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Biomedical subjects

I S Mackay

Publications and source records attributed to I S Mackay.

At least 19 recordsLinked to original sources
PubMed1999

The outcome of endoscopic sinus surgery: correlation with computerized tomography score and systemic disease.

We have prospectively analysed the outcome of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in relation to the Lund and Mackay system of scoring the preoperative computerized tomography scan for extent of disease, and also investigated the possible links of outcome to the presence or absence of systemic respiratory tract conditions which may relate to the pathogenesis of chronic rhinosinusitis. Statistical analysis of the data by chi 2 test, unpaired t-test and logistic regression analysis has shown significant correlation between outcome at 2 years and preoperative computerized tomography scan score, but that the most statistically significant factor determining the success or failure of surgery is the presence of a systemic disease known to predispose to chronic rhinosinusitis.

Causality↗
PubMed1999

A three-centre prospective pilot study to elucidate the effect of uvulopalatopharyngoplasty on patients with mild obstructive sleep apnoea due to velopharyngeal obstruction.

In this paper we describe the outcome of a prospective study designed to investigate the role of uvulopalatopharyngoplasty in the management of mild obstructive sleep apnoea. A group of 21 patients fulfilling strict inclusion and exclusion criteria underwent uvulopalatopharyngoplasty performed by a single surgeon using a modified technique. Specifically designed daily pain questionnaires were completed by the patients for 2 weeks after surgery and the morbidity associated with the procedure was assessed at 2, 6 and 12 weeks after operation. Thirteen of the 21 patients underwent a postoperative sleep study at 3 months after operation. The outcome measures used were the apnoea/hypopnoea index, the minimum O2 saturation, the sleep arousal index, the sleep architecture the Epworth Sleepiness Scale score, the subjective improvement in both the patient's and their partner's sleep and the morbidity associated with uvulopalatopharyngoplasty. We conclude that the patients with mild obstructive sleep apnoea most likely to obtain significant benefit from uvulopalatopharyngoplasty are those with a body mass index of between 27 and 30 with no cephalometric disproportion, those with frequent arousals not associated with periodic limb movements, those whose sleep related breathing disorder is not positional and most importantly those with symptomatic day time sleepiness.

Adult↗
PubMed1998

Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis.

Allergic rhinitis is associated with specific histopathologic changes in the nasal mucosa including squamous metaplasia and local eosinophilia. Previous studies have shown that mometasone furoate aqueous nasal spray is effective and well tolerated in reducing perennial rhinitis and seasonal allergic rhinitis symptoms. We undertook a multicenter, open-label study to evaluate, by nasal biopsy, the tissue changes associated with mometasone furoate use (200 microg/day) during a 12-month treatment period in patients with perennial rhinitis. Of the 69 patients enrolled in the study, 52 completed all 12 months of treatment. Nasal biopsy specimens obtained from patients at baseline and after treatment were evaluated in a blinded fashion by computerized image analysis, qualitative histologic examination, and immunocytochemistry. Morphologic examination of nasal biopsy specimens showed a decrease in focal metaplasia, no change in epithelial thickness, and no sign of atrophy after treatment with mometasone furoate. Immunocytochemical analyses of nasal biopsy specimens obtained before and after treatment revealed a significant decrease in major basic protein-positive eosinophils and tryptase-positive mast cells in the epithelium and lamina propria after treatment. Mometasone furoate appeared to attenuate the inflammatory process by reducing the extent of inflammatory cell infiltration, particularly of eosinophils. This study demonstrated that long-term administration of mometasone furoate is not associated with adverse tissue changes in the nasal mucosa of patients with perennial rhinitis.

Administration, Intranasal↗
PubMed1997

Combined approach intranasal endoscopic and external Lothrop procedure in chronic frontal sinus disease.

The endoscopic approach to the fronto-ethmoidal recess (FER) in the treatment of chronic frontal sinus disease is now widely accepted. The Lothrop procedure was first described in 1914, but was largely replaced with more invasive open frontal sinus procedures until the advent of the rigid Hopkins' rod, since when it has enjoyed renewed popularity. We describe a modification of this technique which allows both transnasal endoscopic and external direct visualization of the FER and frontal sinus and a direct approach to the anterior buttress (or "nasofrontal beak") which allows its quick and simple removal.

Aged↗
PubMed1997

Endoscopic ligation or diathermy of the sphenopalatine artery in persistent epistaxis.

Conventional methods of arterial ligation in persistent epistaxis often involve significant surgical morbidity, as well as failure due to arterial anastomosis. We have performed endoscopic intranasal end ligation or diathermy of 11 sphenopalatine arteries in 10 patients with no complications and with no further episodes of epistaxis, with an average follow-up period of nine months.

Adolescent↗
PubMed1997

Polypoidal rhinosinusitis in cystic fibrosis: a clinical and histopathological study.

The eosinophil may play a key role in the pathogenesis of nasal polyposis. Polyps in cystic fibrosis, however, have been described as neutrophilic. We compared the cell counts in polyps from 44 patients with cystic fibrosis to polyps from 50 patients without cystic fibrosis. The clinical profile, CT-scan and time to polyp recurrence were also compared with the cell counts in the patients with cystic fibrosis. No significant difference was detected in the number of patients with eosinophils (P > 0.25). Significantly more patients in the group with cystic fibrosis had polyp neutrophils (P < 0.01). Polyps from patients without cystic fibrosis contained more eosinophils (P < 0.001) whilst polyps from patients with cystic fibrosis contained more neutrophils (P = 0.001) and plasma cells (P = 0.038). Significant correlation was found between the neutrophil count and the CT score (P = 0.025) and between the recurrence time of polyps and the macrophage count (P = 0.01). Eosinophils are present in varying degrees in polyps from patients with and without cystic fibrosis and to classify polyps as eosinophilic or neutrophilic may be a false distinction.

Adolescent↗
PubMed1997

A prospective study of olfaction following endoscopic sinus surgery with adjuvant medical treatment.

Few studies on the outcome of endoscopic sinus surgery have assessed the effect of this treatment on the sense of smell. We have collected data prospectively on 115 patients, before and 6 weeks after surgery. All patients had bilateral chronic rhinosinusitis. Visual analogue and a 4-grade, patient-rated symptom score related to olfaction was collected. Patients were also asked after surgery whether their sense of smell was normal, better, a little better, the same, a little worse or worse. Paired phenylethyl methyl ethyl carbinol olfactory detection thresholds were determined for 102 of the patients. All parameters showed a statistically significant improvement (P < 0.001). Acoustic rhinometry was performed pre- and postoperatively in 96 patients. The improvement in all olfactory symptom scores was found to correlate with the increase in nasal volume (Spearman rank correlation: visual analogue score, P < 0.005; 4-grade scale, P = 0.03; 'better, same, worse' scale, P = 0.001).

Chemotherapy, Adjuvant↗
PubMed1997

Polypoid rhinosinusitis in patients with host defence deficiencies: cellular infiltration and disease severity.

Polypoid rhinosinusitis is a chronic inflammatory, mucosal disease. Eosinophils may play a key role in driving and maintaining this inflammation. Polyps in conditions associated with chronic infective rhinosinusitis--such as cystic fibrosis (CF) and primary ciliary dyskinesia--however have been described as neutrophilic. We compared cell counts in polyps from 55 patients with host-defence deficiencies (HDD) to polyps from 50 patients without HDD. The CT-scan appearance was also compared to the cell counts in the HDD group. No difference was detected in the percentage of patients with eosinophils from either group. Significantly more patients in the HDD group had polyp neutrophils (p < 0.001). Non-HDD-patient polyps contain more eosinophils (p < 0.000) whilst HDD-patient polyps contained more neutrophils (p = 0.005) and plasma cells (p = 0.05). Significant correlation was found between the neutrophil count and the CT score (p = 0.012) and the mast-cell count and the CT score (p = 0.02). Eosinophils are present in HDD and non-HDD polyps. Whilst the degree of cellular infiltration may vary, to classify polyps as eosinophilic or neutrophilic may be a false distinction.

Adolescent↗
PubMed1996

Grass pollen immunotherapy inhibits allergen-induced infiltration of CD4+ T lymphocytes and eosinophils in the nasal mucosa and increases the number of cells expressing messenger RNA for interferon-gamma.

BACKGROUND: Grass pollen injection immunotherapy is effective in patients with summer hay fever, although efficacy must be balanced against possible side effects. The mechanism of immunotherapy is unknown but may be related to its ability to inhibit allergen-induced late responses, which are known to be characterized by infiltration of T lymphocytes, eosinophils, and cells with messenger RNA for so-called TH2-type cytokines (IL-4 and IL-5). OBJECTIVE: This study was designed to observe the effect of grass pollen immunotherapy on late nasal responses and associated cellular infiltration and cytokine mRNA expression. METHODS: We performed local nasal provocation with grass pollen (and a control challenge) in 28 patients after a 12-month double-blind, placebo-controlled trial of immunotherapy. Nasal biopsy specimens were obtained at 24 hours and processed for immunohistology and in situ hybridization studies. RESULTS: Grass pollen immunotherapy inhibited allergen-induced immediate (0 to 60 minutes) increases in sneezing (p < 0.02) and nasal blocking (p < 0.01) and late (0 to 24 hours) nasal symptoms (p < 0.05). Immunotherapy also inhibited the associated infiltration of the nasal mucosa by CD4+ T lymphocytes and total (major basic protein-containing) and "activated" (cationic protein-secreting) eosinophils (all p = 0.03). There was a significant (p = 0.04) increase in cells expressing mRNA for interferon-gamma at 24 hours after allergen challenge, which correlated inversely with patients' seasonal symptoms (r = -0.65, p < 0.05) and medication requirements (r = -0.75, p < 0.02) during the pollen season. CONCLUSION: The results suggest that successful grass pollen immunotherapy for summer hay fever may act by inhibiting allergen-induced T lymphocyte and eosinophil recruitment and eosinophil activation in the target organ, possibly through a mechanism involving protective local increases in TH1-type cells.

Adult↗
PubMed1996

Snoring--a simple surgical solution.

In this paper a new palatal surgical technique for the treatment of snoring is described and evaluated. All 22 patients were severe snorers with no significant obstructive sleep apnoea, as confirmed by detailed sleep studies. The aim of the surgical technique was to eliminate the vibration of the soft palate and the posterior pillars which occurs during snoring. This was achieved under general anaesthetic by making a 1.5 cm vertical full thickness incision in the soft palate from the superior pole of the tonsil towards the pterygoid hamulus using monopolar cutting diathermy. Specifically designed daily pain questionnaires were completed by the patients during the first 2 post-operative weeks and the level of snoring was assessed by the patient's sleeping partner at 2, 6 and 12 weeks. The presence of any complications was also documented at these times. The results demonstrate that this surgical technique is effective, quick, simple and bloodless. The post-operative pain created is mild and quickly resolves. All patients experienced a dramatic diminution of their snoring and in 55% complete cessation was achieved.

Anesthesia, General↗
PubMed1996

Endoscopic sinus surgery in the treatment of cystic fibrosis with nasal polyposis.

We have performed endoscopic sinus surgery on 46 patients with chronic, polypoid rhinosinusitis since 1989. Follow-up ranged from 1 month to 6 years (mean, 28.2 months). Overall, our patients had a 50% chance either of their symptoms returning to preoperative severity or of undergoing a second endoscopic sinus procedure, by 18 to 24 months of postoperative follow-up. Patients with predominantly infective symptoms of mucopurulent rhinorrhea and pain had a significantly better outcome than those with predominantly nasal blockage. The chance of the former group of patients suffering symptom deterioration back to the preoperative state or undergoing a second endoscopic sinus operation was 37% of that of the latter group. The extent of disease on computed tomography scan had no relation to outcome.

Adult↗
PubMed1995

Endoscopic fenestration of choanal atresia.

We report two cases of unilateral choanal atresia and one of choanal stenosis treated successfully by endoscopic fenestration, with no recurrence at a mean follow-up of 18 months. Rigid endoscopy and axial CT scanning confirm the clinical diagnosis and this technique avoids the need for stenting or prolonged post-operative stay.

Adolescent↗
PubMed1994

Rhinitis, sinusitis and the yellow nail syndrome: a review of symptoms and response to treatment in 17 patients.

A total of 17 patients with yellow nail syndrome are described. Their symptoms, age of onset and severity are examined with particular reference to the presence of rhinosinusitis. Fourteen of the patients (83%) suffered severe rhinosinusitis, which pre-dated nail changes in four, coincided with yellow nails in six, and occurred later in the remaining patients. In general, patients responded poorly to conventional medical and surgical treatment, with the exception of functional endoscopic sinus surgery (FESS) which may be of value in these patients. The frequent association of rhinosinusitis with yellow nails may warrant its recognition as part of the syndrome. Careful inspection of the fingernails in all patients presenting with severe rhinosinusitis is warranted.

Adolescent↗
PubMed1994

Major complications of functional endoscopic sinus surgery.

The results of a postal questionnaire indicate an exponential rise in the practice of functional endoscopic sinus surgery (FESS) in the UK and a major complication rate of 0.23%. Cerebrospinal fluid leak was the most common serious complication accounting for 24 of the 36 reports.

Adult↗