ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01269.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01270.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Day case tonsillectomy, in general, is not considered a routine procedure. Many otolaryngologists would not perform this operation on an out‐patient basis due to the risk of reactionary haemorrhage after discharge from hospital. A prospective trial of carefully selected adult patients undergoing day case tonsillectomy was performed. Each was given a questionnaire to assess post‐operative morbidity including pain, time required to return to normal diet and comments on the ambulatory aspect of their surgery. The results of 48 patients are analysed. None of these had haemorrhage within 24 h of their operation. Twenty patients (42%) were happy to have the procedure performed in this way whilst 19 (39%) found it tolerable. Two patients had to be admitted overnight as they had not recovered enough to be discharged. It is concluded that adult day case tonsillectomy in selected patients is a safe and viable opt

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01271.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

To identify how the spectrum of head and neck complications of HIV disease has altered over the 7‐year period between 1984 and 1991, a prospective collection of data on 429 HIV‐positive subjects referred since 1984 was undertaken. Information was grouped into three study periods by date of presentation for analysis of trends. There has been a trend towards increased heterosexual acquisition (P<0.02) and a decrease over time in the proportion of patients presenting with AIDS, as a proportion of HIV‐positive patients (20/31 1983‐1984; 90/179 1989‐1991:P<0.001). While the occurrence of mucosal candidiasis (P<0.0001) and Kaposi's sarcoma (P<0.05) has decreased that of rhinosinusitis (P<0.0001) and non‐Hodgkin's lymphoma (P<0.05) has increased. Cervical lymphadenopathy has shown a significant decline (P<0.05), but other conditions have been relatively constant. Otolaryngologists should be aware of current emphasis in the head and neck manifestations of HIV infection, which have important implications for diagnosis and

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01272.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This study assesses the outcome in 78 patients who had been diagnosed with acoustic neuroma over a period of 13 years. Forty‐six patients were treated with translabyrinthine surgery, 13 with suboccipital surgery and/or ventricular drainage, and 19 patients (20 neuromas) were kept under observation. Of the 59 patients who had surgery, four died, 30 had problems with eating, drinking and balance, 17 had severe facial palsy, 21 discontinued their work after the operation and 30 had psychological problems. Twenty neuromas have not been operated upon and the patients have not deteriorated medically or socially. It is concluded that acoustic neuroma is a serious disease and that a conservative policy (wait and scan) is preferable in elderly patient

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01273.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The treatment of early piriform fossa cancer can be either primary radiotherapy with salvage surgery, if necessary, or with primary surgery. The present study investigates 65 patients with T1, ≥2or T3stage disease with no cervical lymph node metastases at presentation. Of this group, 17 were treated by primary irradiation, 34 underwent primary surgery and 14 were unsuitable for any curative treatment. The adjusted actuarial 5‐year survival rate for those patients receiving primary radiotherapy was 55% (95% CI 16–78%) and for the surgery group it was 44% (95% CI 18–67%). This difference was not significant (χ21= 1.29). The median survival for untreated patients was 7 months (4–12 months). There was no significant differences in the time to recurrence at the primary site or in the neck, or in survival after recurrence at these sites. Thirty‐five per cent of patients treated by primary irradiation were controlled at the primary site compared with 68% in the surgical group. Failure in the neck was similar for the two groups at 12% and 15% respectively. Salvage surgery was effective for the radiotherapy group with eight out of 11 patients being suitable for treatment. In the final analysis in the radiotherapy group two patients were alive and with their larynx and two alive without their larynx, the remainder of patients having died from the original tumour, intercurrent disease or second primary tumours. The survival figures for the surgery group were proportionately similar except of course, that all patients had lost their larynx. Radiotherapy with salvage surgery for recurrence is a safe oncological treatment option. A high failure rate at the primary site is disappointing but if placed in perspective still allows half the survivors to retain

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01274.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The results and complications of translabyrinthine and transotic surgery for petrous apex lesions between 1980 and 1992 are presented. An acoustic neuroma was found in 52 patients. In 1988, the translabyrinthine approach was modified into the transotic approach and replaced the former technique. There was no mortality in this series, but two patients had mild brainstem infarcts and there was post‐operative bleeding into the cerebellopontine angle in one. Cerebrospinal fluid (CSF) leakage was seen in six patients and meningitis in two. Three suffered deep vein thrombosis in their legs. There was one case each of herniation of the cerebellum and gastric bleeding. Post‐operative facial nerve function was good in 88%, moderate in 10% and poor in 2%. In the case of acoustic neuromas the aim was total tumour removal, but if there was a serious risk of damaging the nerve anatomically, near total or subtotal removal was performed. During the study period, there was a gradual decrease in facial nerve morbidity and surgical complications. This was attributed to increasing experience, the modified wider approach and better post‐operative

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01275.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T3carcinoma, 15 patients T4and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post‐operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post‐operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2‐year recurrence free period and survival were 42% and 51% respectively. The postoperative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post‐operative radiotherapy (0%). Thus, post‐operative radiotherapy seems indicated irrespective of resectio

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01276.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The Youlten Peak Nasal Flow Meter is a convenient device for obtaining objective measurements of nasal patency and gives static values which correlate well—though inversely—with resistance measured by rhinomanometry. In this study peak nasal flow and nasal resistance are compared before and after intranasal challenge using histamine. The comparatively small change in nasal resistance induced by low‐dose histamine is not reliably detected by the peak flow meter. Large changes in nasal resistance with a higher dose of histamine are reflected by significant but small changes in peak nasal inspiratory flow. It is concluded that changes in nasal patency as measured by the Youlten meter are an insensitive measure of nasal patency compared with rhinomanometrically measured resistance changes. Continued use of the latter is recommended for physiological res

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01277.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Fifty consecutive patients discharged from clinic were assessed by questionnaire at the time of discharge and 6 months later. Each patient's practitioner (GP) was sent a questionnaire at 6 months. On discharge, 12.5% of patients would have preferred another appointment and 7.5% were unhappy at being discharged. After 6 months 14% would have preferred ENT follow‐up. Twenty‐six per cent of patients said they saw their GP within 6 months of discharge with symptoms related to their initial ENT complaint. From the GP questionnaire the proportion was 31.5%. General practioners were happy to manage the patients themselves and only one patient was seen again in the ENT department within 6 months. In no case did the GP feel discharge to be premature. Pre‐reading of notes leading to an increase in the proportion of patients discharged from ENT clinics does not result in more discharges being premature or inappropriate. The majority of patients and general practitioners are happy for ongoing medical care to be continued without further ENT appointments if the nature of the condition and its long‐term management is explained

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1994.tb01278.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY