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Biomedical subjects

N S Jones

Publications and source records attributed to N S Jones.

At least 91 records · Page 5Linked to original sources
PubMed2000

Osteomyelitis of the frontal bone secondary to frontal sinusitis.

Osteomyelitis of the frontal bone is becoming an increasingly rare complication of frontal sinusitis. We present seven cases that represent the largest series published in the last 50 years. Three cases were associated with intracranial involvement. Osteomyelitis should enter the differential diagnosis when there is a fluctuant swelling on the scalp, or if there is a discharging fistula. Treatment requires aggressive surgery to remove all sequestra in combination with long-term antibiotic therapy. Intracranial complications should be excluded by imaging and treated simultaneously if present.

Adolescent↗
PubMed2000

A concha bullosa crusher for use in endoscopic sinus surgery.

A concha bullosa may require surgical reduction to facilitate access to the middle meatus during endoscopic sinus surgery. Here we describe an original instrument which enables this procedure to be performed simply with minimal mucosal damage.

Humans↗
PubMed2000

Rhinorrhoea feigning cerebrospinal fluid leak: nine illustrative cases.

Before contemplating surgery for cerebrospinal fluid (CSF) rhinorrhoea it is vital that the correct diagnosis is established. This can be done using immunofixation of beta-2-transferrin, that is nearly always positive in cases of CSF rhinorrhoea. Fluorescein lumbar puncture is useful in establishing the exact site of a leak and also in confirming the absence of a leak where the clinical suspicion is high but the beta-2-transferrin is negative. High resolution computed tomography (CT) scanning is a useful radiological investigation for identifying a bony defect. We present nine patients who presented with clear rhinorrhoea that was clinically highly suggestive of a CSF leak. Three of these patients had undergone previous craniotomies for presumed CSF rhinorrhoea. The diagnosis of CSF rhinorrhoea was excluded in all patients using beta-2-transferrin with or without fluorescein lumbar puncture. The authors believe that measurement of beta-2-transferrin should be mandatory before surgery for CSF rhinorrhoea.

Adult↗
PubMed2000

Retrospective review of augmentation rhinoplasties using autologous cartilage grafts.

The use of graft materials in rhinoplasty presents many challenges for the surgeon. There are a wide variety of alloplastic materials available for nasal augmentation but the graft material of choice remains autologous cartilage. It has considerable advantages over alloplasts. It does not induce an immune response and has a very much lower rate of infection or extrusion. It is also easily harvested and sculpted and is available in plentiful supply. We present a retrospective review of 103 patients who underwent augmentation rhinoplasty using autologous cartilage grafts with a mean follow-up time of three years six months. The revision rate over the follow-up period was 15.5 per cent (n = 16). The same surgeon's revision rate for rhinoplasty without graft over the same period was four per cent in 311 cases. We conclude that while autologous cartilage remains the best graft material available there is a significantly higher revision rate than when no graft is required. This is primarily due to the unpredictable scarring associated with the graft in the medium term and the asymmetric nature of conchal cartilage.

Adolescent↗
PubMed1999

Evaluation of the clearance characteristics of bioadhesive systems in humans.

This paper describes the characterisation, radiolabelling and clearance characteristics of three bioadhesive nasal delivery systems; starch microspheres, chitosan microspheres and chitosan solution. The time taken for 50% of these bioadhesive materials and a control to be cleared from the nasal cavity, after nasal administration to human volunteers, was evaluated using gamma scintigraphy. The data show that the control was cleared rapidly, with a half life of 21 min, whereas the bioadhesive delivery systems had much longer half lives. The clearance of the chitosan solution almost doubled to 41 min, whilst the half life of clearance for the starch microspheres more than tripled to 68 min and for the chitosan microspheres the half life of clearance quadrupled to 84 min. From the results reported in this study it is possible to determine that both chitosan systems and the starch microspheres have good bioadhesive characteristics. The results have supported the hypothesis that chitosan delivery systems can reduce the rate of clearance from the nasal cavity, thereby increasing the contact time of the delivery system with the nasal mucosa, providing the potential for increasing the bioavailability of drugs incorporated into these systems.

Adhesiveness↗
PubMed1999

Current concepts in the management of paediatric rhinosinusitis.

It is well recognized that adenoid hypertrophy and allergic rhinitis are common in children and that recurrent upper respiratory tract infections are a fact of life. The main causes of symptoms associated with rhinosinusitis in children are rhinorrhoea, nasal obstruction, mouth breathing, hyponasal speech and snoring. Most children grow out of adenoid hypertrophy and recurrent colds by the age of eight to 10 and this means that the main treatment strategy should therefore be conservative and not surgical. An explanation to anxious parents, simple non-invasive measures such as teaching nose-blowing, the use of saline sprays or a trial of allergen avoidance and age-appropriate topical nasal anti-inflammatory sprays should be tried before surgery is even contemplated. Because repeated infections are so common, antibiotics given for chronic nasal discharge often have only short-lived effects. Rhinosinusitis in children is not a surgical disease and 'watchful waiting' is advised. Any treatment should first of all be safe, as even without any intervention the problem usually resolves with time. It is likely that growth and maturation of the immunological response to pathogens play a major role in resolution of the disease. There are few exceptions to this principle: nasal polyps (indicating possible cystic fibrosis), and periorbital cellulitis where an assessment of vision, parenteral antibiotics, and if there is concern about the possibility of a subperiosteal abscess, computerized tomography (CT) and drainage of any pus is indicated.

Age Factors↗
PubMed1999

Access to the traumatized vertebral artery: an unusual approach.

Although injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.

Adult↗
PubMed1999

Principles for correcting the septum in septorhinoplasty: two-point fixation.

This article describes the principles which enable a bent septum to be corrected without the loss of tip or supratip support. These principles centre on the need for two points of fixation in order to provide adequate stability for the septal cartilage. These points include the maxillary spine, the vertical plate of the ethmoid bone (at least 4 mm in continuity with the septal cartilage), the vomer, the maxillary crest or suspension from the upper lateral cartilages. A columella pocket offers additional support but cannot be regarded as a primary anchoring point. An adequate height from the maxillary spine to the tip (approximately 28 mm) and dorsal length (24 mm) of cartilage are also needed to support the nasal dorsum. The main strategy for correcting a septal bend which is apparent externally, or a supratip depression is described and centres on the use of cartilage grafts to disguise any assymmetry.

Humans↗
PubMed1999

The use of nasal endoscopy to control profuse epistaxis from a fracture of the basi-sphenoid in a seven-year-old child.

A seven-year-old child sustained a fracture of her basisphenoid resulting in profuse, life-threatening haemorrhage which could not be controlled with a post-nasal pack. The fracture site was identified using rigid endoscopy and packed with oxidized cellulose, resulting in immediate control of the haemorrhage. The use of the nasal endoscope in the management of posterior epistaxis is discussed.

Accidents↗
PubMed1999

The nasal manifestations of sarcoidosis: a review and report of eight cases.

We report eight patients presenting to the Department of Otorhinolaryngology between 1990 and 1998 in whom a diagnosis of sarcoidosis was made. The most common presenting symptom was that of nasal obstruction and crusting and the most common site of involvement was the septum and inferior turbinate. These patients differ from the majority of patients who present with the other manifestations of sarcoidosis in that they are older. Where mucosal changes are present within the nose, biopsy gives a high diagnostic yield. The aim of treatment is to gain symptomatic control with the lowest dose of steroids. The majority of patient's nasal symptoms were managed with local measures and topical steroids. Nasal disease tends to follow a prolonged but benign course. Few had other organ involvement. While nasal sarcoidosis remains a rare cause of nasal obstruction, biopsy of abnormal nasal mucosa along with further investigations as dictated by history, examination and histological findings is important if delay in diagnosis is to be avoided.

Adult↗
PubMed1999

Testing of adult and paediatric ventilators for use in a magnetic resonance imaging unit.

We have assessed the performance of a series of ventilators (modified versions of the ventiPAC, paraPAC and babyPAC ventilators; SIMS pneuPAC Ltd, Luton, UK) in a magnetic resonance imaging (MRI) scanning environment, with MR safety and compatibility issues being addressed. Following initial modifications to remove ferromagnetic components and replace them with MR-safe materials, all three ventilators performed well in a series of tests in static magnetic fields up to 2 T. Ventilator performance was unaffected by static fields, switching gradients or radio frequency fields within the MR suite. Furthermore, the devices produced no degradation of image quality when used during MR scanning. We discuss management strategies for the care of critically ill ventilated patients during MR procedures.

Adult↗
PubMed1999

Twenty-four hour ambulatory nasal pH monitoring.

The nasal delivery of drugs, both for systemic and local use, is an expanding field with many drugs being delivered by this route. It is known that changes in pH can affect drug absorption but there is no data regarding intranasal pH over time. We present the results of 24-h ambulatory nasal pH monitoring in four subjects, each of whom had monitoring on two separate occasions. The apparatus consisted of a pH monitor with two electrodes, thus enabling us to take readings from 1 and 4 cm behind the anterior end of the inferior turbinate. Measurements were recorded every 6 s by the posterior electrode and every 30 s by the anterior electrode. The recording apparatus was worn around the subjects waist. Analysis of the results showed that there was no diurnal variation and no significant differences between the subjects. The mean pH from the anterior electrode was higher than that from the posterior (7.1 versus 6.6). The pH did not fluctuate with daily activities such as eating, drinking or sleeping. The results are interesting and may be of importance with regard to the design of formulations for nasal drug delivery systems.

Activities of Daily Living↗