Malignant melanoma of the head and neck.

Malignant melanoma is rapidly increasing in incidence. The primary lesion is frequently seen in the head and neck and general dental practitioners thus have the opportunity to identify suspicious lesions at an early stage. This article gives an overview of the pathology and clinical features of melanoma.

Fibreoptic intubation using the cuffed oropharyngeal airway and Aintree intubation catheter.

A cuffed oropharyngeal airway has recently been introduced which has larger internal dimensions than a comparable Guedel airway. This allows a ventilation/exchange bougie, the Aintree Intubation Catheter, mounted on a fibreoptic laryngoscope to pass through it. Its 15-mm connector and pharyngeal cuff suggested the possibility of using a Rüsch sealed-port angle piece to allow ventilation through the oropharyngeal airway during fibreoptic laryngoscopy.

The secondary radiation grid; its effect on fluoroscopic dose-area product during barium enema examinations.

The secondary radiation grid is placed between the patient and the image intensifying screen, during fluoroscopy, to attenuate the incident forward scattered radiation. This reduction in scatter improves the radiographic contrast and hence image quality. However, this improved quality is achieved at the expense of greater radiation exposure to the patient, as this higher exposure is required to produce satisfactory image density.

Skull base osteitis following fungal sinusitis.

Aspergillus sp. sinusitis is not uncommon in immunocompromised patients but is unusual in patients who are not immunocompromised. The disease may occur as a saprophytic condition, as an allergic sinusitis or as a potentially lethal invasive disease.

Correlation between blood loss and inferior vena caval pressure during liver resection.

Background: Blood loss and transfusion requirement are major determinants of mortality and morbidity following liver resection. This study was prompted by the observation that blood loss was excessive when the inferior vena cava (IVC) was distended, and determined whether a correlation exists between blood loss and pressure within the IVC during liver resection.

Methods: A 6-month prospective study was conducted on 20 consecutive patients undergoing liver resection in which two variables were measured, the pressure within the retrohepatic part of the IVC and blood loss during resection.

Surgical practice is evidence based.

Background: The quality of surgical research, and particularly the reluctance of surgeons to perform randomized controlled trials, has been criticized. The proportion of surgical treatments supported by satisfactory scientific evidence has not been evaluated previously.

Methods: A 1-month prospective audit was performed of 100 surgical inpatients admitted under two consultants in a general surgical/vascular unit at an urban teaching hospital; the main illness and interventions were agreed through group discussions in each case.

Support services. Domestic bliss.

Healthcare assistants had to leave the patients' bedside to do routine housekeeping work. Replacing a healthcare assistant post with a housekeeper has improved the use of personnel, staff morale and patient care. Allowing healthcare assistants to manage the project has ensured ownership.

Hyaluronidase and peribulbar block.

We have assessed the effect of two concentrations of hyaluronidase on the quality of peribulbar block, using a low volume, single injection technique. We studied 200 patients undergoing elective intraocular surgery, allocated randomly to one of three groups. Group 1 (n = 50) received peribulbar block with 5 ml of a 1:1 mixture of 0.

Nasopharyngeal cavity narrowing associated with posterior maxilla and pterygoid plate fracture: report of three cases.

The CT appearances of three cases with severe nasopharyngeal cavity narrowing are described. In all cases the facial trauma was due to a motor vehicle accident. These cases demonstrate that posterior maxilla and pterygoid plate fractures can cause significant nasopharyngeal soft tissues swelling, most likely due to haemorrhage and/or oedema.

The steroid vitamin D3 reduces cell proliferation in human duodenal epithelium.

1. The active metabolite of vitamin D3, 1,25-dihydroxyvitamin D3, controls calcium absorption in the human duodenum, an effect that is mediated by mucosal vitamin D receptor expression. Functional vitamin D receptor signalling in the human colon is suggested by the reduced colonic mucosal cell proliferation seen in response to 1,25-dihydroxyvitamin D3.

Measuring outcomes in the treatment of alcohol dependency.

The selective promotion of clinical services which have proven effectiveness is a movement that is gaining momentum within healthcare. Outcome evaluation in treatment services for alcohol dependency is given as an example of the methodological issues associated with the establishment of clinical efficacy. It is argued that the adoption of clear protocols for assessment, treatment and outcome are a prerequisite of the process.

Radial forearm flap donor-site complications and morbidity: a prospective study.

One-hundred patients undergoing radial forearm flap reconstruction in the head and neck over a 2-year period were followed prospectively to assess complications and morbidity associated with the radial flap donor site. Eighty-six patients were available follow-up at 3 months and 74 at 1 year (49 fasciocutaneous, 25 composite). Partial loss of the donor-site skin graft occurred in 14 patients (16 percent), with exposure of tendons in 11 patients (13 percent).

Assessing the use of dressings in practice.

An audit was carried out in an NHS trust to identify the degree to which wound management products were being selected and used appropriately. Fifty patients with various types of wounds were involved; observers noted the condition of wounds at dressing changes and the procedures used, then studied each patient's hospital documentation (medical notes, nursing care plan and drug chart). Nursing staff were interviewed to ascertain the input of various disciplines in dressing choice.

Percutaneous endoscopic gastrostomy: evaluation of insertion by an endoscopy nurse practitioner.

Objective: To evaluate the success rate and complications of percutaneous endoscopic gastrostomy (PEG) insertion performed with an endoscopy nurse practitioner, rather than a second doctor, carrying out percutaneous gastric puncture.

Design: A prospective evaluation of one nurse'e performance.

Setting: The endoscopy unit in a district general hospital.

Persistent nasal crusting due to hypohidrotic ectodermal dysplasia.

Hypohidrotic ectodermal dysplasia is an hereditary condition of the ectodermal tissues which may escape recognition because of lack of clinical awareness due to its rarity. Otorhinolaryngological features of this syndrome include chronic respiratory tract infections, persistent foul-smelling nasal discharge and crust formation, and hearing problems. The condition is usually an X-linked recessive disease affecting mainly ectodermal tissue, although nonectodermal tissue may also be affected.

Trends in the management of stage 3 retinopathy of prematurity.

Aims/background: The clinical outcome of 66 consecutive infants with stage 3 retinopathy of prematurity (ROP) is reported.

Methods: Thirty four infants (64 eyes) were treated with cryotherapy and 32 infants (59 eyes) underwent laser photocoagulation.

Results: Infants with anterior-mid zone II ROP had a high rate of disease regression whether treated by cryotherapy or laser photocoagulation.

A histopathological comparison of the uvula between snorers and non-snorers.

Snoring is a very common problem but there are few publications on the histological findings of the soft palate/uvula and these lack consistency. The relative proportions of tissue types in the base of the uvula removed from 17 adults who underwent uvulopalatopharyngoplasty for heavy snoring were therefore compared with 14 cadaveric specimens. The mean percentage of muscle from the snoring group was 12.

Factors influencing the patterns of invasion of the mandible by oral squamous cell carcinoma.

The pattern of tumour invasion of the mandible depends on the extent of invasion. Both the width (P = 0.02) and depth (P = 0.

Laser therapy in the palliation of dysphagia in oesophageal malignancy.

Dysphagia is a distressing symptom commonly found in patients with oesophageal malignancy. Endoscopic laser therapy, in isolation or in conjunction with other treatments, can offer effective palliation. The procedure is outlined together with discussion of the advantages and complications of this technique.

Mucosal-strip/uvulectomy by the CO2 laser as a method of treating simple snoring.

The effect of stiffening the soft palate by inducing scarring after removing a central strip of mucosa with a CO2 laser was investigated in 25 heavy snorers. The results were assessed using a series of Visual Analogue Score (VAS) assessment questionnaires completed by the partner over a period of 6 months. Of the 22 patients who had the laser-strip and uvulectomy, snoring improved in 18 (82%) (median improvement of 75% at 3 months).