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Biomedical subjects

R M Irving

Publications and source records attributed to R M Irving.

At least 55 records · Page 3Linked to original sources

Apo E genotypes in multiple sclerosis, Parkinson's disease, schwannomas and late-onset Alzheimer's disease.

Apolipoprotein E (apo E) exists in three allelic, functionally distinct isoforms (apo E2, E3 and E4). Recent work has suggested that apo-E-dependent uptake of lipoproteins may play important roles in the development and maintenance of the nervous system and in the responses to both peripheral and central nervous system injury. If apo-E-mediated transport of lipids were a rate-limiting step in these processes, one might expect that the functional differences between the alleles would be associated with varying predispositions to neurodegenerative and demyelinating diseases. Thus, we looked for an association between particular apo E genotypes and susceptibility to multiple sclerosis and Parkinson's disease. If apo-E-mediated cholesterol uptake were limiting in neuronal growth, one might also expect that apo E2 alleles would slow CNS tumour growth. Accordingly, apo E genotypes were investigated in individuals with sporadic vestibular schwannomas and neurofibromatosis type 2 (NF-2). No significant alteration in the apo E allele distributions was observed in any of these conditions, nor did the apo E genotypes correlate with disease severity. However, we confirmed the previous findings of an over-representation of the apo E4 allele in autopsy-diagnosed late-onset Alzheimer's disease patients. In addition, our data supported the recent observations that apo E2 may be associated with a protective effect for late-onset Alzheimer's disease. These contrasting risks associated with the apo E2 and E4 alleles strengthen the suggestions that this gene is directly involved in the pathogenesis of Alzheimer's disease.

Alzheimer Disease↗

Sudden deafness in vestibular schwannoma.

Twelve per cent of a series of 284 patients with vestibular schwannoma presented with sudden deafness. If sudden sensorineural hearing loss is present then it is very likely to be the main presenting symptom. The mean length of patients' history is eight months shorter in this group than in the non-sudden deafness group. Sixteen per cent of vestibular schwannoma patients without sudden deafness present with a 'dead' ear whereas 29.5 per cent of those presenting with sudden deafness have total hearing loss. There was no significant difference between the sudden deafness group and the 'all others' group with regard to tumour size, audiogram shape, caloric test, imbalance, and facial numbness. Although the numbers of patients with sudden deafness in this series were too small to reach significance, on the basis of the clinical correlation of vestibular schwannoma morphology it is possible to postulate that compression of the vasculature within the bony internal auditory canal by a laterally arising tumour may be the aetiological factor and may be more likely to occur than in more medially arising tumours.

Adult↗

Somatic NF2 gene mutations in familial and non-familial vestibular schwannoma.

Vestibular schwannoma occurs both as a sporadic tumour and in the dominantly inherited familial cancer syndrome neurofibromatosis type 2 (NF2). The gene for NF2 has recently been isolated on chromosome 22, and the demonstration of inactivating germline mutations in NF2 patients and NF2 associated tumours suggests that it act as a tumour suppressor. We have investigated 85 sporadic and 2 NF2 associated vestibular schwannomas, and one vagal schwannoma for chromosome 22 allele loss and NF2 gene mutations. A further 7 vestibular schwannomas were investigated for NF2 mutations only. Chromosome 22 allele loss was detected in 34 of 87 vestibular schwannomas and in the vagal nerve schwannoma. Six exons of the NF2 gene were investigated by SSCP analysis in all 95 tumours. Somatic NF2 gene mutations were detected in 13 non-familial vestibular schwannomas and in one of the NF2 vestibular schwannomas. Seven non-familial tumours with an NF2 gene mutation also displayed a chromosome 22 allele loss. Thirteen of the mutations were predicted to produce truncation of the NF2 protein. These results suggest that somatic mutations of the NF2 tumour suppressor gene are a critical step in the pathogenesis of both familial and non-familial vestibular schwannoma and that the mechanism of tumourigenesis complies with a 'two-hit' mutation model.

Adult↗

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↗

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↗

Langerhans' cell histiocytosis in childhood: management of head and neck manifestations.

The authors carried out a retrospective analysis of 131 cases of Langerhans' cell histiocytosis treated at two centers over a 30-year period. All those with head and neck manifestations have been reviewed with particular reference to management and outcome. The role of chemotherapy, radiotherapy, and surgery is discussed, and we present our results of the successful introduction of topical nitrogen mustard (Mustine) ear drops for meatal skin involvement. During the period of the study our modus operandi has evolved from an aggressive medical and surgical approach, favored early in the series, to our present more conservative approach, with an attendant reduction in morbidity.

Age of Onset↗

Audiological findings in glomus tumours.

Glomus tumours of the skull base are rare, but as they present with symptoms of hearing loss and tinnitus they are a clinical entity of which audiologists should be aware. This paper describes the findings of the major series of skull base glomus tumours found in the literature, and notes that the contribution of conductive and sensorineural components varies with tumour classification. The reported incidence of hearing loss and tinnitus in glomus tympanicum and glomus jugulare is reviewed and compared with the Cambridge series, in which two tumours were Fisch type A, four type B, two type C and five type D. In each case a mixed hearing loss was found, though the extent of sensorineural impairment was variable. The length of history of tumours limited to the middle-ear was far shorter (mean 8 months) than for more extensive lesions (type B, mean 64 months; C, 48 months; and D, 23 months). Eleven patients (85%) reported the symptom of hearing loss, and 12 (92.5%) of tinnitus, and some patients had experienced these symptoms for some time without seeking the advice of an otologist. It may be concluded that the presence of subjective pulsatile tinnitus or a retrotympanic mass should be considered an indication for an otological opinion, wherein the use of high resolution imaging techniques and arteriography will be considered in conjunction with detailed audiological assessment. Audiologists should be aware of the possibility of glomus tumour in such cases.

Adult↗

Molecular genetic analysis of the mechanism of tumorigenesis in acoustic neuroma.

OBJECTIVE: Acoustic neuroma, both familial and sporadic, is clinically and biologically a heterogeneous condition with a wide variation in age of presentation, length of history, and tumor growth rate. In an attempt to correlate this clinical diversity with the underlying molecular pathology, we have analyzed 43 paired blood-tumor DNA samples from patients with acoustic neuromas. DESIGN: Molecular genetic analysis. SETTING: Molecular genetic research laboratory. PATIENTS: Paired blood-tumor DNA samples were obtained from 43 patients (41 sporadic and two patients with neurofibromatosis type 2). MAIN OUTCOME MEASURES: Loss of constitutional heterozygosity was looked for in the region of tumor suppressor genes on chromosomes 3p, 5q, 11p, 17p, 17q, and 22. RESULTS: We found loss of heterozygosity exclusively for markers on chromosome 22. Thirty-nine percent of tumors showed allele loss, and in each case the loss of heterozygosity included the region of the neurofibromatosis type 2 (NF2) gene. No loss of heterozygosity was detected in the region of known or putative suppressor genes in chromosomes 3p, 5q, 11p, 17p, and 17q. CONCLUSIONS: This study has demonstrated that (1) chromosome 22 allele loss is a frequent event in sporadic acoustic neuroma; (2) the minimal region of loss of heterozygosity in acoustic neuroma includes the NF2 gene; (3) the known tumor suppressor genes investigated (VHL, adenomatous polyposis coli, WT2, p53, and NF1) do not appear to be important in the pathogenesis of acoustic neuroma; and (4) patients with extensive chromosome 22 loss tended to be younger and with a slightly shorter clinical history than those with no detectable allele loss.

Adult↗

Posterior glottic stenosis in children.

The management of posterior glottic stenosis resulting from impaired crico-arytenoid joint (CAJ) mobility in infants and children presents a perplexing and frequently unrewarding surgical dilemma; any improvement in the airway is almost invariably at the expense of the voice. Progress in this area has been hampered not only by the rarity of cases, but also by the technical difficulty of achieving an accurate diagnosis at endoscopy. In order to address this problem we have undertaken a retrospective analysis of 35 infants and children, treated at Great Ormond Street between 1980 and 1991, with endoscopically confirmed impairment of CAJ mobility. Five cases of mild posterior glottic stenosis were successfully treated either conservatively or by laser scar division. Thirty cases of moderate or severe stenosis were identified, and 19 of these have undergone corrective surgery. Of these 19, 17 had a prior tracheostomy, and 12 have been decannulated. No problems with aspiration were encountered but five (i.e. 25%) of those treated surgically suffered a deterioration of voice quality.

Child, Preschool↗

Parapharyngeal space tumour presenting as recurrent uvular oedema.

Neoplasms of the parapharyngeal space are uncommon and usually present as an intra-oral or neck mass. They often elude early diagnosis due to their deep-seated nature. Here we report a case presenting with recurrent oedema of the uvula. The pathophysiology of this previously unreported mode of presentation is discussed.

Adult↗

Melanotic neuroectodermal tumour of infancy.

The melanotic neuroectodermal tumour of infancy is a rare, pigmented neoplasm that most frequently arises from the anterior maxillary alveolar ridge. It presents in the first few months of life, and usually follows a benign course. A classical case is presented and the clinical, radiological and pathological characteristics are discussed. The importance of early conservative surgical excision is emphasized with, in general, a good prognosis. This tumour, which many otolaryngologists may not be familiar with, should be included in the differential diagnosis of head and neck neoplasms in infants and young children.

Humans↗

ENT manifestations of Fraser syndrome.

Fraser Syndrome is a rare autosomal recessive disorder (Gupta and Saxena, 1962; Smith, 1982). The most consistent feature is cryptophthalmos (hidden eye), but frequently abnormalities of the ears (meatal stenosis, dysplastic pinna), nose (hypoplastic notched nares, choanal stenosis or atresia), and larynx (glottic web, subglottic stenosis), as well as numerous other anomalies are encountered. We present four cases that have been treated at the Hospital for Sick Children in the last ten years, and describe the various ENT anomalies characteristic of this syndrome.

Abnormalities, Multiple↗

Pulmonary tuberculosis presenting as suspected foreign body aspiration.

Tuberculosis is a disease of protean manifestations, and despite a falling incidence is still prevalent in our society. We present a case of a child whose history and preoperative chest radiograph suggested the presence of a foreign body, but subsequent examination of the material removed at endoscopy revealed a diagnosis of tuberculosis. We suggest that all friable material removed from the lower respiratory tract be submitted for microscopy, culture and histopathology with this diagnosis in mind.

Bronchoscopy↗

Photometrics: a new method of measuring the cross-sectional area of the subglottis.

A new endoscopic method of measuring the cross-sectional area of a subglottic stenosis is presented. The method was tested against existing techniques using a model. By standardizing the distance from the objective of the endoscope to the stenotic area we were able to measure the cross-sectional area using a graduated grid held against the video screen. This technique was then compared with the standard one of estimating the diameter of a stenosis from the external diameter of the bronchoscope which can be passed through the stenosis. The methods were found to be equally accurate in measuring the lumen diameter. However, when measuring the minimum cross-sectional area, three of five observers were significantly better (P less than 0.01) using the photometric method rather than the standard method (Wilcoxon's rank sum test for paired data). The photometric technique of measuring the cross-sectional area of the subglottis is easily performed, non-traumatic, and allows a visual record to be kept.

Bronchoscopes↗

Tuberous sclerosis with primary meningioma of the maxillary antrum.

Primary extracranial meningiomas are uncommon; they have been documented in the ear, skin, orbit, parapharyngeal space, parotid gland, mediastinum, and rarely the paranasal sinuses. Tuberous sclerosis is an autosomal dominant neurocutaneous syndrome characterized by multiple connective tissue tumours. We report the first case of a tuberous sclerosis patient with a maxillary antral meningioma.

Adolescent↗

CT and MR imaging in lateral sinus thrombosis.

Establishing a pre-operative diagnosis of lateral sinus thrombosis can be difficult, as the clinical features are non-specific and laboratory tests unhelpful. CT may demonstrate abnormal high density of the lumen of the sinus, which does not enhance after intravenous contrast medium. Enhancement of the dura surrounding the sinus may be prominent, causing the 'empty triangle' or 'delta sign' which may suggest the diagnosis. Magnetic resonance (MR) imaging may show both lack of flow and abnormal signal from the sinus, thus providing definitive evidence of thrombosis.

Adolescent↗

A guide to the selection of paediatric tracheostomy tubes.

A large range of tracheostomy tube types and sizes are available for use in children. Regional preference, rather than individual patient assessment, tends to determine selection. We present a table designed to assist with appropriate size selection, and discuss the relative merits and shortcomings of the tubes currently available.

Adolescent↗

Role of tympanic neurectomy in otalgia.

Tympanic neurectomy was first described 44 years ago. Although its indications have subsequently increased, it has not become a popular procedure. This paper concentrates on its use in treating otalgia. The history of tympanic neurectomy, the anatomy of the tympanic plexus and the aetiology of otalgia with specific reference to the tympanic plexus are discussed and a case of bilateral otalgia due to glossopharyngeal neuralgia successfully treated by staged, bilateral tympanic neurectomy reported. It is suggested tympanotomy performed under local anaesthesia with selective stimulation of the intra-tympanic nerves may lead to accurate diagnosis and treatment of the various forms of neuralgic otalgia.

Adolescent↗