Sir Harold Delf Gillies, the otolaryngologist and father of modern facial plastic surgery: review of his rhinoplasty case notes.

BACKGROUND: Sir Harold Gillies, born in New Zealand, is widely considered a British icon and the father of modern plastic surgery. OBJECTIVE: This article provides an overview of his life and the circumstances which led to him laying the foundations of plastic surgery in Britain in the early twentieth century. METHODS: A hand search and review of case notes from the Gillies Archives at Queen Mary's Hospital in Sidcup, UK, where he made history, was conducted. RESULTS AND CONCLUSION: Gillies' ongoing legacy was found to also include his influence on the development of his cousin Sir Archibald McIndoe's work. Gillies was a talented sportsman who engaged in charitable activities. Additionally, he was a gifted teacher, with his hospital attracting many young surgeons from around the world. He was found to have expressed genius in both the design and execution of the art and science of surgery. He incepted reconstructive techniques ranging from the world's first gender reassignment operation to facial reanimation procedures for the treatment of facial paralysis. His operative work on ex-servicemen in need of complex rhinoplasty and in particular the inception of the tubed pedicle flap are depicted.

The relationship between vestibular aqueduct diameter and sensorineural hearing loss is linear: a review and meta-analysis of large case series.

INTRODUCTION: Inner ear homeostasis is dependent on the vestibular aqueduct and its content, the endolymphatic duct. Narrow and enlarged vestibular aqueducts have both been associated with hearing loss in Ménière's and large vestibular aqueduct syndromes. This review investigated the correlation between vestibular aqueduct diameter and pure tone average, and the effect of measurement site (i.e. the midpoint or the external aperture). MATERIALS AND METHODS: A systematic review of the literature and meta-analysis of large case series published on the Allied and Complementary Medicine, British Nursing Index, Cumulative Index to Nursing and Allied Health, Embase, Health Business Elite, Health Management Information Consortium, Medline, PsycInfo and PubMed databases. References and personal books were also scrutinised. RESULTS: A linear relationship between vestibular aqueduct diameter and hearing loss was observed, with a projected increase of 6 dBHL per unit of vestibular aqueduct diameter (95 per cent confidence interval, 2-10; p = 0.003). This relationship was independent of measurement site. DISCUSSION: This dose-dependent or linear relationship supports the role of flow and/or pressure change as aetiological factors in the pathogenesis of hearing loss, as per Poiseuille's law. This aetiological association is strengthened by the fact that the observed relationship is independent of measurement site.

Treatment of acrophobia of an institutionalized adult with mental retardation.

Treatment of an institutionalized 34-year-old female with mental retardation (who may have been psychotic) for acrophobia was described. Prior to therapy her phobia had precluded her placement in an upper-level ward. Assessment and therapy took place over 6 weeks and involved 13 sessions, totalling 15 hours of graduated exposure. A further 10 hours of therapy were undertaken 7 months later due to the demands of her new setting. Eighteen-month follow-up indicated that all gains had been maintained. Unprogrammed generalization was limited.

Clinical utilization of perfusion lung scans in the diagnosis of pulmonary emboli.

To study the utilization of perfusion lung scans, the records of 116 consecutive patients who had "pulmonary embolus" (PE) as a discharge diagnosis were reviewed. The PE group was identical to the control group in the percent of male patients and of white patients. However, the PE group was older (60.4 versus 47.5 years), had a higher percentage of smokers (53.1 versus 34), and had a higher proportion of obese individuals (39.6 versus 25) than controls. Mortality was significantly greater in the PE patients (9.5% versus 1%) as was the length of hospital stay (21 versus 9 days). The PE group had more chest x-rays than did controls (6.1 versus 1.8) and had a higher percentage of lung scans (95.7 versus 5). While 95.7% of the patients diagnosed as having PE were studied by perfusion lung scans, 4.3% had none. Further, 18.1% had only one lung scan. Of 111 patients with perfusion lung scans, 3.6% were discharged with a diagnosis of PE despite a negative study. While clinical acceptance of perfusion lung scans is high, some patients diagnosed as having pulmonary emboli did not have a scan but underwent other diagnostic tests, while a small group of others were assigned the diagnosis despite a negative lung scan. This points to the need for better communication with referring clinicians.