Biomedical subjects
Publications and source records attributed to M G Watson.
It is now a widely held belief that so-called 'lateral aberrant thyroid' tissue actually represents a metastasis from a malignant tumour of the thyroid gland. A case is presented which suggests that this is not always true, and an extensive review of the relevant literature is discussed.
Twenty-one patients with non-Hodgkin's lymphoma involving the palatine tonsil were studied in an attempt to relate pathological data to clinical outcome. Eleven tumours were classified as low-grade and ten as high-grade on morphological criteria. The results of immunohistochemical investigations are presented; all tumours but one were of B-cell origin. None of the pathological factors studied were found to be useful prognostic indicators.
Pseudoaneurysm of the internal carotid artery is an uncommon but potentially lethal complication of tonsillar or peritonsillar sepsis, which appears to have occurred more frequently prior to the introduction of penicillin. Management of such a case is discussed, and a literature review presented.
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This paper presents our experience with four cases of impacted laryngeal foreign bodies. A review of the literature reveals that the condition is rare, but far more dramatic and life threatening than bronchial foreign bodies. The history may not indicate the diagnosis, especially in the ethnic minority races where there is a language barrier. Suspicion of the diagnosis by the casualty officer and the immediate attendance of an experienced otolaryngologist may be life saving. Radiological examination is not necessary where the diagnosis is obvious. If the diagnosis is in doubt it must be remembered that many foreign bodies are not radio-opaque. The patient must be accompanied at all times by an otolaryngologist until the foreign body is removed.
The use of diathermy in achieving haemostasis at tonsillectomy was assessed by means of a postal questionnaire sent to consultant otolaryngologists practising in the U.K. A response of 81 per cent was obtained. Forty-four per cent presently use diathermy. Few considered the age of the patient or a history of a quinsy a contraindication to its use. The diathermy experience of users and non-users with regard to speed, post-operative pain and haemorrhage differs markedly. This dichotomy of opinions is confirmed by a review of the literature. Clearly there is a need for further studies to clarify the role of diathermy in tonsillectomy.
Intranasal adhesions are a common complication following nasal surgery. They may be prevented by the use of silastic splints, which are also a very effective treatment for established lesions. We report a patient where intranasal adhesions rapidly recurred despite the use of splints, who was found to be suffering from Wegener's granulomatosis.
To assess the aetiological contribution made to spontaneous epistaxis in adults over the age of 50 years by various groups of drugs, a controlled study was designed. Fifty-three consecutive epistaxis patients were compared with 50 controls. Significant differences were found between the groups in their consumption of warfarin, dipyridamole and non-steroidal anti-inflammatory drugs. Hypertension was equally common in the two groups, but tended to be less well controlled in the epistaxis patients compared to the controls. It is thought that the link between the use of nonsteroidal anti-inflammatory drugs and the occurrence of epistaxis may be due to alteration of platelet function.
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To investigate the possibility that learning of skills (ie, procedural memory) is preserved during posttraumatic amnesia, 16 amnesic survivors of severe closed head injury and 16 control subjects were studied. Procedural learning tasks included mirror reading, mazes, and a pursuit rotor task that involved tracking a rotating target. Declarative memory was assessed by testing recognition of the words used in mirror reading and a questionnaire concerning details of the previous testing session. Learning was evaluated on 3 consecutive days and a fourth session was scheduled after resolution of posttraumatic amnesia. Despite stable impairment of declarative memory during posttraumatic amnesia, the performance of head-injured patients improved across sessions on all procedural tasks and showed transfer to testing after resolution of posttraumatic amnesia.
An unusual case of cryptococcosis of the larynx is described in a non-immunocompromised patient. To our knowledge this is the second reported case in the literature.
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The various techniques available for the investigation of salivary gland disease are described and their clinical applications discussed. Sialography and scintigraphy are most helpful in cases of recurrent glandular swelling, and CT or MRI in the evaluation of tumors.
Two cases of vagal neurilemmoma are presented and are added to the 64 such cases previously reported. Current management is discussed, with emphasis on diagnostic procedures, which include preoperative CT scanning and exploration of the neck, with careful definition of the tumor under general anesthesia. The operative techniques used are discussed. Attention is also drawn to severe transient bradycardia that may occur during removal of these tumors.
A prospective study was performed on 106 patients undergoing routine nasal surgery to compare the influence of three different packing methods on the final outcome. Pneumatic balloons were found to cause persistent nasal obstruction and an increased incidence of adhesion formation, while lubricated ribbon gauze was more uncomfortable for the patient. Glove finger packs were associated with the least problems.
The 'minitracheotomy', i.e. an indwelling narrow-bore endotracheal tube which is inserted via the cricothyroid membrane to provide access for the removal of secretions from the tracheobronchial tree following major thoracic and abdominal surgery, has recently been developed. In order to investigate whether its use may be injurious to the larynx, a prospective study was carried out assessing laryngeal function pre- and post-operatively in 14 patients. No permanent changes in laryngeal function were found and it was concluded that, when used for short post-operative periods, the larynx is not adversely effected.