Associations between high ambient temperatures and heat waves with mental health outcomes: a systematic review.

OBJECTIVES: The objective of this study was to describe the mental health effects of high ambient temperatures and heat waves, determine whether heat-related morbidity and mortality are increased among people with known mental disorders and identify knowledge gaps to inform targeting of future research. STUDY DESIGN: Systematic literature review and narrative synthesis. METHODS: A systematic review of published literature using MEDLINE, Embase and PsycINFO without geographical or temporal limits was conducted. We included studies that explicitly linked high ambient temperatures and/or heat waves to mental health outcomes. Evidence was graded using a National Institute of Health framework. RESULTS: A total of 35 studies were included in the review, among which 34 were observational studies and one was a case-control study. Six broad mental health outcome categories were identified: suicide and heat; bipolar disorder, mania and depression and heat; schizophrenia and heat; organic mental health outcomes and heat including dementia; alcohol and substance misuse and heat; and multiple mental health outcomes/mental health service usage and heat. The studies included were heterogeneous in terms of study design, population, setting, exposure measures, outcomes and location making meta-analysis unfeasible. Fifteen studies showed an increased suicide risk with heat (relative risk [RR] 1.014-1.37 per 1 °C, P < 0.05; r = 0.10-0.64, P < 0.05). Increased risks of mental health-related admissions and emergency department visits at higher temperatures were also found. No evidence of change in community care use was found. Evidence for the impact of heat on other mental health outcomes was mixed. CONCLUSIONS: High ambient temperatures have a range of mental health effects. The strongest evidence was found for increased suicide risk. Limited evidence was found for an increase in heat-related morbidity and mortality among people with known mental health problems. Knowledge gaps exist on the impact of high temperatures on many common mental health disorders. Mental health impacts should be incorporated into plans for the public health response to high temperatures, and as evidence evolves, psychological morbidity and mortality temperature thresholds should be incorporated into hot weather-warning systems.

Classification and management of cervical paragangliomas.

INTRODUCTION: Cervical paragangliomas are slow-growing tumours that eventually cause lower cranial nerve palsies and infiltrate the skull base. Surgical treatment may cause the same deficits and, in some, risks more serious neurological deficits. We describe a classification used to guide investigation, consent and management of cervical paragangliomas based on extensive experience. METHODS: The case notes of patients managed by the senior author at a tertiary referral skull base unit between 1987 and 2010 were reviewed retrospectively. A total of 87 cervical paragangliomas were identified in 70 patients (mean age: 46 years, range: 13-77 years). Of these, 35 patients had 36 vagal paragangliomas, 43 patients had 50 carotid body paragangliomas and 8 had both. One cervical paraganglioma arose from neither the carotid body nor the nodose ganglion. The main outcome measures were death, stroke, gastrostomy and tracheotomy. RESULTS: All tumours were classified pre-operatively based on their relationship to the carotid artery, skull base and lower cranial nerves. Type 1 tumours were excised with a transcervical approach, type 2 with a transcervical-parotid approach and type 3 with a combined transcervical-parotid and infratemporal fossa approach. Type 4 patients underwent careful assessment and genetic counselling before any treatment was undertaken. There were no peri-operative deaths; two patients had strokes, one required a long-term feeding gastrostomy and none required a tracheotomy. CONCLUSIONS: The use of a pre-operative classification system guides management and surgical approach, improves accuracy of consent, facilitates audit and clarifies which patients should be referred to specialised centres.

The long-term effect of unilateral t-tube insertion in patients undergoing cleft palate repair: 20-year follow-up of a randomised controlled trial.

OBJECTIVES: Between July 1984 and March 1987, all children that underwent repair for primary cleft palate at the Queen Victoria Hospital were enrolled in a clinical trial. Those found to have otitis media with effusion at time of surgery had a t-tube inserted into one randomised ear, whilst the other ear received no treatment. The object of the study was to reassess the patients from the original trial to discover the impact of the unilateral t-tube, twenty years later analysed on an intention to treat basis. DESIGN: Children that underwent primary palatal closure during the study dates were identified from the cleft palate database. Patients that were involved in the original trial were identified, contacted and invited to take part in the follow-up study. SETTING: Tertiary referral Specialist unit. PARTICIPANTS: Twenty-two patients were identified as potential study participants. Of this group, fourteen were contactable and seven participants agreed to take part in our follow-up study. MAIN OUTCOME MEASURES: Persistent symptomatology, otoscopy, pure tone audiometry and tympanometry. RESULTS: Follow-up results were compared within the original treatment groups from the primary study, on an intention to treat basis. Otoscopically the ears were normal in 2 of the 7 treated ears compared with four of the seven non-treated ears. All the other ear ears had various types of chronic otitis media. Four of the seven had hearing of >10 dB in the treated ear compared with the non-treated ear. CONCLUSIONS: These findings would indicate need for caution in the use of t-tubes in the cleft population and raises the question of long-term follow-up to assess for secondary cholesteatoma.

Familial systemic amyloidosis associated with bilateral sensorineural hearing loss and bilateral facial palsies.

The Finnish type of familial amyloid polyneuropathy due to variant gelsolin is a rare form of familial amyloidosis. The subtype was first described in 1969 and is characterized by progressive cranial neuropathies, corneal lattice dystrophy and distal sensorimotor dysfunction. It is extremely uncommon, with only two families known to be affected in the UK. We discuss the case of a 70-year-old woman who presented with bilateral facial nerve palsies, bilateral sensorineural hearing loss and Finnish type familial hereditary amyloidosis. A literature search of the Medline database (1966-2005) was performed, using the keywords 'amyloid', 'hearing loss' and 'facial palsy'; however, this association appears to be a novel finding. We review the current literature and discuss otorhinolaryngological presentations of amyloidosis.

The development of the spiral ganglion in the human foetus.

The development of the spiral ganglion was studied in steps sections of 81 human temporal bones. By the 8th week, the spiral ganglion has already separated from the vestibular ganglion. At 13 weeks two distinct populations are observed that correspond to neuron and Schwann cells. At 15 weeks the spiral ganglion has increased its distance from the cochlear duct and is surrounded by mesenchyme near the scala tympani. At 14 weeks a gradual decrease in the nucleus-to-cell area ratio was observed in spiral ganglion neurons that may reflect a morphological adaptation to function. By the 23rd week the modiolus begins to ossify and the spiral ganglion is surrounded by bony trabeculae. The time course of spiral ganglion development follows that of the stria vascularis and organ of Corti, although maturation changes are still observed in the neuronal population even beyond 20 weeks.

Congenital sialolipoma of the parotid gland first reported case and review of the literature.

Tumours of the parotid gland in children are uncommon, and represent only 1.3% of all benign salivary tumours. Lipomas of the parotid are also rare, and account for 0.5% of all parotid gland tumours. Sialolipoma is a new variant of salivary gland lipoma, consisting of adipose and glandular tissue that was first proposed by Nagao et al. in 2001. Ten cases of parotid gland lipoma associated with glandular elements have been previously reported in the literature. All have been in adults and none in children. We present the first reported case of congenital sialolipoma that had developed in a female infant. It was managed successfully by superficial parotidectomy undertaken at ten weeks of age.

Langerhans cells in Dupuytren's contracture.

We have examined biopsies of Dupuytren's contracture palmar fascia, overlying subcutis and skin, and have correlated the distribution of gross macroscopic changes in the hand, mapped pre- and intraoperatively, with light microscopic immunohistochemical findings. We report increased numbers of S100 positive Langerhans cells (an epidermal cell of dendritic lineage) and CD45 positive cells, both in "nodules" and at dermo-epidermal junctions, in the biopsied tissues. This suggests that Langerhans cells migrate from the epidermis into Dupuytren's contracture tissue, possibly in response to local changes in levels of inflammatory cytokines within the tissue. Our findings, together with other reports of increased numbers of dermal dendrocytes and inflammatory cells in Dupuytren's contracture tissue, lend circumstantial support to the "extrinsic theory" of the pathogenesis of Dupuytren's contracture. However, the earliest stages of the disease process have not been defined, and therefore the events which ultimately produce fibrosis in the palmar fascial complex in susceptible individuals could begin in the skin and/or within deeper tissues, especially where there is dysregulation of the immune system.