PubMed1989

Craniofacial resection. An alternative incision and skull base repair.

Neoplasia of the superior group of paranasal sinuses (frontal, ethmoidal and sphenoidal) has an extremely poor prognosis. Resection, preceded or followed by radiotherapy offers a 5 year survival of less than 30% (1). Satisfactory surgical excision has been undermined by difficulties of access to the cribriform plate area, a common site for residual disease. Furthermore the practice of piecemeal removal invariably resulted in inadequate clearance. The craniofacial approach allows not only excellent access to the anterior skull base but also in bloc excision. The results of treating 7 patients with craniofacial resection for tumours in this area are presented. Particular reference is made to a horizontal forehead skin crease incision for intracranial access. A new technique using a combination of surgical, pericranium, partial thickness skin and fibrin glue to repair the skull base defect is described.

Adult↗
PubMed1988

Goode T-tubes: do the benefits of their use outweigh their complications?

In this retrospective study of 130 ears over a 5-year period, the effect of intubation with the Goode T-tube was evaluated. The tubes improved the hearing in 86% of ears with a conductive loss secondary to a middle ear effusion to an average 5 dB airbone gap. They improved the early stage retracted tympanic membrane but had no effect on the established postero-superior retraction pocket. They were successful in treating barotrauma. The main complication with their use was otorrhoea which occurred in 28% of ears, and persistent perforation occurring in 6% of the ears. Seventy-seven per cent of tubes were in place after 36 months. Extrusion was significantly related to infection in the ear, and also to the presence of glue on insertion but there was no correlation between the number of previous grommets or the age of the patient. The Goode T-tube is advocated for use in middle ear effusion refractory to conventional grommet insertion or that due to cleft palate.

Adolescent↗
PubMed1988

Cleft palate and glue ear.

The invariable presence of otitis media with effusion in children with cleft palate aged from 2 to 20 months is confirmed in a prospective trial, and the diagnosis was made in each case by myringotomy. Treatment planning should take account of this, and long term ventilation of at least one ear seems to be mandatory in order to correct bilateral congenital deafness. Close cooperation between otologist and plastic surgeon is essential for diagnosis and treatment of otitis media in these patients.

Cleft Palate↗
PubMed1986

Resection of the cervical trachea: a different incision?

Excision of the entire trachea at laryngectomy may make it impossible to suture retrosternal tracheal circumference to skin without tension if traditional skin incisions are used. A satisfactory and possibly original approach to this problem is described with two illustrative case histories. The incision described using a laterally based skin flap allows adjacent skin to be drawn into the neck and any resulting defect is closed with partial thickness skin. The advantages of such a flap over traditional incisions are discussed.

Adenocarcinoma, Papillary↗
PubMed1985

Postcricoid carcinoma: a retrospective study of 13 patients.

Thirteen consecutive patients presenting with squamous cell carcinoma in the postcricoid region (PCC) are studied and details of their age, sex, TNM status, treatment and results are analysed. Follow-up ranges from 33 months to 11 years. Three patients presented with cervical node involvement and 2 of these remain disease free without surgical intervention, at 33 months and 9 years. The principal treatment policy has been the combination of multi-agent chemotherapy with radical radiotherapy, reserving wide excision surgery for patients with residual or recurrent carcinoma. Only 4 patients underwent pharyngolaryngectomy, one radical neck dissection was performed and 7 of the 13 patients have remained free of disease for more than 3 years.

Adult↗
PubMed1976

Chemotherapy for head and neck tumours. Observations on a twelve-month study.

This paper describes a multiagent protocol of chemotherapy suitable for head and neck cancer which has been used at King's College Hospital since 1974. It studies a twelve month period in which 30 patients received chemotherapy and offers details of eight patients who were free of tumour from two to twelve months after completing the treatment. No statistical evaluation is attempted as the follow-up period is so short and the clinical material so diverse.

Adenocarcinoma↗
PubMedDate not supplied

Aminosidine (paromomycin) in the treatment of leishmaniasis imported into the United Kingdom.

We report 11 patients with leishmaniasis from different endemic areas, treated in the UK with intravenous aminosidine alone or in combination with other drugs. Clinical and parasitological cures were achieved in all 7 patients from the Mediterranean zone who had visceral disease, with one relapse. Two of 4 patients with cutaneous or mucosal disease were cured; the other 2, from Iraq and Iran, did not respond. Toxic effects were high-tone deafness in 2 patients, one of whom had pre-existing renal impairment, and transient, mild elevation of serum creatinine in 3. Aminosidine is an effective, tolerable and relatively non-toxic alternative to existing antileishmanial drugs for the treatment of visceral leishmaniasis. Further studies will be needed to assess its place in cutaneous and mucosal disease.

Adolescent↗