The value of otoscopy.
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Accidents, Aviation↗
Biomedical subjects
J D Bennett
Publications and source records attributed to J D Bennett.
Reduction of bowel motion artifact during digital subtraction angiography: a comparison of hyoscine butylbromide and glucagon.
The authors compared the effectiveness of hyoscine butylbromide (Buscopan) and glucagon in reducing bowel motion artifact during abdominal intra-arterial digital subtraction angiography. Sixty-six patients referred to the radiology department of a tertiary-care hospital for abdominal angiography between October 1989 and July 1992 consented to participate in the study. Diabetic patients receiving insulin and those with glaucoma were not considered for the study. The patients were assigned at random to receive either Buscopan (39 patients) or glucagon (27) intravenously before angiography. Images obtained at three stages during the procedure were reviewed independently by three experienced vascular radiologists who were blinded as to treatment group; images for nine patients in the Buscopan group and seven in the glucagon group were excluded because of breathing artifact or body movement. For each image the radiologists scored bowel motion in each section of a six-section grid. The bowel motion scores during early, middle and late arterial phases and the total scores for the two groups did not differ significantly (t-test). On the basis of these findings, the authors continue to use Buscopan because it is less expensive than glucagon.
Angiography, Digital Subtraction↗
Fibrous histiocytoma of the larynx.
Fibrous histiocytoma has a variable, unpredictable behaviour and potential for malignancy. The treatment of choice is wide local excision, which, in the larynx, entails total laryngectomy. A case of fibrous histiocytoma of the larynx, treated successfully by radiotherapy, is presented. A recurrence was treated with cryosurgery and the patient is well at 10-year follow-up. The pathological characteristics of fibrous histiocytoma and the difficulties of classification are reviewed.
Adult↗
Dysphagia caused by a foreign body in the thyroid.
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Adult↗
Non-medical prescribing.
Non-medical prescribing is increasingly being seen as a cost effective option by both the government and paramedical professional bodies. The use of potentially dangerous preparations in a wide range of clinical settings is not without danger, as illustrated by this case of facial palsy associated with the use of a proprietary brand of wax softener in an ear with a perforated ear drum.
Adult↗
Nasal polyps--a preliminary diagnosis.
It is often considered that where nasal obstruction can be attributed to the presence of nasal polyps that the diagnostic process is at an end. The fact that the majority of simple nasal polyps are benign reinforces this view. Linked with this, the fact that the majority of serving soldiers are healthy, may lead the unwary into not suspecting some of the other types of nasal polyp.
Adult↗
Frey's syndrome--the untold story.
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History, 20th Century↗
Argyll Robertson--a breadth of vision.
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History, 19th Century↗
Scaphoid dislocation with radial-axial carpal disruption.
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Carpal Bones↗
The therapeutic value of medical photography.
Medical photography is shown to have therapeutic value in illustrating to a patient a previously hidden clinical lesion. The sight of the extent and nature of a hole in her nasal septum which the patient had caused by picking her nose allowed her to stop this habit where previous medication and psychotherapy had failed.
Adult↗
Aortoiliac angioplasty: is there a need for other types of percutaneous intervention?
In a retrospective study, the authors compared results in 81 patients who underwent 117 percutaneous transluminal angioplasty (PTA) procedures in the iliac arteries and 21 patients who underwent iliac artery atherectomy. Both groups were similar with respect to symptoms and risk factors. The overall technical success rates were 97.4% for PTA and 100% for atherectomy. The initial clinical success was 92.8% for PTA and 100% for atherectomy. Complications requiring surgery occurred in four of 117 (3.4%) PTA and one of 21 (4.8%) atherectomy procedures. The 2-year patency rate for PTA was similar to that achieved with atherectomy in a smaller patient population. These results indicate that atherectomy does not offer any definite advantage over conventional PTA for the routine management of iliac lesions and make it difficult to justify the additional expense and complexity of this technique.
Angioplasty, Balloon↗
Draffin and his rods.
Draffin's rods or bipods are now a well-known, internationally accepted ENT instrument. Before their invention in 1951, the attendant anaesthetist or nurse was obliged to support the mouthgag during tonsillectomy. Research into the life of their originator, David Alexander Draffin, reveals that in addition to his evident design skills, he was a surgeon of courage, wit and great charm.
Anesthesiology↗
An absorptiometry method for the determination of arterial blood concentration of injected iodinated contrast agent.
A single photon absorptiometry method to measure the arterial concentration of injected iodinated contrast agent was developed. A prototype absorptiometry unit was built which consists of either a square or circular cross section acrylic (polymethylmethacrylate) cuvette connected to an arterial catheter at one end and a paristaltic pump at the other via PE60 surgical tubing. At opposing ends of the length of the cuvette were a 0.4 GBq 125I source and a scintillation crystal/photomultiplier tube assembly. This assembly was connected to a single-channel analyser (SCA)/scaler unit to count the transmitted photons through the cuvette. The scaler was interfaced to an IBM PC and counts accumulated in preset time intervals were transmitted to the computer via a serial interface. Experiments were performed to calibrate the unit for measurement of blood concentration of contrast agent (Isovue 300) and to determine the dispersion characteristics of the unit. Deconvolution was used to correct the measured concentration waveform for the dispersion introduced by passage through the lead-in tubing and the cuvette. The precision of concentration measurements was determined to be between 5 and 10% using computer simulations and theoretical calculations. The method was used successfully in a number of patient and animal studies to measure the contrast concentration in blood following intravenous injection of contrast agent.
Absorptiometry, Photon↗
The general practice 'management of otitis externa'.
Clinical confusion, treatment failure and recurrence commonly plague the Management of Otitis Externa. The aim of this study was to investigate the clinical attitudes and habits of army general practitioners and to review the recent literature. The results of a questionnaire survey showed that although all the respondents agreed that aural toilet was important, only 50% felt confident in performing aural toilet and packing. There also appeared to be much greater scope for the use of astringents and effective preventative measures in addition to aural toilet. The discussion emphasises and need for careful selection of the most appropriate topical agent, whilst highlighting the roles of practical procedures, bacteriology and prevention. A practical guide to diagnosis and management is offered with the aid of illustrations and an algorithm.
Administration, Topical↗
Deep pelvic abscesses: transrectal drainage with radiologic guidance.
Transrectal catheter drainage was performed under radiologic guidance in eight patients with deep pelvic abscesses during a 7-month period. One patient underwent two procedures. In five patients, the abscess could not be palpated at rectal examination. Seven procedures were performed with fluoroscopic guidance. Transrectal ultrasound was performed in conjunction with fluoroscopy for two procedures. Medium to large (8-14-F) locking catheters were used in seven procedures, and small (5-F) nonlocking pigtail catheters were used in two. The catheter was left in place for 3 days or less in all but one patient, in whom the catheter was left in place for 20 days. Five abscesses were drained through the anterior or anterolateral rectal wall and four, including one repeat drainage, through the posterior rectal wall. No complications occurred as a direct result of transrectal drainage. Successful initial drainage was established with clinical improvement in all cases. Two patients eventually required surgery, one for continued bleeding into an infected hematoma and one for abscess recurrence after tube dislodgment. Transrectal drainage performed with radiologic guidance is a safe, feasible procedure; is well tolerated by patients; and is relatively easy to perform with the techniques described.
Abscess↗
Unsuspected factors in 'self-limiting' ailments.
An unsuspected subtotally perforated eardrum treated with wax softening drops shows how clinical findings do not always correlate with symptoms or history. Attention is drawn to the dilemma posed by delegating matters such as diagnosis and prescribing which have been considered to be purely in the medical sphere.
Administration, Topical↗