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1.
Article in English | MEDLINE | ID: mdl-11713428

ABSTRACT

We report the case of a 72-year-old female suffering from mild myelodysplasia who initially presented with a peri-orbital cellulitis secondary to rhinosinusitis. The pre-septal infection failed to completely resolve despite intensive antibiotic therapy and endoscopic drainage of the sinuses. Computerised tomography revealed a complicating suppuration of the lacrimal gland. Incision and drainage of the lacrimal gland abscess led to a complete resolution of the pre-septal cellulitis. Suppuration of the lacrimal gland is, as far as we are aware, a previously unreported complication of rhinosinusitis. Its presence could be borne in mind when evaluating computerised tomography scans of patients presenting with orbital complications of sinusitis, particularly in the immunocompromised.


Subject(s)
Abscess/etiology , Abscess/surgery , Lacrimal Apparatus/surgery , Rhinitis/complications , Sinusitis/complications , Abscess/diagnostic imaging , Aged , Drainage , Female , Humans , Lacrimal Apparatus/diagnostic imaging , Rhinitis/diagnostic imaging , Sinusitis/diagnostic imaging , Tomography, X-Ray Computed
2.
Head Neck ; 22(7): 722-7, 2000 Oct.
Article in English | MEDLINE | ID: mdl-11002329

ABSTRACT

BACKGROUND: Renal cell carcinoma represents 3% of all malignant tumors. Metastatic deposits of renal cell carcinoma to the head and neck region are infrequent. The objective of this work is to analyze the clinical presentation, radiologic features, surgical and radiotherapy treatment, and outcome of metastatic renal cell carcinoma to the nose and sinuses. METHODS: Retrospective review of 6 patients diagnosed with renal cell carcinoma who had nasal metastasis develop and were seen at the Christie Hospital in Manchester over the past 8 years. RESULTS: Six patients with renal cell carcinoma were seen with recurrent epistaxis, nasal obstruction, and unpleasant nasal crusting. Three patients had orbital involvement. Examination under general anaesthesia and biopsy was performed in all 6 cases. Histologic studies confirmed metastases of renal cell carcinoma in all 6 patients. All patients underwent local external beam radiotherapy. The most common dose used was 35 Gy in 8 daily fractions. All patients had symptomatic control of local nasal disease with a minimum follow-up of 2 years in 4 patients. Two patients died within 6 months of the radiotherapy treatment as a result of their primary tumor. CONCLUSIONS: Metastatic renal cell carcinoma to the nose and paranasal sinuses is rare but has unpleasant symptoms. Local symptomatic control with radiotherapy is excellent.


Subject(s)
Carcinoma, Renal Cell/radiotherapy , Carcinoma, Renal Cell/secondary , Kidney Neoplasms/pathology , Nose Neoplasms/radiotherapy , Nose Neoplasms/secondary , Paranasal Sinus Neoplasms/radiotherapy , Paranasal Sinus Neoplasms/secondary , Aged , Biopsy , Carcinoma, Renal Cell/pathology , Female , Humans , Male , Middle Aged , Nose Neoplasms/pathology , Paranasal Sinus Neoplasms/pathology , Prognosis , Retrospective Studies , Tomography, X-Ray Computed
3.
Ann Otol Rhinol Laryngol ; 109(6): 590-3, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10855572

ABSTRACT

Squamous cell carcinoma of the hypopharynx and cervical esophagus usually presents in the late-middle-aged and elderly. When diagnosed in young adults, the disease process is often thought to be more aggressive and have a worse long-term outcome. Four hundred ninety patients presented to the Christie Hospital and Manchester Royal Infirmary between 1981 and 1990 with squamous cell carcinoma of the hypopharynx and cervical esophagus. Of this group, 24 patients (5%) received their diagnosis before the age of 45. A comparison is made with a control group of 156 (32%) patients who presented between the ages of 60 and 69 years. Analysis of tumor and nodal staging at presentation demonstrates no statistically significant difference between the 2 age groups. There is a higher incidence of a combination of smoking and alcohol abuse in the older age group, but it is of no statistical significance. There is no difference in 5-year survival results between the 2 groups. We conclude that patients with squamous cell carcinoma of the hypopharynx and cervical esophagus who receive their diagnosis under the age of 45 show no difference in tumor stage or long-term outcome when compared with a control group encompassing the mean age of presentation.


Subject(s)
Carcinoma, Squamous Cell/diagnosis , Esophageal Neoplasms/diagnosis , Hypopharyngeal Neoplasms/diagnosis , Adult , Age Factors , Aged , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Female , Humans , Hypopharyngeal Neoplasms/mortality , Hypopharyngeal Neoplasms/pathology , Hypopharyngeal Neoplasms/therapy , Male , Middle Aged , Neoplasm Staging , Prognosis , Risk Factors , Survival Rate
4.
J Laryngol Otol ; 113(6): 548-54, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10605586

ABSTRACT

Positron emission tomography (PET) scanning has recently been introduced into clinical practice but its usefulness in the management of head and neck cancer is not well defined. The aim of this prospective preliminary study was to examine the clinical value of fluorodeoxyglucose (FDG)--PET in patients with head and neck cancer treated by radiotherapy with surgery in reserve by (i) relating quantitative uptake of isotope to tumour type and histological grade and (ii) comparing the imaging findings of PET and magnetic resonance imaging (MRI) in post-radiotherapy assessment of tumour response. Twenty-one patients had pre-treatment PET and MRI scans and these were repeated four and eight months after treatment if there was no clinical relapse. Pre-treatment uptake of FDG using tumour to cerebellar ratio parameters was significantly related to the histological grade of squamous cancer (p = 0.04) but not to tumour type. Discordance of post-treatment PET/MRI findings in one case indicates a possible role for PET in the early detection of tumour recurrence. Other potential uses of PET scanning in the management of head and neck cancer are discussed.


Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Fluorodeoxyglucose F18 , Head and Neck Neoplasms/diagnostic imaging , Radiopharmaceuticals , Tomography, Emission-Computed , Adult , Aged , Carcinoma, Squamous Cell/radiotherapy , Female , Head and Neck Neoplasms/radiotherapy , Humans , Laryngeal Neoplasms/diagnostic imaging , Laryngeal Neoplasms/radiotherapy , Magnetic Resonance Imaging , Male , Middle Aged , Nose Neoplasms/diagnostic imaging , Nose Neoplasms/radiotherapy , Pilot Projects , Predictive Value of Tests , Prospective Studies , Tonsillar Neoplasms/diagnostic imaging , Tonsillar Neoplasms/radiotherapy
5.
Rhinology ; 37(3): 131-2, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10567993

ABSTRACT

Epistaxis is a common and difficult problem to manage in patients with bleeding disorders. We present a case of recurrent epistaxis in a patient with Bernard-Soulier syndrome (a platelet disorder) and describe a non-invasive but effective method of closing the nasal vestibule using a silastic obturator thus preventing the drying effects of airflow on the nasal mucosa which may precipitate epistaxis in patients with a bleeding diathesis.


Subject(s)
Bernard-Soulier Syndrome/complications , Epistaxis/therapy , Prostheses and Implants , Adult , Epistaxis/etiology , Humans , Male , Nose , Prosthesis Design , Recurrence , Treatment Outcome
6.
Radiother Oncol ; 53(1): 15-21, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10624848

ABSTRACT

BACKGROUND AND PURPOSE: Assuming that the dose-response curve for T3N0M0 glottic carcinoma is steep and that the rate of occult lymph node metastases is low, it should be possible to employ high biological tumour doses to modest target volumes and thereby maximise laryngeal control without compromising final neck control. Within the constraints of a retrospective study we aim to examine this policy with respect to local control, incidence of nodal relapse and late complications. MATERIALS AND METHODS: One hundred and fourteen patients with T3N0M0 glottic carcinoma who received a 3-week schedule of radical radiotherapy between 1986 and 1994 were analysed. The median age was 67 years (range, 34-85 years) and the median follow-up for living patients was 4.8 years (1.9-8.9 years). There were no strict selection criteria for those patients treated with radiotherapy. RESULTS: The 5-year overall survival was 54%. The 5-year local control with radiotherapy and the ultimate loco-regional control following salvage laryngectomy were 68 and 80%, respectively. Nine patients (8%) suffered a regional nodal relapse but only three of these (3% overall) occurred in the absence of local failure. Four patients (3.5%) developed serious late complications requiring surgical intervention (three received 55 Gy and one 52.5 Gy). CONCLUSIONS: It is possible to employ maximum tolerable doses to specific target volumes and thereby exploit the dose response demonstrated and minimise major late effects. The use of modest target volumes resulted in only 3% of patients requiring surgery that might have been avoided had prophylactic neck irradiation been employed.


Subject(s)
Carcinoma/radiotherapy , Laryngeal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Carcinoma/mortality , Carcinoma/pathology , Female , Glottis , Humans , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Lymphatic Metastasis , Male , Middle Aged , Radiotherapy/adverse effects , Radiotherapy Dosage , Retrospective Studies , Survival Rate
7.
J Laryngol Otol ; 113(9): 847-8, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10664692

ABSTRACT

Tracheo-oesophageal puncture for voice restoration is a well-established technique post-laryngectomy. A number of complications can occur with the creation of a tracheo-oesophageal fistula (TOF) and in the subsequent management of the patient with an indwelling voice rehabilitation system. This article is the first to report the use of Hylaform, a colourless viscoelastic gel, to treat an intractable case of leakage around a Provox 2 voice prosthesis. The procedure which required no anaesthesia resulted in no further leak around the valve to the present day, now more than four weeks post-viscoaugmentation.


Subject(s)
Laryngectomy , Larynx, Artificial/adverse effects , Tracheoesophageal Fistula/etiology , Gels , Humans , Male , Middle Aged , Tracheoesophageal Fistula/therapy , Treatment Outcome
8.
J Laryngol Otol ; 112(6): 543-6, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9764293

ABSTRACT

A new technique is described for closing the nasal vestibule in cases of secondarily-acquired atrophic rhinitis. This involves occlusion of the nasal vestibule with an obturator made from dimethylpolysiloxane. Being a non-invasive method it is specifically indicated in the management of cases of secondarily-acquired atrophic rhinitis where any surgical treatment is contra-indicated. We describe its use in a case each of unilateral and bilateral secondary atrophic rhinitis.


Subject(s)
Nasal Cavity , Rhinitis, Atrophic/therapy , Adult , Aged , Chronic Disease , Equipment Design , Humans , Male , Silicone Elastomers
9.
Clin Otolaryngol Allied Sci ; 22(4): 370-4, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9298615

ABSTRACT

One hundred and forty-three patients with post-cricoid squamous cell carcinoma are described. Twenty-nine patients (20%) underwent pharyngolaryngoesophagectomy with gastric transposition. Forty-four patients (31%) were treated with radical radiotherapy and 70 (49%) had palliative therapy. Kaplan Meier 5-year survival following surgery was 45% and radiotherapy was 23%. The presence of nodal disease at presentation was the most significant prognostic factor. The 5-year survival of patients undergoing surgery with no palpable lymph node spread at presentation was 63% which compared with 25% following radiotherapy. This difference was statistically significant (P = 0.0153, Logrank test stratified by nodal status). Patients with palpable metastatic nodal spread at presentation had 5-year survivals of 10% and 0% in the surgical and radiotherapy groups respectively. This study demonstrates that patients with post-cricoid carcinoma who present without palpable lymph node spread have a significant improved 5-year survival following surgery when compared with radiotherapy.


Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Hypopharyngeal Neoplasms/radiotherapy , Hypopharyngeal Neoplasms/surgery , Adult , Aged , Anastomosis, Surgical , Carcinoma, Squamous Cell/mortality , Esophagus/surgery , Humans , Hypopharyngeal Neoplasms/mortality , Larynx/surgery , Lymphatic Metastasis , Middle Aged , Neoplasm Staging , Pharynx/surgery , Postoperative Complications , Prognosis , Retrospective Studies , Survival Rate
10.
Br J Cancer ; 75(6): 921-7, 1997.
Article in English | MEDLINE | ID: mdl-9062417

ABSTRACT

Extramedullary plasmacytomas (EMP) of head and neck are rare tumours. Between 1972 and 1993, 25 cases of EMP of head and neck were seen at our institute. The clinical and pathological features and response to treatment are presented. At initial presentation, 23 (92%) patients presented with disease confined to a single extramedullary site only and two patients had in addition clinical involvement of cervical lymph nodes. All except these two patients received radiotherapy to the primary site only as initial treatment. Initial primary control of local disease was obtained in 16 of 24 (67%) patients treated with radical intent. With salvage treatment of further radiotherapy and/or chemotherapy, local disease control was achieved in 21 of 24 (88%) patients. One patient was treated with palliative intent. Conversion to multiple myeloma was seen in two patients (8%). Pathologically, the tumours were classified into low, intermediate and high grade, which correlated closely with outcome. This classification has been used for the first time in extramedullary plasmacytomas and is based on the multiple myeloma grading criteria devised by Bartl et al (1987). Fifteen of eighteen (83%) low-grade tumours and only one of six (17%) intermediate- and high-grade tumours were locally controlled after primary radiotherapy. This is statistically significant for local control (P= 0.0019) but not for overall survival (P= 0.12). The median survival and 5-year overall survival is 68 months and 58.9% respectively. We recommend consideration of adjuvant chemotherapy in patients with higher grade disease.


Subject(s)
Head and Neck Neoplasms/pathology , Plasmacytoma/pathology , Adult , Aged , Aged, 80 and over , Disease Progression , Female , Head and Neck Neoplasms/radiotherapy , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/radiotherapy , Plasmacytoma/radiotherapy , Treatment Outcome
11.
J Laryngol Otol ; 110(11): 1012-6, 1996 Nov.
Article in English | MEDLINE | ID: mdl-8944873

ABSTRACT

Olfactory neuroblastoma is an uncommon tumour arising in the nasal cavity or paranasal sinuses. We report the management of nine cases treated with external beam radiotherapy subsequent to surgery, either attempted definitive removal or biopsy only. Recent refinements in pathological evaluation of these tumours are discussed. Seven cases were deemed classical olfactory neuroblastoma whilst two were classified as neuroendocrine carcinoma. The clinical features, radiotherapy technique and variable natural history are presented. Seven of eight patients treated radically were controlled locally, with a minimum follow-up of two years. Three patients developed cervical lymph node disease and three patients died of systemic metastatic disease. Suggestions are made as to which patients should have en-bloc resection rather than definitive radiotherapy.


Subject(s)
Esthesioneuroblastoma, Olfactory/radiotherapy , Nasal Cavity , Nose Neoplasms/radiotherapy , Aged , Aged, 80 and over , Combined Modality Therapy , Esthesioneuroblastoma, Olfactory/pathology , Esthesioneuroblastoma, Olfactory/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nose Neoplasms/pathology , Nose Neoplasms/surgery , Treatment Outcome
12.
J R Coll Surg Edinb ; 41(5): 333-5, 1996 Oct.
Article in English | MEDLINE | ID: mdl-8908962

ABSTRACT

Neuroendocrine carcinomas (NEC) of the larynx are rare. The key to diagnosis is therefore an increased awareness of such lesions amongst otolaryngologists and pathologists. A precise histological diagnosis is crucial, as the management is different for each NEC sub-type. Advances in immunohistochemistry have been a great help in this respect. We report a typical case of large cell NEC (atypical carcinoid) and highlight the clinical pointers to the histological diagnosis.


Subject(s)
Carcinoma, Neuroendocrine/pathology , Laryngeal Neoplasms/pathology , Larynx/pathology , Carcinoma, Neuroendocrine/classification , Carcinoma, Neuroendocrine/secondary , Carcinoma, Neuroendocrine/therapy , Combined Modality Therapy , Humans , Laryngeal Neoplasms/therapy , Male , Middle Aged , Skin Neoplasms/secondary
13.
Ann Otol Rhinol Laryngol ; 104(11): 868-70, 1995 Nov.
Article in English | MEDLINE | ID: mdl-8534026

ABSTRACT

External ear canal cholesteatoma is a rare condition in otologic practice. A case in a 43-year-old woman is presented in which despite the extensive nature of the lesion, minimal symptoms and absence of signs delayed diagnosis. The cause of the lesion and its treatment are discussed.


Subject(s)
Cholesteatoma/pathology , Ear, External/pathology , Adult , Audiometry, Pure-Tone , Cholesteatoma/complications , Cholesteatoma/diagnosis , Female , Hearing Disorders/diagnosis , Hearing Disorders/etiology , Hearing Loss, Conductive/etiology , Humans , Keratosis/complications , Mastoid/surgery
14.
J Laryngol Otol ; 108(6): 479-83, 1994 Jun.
Article in English | MEDLINE | ID: mdl-8027645

ABSTRACT

Four cases with a neopharyngeal diverticulum following total laryngectomy are presented. Each patient required surgery for complications directly related to the pouch. The relevance of these diverticulae is discussed with reference to their aetiology, complications and management.


Subject(s)
Diverticulum/diagnostic imaging , Laryngectomy , Pharyngeal Diseases/diagnostic imaging , Postoperative Complications/diagnostic imaging , Diverticulum/surgery , Female , Humans , Laser Therapy , Male , Middle Aged , Pharyngeal Diseases/surgery , Pharynx/surgery , Postoperative Complications/surgery , Radiography
15.
J Laryngol Otol ; 108(3): 226-9, 1994 Mar.
Article in English | MEDLINE | ID: mdl-8169504

ABSTRACT

A series of 59 patients of all ages with recurrent respiratory papillomatosis (RRP) treated over an 18-year period is presented. A number of these patients were initially diagnosed in childhood but required treatment throughout adult life. The frequency of laser treatment was not related to either disease duration or age at onset. In 28 patients, the HPV type was identified, showing that HPV type 11 was more common in children and ran a more protracted clinical course. The requirement for tracheostomy in this series was small, whereas the incidence of malignant change in adult patients was significant.


Subject(s)
Laryngeal Neoplasms/surgery , Neoplasm Recurrence, Local/surgery , Papilloma/surgery , Adolescent , Adult , Age Factors , Aged , Child , Child, Preschool , Female , Humans , Infant , Laryngeal Neoplasms/microbiology , Larynx/microbiology , Laser Therapy , Male , Middle Aged , Papilloma/microbiology , Papillomaviridae/classification , Retrospective Studies , Time Factors , Tracheostomy
16.
Clin Otolaryngol Allied Sci ; 19(1): 70-2, 1994 Feb.
Article in English | MEDLINE | ID: mdl-8174306

ABSTRACT

Muscle obliteration of the troublesome mastoid cavity is one method of achieving a permanently dry ear, although long-term results are often disappointing. An operation is described, which is a modification of existing techniques and utilizes a temporalis myofascial flap. This procedure has been used on 46 discharging mastoid cavities and produced encouraging results. It provides a simple, safe and reliable solution to the problem.


Subject(s)
Fascia/transplantation , Mastoid/surgery , Surgical Flaps/methods , Temporal Muscle/transplantation , Adult , Cholesteatoma/surgery , Ear Diseases/surgery , Ear, Middle/surgery , Follow-Up Studies , Granulation Tissue/pathology , Humans , Surgical Flaps/pathology , Surgical Flaps/physiology , Wound Healing
17.
J Laryngol Otol ; 107(11): 1059-60, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8288984

ABSTRACT

Spontaneous perforation of the oesophagus is extremely rare in children, as is perforation due to vomiting in pregnancy. We report the case of a 15-year-old in whom vomiting in early pregnancy resulted in oesophageal perforation with subcutaneous emphysema causing marked facial swelling in the absence of other signs. The more common clinical presentation of spontaneous oesophageal rupture (Boerhaave's syndrome) is discussed.


Subject(s)
Esophageal Perforation/etiology , Hyperemesis Gravidarum/complications , Adolescent , Female , Humans , Pregnancy , Subcutaneous Emphysema/etiology
18.
J Laryngol Otol ; 107(4): 352-3, 1993 Apr.
Article in English | MEDLINE | ID: mdl-8320527

ABSTRACT

Tracheopathia osteoplastica is a benign dysplasia of the tracheobronchial tree which rarely presents clinical problems especially when localized. We present a case which caused an unexpected difficulty in intubation and was subsequently removed endoscopically using the CO2 laser.


Subject(s)
Osteitis Fibrosa Cystica/surgery , Tracheal Diseases/surgery , Bronchoscopy , Humans , Intubation, Intratracheal , Laser Therapy , Male , Middle Aged
19.
J Laryngol Otol ; 107(3): 183-7, 1993 Mar.
Article in English | MEDLINE | ID: mdl-8509690

ABSTRACT

Severe radionecrosis of the temporal bone is a potentially lethal condition which still occurs despite improvements in radiotherapy. A series of seven such cases is presented to outline the varied clinical features and management of this disease.


Subject(s)
Bone Diseases/etiology , Osteoradionecrosis/etiology , Radiotherapy/adverse effects , Temporal Bone/radiation effects , Adult , Aged , Bone Diseases/surgery , Female , Head and Neck Neoplasms/radiotherapy , Humans , Middle Aged , Osteoradionecrosis/surgery , Radiotherapy, High-Energy/adverse effects , Temporal Bone/surgery
20.
Clin Otolaryngol Allied Sci ; 17(2): 113-6, 1992 Apr.
Article in English | MEDLINE | ID: mdl-1375135

ABSTRACT

The treatment of temporal bone carcinoma is a widely discussed topic with marked variation in published results. Most conclude that a combination of radical surgery and radiotherapy is the optimum treatment. The present study reviews the results of radiotherapy used as the main primary treatment for this condition. Five-year survival in 56 patients was 32% for radical and palliative therapy, with an excellent response in 'early' cases. It is concluded that improvement in survival could be attained by defining those groups which would benefit from a combination of treatment methods.


Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Ear Neoplasms/radiotherapy , Ear, Middle/radiation effects , Mastoid/radiation effects , Skull Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Ear Neoplasms/pathology , Female , Humans , Male , Middle Aged , Neoplasm Staging , Palliative Care , Radiotherapy, High-Energy , Skull Neoplasms/pathology , Survival Rate
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