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Biomedical subjects

M S Timms

Publications and source records attributed to M S Timms.

At least 19 recordsLinked to original sources
PubMed2002

Coblation tonsillectomy: a double blind randomized controlled study.

Tonsillectomy has been performed by a number of techniques. This double blind randomized controlled study compares the technique of tissue coblation with bipolar dissection for the removal of tonsils in 10 adult patients with a history of chronic tonsillitis. A significant reduction in post-operative pain and more rapid healing of the tonsillar fossae were found in the side removed by tissue coblation. There were no episodes of primary or secondary haemorrhage on either side. This new technique for tonsil removal warrants further study.

Adolescent↗
PubMed2001

Paediatric coblation tonsillectomy.

OBJECTIVE: Tonsillectomy has been described using a number of techniques. Recently Coblation Technology has been used to remove tonsils with anecdotal evidence of a reduction in post-operative morbidity. In this study we aim to see if there is any difference in post-operative pain, tonsillar fossae healing and return to a normal diet performing tonsillectomy, using tissue coblation compared with standard bipolar dissection. METHODS: A double blind randomised control trial to compare the technique of tissue coblation with standard bipolar dissection to remove tonsils in 38 children on the waiting list for tonsillectomy, with a history of chronic tonsillitis or obstructive tonsils. RESULTS: A significant reduction in post-operative pain was found in the children whose tonsils were removed by tissue coblation (P<0.0001). More rapid healing of the tonsillar fossae was found in the coblation group. Children who had their tonsils removed by coblation were found to return to their normal diet far sooner than those who underwent bipolar dissection. There were no episodes of primary or secondary haemorrhage in either group. CONCLUSIONS: This new technique using tissue coblation for tonsil removal offers significant advantages in the post-operative period, with rapid return to a normal diet and a drastic reduction in analgesic requirements following the surgery.

Child↗
PubMed2001

Winer's dilated pore, rare presentation in the external ear canal.

A 51-year-old female patient was admitted to our outpatient department with a discharging right ear of six months duration and not responding to aural toilet and topical antibiotics. Microscopic examination showed a collection of soggy keratin in the floor of the ear canal. Suction cleaning showed a skin defect of about 7 mm in diameter. A CT scan showed rarefaction in the bony canal. Histological diagnosis following an excision biopsy under general anaesthetic showed Winer's dilated pore. Winer's dilated pore is a hair follicle tumour arising from the pilosebaceous apparatus. Hair follicle tumours are relatively rare and their clinical appearance is commonly non-specific. In spite of their non-specific features, they show a keratotic plug grossly which when removed reveals a skin defect and may show bone erosion occasionally if the underlying structure is bone. These features can be misinterpreted for more serious lesions such as squamous cell carcinoma or basal cell carcinoma of the ear canal that can lead to pursuing a more aggressive line of management for a benign lesion. We present this rare lesion illustrating the pathological features, differential diagnosis and management.

Diagnosis, Differential↗
PubMed2001

Blood loss reduction during laser turbinectomy.

The use of a combination of topical and injected anaesthetic and vasoconstrictive agents is widely applied in rhinological practice. To prepare the nose prior to a laser inferior turbinectomy under combined general and local anaesthetic, we routinely spray the nose with 1:1000 epinephrine and inject 2% xylocaine with 1:80.000 epinephrine into each inferior turbinate. With the current climate tending towards evidence based medicine, we were keen to show that our technique of pre-operative nasal preparation was effective. A randomised, double blind, prospective study was carried out, with patients acting as their own control. We found that the injection of 2% xylocaine with 1:80.000 epinephrine did not confer any additional benefit, in terms of blood loss or post-operative pain, in the treatment of these patients. The inferior turbinate that was injected bled more during the procedure than the non-injected side; there was no difference in post-operative discomfort between the 2 sides.

Adolescent↗
PubMed1996

An unusual cause of facial pain.

A case of chronic facial pain and headache is presented. This was found to be due to two pieces of windscreen-glass lodged in the superior meatus of the patient's nose since a road-traffic-accident 14 years earlier. Despite being reported as normal, review of previous X-rays of her sinuses showed that the glass was visible. The importance of carefully assessing the intranasal area on sinus-views is illustrated.

Accidents, Traffic↗
PubMed1992

Nasopharyngeal Corynebacterium ulcerans: a different diphtheria.

A case of toxigenic Corynebacterium ulcerans infection is presented. The diagnosis was delayed and no anti-toxin administered. A nasopharyngeal biopsy was complicated by severe haemorrhage necessitating a post nasal pack. A brief review of the pathology and treatment of Corynebacterium ulcerans is given.

Adult↗
PubMed1991

Association of supraglottic and gingival idiopathic plasmacytosis.

Three cases of gingival plasmacytosis in which laryngeal symptoms eventually developed are reported. Two of the three patients underwent endoscopic biopsy of supraglottic lesions, which proved to be similar to those in the oral cavity. The third patient had supraglottic erythema only and was not subjected to biopsy. Known etiologic factors associated with plasma cell gingivitis were excluded. Treatment with oral and topical steroids resulted in good control of the lesions.

Adult↗
PubMed1991

Promontory stimulation following labyrinthectomy.

Promontory stimulation testing was carried out on a series of ten patients who had undergone osseous labyrinthectomy. The thresholds, discomfort levels and dynamic ranges were found to be comparable with a series of ten patients who have subsequently been successfully implanted with the Nucleus 22 channel cochlear implant. These findings suggest that cochlear implantation might be possible in a labyrinthectomized ear.

Adult↗
PubMed1991

Incidence and prevention of conjunctival contamination with blood during hazardous surgical procedures.

The incidence and risks of conjunctival contamination with patients' blood during a range of otolaryngological surgical procedures was assessed. Risks were found to be highest in three groups of procedures; tracheostomy, operations preceded by local anaesthetic injections and procedures involving the use of the air drill. A simple and effective method of protection using spectacles with large plain lenses is presented.

Blood↗
PubMed1989

Incidence of abnormality in routine 'vocal cord checks'.

Where elective surgery carries a risk of damage to the recurrent laryngeal nerve, pre-operative examination of the larynx is routine. The incidence of positive findings at such examination has been determined by retrospective review of 1,947 clinic records. Only 31 vocal cord palsies were found. The possible causes and relevance of such findings are discussed.

Cardiac Surgical Procedures↗
PubMed1988

Comparative toxicity of cisplatin, carboplatin (CBDCA) and iproplatin (CHIP) in combination with cyclophosphamide in patients with advanced epithelial ovarian cancer.

Sixty patients with FIGO stage IIb, IIc, III and IV ovarian cancer were entered into a randomized Phase III study of cyclophosphamide 600 mg/m2 with cisplatin 100 mg/m2, iproplatin 240 mg/m2 or carboplatin 300 mg/m2. Dose modifications were made according to renal function and myelotoxicity. The arms containing carboplatin (CBDCA) and iproplatin (CHIP) were not shown to be significantly different from the cisplatin containing arm with regard to response rate, duration of response and survival. Subjective toxicity showed that cisplatin and cyclophosphamide therapy was associated with more nausea and vomiting (P = 0.0005). The duration of vomiting showed a significant increase with successive courses of chemotherapy for the cisplatin containing arm only (P less than 0.003). The cyclophosphamide/CHIP combination caused significantly more diarrhoea (P less than 0.0006). Alopecia was more severe (P less than 0.02), and neurotoxicity was more common, in patients who received cyclophosphamide and cisplatin (paraesthesiae P = 0.0007, tinnitus P less than 0.00005, deafness P = 0.0018). All three combinations caused cumulative toxicity on haemoglobin (Hb) (P less than 0.001 for each treatment), leukocyte count (WCC) (P less than 0.0005 for each treatment), and platelet count (P less than 0.0005 for each treatment). The degree of fall in Hb for each course of therapy was greater in the cisplatin containing arm compared with the CHIP and CBDCA arms which were not significantly different from each other (P = 0.0005). For WCC the cisplatin/cyclophosphamide regimen was significantly less toxic than CHIP/cyclophosphamide, with CBDCA/cyclophosphamide falling between the two and not being significantly different from either (P = 0.0005). The CHIP containing arm caused more thrombocytopenia than the other arms which were of equal toxicity (P less than 0.0005). Serum creatinine showed a gradual significant overall rise with each course of cisplatin/cyclophosphamide therapy (P less than 0.0005), whereas the CBDCA arm showed no change and the CHIP arm showed a small fall in serum creatinine after most courses of therapy. This study showed that CHIP or CBDCA in combination with cyclophosphamide was less toxic than cisplatin/cyclophosphamide therapy with regard to alopecia, degree and duration of nausea and vomiting, renal toxicity, neurotoxicity and anaemia. The CHIP/cyclophosphamide regimen caused more thrombocytopenia and diarrhoea. The CHIP and CBDCA containing arms caused more leukopenia than the cisplatin containing regimen. Either iproplatin or carboplatin would be an acceptable alternative to cisplatin in chemotherapy regimens, and would result in reduced toxicity.

Aged↗
PubMed1988

Experience with a new topical anaesthetic in otology.

Producing good local anaesthesia of the external auditory meatus and tympanic membrane has always been a difficult problem facing otologists. Previously used methods are mentioned and the use of a new eutectic mixture of local anaesthetics (EMLA) for electrocochleography, myringotomy and grommet insertion in adults and older children is described. A double-blind controlled trial involving 15 patients (30 ears) undergoing electrocochleography showed EMLA to be a very effective, safe and convenient preparation for outpatient otological use.

Adolescent↗