Is POSSUM predictive of morbidity and mortality in laryngectomy patients?

Objectives: To test the validity of the comparative audit tool of POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) against a cohort of 92 consecutive laryngectomies at a major tertiary referral centre for head and neck cancer. The major outcome measurements were 30-day mortality rates, formation of a pharyngo-cutaneous fistula, and length of hospital stay.

Methods: By means of a prospective and retrospective case note analysis.

Percutaneous tracheostomy: a 6 yr prospective evaluation of the single tapered dilator technique.

Background: The single tapered dilator (STD) percutaneous dilatational tracheostomy (PDT) technique now appears to be the single most common method of performing a tracheostomy in the critical care unit (CCU).

Methods: A single-centre, prospective evaluation of all PDTs performed in an adult mixed surgical and medical CCU between November 2003 and October 2009 was done. All procedures were undertaken by critical care physicians.

Pituitary adenomas in childhood, adolescence and young adulthood: presentation, management, endocrine and metabolic outcomes.

Objective: To elucidate the long-term outcomes of pituitary adenomas diagnosed in childhood and adolescence, knowledge of which remains sparse.

Design And Methods: A retrospective review of patients aged ≤21 years at diagnosis of pituitary adenoma, attending a neuroendocrine service in Liverpool, UK, between 1984-2009.

Results: There were 41 patients (33 female), mean age at diagnosis 17.

Nurse-led clinics for strict hypertension control are effective long term: a 7 year follow-up study.

Aims: The primary aim was to assess long-term blood pressure in 110 patients with Type 2 diabetes who had achieved optimal blood pressure control during attendance at a protocol-based nurse-led hypertension intensive intervention clinic 7 years previously. The secondary aim was to assess modifiable cardiovascular risk factor status.

Methods: One hundred and ten patients who attended the clinic during 2000-2002 were selected to reattend to have their blood pressure measured to the same standard as it was during the intensive intervention clinic, by the same specialist nurse.

Objective cough frequency in Idiopathic Pulmonary Fibrosis.

Background: Cough is a common presenting symptom in patients with Idiopathic Pulmonary Fibrosis (IPF). This study measured cough rates in IPF patients and investigated the association between cough and measures of health related quality of life and subjective cough assessments. In addition, IPF cough rates were related to measures of physiological disease severity and compared to cough rates in health and other respiratory conditions.

Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma.

Trismus is a serious problem for some patients after oral and oropharyngeal cancer, and it has a detrimental impact on quality of life and function. We know of few published papers that include preoperative assessment in reports on the longitudinal outcomes of mouth opening after oral and oropharyngeal surgery. We prospectively measured mouth opening in patients who had primary surgery for oral and oropharyngeal cancer from baseline to six months to find out the characteristics at baseline and at discharge of those who develop trismus at six months.

The influence of growth hormone replacement on peripheral inflammatory and cardiovascular risk markers in adults with severe growth hormone deficiency.

Background: Adult GHD syndrome is associated with clustering of adverse cardiovascular (CV) risk factors such as abnormal body composition, dyslipidemia, insulin resistance and abnormal haemostatic factors. There is a wealth of evidence linking CV events with elevated levels of inflammatory markers (hs-CRP and IL-6) in the general population; however data on their abnormalities in GHD and specially the effects of GH replacement (GHR) on these inflammatory markers are limited.

Objective: To study the effects of GHR on inflammatory markers, glucose homeostasis and body composition in a cohort of adults with recently diagnosed severe GHD due to hypothalamic pituitary disease.

A systematic review of p53 as a prognostic factor of survival in squamous cell carcinoma of the four main anatomical subsites of the head and neck.

Objectives: To summarize existing evidence about whether the presence of mutant or upregulated p53 is a prognostic factor for patients presenting with squamous cell carcinoma arising from the larynx, oropharynx, hypopharynx, or oral cavity.

Method: Relevant articles were identified using strict criteria for systematic searches. Associations between mutant or upregulated p53 versus wild-type or low/undetectable p53 in relation to overall survival and DFS were summarized by extracting or deriving hazard ratio (HR) estimates.

'Honeycomb' tegmen: multiple tegmen defects associated with superior semicircular canal dehiscence.

Objective: To report the coexistence of multiple tegmen defects, forming a 'honeycomb' pattern, together with dehiscence of the superior semicircular canal.

Case Reports: We describe three cases in which the above findings were noted, and we review the relevant literature.

Conclusion: Superior semicircular canal dehiscence is defined as the absence of portions of bone over the canal along the floor of the middle fossa.

Screening for dysfunction to promote multidisciplinary intervention by using the University of Washington Quality of Life Questionnaire.

Objective: To investigate the potential of the University of Washington Quality of Life Questionnaire (UW-QOL) in routine clinics as a quick screening tool for possible dysfunction in patients after treatment of head and neck cancer.

Design: Retrospective analysis.

Setting: Regional Maxillofacial Unit, Aintree University Hospitals National Health Service Foundation Trust Liverpool, a National Health Service teaching hospital.

Skull base osteomyelitis after maxillectomy: a rare complication.

We report a case of skull base osteomyelitis that presented 4-8 weeks after a level 2 maxillectomy for a plexiform ameloblastoma of the right posterior maxilla. This is an extremely rare complication, and we know of no previously reported cases that developed after maxillectomy. We summarise the presentation, differential diagnosis and management.

Standardized antibacterial honey (Medihoney) with standard therapy in wound care: randomized clinical trial.

Aim: This paper is a report of a study to compare a medical grade honey with conventional treatments on the healing rates of wounds healing by secondary intention.

Background: There is an increasing body of evidence to support the use of honey to treat wounds, but there is a lack of robust randomized trials on which clinicians can base their clinical judgement.

Method: A sample of 105 patients were involved in a single centre, open-label randomized controlled trial in which patients received either a conventional wound dressing or honey.

Fine-needle aspiration cytology in a regional head and neck cancer center: comparison with a systematic review and meta-analysis.

Background: Fine-needle aspiration cytology (FNAC) is used to diagnose masses presenting in the head and neck region. No systematic review of FNAC in this group has yet been performed.

Methods: A systematic review of the published literature and meta-analysis of data extracted from the included studies were compared with a 10-year review of head and neck FNAC from our institution.

Changing trends in intracranial abscesses secondary to ear and sinus disease.

Objectives: To review the management, causative organisms, morbidity and mortality of intracranial abscesses secondary to sinus and ear disease.

Study Design And Setting: Retrospective, case note review of suppurative intracranial complications of ear and sinus disease in patients admitted to a regional neurosurgical centre between 1980 and 2004. These data were compared with published material from the same region from 1950-1979.

Blood pressure measurement.

Blood pressure measurement is an essential clinical skill for all nurses. However, if the procedure is not followed carefully there is potential for error that can adversely affect patient management. Nurses performing blood pressure measurement should be appropriately trained and updated on the procedure and the correct use of equipment.

Goldmann tonometer calibration: a national survey.

Introduction: Recent studies suggest that Goldmann tonometers can rapidly develop calibration errors (CEs) in clinical use and routine checks are necessary to ensure accuracy.

Purpose: To determine current practice regarding CE checks in the United Kingdom and assess the views of senior nursing staff in charge of running ophthalmology outpatient clinics as to whom they feel to be responsible for CE checks.

Methods: Every ophthalmology unit with training recognition in England, Northern Ireland, Scotland, and Wales was contacted.

Aerobic fitness and hand grip strength in Type 1 diabetes: relationship to glycaemic control and body composition.

Aim: To clarify the relationship of aerobic fitness and handgrip strength with glycaemic control (HbA1c), body composition and lipid profile in Type 1 diabetes.

Methods: Aerobic capacity (Chester Step Test), handgrip strength and body composition (bioelectrical impedance) were measured in 141 patients with Type 1 diabetes.

Results: Aerobic capacity correlated positively with HbA1c and lean body mass and negatively with body mass index and fat mass.

Tonometer disinfection practice in the United Kingdom: a national survey.

Purpose: To assess current tonometer disinfection practice in the UK, and compare with published recommendations.

Methods: Every ophthalmology unit with training recognition in the UK was contacted (n=155). A senior nurse at each institution completed a telephone questionnaire regarding local tonometer disinfection practice.

Corneal topographic features in a family with nanophthalmos.

Purpose: To characterize the corneal topographic features in a family with nanophthalmos.

Methods: Two observational case reports and a review of the literature. Corneal shape was analyzed using a topographic modeling system (TMS) and an Orbscan topographic system, with further analysis based on Fourier series and Zernicke polynomials.