A prospective treatment trial of nasal polyps in adults with cystic fibrosis.

This is the first prospective, randomised, double-blind trial of the treatment of nasal polyps in cystic fibrosis. We found that betamethasone nasal drops showed a statistically significant reduction in polyp size in comparison to placebo.

The prevalence of nasal polyps in adults with cystic fibrosis.

The endoscopic intranasal appearance of 211 adult patients with cystic fibrosis was studied. The prevalence of nasal polyps in this study was 37%. The commonest nasal symptoms were discharge, headache and obstruction. Intranasal endoscopy usually demonstrated mucosal oedema and thin, clear discharge. The prevalence of allergy, as diagnosed by skin prick testing, was almost twice that of the general population. Tympanometry showed that middle ear effusion was uncommon in these patients.

Receiving shadows: governance and liminality in the night-time economy.

This paper focuses upon the emergence of the night-time economy both materially and culturally as a powerful manifestation of post-industrial society. This emergence features two key processes: firstly a shift in economic development from the industrial to the post-industrial; secondly a significant orientation of urban governance involving a move away from the traditional managerial functions of local service provision, towards an entrepreneurial stance primarily focused on the facilitation of economic growth. Central to this new economic era is the identification and promotion of liminality. The State's apparent inability to control these new leisure zones constitutes the creation of an urban frontier that is governed by commercial imperatives.

Medial orbital protrusion--a potentially hazardous anomaly during endoscopic sinus surgery.

We report the case of a 57-year-old patient with a presumed developmental anomaly of the medial orbital wall. The resultant protrusion of orbital contents into the ethmoidal complex was clearly demonstrated on coronal computed tomography (CT) scans of the paranasal sinuses. This anomaly presents a high risk of iatrogenic injury to the medial rectus and orbit during functional endoscopic sinus surgery and has not previously been described.

A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup.

BACKGROUND: In children with croup, treatment with nebulized budesonide decreases symptoms, but it is uncertain how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization. METHODS: We performed a double-blind, randomized trial involving 144 children with moderately severe croup. The children were treated with racepinephrine and a single dose of 4 mg of nebulized budesonide (48 children), 0.6 mg of intramuscular dexamethasone per kilogram of body weight (47 children), or placebo (49 children). The children were assessed before treatment and then hourly for five hours after treatment. Physicians who were unaware of the treatment assignments determined the children's need for further treatment and hospitalization. RESULTS: The characteristics of the groups were similar at base line, including the types of viruses identified, the types of croup, and the clinical severity of the illness. The overall rates of hospitalization were 71 percent in the placebo group (35 of 49 children), 38 percent in the budesonide group (18 of 48 children), and 23 percent in the dexamethasone group (11 of 47 children) (unadjusted P=0.001 for the comparison of budesonide with placebo, P<0.001 for the comparison of dexamethasone with placebo, and P=0.18 for the comparison of budesonide with dexamethasone). Children treated with budesonide or dexamethasone had a greater improvement in croup scores than those given placebo (P=0.03 and P<0.001, respectively), and those treated with dexamethasone had a greater improvement than those treated with budesonide (P=0.003). CONCLUSIONS: In children with moderately severe croup, treatment with intramuscular dexamethasone or nebulized budesonide resulted in more rapid clinical improvement than did the administration of placebo, with dexamethasone offering the greatest improvement. Treatment with either glucocorticoid resulted in fewer hospitalizations.

Synergistic necrotizing cellulitis resulting from peri-tonsillar abscess.

This case demonstrates the rare but potentially fatal condition of synergistic necrotizing cellulitis of the head and neck. Although similar to necrotizing fasciitis, this is more extreme as it also destroys muscle. Peri-tonsillar abscess is a recognized cause, but has not previously been described in this country, however it is a condition commonly referred to otolaryngologists and awareness of the complication of synergistic necrotizing cellulitis is necessary to allow early recognition and prompt treatment. This should be by broad-spectrum intravenous antibiotics with extensive surgical debridement and drainage procedures repeated as necessary. Although this case had a successful outcome, many patients do not survive, particularly if treatment is delayed or inadequate.

Adenoid cystic carcinoma of the maxilla--the value of histopathology in diagnosing a second primary.

Adenoid cystic carcinoma is the commonest tumour of minor salivary glands. In the case described here a pulmonary mass was found. This was likely to be a distant metastasis, particularly as the primary tumour was of cribriform subtype with perineural invasion and resection was microscopically incomplete. However, surgical excision of the pulmonary mass enabled histopathological studies to be carried out which found it to be an unrelated bronchioloalveolar carcinoma.

The ENT manifestations of HIV infection in children.

This study identified the ENT symptoms of 66 HIV infected children over an 8 year period (1986-1993) at Great Ormond Street Hospital for Children. The incidence, nature and age of onset of ENT symptoms were investigated; 91% of the children had ENT symptoms, the most common being cervical lymphadenopathy, oro-oesophageal candidiasis and otitis media. The HIV infected children suffered from the common ENT diseases of childhood. They also presented with specific conditions such as diffuse parotid swelling. Therefore, their clinical features differed from HIV infected adults as well as non-infected children. An increasing incidence of paediatric HIV infection was demonstrated by the study. Most were due to vertical transmission. ENT surgeons are likely to see more HIV infected children in future, either with the usual ENT diseases of childhood (to which they seem more susceptible) or with HIV-specific conditions. Although the diagnosis of HIV may be known, the ENT condition could be the initial presentation suggestive of immunodeficiency.

Facial palsy due to tuberculosis: the value of CT.

This case report demonstrates the value of CT in the investigation of facial palsy due to tuberculous mastoiditis. This is the best imaging modality available for identifying features suggestive of tuberculosis, the disease extent, presence of complications and demonstration of anatomy prior to surgery.

Otitis externa in Langerhans' cell histiocytosis--the successful use of topical nitrogen mustard.

Otitis externa is a common symptom of Langerhans' cell histiocytosis, and occurs in half of all children with the disease. Previous treatment regima have been either unsuccessful, or associated with undesirable side-effects. This study describes the successful use of topical 20% nitrogen mustard ear drops in the management of five children who had Langerhans' cell histiocytosis with otitis externa. All of them had previously been resistant to other forms of treatment. The children were aged between 6 months and 6 years. The otitis externa fee period to date is up to 5 years. Topical nitrogen mustard ear drops are rapidly effective, can be administered at home, have not caused any adverse effects, and are of long-term benefit.