Novel method of intralesional cidofovir injection into laryngotracheal papillomata.

Laryngeal papillomatosis is characterised by multiple papillomata affecting the upper respiratory tract. This condition is difficult to treat due to its recurrent nature. Treatment often involves surgical debulking. A number of non-surgical treatments have been reported. Intralesional cidofovir, a cytosine nucleoside analogue with antiviral activity, has been used in an attempt to manage the condition. We present a novel technique of administering cidofovir in a case of recurrent laryngotracheal papillomata.

Is there an association between blood group O and epistaxis?

INTRODUCTION: Blood group O is associated with lower expression of von Willebrand factor suggesting a relative bleeding tendency. A lower admission rate for epistaxis among Asians compared with Caucasians has also been noted, with one explanation being higher prevalence of blood group O among Caucasians. This study investigates whether blood group O is over-represented in patients admitted with epistaxis. METHODS: A retrospective study was conducted, using computerised hospital in-patient and blood bank databases to identify Caucasians admitted with epistaxis between January 2000 and December 2005 inclusive. The control group consisted of 500 consecutive patients who had a primary total hip arthroplasty and 500 consecutive patients who gave birth within the delivery suite. RESULTS: 1261 Caucasians admitted with epistaxis were identified. Among epistaxis patients, 50.44 per cent were blood group O but among the control group this was 45.10 per cent (chi-square test p = 0.008). CONCLUSION: Blood group O appears over-represented in Caucasian patients admitted with epistaxis, compared with the control population, raising the possibility that blood group O is a risk factor for epistaxis.

Is admission for epistaxis more common in Caucasian than in Asian people? A preliminary study.

OBJECTIVES: Epistaxis is a common ENT complaint. Although casual observation suggested that it is more common in Caucasian, compared with Asian people, a literature search failed to find any studies investigating ethnicity and epistaxis. The aim of this study was to identify any differences in emergency admission rates for epistaxis between Asian and Caucasian people. DESIGN: Retrospective observational study using hospital computerised data (HISS). SETTING: Large University Hospital accepting ENT emergencies. PARTICIPANTS: All Asian and Caucasian patients admitted under ENT care as an emergency (1 January 2000 to 30 November 2005), split into two groups: one composed of epistaxis patients, the other of all other ENT emergency admissions. MAIN OUTCOMES MEASURES: The proportions of Asian and Caucasian patients among the two patient groups, either epistaxis admissions or other ENT emergency admissions. RESULTS: The proportions of Asian and Caucasian patients in the group admitted with emergency epistaxis were 7.1% (100/1410) and 92.9% (1310/1410) respectively. However, the proportions of Asian and Caucasian patients in the group composed of any other ENT emergency were 13.2% (729/5515) and 86.8% (4786/5515), respectively (chi-squared P < 0.01). CONCLUSIONS: Caucasian people form an unexpectedly large, and Asians a smaller proportion of emergency epistaxis admissions. The possibility of an ethnic risk factor for epistaxis warrants further investigation.

New World leishmaniasis from Spain.

A 69 year old man living in Spain contracted mucocutaneous leishmaniasis involving the nose. The infecting organism was Leishmania infantum, which only rarely causes the New World form of the disease. The source of infection was probably a neighbour's dog. The patient began treatment with liposomal amphotericin B but died of pneumonia two months later.

Malignant fibrous histiocytomas of the larynx--report of two cases.

Malignant fibrous histiocytoma of the larynx is a rare entity. It is even more infrequent for the tumour to arise from a specific location on the larynx namely the vocal cords. We report two cases of vocal cord malignant fibrous histiocytoma, one in a 27-year old man who underwent frontal partial laryngectomy, and the other in a 57-year old man who was managed with total laryngectomy. Both patients remain disease-free after 5 years of follow-up. We present a discussion of the available literature on this subject. As these tumours occur very infrequently, no one centre is able to acquire the prerequisite amount of experience to be able to lay down firm scientifically based guidelines on the management of these tumours. It is thus inevitable that whatever evidence we have is purely anecdotal in nature.

Cervical necrotizing fasciitis: a distinct clinicopathological entity?

Necrotizing fasciitis of the head and neck has previously been classified as a homogeneous group. We present two cases of necrotizing fasciitis confined to the neck and demonstrate with a review of the literature that cervical necrotizing fasciitis and craniofacial necrotizing fasciitis are two distinct clinicopathological conditions.

A canalplasty technique for the surgical treatment of chronic otitis externa.

This article describes a surgical technique for the treatment of chronic stenosing otitis externa. A retrospective survey of the post-operative course in eight patients (10 ears) showed this to be a satisfactory treatment with no recurrence of symptoms.

Organization of day-case adenoidectomy in the management of chronic otitis media with effusion--preliminary results.

We report our initial findings of adenoidectomy performed in Leicester as a day case on 149 children between the ages of 3 and 9 years, who have been assessed for suitability for day-case surgery according to specific medical and social criteria. The selection a paediatric community nurse. All of the surgical procedures have been performed by experienced medical staff and the various anaesthetic techniques used by consultants or senior registrars have been documented. Six children were admitted postoperatively for overnight observation, three of whom had suffered a primary haemorrhage. No patients have been returned to theatre because of haemorrhage and there have been no re-admissions after discharge. A strict entry protocol has been observed to ensure the safety of this type of surgery and to date the acceptability of such a scheme and its organization has been widespread amongst those children and their parents who have participated.

Life-threatening peripharyngeal sepsis with mediastinitis.

A case of life-threatening peripharyngeal sepsis with mediastinitis is described. The pathology, relevant anatomy and treatment are discussed and the literature is reviewed.

Transient facial paralysis (a report of three cases).

Local anesthetic infiltrated into the external auditory meatus prior to ear surgery is a cause of transient ipsilateral facial nerve paralysis in the immediate post-operative period. This phenomenon is only rarely described. Three such cases are reported.

The effect of submucosal diathermy to the inferior turbinates on nasal resistance to airflow in allergic and vasomotor rhinitis.

Twenty-one patients with nasal obstruction due to allergic or vasomotor rhinitis were assessed rhinomanometrically before and after the operation of submucosal diathermy to the inferior turbinates. It was found that the operation significantly improved the nasal airway. Most patients with an objective improvement reported a corresponding reduction in nasal obstruction. There was no tendency for patients with allergic rhinitis to be dissatisfied with the operation.

The flexible fibreoptic rhinolaryngoscope.

An accurate, reliable, inexpensive and safe method for the examination of the upper aero-digestive tract is described. Its efficacy is evaluated retrospectively on 250 patients over an 18-month period.

Effect of aspirin on nasal resistance to airflow.

The effect of aspirin on nasal resistance to airflow was investigated by rhinomanometry in 25 healthy subjects before and after ingestion of aspirin or vitamin C in a double blind crossover trial. Aspirin caused a significant increase in nasal resistance compared with vitamin C. The effect of aspirin may be due to its inhibition of the synthesis of prostaglandins.

The prevention of wound infection after head and neck resections: a pilot study using gentamicin impregnated beads.

A pilot study of 16 patients undergoing major head and neck resections is presented. At the end of surgery gentamicin (Garamycin) chains are inserted into the wound prior to skin closure and left in place for 48 hours. The rate of wound infection is shown to be low (6.25% requiring antibiotics, 18.75% overall); there have been no complications from use of the chains.

Use of a local gentamicin preparation ('Garamycin' Chains) as prophylaxis against infection in major head or neck surgery: a pilot study.

A pilot study was carried out in 16 patients undergoing major head or neck surgery to assess the effectiveness of antibiotic prophylaxis against wound infection using a local gentamicin preparation. Chains of 8 beads containing 7.5 mg gentamicin sulphate per bead, the drug being released over a prolonged period, were inserted on both sides of the operative wound before closure and left in place for 48 hours before removal. The results showed that only 3 of the 16 patients developed any clinical or bacteriological evidence of post-operative wound infection over the following 3 days. The chains proved easy to use. Satisfactory wound closure was obtained in all cases and there were no problems in their removal.