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Biomedical subjects

J E Fenton

Publications and source records attributed to J E Fenton.

50 records · Page 3Linked to original sources
PubMed1995

Bismuth subgallate--its role in tonsillectomy.

There have been many attempts at identifying substances and describing methods that would assist the surgeon and be of benefit to the patient undergoing a tonsillectomy. The use of bismuth subgallate as a haemostatic adjunct during tonsillectomy has only been described previously in retrospective studies. A controlled prospective randomized trial of 100 paediatric patients, in which 50 patients had a tonsillectomy performed using bismuth subgallate as a haemostatic agent and in which the remainder did not have any associated haemostatic substance, is presented here. Data on 72 patients was analysed, 39 patients belonging to the bismuth subgallate group and the remaining 33 to the control group. The time for haemostasis was three to 18 (mean 7.8) minutes in the bismuth group. It was four to 16 (mean 9.9) minutes in the non-bismuth group. These figures are statistically significant. The range of ties used in the bismuth group was none to three (mean 1.5) ties and one to seven (mean 3.4) ties in the non-bismuth group. These figures are also statistically significant. The remainder of the recorded parameters did not differ significantly. It was found that bismuth subgallate/adrenaline paste decreases operating time by significantly reducing the haemostasis time and the number of ties required but does not decrease post-operative morbidity.

Adolescent↗
PubMed1995

The influence of race on the position of the jugular bulb.

The position of the jugular bulb (JB) is of great clinical significance to the otologist. A high and laterally situated jugular bulb may pose difficulties when dealing with the middle ear while a high and medially sited jugular bulb can create problems in neuro-otological surgery. This paper aims to study possible racial differences in the position of the jugular bulb. Fine-cut computed tomogram (CT) scans of temporal bones (in the axial plane) of 34 Caucasians and 34 Chinese were studied. The position of the jugular bulb was determined with reference to the midpoint of the lumen at the inferior limit of the cochlea (mpC). Of the 60 Caucasian and 58 Chinese temporal bones with identifiable jugular bulbs, 33 jugular bulbs of the Caucasian (55 per cent) and 34 jugular bulbs of the Chinese (58.6 per cent) were at the same height or higher than the mpC (p = 0.2; chi-squared test). The midpoint of the jugular bulb was 8.67 +/- 1.73 and 8.61 +/- 2.49 mm posterior to the mpC for the Caucasian and Chinese respectively (p = 0.2; t-test). However, the midpoint of the jugular bulb of eight Caucasian (24.2 per cent) and 22 Chinese (64.7 per cent) were medial to the mpC (p < 0.001; chi-squared test). Race does not influence the height of the jugular bulb nor its position in the sagittal plane but can influence whether a high jugular bulb is medially or laterally situated.

Adult↗
PubMed1995

Lymphoma and Hashimoto's thyroiditis.

Development of malignant lymphoma in Hashimoto's thyroiditis is well documented. A case of tracheal invasion by a lymphoma which accompanied Hashimoto's disease is described. The clinical and diagnostic difficulties which were encountered are presented. The magnetic resonance imaging (MRI) findings which have not been reported previously are outlined.

Humans↗
PubMed1995

Racial considerations in acoustic neuroma removal with hearing preservation via the retrosigmoid approach.

Racial differences in the size, shape and structure of the cranium exist. This paper evaluates the importance of race in influencing the required sizes of craniotomies for gaining access to the lateral end of the internal auditory meatus without breaching the labyrinth via the retrosigmoid approach. Fine-cut CT scans of the temporal bones (axial cuts) of 34 Chinese and 34 Europeans were studied. The relevant distances and angles of the posterior cranial fossa and temporal bone were measured and statistically significant differences between the two races were found. This led us to the conclusion that a larger craniotomy is required in Europeans than in Chinese. In recommending an optimal size for a retrosigmoid craniotomy to remove acoustic neuromas completely and preserve hearing, the racial factor must be considered.

Adult↗
PubMed1994

The otological manifestations of Wegener's granulomatosis.

Three cases of Wegener's granulomatosis are described in which the common presenting symptoms were those of aural discomfort and discharge. The otological manifestations of this disease process are discussed and a review of the literature is presented.

Acute Disease↗
PubMed1994

Recurrent laryngeal nerve palsy secondary to benign thyroid disease.

A recurrent nerve palsy occurring in the presence of a goitre is considered to be caused by thyroid malignancy until proven otherwise. Three cases are described in which benign thyroid disease resulted in recurrent laryngeal nerve paralysis. Recent haemorrhage was implicated histologically as the possible aetiology in all three cases. The importance of identifying and preserving the recurrent laryngeal nerve in the surgical management is highlighted.

Aged↗
PubMed1994

Large vestibular aqueduct syndrome and stapes fixation.

An abnormally large vestibular aqueduct has a well recognized association with inner ear anomalies and it has been assumed previously to be a variant of a Mondini type of deformity (Shuknecht, 1980; Emmett, 1985). The sole radiological finding in some patients with progressive sensorineural loss has been a large vestibular aqueduct (Valvassori and Clemis, 1978; Valvassori, 1983), which is now accepted as a separate clinical entity, i.e. the large vestibular aqueduct syndrome (LVAS). A case is presented which is believed to be the first reported with unilateral LVAS and stapes fixation and also the first stapes gusher described in association with LVAS.

Adult↗
PubMed1994

Adult day case tonsillectomy: a safe and viable option.

Day case tonsillectomy, in general, is not considered a routine procedure. Many otolaryngologists would not perform this operation on an out-patient basis due to the risk of reactionary haemorrhage after discharge from hospital. A prospective trial of carefully selected adult patients undergoing day case tonsillectomy was performed. Each was given a questionnaire to assess post-operative morbidity including pain, time required to return to normal diet and comments on the ambulatory aspect of their surgery. The results of 48 patients are analysed. None of these had haemorrhage within 24 h of their operation. Twenty patients (42%) were happy to have the procedure performed in this way whilst 19 (39%) found it tolerable. Two patients had to be admitted overnight as they had not recovered enough to be discharged. It is concluded that adult day case tonsillectomy in selected patients is a safe and viable option.

Adolescent↗
PubMedDate not supplied

Airway intervention in adult supraglottitis.

BACKGROUND: The timing of aggressive airway intervention in adult epiglottitis is controversial. AIMS: To correlate Friedman's staging of epiglottitis on admission with the airway interventions undertaken. METHODS: A retrospective study of 23 adult patients, mean age 51 years (range 29-81 years), who had been admitted with acute supraglottitis between March 1988 and December 2000 was undertaken. RESULTS: Three patients (13%) had airway interventions; two with tracheostomy and one with tracheal intubation. All were Friedman stage III and had rapid symptom progression during the 24 hours prior to admission. Three other stage III patients with symptom progression longer than 24 hours and all the remaining patients (stage II or less) were managed with observation and intravenous therapy. CONCLUSIONS: Friedman originally advocated airway intervention in any patient stage II or worse, but this intubation threshold should probably be lowered to those patients with rapid-onset stage Ill (moderate respiratory distress, stridor, respiratory rate > 30 per minute, pCO2 > 45mmHg) disease.

Acute Disease↗
PubMedDate not supplied

Sinogenic brain abscess.

The otolaryngological contribution to the combined treatment of intracranial suppuration secondary to sinusitis can vary from observation to external approach sinus exploration. Limited surgical intervention using the endoscopic approach, in conjunction with neurosurgical drainage, has recently been adopted at our department as the initial therapeutic strategy in the management of such cases. A retrospective analysis of the otolaryngological input into the treatment of 16 patients with sinogenic brain abscess at the Department of Otolaryngology/Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland is presented. This study reveals that it is generally a disease of young adult males without an antecedent history of sinus disease and that Strep. Milleri is the most common causative organism. It is demonstrated that there is a lack of a consistent approach to the management in the acute phase and that there is an inadequate initial radiologic evaluation of the paranasal sinuses. There are two forms of presentation: 1) an ENT complaint with development of an abscess, and 2) an idiopathic abscess with subsequent identification of a paranasal sinus infective source. Extensive initial intervention seems to be associated with an increased incidence of revision surgery, thus suggesting that a limited endoscopic approach combined with neurosurgical drainage is the optimal course in the first-line management of sinogenic abscess.

Adolescent↗