Incidence of vestibular schwannoma and incidental findings on the magnetic resonance imaging and computed tomography scans of patients from a direct referral audiology clinic.

OBJECTIVE: To identify the incidence of vestibular schwannoma amongst patients referred from a direct referral audiology clinic, and also the number of incidental findings, as seen on magnetic resonance imaging or computed tomography scans. METHOD: Prospective data collection for patients referred from a direct referral audiology clinic due to audiological evidence of asymmetrical hearing loss. The audiograms, magnetic resonance imaging and computed tomography scans of patients with diagnosed vestibular schwannoma were subsequently reviewed. RESULTS: A total of 4100 patients were seen during the study period, with 396 scans performed. Six (1.5 per cent) patients had vestibular schwannoma, while 12 (3 per cent) had significant incidental findings. CONCLUSION: Patients referred from the direct referral audiology clinic had a low incidence of vestibular schwannoma detection. Their detection rate for significant incidental findings was similar to previous reports. If the current protocol had not been in place, over 300 patients would have been needlessly added to the ENT clinic list. Thus, general practitioner referral to direct referral audiology clinics provides a cost-effective way of managing asymmetrical sensorineural hearing loss in older patients. The number of such clinics could be expanded.

An oncogenic role of eIF3e/INT6 in human breast cancer.

Altered expression of the eukaryotic translation initiation factor 3 (eIF3) subunit eIF3e/INT6 has been described in various types of human cancer, but the nature of its involvement in tumorigenesis is not yet clear. Using immunohistochemical analysis of 81 primary breast cancers, we found that high tumor grade correlated significantly with elevated cytoplasmic eIF3e level in epithelial tumor cells. Analysis of protein synthesis after siRNA-mediated knockdown in breast cancer cell lines indicated that eIF3e is not required for bulk translation. Microarray analysis of total and polysomal RNAs nonetheless identified distinct sets of mRNAs regulated either positively or negatively by eIF3e; functional classification of these revealed a marked enrichment of genes involved in cell proliferation, invasion and apoptosis. Validated mRNA targets regulated positively at the translational level by eIF3e included urokinase-type plasminogen activator and apoptotic regulator BCL-XL, whereas synthesis of proteins including the mitotic checkpoint component MAD2L1 was negatively regulated. Finally, eIF3e-depleted breast carcinoma cells showed reduced in vitro invasion and proliferation. Taken together, our study data suggest that eIF3e has a positive role in breast cancer progression. It regulates the translation, and in some cases abundance, of mRNAs involved in key aspects of cancer cell biology.

Unusual location for Castleman's disease.

OBJECTIVE: We present the first reported case of persistent, posterior triangle lymphadenopathy in a child, caused by Castleman's disease. CASE REPORT: A seven-year-old boy presented with a painless swelling in the posterior triangle of his left neck, with no compression of the surrounding structures. A histological diagnosis of Castleman's disease was made. Eventual treatment was by complete excision. At six-month follow up, there were no signs of recurrence. CONCLUSION: The causes of persistent cervical lymphadenopathy in children are many. Most are not significant, but some are life-threatening. Castleman's disease should be considered as a possible diagnosis in persistent childhood lymphadenopathy.

Stridor: an unusual presentation of lateral medullary syndrome.

We report an unusual case of lateral medullary syndrome which presented with symptoms of acute upper airway obstruction mimicking angioneurotic oedema. Although dysphonia and dysphagia are common symptoms of lateral medullary syndrome, we have found no other reports of this condition presenting as stridor. This case highlights the importance of maintaining a high index of suspicion for central causes of common otolaryngological symptoms in the absence of local signs.

High-pressure water jet injury to the pharynx, requiring intubation.

We report a case of upper airway obstruction following high-pressure water jet injury to the pharynx incurred from a car wash jet. Injuries from high-pressure water jets are relatively rare and, to the best of our knowledge, airway obstruction as a result has not been reported. Since this unusual injury may be associated with life-threatening complications, it must be promptly recognized and treated.

Perforation of cervical oesophagus.

Spontaneous perforation of the oesophagus is an uncommon condition that almost invariably affects the thoracic oesophagus. We present an unusual case of perforation of the cervical oesophagus, in which an unsuspected ingested foreign body was ultimately found to be responsible.

Otoplasty: a review of the surgical techniques.

Otoplasty surgery carries a high satisfaction rate for participants (96%). Surgeons are more critical of the results of otoplasty than the participants or parents (92% satisfied). There is no statistical difference in qualitative results with different surgical techniques when comparing the published data. Data on otoplasty surgery is numerous, but quantitative assessment of surgical outcome is rare. The authors propose the measurement of cephaloauricular distance to allow comparison between studies.

Effect of nitric oxide donation on mucin production in vitro.

Otitis media with effusion (OME) is characterized by the accumulation of a viscous fluid rich in mucins in the middle ear cleft. There is increasing evidence that this fluid is the result of an inflammatory reaction and that nitric oxide (NO) is an important mediator in this reaction. The goblet cell line HT29-MTX produces principally MUC5AC, an important mucin in middle ear effusions, and thus is a good model for the study of mucus-secreting epithelia. Confluent cell cultures were trypsinized, subcultured and incubated with isosorbide dinitrate (ISDN), a NO donor, for 0.5, 1 and 2 h at a concentration of 1 mm and in concentrations of 0.01, 0.1, 0.5, 1 and 2 mm for 1 h. Experiments were performed four times. Mucin production was detected by a slot blot ELISA assay, using a monoclonal mouse antibody to human MUC5AC mucin. Statistical significance was tested using a one-way analysis of variance. NO donation by ISDN caused a consistent rise in mucin production above control. Maximal mucin production of 35% above control occurred at 1 h with 1 mm ISDN. Mucin production increased from 12% above control with 0.1 mm ISDN dinitrate to 45% above baseline with 2 mm ISDN. NO donation by ISDN results in an increase in mucus production, which is both dose and time related. This adds further evidence to an inflammatory model for mucus secretion in OME.

Is there agreement among general practitioners, paediatricians and otolaryngologists about the management of children with recurrent tonsillitis?

Tonsillectomy is the second most common operation undertaken in children in the United Kingdom, but the rate at which tonsillectomy is performed varies greatly across the Health Authorities. The reasons for the variation appear to be related to differences in local medical practice rather than differences in regional morbidity. This study was undertaken to compare the factors used to diagnose tonsillitis in children, the indications for tonsillectomy and the expected benefits of tonsillectomy in children by general practitioners, paediatricians and otolaryngologists. There was poor correlation between general practitioners, paediatricians and otolaryngologists in all study objectives. There appears to be no consistent clinical pathway by which children with recurrent tonsillitis are managed. The wide variation in tonsillectomy rates across the United Kingdom will probably continue until the decision-making process of doctors involved in the treatment of children with recurrent tonsillitis is better understood.

A comparison of sleep quality in normal children and children awaiting (adeno)tonsillectomy for recurrent tonsillitis.

Poor quality sleep and sleep-related hypoxia have been described in children awaiting (adeno)tonsillectomy even in the absence of a history which would suggest such problems. However, restless sleep has also been commonly reported in children from a normal population. It has not been shown whether an increasing frequency of tonsillitis is associated with deterioration in sleep quality. This study directly compares sleep quality in three groups of children: (1) a normal population; (2) children from a normal population who have tonsillitis but are not awaiting tonsillectomy; and (3) children awaiting tonsillectomy for recurrent tonsillitis. A questionnaire was completed by the parents and the answers compared using the chi2 and Spearman's rank correlation tests. The results show that children awaiting tonsillectomy have poorer sleep quality than their normal peers. However, there is no dose-response effect between deteriorating sleep quality and increasing frequency of tonsillitis.

How well do parents recognize the difference between tonsillitis and other sore throats?

Little evidence exists from randomized controlled trials to support the role of tonsillectomy in children with recurrent tonsillitis. Despite this, parents report a great change for the better in their children following the operation. Previous trials vary in their inclusion criteria, both in terms of the definition of tonsillitis and in the frequency of sore throats required before entry into the study is permitted. The aims of this study are to define tonsillitis from the perspective of parents whose children are awaiting tonsillectomy for recurrent sore throats, and to determine whether such parents have a better understanding of the difference between tonsillitis and other sore throats than parents of children from a normal population control group. These aims demonstrate whether parents who request tonsillectomy for their children do so on the basis of a recognized clinical problem. We report that parents can clearly identify a sore throat illness that they call tonsillitis and which is differentiated from other sore throats by different symptom complexes. The parental history is important in the assessment of a child prior to tonsillectomy. The views of parents whose children have recurrent tonsillitis must be further investigated if the difference between randomised controlled trial results and parents' opinions regarding the benefit of tonsillectomy is to be understood.

Is the incidence of tonsillectomy influenced by the family medical or social history?

Previous reports have suggested that the incidence of tonsillectomy, and/or tonsillitis in children, is influenced by factors such as parental smoking, maternal health and previous parental tonsillectomy. The reports have considered single factors and have not considered the possible confounding effect of the factors upon one another. Previous studies have not investigated the influence of social class. This paper uses the background of a large case-control trial of children awaiting tonsillectomy for recurrent tonsillitis, and a normal control group to study the influence of parental smoking, parental surgical history, parental tonsillectomy, family atopy and social class upon the reported incidence of sore throats and tonsillitis. A multivariate analysis is used. The paper shows that parental smoking, previous parental surgery and social class have no effect upon the number of sore throat episodes. A history of parental tonsillectomy and a family history of atopy are both significant predictive factors for the number of reported sore throats and episodes of tonsillitis in children.

Day-case adenoidectomy, parental opinions and concerns.

Day-case surgery has been urged on the National Health Service by the Audit Commission in the last decade despite concerns about safety. A questionnaire was posted to the parents of 109 children who had recently undergone day-case adenoidectomy, addressing parental concerns and opinions. Eighty per cent of the questionnaires were returned. A high level of satisfaction with day-case adenoidectomy was expressed by the parents. All the children were observed for six hours after surgery prior to discharge. One child was visited at home by his general practitioner in the first 24 hours of discharge but there were no serious post-operative complications and none of the children required re-admission to hospital. Day-case adenoidectomy is safe, very acceptable to parents and does not result in a greatly increased workload for general practitioners.

Uvulopalatopharyngoplasty for snoring: the Belfast experience.

We have studied thirteen patients to assess the efficacy of uvulopalatopharyngoplasty on snoring and on oxygen desaturation during sleep. Pre- and post-operative overnight pulse oximetry studies were performed and the patients were divided into snorers and those with obstructive sleep apnoea on the basis of the preoperative test. Uvulopalatopharyngoplasty did not result in a significant change in the number of oxygen saturation dips in either snorers or those with the obstructive sleep apnoea syndrome. Subjectively, 85% (11/13) of patients reported good or excellent improvement in snoring following surgery.

An unusual presentation of oat cell carcinoma.

A case is reported of oat cell carcinoma of the lung presenting with unusual sites of metastasis to the orofacial region. Distant metastases are common in oat cell carcinoma but a literature review did not reveal any reports of metastases either to the hard palate or to medial canthus of the eye.

Geographic variation in infant loss of maternal measles antibody and in prevalence of rubella antibody.

Maternal and cord measles and rubella antibodies were compared in 15 populations from Brazil, Ecuador, Chile, India, Jordan, Nigeria, South Africa, Taiwan, and the United States. Review of the literature concerning these countries showed that a higher proportion of children 6-12 months of age responded immunologically to measles vaccine in areas with low per capita product than in wealthier populations. The authors show that this difference reflects differences in maternal antibody titer and differences in efficiency of transport of measles immunity across the placenta. No variation in the half-life of passive measles immunity in the infant was found in comparing three geographic areas. When these biologic factors are fully evaluated, it should be possible to predict the response to be expected from vaccination at any particular age without directly testing the vaccine in children below and above generally recommended ages for vaccination. With regard to rubella, high antibody prevalence rates were found in most of the developing countries, as well as in the United States, and these countries are therefore unlikely to encounter widespread problems with congenital rubella. However, Taiwan, and all of four areas of Brazil have prevalence rates which are no higher than those which pertained in the United States prior to establishment of the rubella immunization program. The authors believe that protection of the infants in these countries is a matter of high priority, but that, if approached hastily, it could exacerbate the problem.

Hepatitis B epidemiology and its relation to immunogenetic traits in South American Indians.

Serologic tests for hepatitis B prevalence and immunogenetic characterizations were carried out on a sample of 800 persons from several isolated tribes of the lower Amazon basin and the southern Andes. The prevalence of hepatitis B antigen carriers and of antibody to the surface antigen varied from one tribe to another, but were high in all the forest tribes. The serologic evidence indicated high infection rates early in life, but also an increasing proportion showing evidence of infection with increasing age. The frequency of past infections was not differentially associated with the antigen status of the mother or father. A higher proportion of infected males than females had antigenemia. Contrary to published reports, no association of antigenemia was found with any HLA-A, B or C antigen or immunoglobulin allotype, individually or interactively. Antibody prevalence, however, did differ in persons with different HLA haplotypes.