ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00589.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00590.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A randomized trial involving 40 consecutive patients with an acute painful peritonsillar swelling was set up to determine if an enhanced computerized neck tomogram was cost‐effective or improved patient management. Each patient was placed into one of two groups. The first group had enhanced computerized tomography (CT) which allowed precise identification of a quinsy and this was aspirated with an 18G needle aspiration at the site directed by the scan. The second group of patients had 3‐point permucosal 18G needle aspirations.A proportion of patients from each group, but primarily from the second, required immediate or delayed admission to hospital after aspiration, for persistent or recurrent symptoms. Costing each groups treatment, including the scan and hospitalization on intravenous antibiotics, we conclude that CT scanning prevents the morbidity associated with unsuccessful attempts at drainage in the patient with cellulitis and ensures complete drainage of pus, thereby optimizing patient treatment and it is cost‐effe

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00591.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The elevation of a forearm flap based on the ulnar artery has been described as an alternative to a flap based on the radial artery. Despite the fact that 15‐30% of operated patients complain of symptoms in the hand due to impaired circulation, this flap is still regulaly raised upon the radial artery. Using Doppler ultrasonographic examination before elevating the forearm flap, the dominant artery to the hand can be determined. The preliminary experience in 11 patients operated upon (the flap has been based upon the ulnar artery five times) is satisfactory. None complained of weakness of the hand, a feeling of coldness or cold intoleranc

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00592.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Vocal rehabilitation in laryngectomized patients can be attained by surgical (tracheoesophageal speech) or conservative methods (oesophageal speech or artificial larynx). We prospectively studied voice restoration in 37 patients who underwent total laryngectomy in the period from February 1991 to February 1993. The patients were given the opportunity to assess both non‐shunt oesophageal speech and shunt oesophageal speech using the Provox voice prosthesis. The Provox low resistance, self‐retaining voice prosthesis is a biflanged device made of silicon rubber. A primary tracheoesophageal puncture was made in 28 patients, while a secondary puncture was performed in another nine patients. The results were assessed according to criteria established at the ‘Third International Congress on Voice Prosthesis’ in Groningen (1988). Functional tracheoesophageal speech after primary puncture was achieved in 95% of patients 12 months after puncture, while oesophageal voice was acquired by 55%. Only minor surgical and prosthesis‐related complications were encountered during this follow‐up period in 29% of the patients. The device lifetime varied from 3 months to at least 2 years (mean

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00593.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This article reviews 12 patients with bilateral acoustic neuromas. The sex incidence was equal and the mean age at diagnosis was 26.2 years. The family history was positive in nine of the patients. Five patients have had incomplete surgical removal of acoustic neuromas on both sides. Two of them are completely deaf and the other three have severe sensorineural hearing loss in one ear and no hearing in the other ear. In five patients the tumour on one side has been operated on and the other side is being observed with at least short‐term preservation of good hearing. The remaining two patients died of intra‐cranial complications, one of them post‐operatively. Four patients developed facial palsy immediately following surgery and one developed facial weakness 6 months after surgery. Guidelines are discussed for the care of these patients including the timing of surgery and alternative treatment options (observation, radio‐surgery adn chemotherapy). This is essentially a group of young individuals who have had multiple operations for bilateral acoustic tumours and associated manifestations and for whom the disease and the sequelae of treatment can be

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00594.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The effect of consultant supervision on management of patients by junior staff was assessed. Supervision was exercised by pre‐reading the notes with the consultant at the start of the clinic. The principle finding was that less patients were brought back for another appointment. For new patients, the proportion fell from 40% to 19%, and for follow‐up patients it fell from 49.5% to 29%. The overall rate fell from 46% to 23.5%. This has major implications with respect to use of resources and, in the unit studied, this change would make available 38 extra clinic appointments for each registrar per month. The study also raises issues regarding the use of out‐patient clinics for post‐graduate training and consultant supervision of patient management in

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00595.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A finite element programme developed previously to calculate the natural frequencies of vibration of the human tympanic membrane, has been modified to take into account both natural and geometric rigidities. The natural rigidities take the form of internal membrane stress/strain parameters, while the geometric rigidities are the flexural and membrane stress resultants.The first six natural frequencies calculated are similar to those measured by Laser holography on cadaver membranes and analysed recently by interference techniques. Using a generalized stress/strain constitutional relationship, the natural frequencies were found to be linearly related to the square root of the forces within the membrane. It was proposed in our earlier work,1that these internal stresses as well as maintaining the complex shape of the tympanic membrane, serve to enhance its frequency range and response.The role of the radial and circular fibres embedded within the ground substance of the membrane on the frequencies and mode shapes have also been examined by super‐imposing beam elements on the semi‐loof membrane elements. It was found that the modes of vibration of the membrane are restricted to a fairly simple pattern up to beam moduli values of approximately 50 MPa. Above this beam modulus, the normal mode shape was observed with a gradually increasing complex vibration pattern as the frequency increases.This new treatment of membrance re‐inforcement suggests a non‐Hookean behaviour of the drum displacements. In order to account for the earlier measured frequencies of Tonndorf&Khanna,2the previously proposed internal stress/strain parameters1are believed to be less important and have been calculated to be small compared with the membrane

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00596.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Previous reports of the blood supply to the lenticular and long processes of the incus have failed to consider the potential contribution of the periosteal vascular plexus. This scanning electron microscopic study of vascular foramina on the cortical bone surface demonstrates that there is no statistical difference between the numbers of vascular foramina on the lenticular and long processes, as opposed to the body and short process. These results suggest that the blood supply to this portion of the ossicular chain may not be as tenuous as has been thought.

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00597.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Velopharyngeal function, voice and speech changes following uvulopalatopharyngoplasty (UPPP) were studied prospectively and compared with those in an age and sex matched group undergoing tonsillectomy. The fundamental frequency of voice was significantly lower in those undergoing UPPPP. All the other changes studied were not significantly different in the two groups.

ISSN:0307-7772    

DOI:10.1111/j.1365-2273.1993.tb00598.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY