The use of magnetically controlled growing rods in paediatric Osteogenesis Imperfecta with early onset, progressive scoliosis.

Osteogenesis Imperfecta (OI) is a condition of bone fragility and can present with early onset scoliosis that can cause respiratory complications in later life. The fear of instrumenting the spine in OI is the possibility of fracture either on primary insertion or subsequent lengthening. Magnetically controlled growing rods were inserted to control a scoliosis in a 6-year old with OI type IV. Fixation was obtained using pedicle screws proximally and distally with sublaminar bands around the ribs proximally. These rods have been remotely lengthened on multiple occasions over a 2-year period. This has controlled the scoliosis whilst also allowing the spine to grow. There are no complications to report. This case reports the use of magnetically controlled growth rods used to manage early onset scoliosis in OI. Frequent lengthening, achieving small increases in length on every occasion protects against the risk of fracture during the lengthening procedure.

Omalizumab treats chronic rhinosinusitis with nasal polyps and asthma together-a real life study.

INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and thus treating both with one intervention is an attractive strategy. OBJECTIVE: To prospectively evaluate whether treatment with the monoclonal antibody against IgE Omalizumab for severe allergic asthma also effectively treats co-existent CRSwNP. METHODS: SNOT-22 and the ACQ-7 scores were recorded at 4 and 16 weeks of treatment in a cohort of patients with both CRSwNP and severe refractory allergic asthma treated with Omalizumab (n=13) according to UK guidelines for their severe asthma. SNOT-22 in a surgery only treated CRSwNP with asthma group (n=24) was compared. RESULTS: Rapid improvement was seen at 4 weeks and 16 weeks of treatment in both CRSwNP and asthma control. The improvement in CRSwNP with Omalizumab was similar to that seen in a group of patients who received upper airway surgery. CONCLUSION: Omalizumab treatment for severe allergic asthma also improves co-existent CRSwNP. Further clinical studies of current and emerging biological agents for severe asthma should include upper airway outcomes. These agents may be effective for severe CRSwNP and comparative studies with surgery are warranted.

A novel amorphous calcium phosphate polymer ceramic for bone repair: I. Synthesis and characterization.

Traditional materials for bone repair or replacements such as autografts and allografts have a limited supply and other complications. Thus, alternative materials need to be explored. Three-dimensional, porous composites prepared from bioresorbable polymers and hydroxyapatite or other calcium phosphate ceramics are promising materials for the repair or replacement of diseased or damaged bone. However, in many cases the ceramic component of these composites is crystalline in nature, while bone apatite is made of a poorly crystalline, carbonated phosphate system. In this study, we synthesized a noncrystalline, carbonated calcium phosphate ceramic by carrying out the reaction within bioresorbable PLAGA microspheres using a modified emulsion/solvent evaporation technique, making each individual microsphere a composite. Sintering the composite microspheres together yielded a bioresorbable, porous, 3-dimensional scaffold that may be ideal for tissue ingrowth, making this composite scaffold potentially suitable for bone repair applications.

Prospective multicentre study comparing levonorgestrel implants with a combined contraceptive pill: final results.

Norplant is a hormonal, long term method of contraception requiring the sub-dermal placement of six flexible capsules containing levonorgestrel in the inner aspect of the upper non-dominant arm. This open, prospective, multicentre, parallel group study, comparing the acceptability of Norplant and a combined pill, was originally designed to follow 700 subjects for five years, but was discontinued early. The main outcome criteria were duration of use and reason for discontinuation if appropriate. This final analysis, concerning the 364 subjects who used the implant and 307 subjects who used a gestodene/ethinyloestradiol combined pill, shows a statistically significantly higher (p<0.001) continuation rate amongst the implant users at 83.4 per cent compared to the pill users at 64.4 per cent at one year and this difference decreased only slightly by two years. The most common reasons for discontinuation by the end of the study were adverse events in both groups (menstrual and then mood changes in the implant group and mood changes and then headaches in the pill group). From the whole cohort the proportion which were 'very satisfied' were higher in the implant group (28.5 per cent compared to 14.6 per cent). This study confirms, in the UK, a high continuation rate for implant users similar to other countries as reported in the literature. If acceptability and continuation rates are similar in the none study setting, then a substantial number of women will seek removal of the implant and possible reinsertion five years after the time of initial high popularity (ie 1999). Doctors need to be prepared for this possible high level of activity.

PIP: This is a multicenter comparative study on the acceptability of levonorgestrel implants (Norplant) and the ethinyl estradiol/gestodene combined pill (Femodene/Minulet) conducted in the UK, which was originally designed to follow 700 subjects for 5 years but was discontinued early. Norplant is a hormonal, long-term method of contraception requiring the subdermal placement of 6 flexible capsules containing levonorgestrel in the inner aspect of the upper nondominant arm. 364 subjects who used the implant and 307 subjects who used a combined pill were included in the final analysis, which showed a significantly greater (p 0.001) continuation rate among the implant users (83.4%) compared to the pill users (64.4%) at 1 year, with a slight decrease in difference at 2 years. The most common reasons for discontinuation were menstrual and mood changes in the implant group and mood changes and headaches in the pill group. A higher proportion of "very satisfied" users was noted in the implant group (28.5%) compared to the combined pill group (14.6%). The high continuation rate for implant users in this study is similar to the rate in the reported literature in other countries.

Initial UK experience of the levonorgestrel-releasing contraceptive intravaginal ring.

A study was performed to establish the tolerance, acceptability and associated efficacy of a levonorgestrel-releasing intravaginal ring (IVR) in a sample of British women requiring contraception. This was achieved with an open non-randomized prospective study of 1710 women aged 18-40 years, recruited in 75 centers geographically spread around the UK using an IVR designed to release 20 microg/day of levonorgestrel. Assessments were made at baseline, after 6 weeks, after 3 months and then 3-monthly. After initial insertion of the IVR, it was changed at 3-monthly intervals. A total of 1591 women were eligible for analysis, with 572 available after 12 months and 34 after 24 months of use. Life-table analysis revealed pregnancy rates of 5.1% and 6.5% at 12 months and 24 months, respectively. The IVR was rated as acceptable or very acceptable as a form of contraceptive by 60.7% of women at 12 months. The most common adverse events were menstrual disturbance, headache and vaginal discharge. No significant pattern of biochemical, hematological, microbiological or cytological abnormalities was found but vaginal erythematous lesions were noted at some centers. This IVR was found to be a generally well-accepted method of contraception with a failure rate comparable to some other progestogenonly methods. On this basis, further development of hormone-releasing intravaginal rings is justified.

Olfactory neuroblastoma - our experience.

The authors present six cases of olfactory neuroblastoma with or without intracranial extension operated on by the team headed by Otolaryngologists and Neurosurgeons. Data was analysed with respect lo age group, sex, presenting symptoms and signs, stage, and results of combined modality of treatment. The author's experience suggests excellent local control can be achieved by combined craniofacial resection followed by radiation therapy. Hence the authors recommend planned combined radical treatment for all the resectable lesions and routine use of nasal endoscope along with other conventional methods for compehensive follow-up of all cases.

Hearing anomalies following radiation therapy for head and neck cancers.

Ionizing radiation used for the treatment of head and neck tumors affected epithelial and connective tissue. Epithelial lining of the middle ear mucosa desquamated, when exposed to conventional dose of radiation. Mucosa becomes oedematous which subsequently lead to formation and collection of sterile fluid within middle ear cavity and thus producing radiation otitis media with conductive deafness. Radiation induced changes in the structure surrounding the end organs of hearing such as vascular and connective tissue alterations which later eventually could affect the end organ leading to perceptive type of hearing loss as a result of chronic anoxia to end organ.

Giant neurofibroma of the tongue.

Neurofibroma of the tongue arising from the hypoglossal nerve is rare [7], but a combined neurofibroma of the hypoglossal and lingual nerve is extremely rare in the English literature to our knowledge [4,6]. Here one such case is being presented for its rarity, peculiarity of its clinical presentation and the surgical approach to excise it.

Osteogenic sarcoma of sphenoid bone: an extended lateral skull base approach.

Osteogenic sarcoma involving the sphenoid bone is an extremely rare condition. The rarity of the disease and the close proximity of the sphenoid bone to the various important intracranial structures poses a real challenge in diagnosis and surgical management of these lesions. An extended lateral craniofacial resection by a multidisciplinary approach was carried out in one such case to attempt en bloc resection. This case is presented and also a review of the relevant literature.

Foreign body in the ethmoid sinus.

An air gun pellet lodged in the posterior ethmoid sinus in a 1-year-old child is described. Functional endoscopic sinus surgery enabled the removal of the pellet, obviating an external ethmoidectomy.

Congenital internal carotid artery aneurysm.

Congenital carotid aneurysms are frequently found in the intracranial arteries but rarely seen in extracranial part of the internal carotid artery. A case of a congenital internal carotid artery aneurysm at the skull base was treated in a 13-year-old female child. This case is being presented for its rarity and also to highlight the ease of exposing the upper end of the aneurysm via lateral skull base approach. Infratemporal fossa approach was adopted in this case. The carotid canal was drilled off and the upper end of the aneurysm in the intrapetrous part was mobilized and vascular clip applied before dissection of the aneurysm. Relevant literatures pertaining to this case are also reviewed.