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Biomedical subjects

R F Gray

Publications and source records attributed to R F Gray.

At least 19 recordsLinked to original sources
PubMed1996

Upper airway obstruction in children with Down syndrome.

OBJECTIVES: To analyze the complex nature of upper airway obstruction (UAO) and the response to surgery in children with Down syndrome. DESIGN: Retrospective medical chart review of all patients with Down syndrome who had UAO during a 5-year period. SETTING: Academic tertiary care children's hospital. PATIENTS: Seventy-one pediatric patients with Down syndrome who had significant UAO. Thirty-four patients had pulmonary artery hypertension; 44 patients had multiple sites of airway obstruction. The obstructive problems included lymphoid hyperplasia, macroglossia, narrow nasopharynx, laryngomalacia, congenital subglottic stenosis, tracheobronchomalacia, and tracheal stenosis. INTERVENTIONS: Children with Down syndrome and UAO underwent surgical procedures including tonsillectomy, adenoidectomy, tonsillar pillar plication, uvulopalatopharyngoplasty, anterior tongue reduction, tonguehyoid suspension, laryngotracheoplasty, and tracheotomy. MAIN OUTCOME MEASURES: Postoperative symptoms found on medical chart review, or parental telephone survey, or both, and results of postoperative diagnostic tests. Patients were grouped as "improved" or having "significant residual symptoms." RESULTS: Twenty-seven of the 55 surgical patients had mild obstructive symptoms, and most improved after tonsil or adenoid surgery, or both. The remaining patients were younger and had more severe symptoms, multiple sites of obstruction, and a high incidence of cardiac disease. Eleven (39%) of the 28 patients in this group had significant residual symptoms after surgery. Four children are tracheotomy-dependent. Five deaths occurred; 3 were attributable to the upper airway. CONCLUSIONS: Upper airway obstruction in children with Down syndrome often is a complex process with multifocal causes. Residual symptoms of airway obstruction are common after surgery. A comprehensive and individualized approach is important in the management of UAO in Down syndrome.

Adenoidectomy↗
PubMed1995

Cochlear implant results: a comparison of live-voice and videotaped tests.

The Cambridge Cochlear Implant Programme has so far implanted the Ineraid multichannel cochlear implant in 16 profoundly deaf adult patients; there has been a 9-month or longer follow-up period with these patients. We have evaluated these patients by open-set Bamford-Kowal-Bench (BKB) Standard Sentence List testing in two different delivery strategies, live-speaker testing by the same speaker and high-resolution videotaped testing. The performance in lip reading both before and 9 months after implantation has been tested, as well as performance with the implant alone and with the implant in conjunction with lip reading at the 9-month stage. We have compared the performance in these two delivery strategies and have found a significantly better performance in the live-speaker tests that is attributable to slower and perhaps more sympathetic delivery. We have also found evidence of a ceiling effect in the performance of the implant with lip reading in the live-speaker mode and, of greater importance, a floor effect in the performance of the implant alone with the videotaped test. These results and the implications for a complementary role of these two test-delivery modes are discussed.

Cochlear Implants↗
PubMed1995

Patient performance over eighteen months with the Ineraid intracochlear implant.

We present our results with an 18-month follow-up for 15 adult patients treated with the Ineraid (formerly Symbion) four-channel intracochlear implant. All were postlingually deaf with profound or total hearing loss. Performance was tested in lipreading, implant only, and combined lipreading and implant modes using Boothroyd word lists, Bamford-Kowal-Bench (BKB) sentences, and Connected Discourse Tracking. Assessments were made after 10 hours of training and again at 9 and 18 months postimplantation. Mean scores at 18 months in the implant only mode were for Boothroyd word lists 39%, for BKB sentences 47%, and for connected discourse tracking 31 words per minute. In the combined implant and lipreading mode the mean scores were for Boothroyd word lists 85%, for BKB sentences 96%, and for connected discourse tracking 75 words per minute. A profile of implant performance against time shows that after 10 hours' training, 12 of the 15 subjects had some speech discrimination in the implant only mode for all three tests. When using their implant combined with lipreading, all 15 subjects improved their speech discrimination scores over those obtained with lipreading alone after 10 hours' training. By 9 months, all subjects had some speech discrimination in the implant only mode on all three tests. Between 9 and 18 months there was a slight trend toward improvement in implant performance, both when the implant was used alone and when it was combined with lipreading.

Adolescent↗
PubMed1995

Cochlear implants in chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) in profoundly deaf patients is a contraindication for cochlear implantation. Eight (6%) of the 126 patients referred to cochlear implantation at this center between 1986 and 1992 became deafened as a result of bilateral CSOM but were otherwise suitable candidates. This study details the methods used in four patients to prepare the septic ear for a sterile device. Two patients had wet radical cavities with residual cholesteatoma, and two had discharging safe perforations resistant to surgical repair. Obliteration of the middle ear cleft with blind pit closure of the ear canal was attempted in all four patients, and cochlear implants were installed at a second operation 3 to 6 months later. The hearing results were as good as in implanted patients without CSOM, and the only complication has been the finding of a cholesteatoma pearl at the second operation in one patient. Fat obliteration of the mastoid and middle ear with blind pit closure of the ear canal can be adapted to make most chronic ears fit for implantation, if the patient is prepared to undergo two operations.

Aged↗
PubMed1994

Microscope and hot wire cautery management of 100 consecutive patients with acute epistaxis--a superior method to traditional packing.

The technique of microscope examination and hot wire cautery in a prospective study of 100 consecutive patients with acute epistaxis is described. The method was successful in arresting haemorrhage in 94 per cent of patients bleeding at the time of examination, and in 86 per cent, discharge home within one hour was possible. Due to improved illumination, magnification and control of the cautery instrument, nasal packing was required in only nine per cent of cases. By achieving this and by reducing the overall need for admission to 20 per cent, we recommend this method of treatment both as a successful cost saving measure, as well as advantageous to the patient.

Acute Disease↗
PubMed1994

Mastoid obliteration using bone pâté.

The technique of mastoid revision and obliteration using bone pâté and a superiorly based temporalis musculo-periosteal flap is described in detail. This method has evolved and been employed in our department over the past 10 years.

Bone Transplantation↗
PubMed1994

Bone pâté obliteration or revision mastoidectomy: a five-symptom comparative study.

A survey of 47 patients who underwent surgical treatment for persistent symptomatic mastoid cavities following mastoidectomy for cholesteatoma, was carried out. There were two groups comprising 26 patients who underwent revision mastoidectomy (14 with meatoplasty); the technique favoured early in the series, and 21 managed by mastoid revision and obliteration with autologous bone pâté and a superiorly based temporalis musculo-periosteal flap. A questionnaire was used to assign a symptom score to each patient's pre and post-operative condition, with a maximum score of 15 and minimum of zero. The pre-operative scores for the two groups were not significantly different, but the patients treated by obliteration with bone pâté had a significantly lower (P = 0.05) postoperative symptom score than those who had their mastoids simply revised. This study suggests that revision mastoidectomy with bone pâté obliteration achieves a more favourable result than revision mastoidectomy alone, and is, we believe, the technique of choice for the patient with a symptomatic mastoid cavity.

Adult↗
PubMed1994

Maintaining the Ineraid cochlear implant.

Managing a patient with acquired profound deafness with a cochlear implant involves a lifetime commitment to rehabilitation and also to maintaining the device in a functioning condition. This paper describes the Cambridge experience of maintaining the Ineraid cochlear implant in a series of 25 patients over a 4 year period. On average, maintenance (repair of replacement) of components was required every 2.3 months of implant use, although some minor variations were noted between patients, and between component type. This rate of failure is sufficient to cause an Implant Centre to consider provision for repairs and holding of spare stock. It should be remembered that each breakdown returns the patient to a deafened state, albeit temporarily, but this can cause significant distress.

Cochlear Implants↗
PubMed1993

Profound deafness treated by the Ineraid multichannel intracochlear implant.

Twelve deaf adults and two deaf children were treated with the Ineraid (formerly Symbion) four channel intracochlear implant between September 1989 and October 1991 at Addenbrooke's Hospital in Cambridge. All were post-lingually totally deaf and had found themselves beyond the reach of hearing aids. The effect of the implant upon the patients ability to lip-read was tested with the speech tracking test, BKB sentences (comparable to CID sentences) and Boothroyd word lists (comparable to NU6 word lists). All patients showed an improvement in their ability to understand speech with the help of the implant. Discrimination of speech without lip-reading was tested with Boothroyd word lists and BKB sentences, eight patients (57 per cent) demonstrated some 'open set' speech discrimination. The acceptability of the carbon percutaneous pedestal is discussed from the patient's, audiologist's and surgeon's points of view.

Adolescent↗
PubMed1993

Cholesterol metabolism and violence: a study of individuals convicted of violent crimes.

To examine the relationship between plasma lipoproteins and apolipoproteins in men with convictions for violent offences, blood was obtained from 15 men with a history of violence who were serving prison sentences for violent offences, and 25 age-matched male controls from the staff of the Argyll and Bute Psychiatric Hospital, who had no criminal records. The two groups did not differ in plasma total cholesterol concentrations, HDL-C, LDL-C, VLDL-C or in HDL subfractions. The most significant differences in the offenders were higher apoprotein AIV (3.62 vs 0.85: p = < 0.000001) and higher apoprotein E (7.70 vs 5.19: p = < 0.0002).

Adult↗
PubMed1993

Measuring variations in nursing care per DRG.

A state nurses' association, a state department of health and a consulting agency collaborate annually in a special nursing study to develop appropriate measures of the relative variation in nursing care associated with each DRG. This activity provides a mechanism for professional nurses and the nursing profession to have direct input into a state's reimbursement methodology. This methodology is unique in the nation and may serve as an important prototype for nurses in other states who are seeking recognition of nursing care and services in the DRG reimbursement system.

Costs and Cost Analysis↗
PubMed1992

Perforating injury of the neck and vertebral artery trauma.

A 10-year-old schoolboy presented with a penetrating wound to the neck after a children's slide accident. A CT scan and endoscopy showed a traumatic oesophageal-cutaneous fistula. Neurologically the child deteriorated over a period of 34 hours and finally succumbed to a respiratory arrest. Post-mortem findings showed a hypoplastic right vertebral artery. In the left suboccipital triangle a venous clot had blocked the dominant artery thus leading to cerebellar and brainstem infarction. This extraluminal compression leading to obstruction of an otherwise non traumatized vertebral artery is unique in the literature.

Child↗
PubMed1991

Radiology for cochlear implants.

One fifth of patients selected for cochlear implants have such bony irregularities in the cochlear duct that full insertion of a multichannel electrode array is impossible. Three cases of cochlear deafness are presented where pre- and post-operative radiology played an important part in the management. Standard CT at 2 mm cuts is compared with ultra high resolution CT at 1 mm cuts. The pitfall of poor definition is that the inexperienced surgeon may find himself unexpectedly drilling out an obliterated cochlear duct. Sections 30 degrees caudal to Reid's infra orbito-meatal base line at 1 mm intervals give maximum information for minimum radiation. Plain films show the placement of individual platinum electrode contacts in relation to the spiral 'frequency map' of the cochlea. This is vital information for the audiologist who has to route specific frequencies to specific sites within the ear for a good hearing result.

Adult↗
PubMed1991

Mastoid misery: quantifying the distress in a radical cavity.

Seventy-eight mastoid cavities were studied in 39 patients who required revision surgery for troublesome symptoms. A retrospective questionnaire was used to assign a symptom score to each patient in his pre and post-operative condition. The 5 leading symptoms of pain, wax, discharge, smell and giddiness were reviewed. A score of 15 points represented the worst case and zero the best. The average improvement after surgery was 4.7 points. Hearing was not considered in this study.

Humans↗
PubMed1990

Cricoid release in a preterm neonate.

A baby born at 23 weeks gestation could not be extubated at 34 weeks and nine weeks intubation was causing laryngeal granulation. Anterior cricoid release saved the infant from a tracheostomy. The case is reported because of (a) the prematurity and small size of the neonate and (b) the microsurgical technique and non-penetration of tracheal mucosa, neither of which have been addressed in previous publications.

Cricoid Cartilage↗