Biomedical subjects
Publications and source records attributed to M R Laing.
Silver nitrate cautery is frequently used to control epistaxis. Although relatively free of side effects, we have encountered a case of a severe mucocutaneous reaction to silver nitrate cautery to the nose. The pathogenesis of this adverse effect is discussed.
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A review was undertaken of 103 patients with pharyngeal pouch presenting over a 10-year period. Management was conservative in 35 patients and 68 patients were treated using external diverticulectomy and cricopharyngeus myotomy. The fistula rate was 8.9% and median hospital stay was 7 days. The results of this large series are compared to other reported series, and a long-term follow-up showing clinical outcome is reported.
One hundred consecutive adult patients having tonsillectomy were carefully analysed with regard to preoperative history, operative findings and pathology. Follow-up was made at 1 and 3-year intervals, with particular reference to the patient's view of the outcome. Results of operation were compared with the clinical course of 100 age and sex-matched controls who had been on the waiting list for tonsillectomy for 2 or more years. These results are presented and a case is made for tonsillectomy in young adults as a valid and cost-effective procedure.
Eight cases of intra-thoracic tracheal stenosis presenting to the ENT department at the Hospital for Sick Children, Great Ormond Street, over the past 10 years are reported. The varied aetiology and presentation of these cases is discussed and the frequency of associated cardio-pulmonary anomalies emphasized. Difficulties in diagnosis and investigation are outlined, in addition to an overview of current management. While the overall outlook for many of these children remains poor there is reason to believe that a balance of conservative management and surgical reconstruction in selected cases will result in improved survival figures.
The records of 44 cases of non-Hodgkins lymphoma (NHL) presenting to the ear, nose and throat department in the Grampian area from 1980-1988 were examined in relation to site of occurrence, histology, age at presentation, clinical stage, treatment and survival. The median age was 67 years and there was a preponderance of high grade histology, especially in disease affecting the tonsil. Most deaths occurred in the first year; patients with high grade disease and those in stages three and four had a significantly poorer survival during the first year. The site of disease had no influence on survival.
We present a prospective controlled trial, comparing methods of analgesia for the relief of discomfort on removing nasal packing, including a general discussion on the considerations for, and methods of, nasal tamponade. On the basis that nasal packing is likely to continue to be used frequently, nitrous oxide (as Entonox) is advocated as a safe and relatively cheap means of pain relief with a statistically significant advantage over papaveretum.
Fifty-four cadaver dissections of the parotid gland and the extracranial course of the facial nerve were made. In 52 out of 54 specimens dissected (96.3 per cent) the retromandibular vein was present and of significant calibre (greater than 2 mm). In all specimens the main facial nerve trunk or its major divisions were in direct contact with the retromandibular vein at the level of its entry into the parotid gland. This finding is discussed in the context of new developments in body scanning techniques and put forward as a potential adjuvant in the clinical management of lumps in the parotid region.
A 71-year-old female presented with a midline neck mass. The clinical impression was that of a thyroglossal cyst but preoperative assessment suggested a solid lesion, possibly malignant. The mass was removed surgically using the Sistrunk technique and shown pathologically to be a mixed papillary-follicular carcinoma of the thyroid with no cystic elements. Clinically and radiologically the thyroid was normal and thyroidectomy was not performed. This management is discussed along with a brief review of the relevant literature on the pathology and treatment of similar lesions.
One hundred and thirty-seven consecutive acute superficial abscesses were randomly allocated to incision, curettage and primary suture without parenteral antibiotics (64 cases) or to conventional treatment with incision, drainage and dressings (73 cases). Wound healing was faster; 7.0 days: 25.1 days (P less than 0.01, Wilcoxon's rank sum test), the number of hospital visits was smaller; 3.8 visits: 11.1 visits (P less than 0.01) and the time off work was shorter; 4.0 days: 14.1 days (P less than 0.01) in the group treated by primary closure compared with those managed conventionally. In this study no complications attributable to the withholding of antibiotics occurred. Incision and primary closure of abscesses is safe and more economic than conventional drainage. Routine antibiotic cover is not necessary.