Biomedical subjects
Publications and source records attributed to R F Gray.
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.
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.
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.
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.
An improved technique for fixation of a Foley catheter in posterior epistaxis is presented. It has the advantage of rigidity combined with a narrow diameter.
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).
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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.
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.
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.
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.
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.
Many suggestions have been made as to the most appropriate tests for the selection of patients for cochlear implantation. One of the most appropriate tests when selecting patients for a round window extracochlear device is stimulation of the round window itself by a temporary electrode of the same size. Fourteen patients have been tested, 7 of whom were judged to have a good response to electrical stimulation. Six patients have gone on to permanent implantation with a round window cochlear implant.
Vertigo induced by aural suction was abolished by maintaining a constant temperature in the mastoid cavity during the procedure. This was achieved using humidified air at 38 degrees C at the wider end of the aural speculum. The cavity temperature fell by a maximum of 0.2 degrees C (average) in 24 patients, none of whom experienced rotatary vertigo despite prolonged suction. This contrasted with a maximum temperature drop of 8.9 degrees C (average) in the same group of patients, 18 of whom then suffered vertigo and nystagmus, when the cavity temperature was not controlled during suction.
Information has been collected by questionnaire from parents and teachers of 928 deaf school children in South India. 374 of these children were examined during a 21-day visit to Madras. These findings are part of the outcome of the visit by a working party organised and financed by the Commonwealth Society for the Deaf. The Society has organised surveys of deafness in West Africa and Gambia. In this survey the causes of severe deafness in Madras have been identified. Streptomycin injections were responsible for 3.6% of cases and meningitis for 5.3%. Examination found 29% of children with ophthalmic signs of intrauterine rubella. These could be prevented. Only a third of Indian mothers of children with eye signs are aware of having had rubella infection during pregnancy.
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In November 1987, a post-lingually deafened eight-year old became the first child to receive a cochlear implant in Britain. The case aroused considerable controversy and the following paper examines the decision to implant the child, the difficulties experienced and the favourable outcome of the procedure to date.
Suction toilet of mastoid cavities leads to unpleasant vertigo in many patients. We have shown that suction causes cooling within the cavity, in a series of 20 patients. This is of the same order of magnitude as a cold air caloric, showing the temperature drop to be an important factor. The relevant physical principles are examined. During suction a flow of cold, dry room air replaces the warm, moist cavity air, causing cooling both directly and by vaporization of water. Introducing humidified air at near body temperature should eliminate these effects and a study is being set up to evaluate the potential clinical applications of the method in the ENT Outpatient Department.