The facial skin lesions "see and treat" clinic: A prospective study.

Facial lesions are commonly referred to ear, nose and throat surgeons. Almost all are amenable to excision under local anaesthetic as a day case. However, in the UK, there is still a significant delay between referral by the general practitioner (GP) and final surgery.

Sonographic diagnosis of toddler's fracture in the emergency department.

We describe 3 cases of toddler's fracture of the tibia that were diagnosed via sonographic examination. In cases, initial radiographs did not show the fracture, whereas sonographic examination revealed a layer of low reflectivity superficial to the tibial cortex and an elevated periosteum, suggesting a fracture hematoma. The diagnosis was confirmed at 2-3 weeks with radiographs demonstrating periosteal reaction.

The learning curve in stapes surgery and its implication to training.

Objective: To identify the stapedotomy learning curve of two U.K. otolaryngologists.

Long-term results of ossiculoplasty: reasons for surgical failure.

Objectives: To present the value of a dedicated ear audit clinic, the overall long-term results of ossiculoplasty, and the reasons for surgical failure.

Study Design: Retrospective analysis was performed on ossiculoplasty cases in a county hospital. The information was extracted from a computer database.

Is routine biopsy of the lacrimal sac wall indicated at dacryocystorhinostomy? A prospective study and literature review.

Objective: To determine whether routine biopsy of the lacrimal sac wall at dacryocystorhinostomy (DCR) is indicated.

Methods: A prospective study and literature review. In 193 consecutive endoscopic DCRs performed on 164 patients (108 females and 56 males) part of the medial wall of the lacrimal sac was sent for histological examination.

An international otology database.

There are many reports in the literature on the outcome of ear surgery. However, it is difficult to make comparisons from these reports because of a lack of uniformity in the way in which outcomes are reported. At the same time, the general public expects doctors to provide them with information regarding the benefits and risks of surgery.

Micro-pigmentation: implications for patients and professionals.

In the UK, reconstructive breast surgery is routinely offered to patients undergoing surgery for breast cancer. The results can be excellent, but without a nipple-areola complex the patient can feel incomplete. In response to patient need, an innovative nurse-led micro-pigmentation service has been developed in the authors' NHS trust, which provides women (and men) an opportunity to complete their reconstruction process.

Epidemiology of systemic vasculitis.

The systemic vasculitides are heterogeneous conditions of unknown etiology characterized by inflammation and necrosis of different sized blood vessels. Wegener's Granulomatosis, microscopic polyangiitis, and Churg Strauss syndrome are associated with anti-neutrophil cytoplasmic antibodies and affect small and medium blood vessels. They are very rare in childhood and peak in the 65 to 70 year old age group.

Home blood transfusion: a necessary service development.

An alternative to the transfusion of blood and platelets in hospital was assessed with the aim of reducing the demand on acute services and the need for hospital admission. Patients and general practitioners [GPs] were surveyed before a home blood transfusion service was set up. The majority of GPs and patients did not support the scheme initially.

Effects of dose titration on tolerability and efficacy of interferon beta-1b in people with multiple sclerosis.

Multiple sclerosis (MS) treatment with interferon beta is associated with well-known, easily managed adverse events, including influenza-like symptoms and injection-site reactions that decline over time. Initial dose titration has been shown to be one way of limiting these adverse events. Hence, a placebo-controlled, multicentre study of 98 patients was set up to explore whether a slower, four-stage, 4-week titration to a final dose of 250 microg subcutaneous interferon beta-1b might improve tolerability over a more rapid two-stage, 2-week titration in patients with relapsing-remitting MS.

Sustained silver-releasing dressing in the treatment of diabetic foot ulcers.

This study investigated the clinical performance and safety of a sustained silver-releasing foam dressing, Contreet Foam, in the treatment of diabetic foot ulcers. Twenty-seven patients with diabetic foot ulcers of grade I or II (Wagner's classification) were followed for six weeks: one week run-in using Biatain dressings, four weeks' treatment with Contreet dressings. Four ulcers healed during the four-week treatment with Contreet 56% in average.

Non-invasive ventilation for acute respiratory failure.

Non-invasive ventilation has become an increasingly utilised tool for the treatment of acute respiratory failure. Potential benefits include a decreased incidence of intubation, duration of hospital stay and mortality. Non-invasive ventilation is also being used more and more outside the intensive care environment.

The LDIflare: a novel test of C-fiber function demonstrates early neuropathy in type 2 diabetes.

Objective: The aim of this study was to evaluate a novel method for assessing the axon reflex and to determine its value in detecting neuropathy in type 2 diabetes.

Research Design And Methods: The neurogenic flare response to nociceptive stimuli is mediated by an axon reflex involving small unmyelinated C-fibers. We developed a method to assess this reflex involving skin heating to 44 degrees C to evoke the flare followed by scanning the site using a laser Doppler imager (LDI) to measure the area; we termed this method LDIflare.

The Yung percutaneous mastoid vent: results of a multicenter trial.

Objective: The primary goal of the study was to find out whether the Yung vent would remain patent long-term. The secondary goal was to find out whether mastoid ventilation could overcome permanent ventilation disorder within the middle ear.

Study Design: The study was an open prospective investigation.

Narratives of therapeutic touch.

This article aims to increase the understanding of therapeutic touch (TT) and its role in supporting patients with cancer through the different stages of illness. The article includes a number of narratives, collected during an audit and written by patients, to illustrate the use of TT in helping them to cope with the emotional experiences associated with diagnosis and subsequent treatment.

Comparative roles of microvascular and nerve function in foot ulceration in type 2 diabetes.

Objective: To determine the relative roles of different modalities of sensory nerve function (large and small fiber) and the role of microvascular dysfunction in foot ulceration in type 2 diabetic subjects.

Research Design And Methods: A total of 20 control subjects and 18 type 2 diabetic subjects with foot ulceration and 20 without were studied. None of the subjects had clinical features of peripheral vascular disease.

Nurse prescribing: current status and future developments.

The recent government proposal to add another 60 drugs to the nurse prescribers' formulary is yet another change in the fast developing area of nurse prescribing. Prescribing offers nurses the chance to improve the care that they deliver to their patients. It also provides opportunities for collaborative work in driving the national directives forward, resulting in new roles for nurses.

Rheumatoid vasculitis: becoming extinct?

Background: Systemic rheumatoid vasculitis (SRV) is a relatively rare complication of RA. The incidence of SRV appeared to increase during the 1970s and 1980s from 6.0 to 12.

Concomitant nasal procedures in endoscopic dacryocystorhinostomy.

Dacryocystorhinostomy (DCR) is the preferred treatment for lacrimal duct blockage. Endoscopic DCR has been practised increasingly in recent years as it avoids a facial scar and can be performed as a day procedure. Recent improvements in endonasal surgical technique led to success rates of up to 90 per cent.

A double-blind study comparing 0.5% and 1% tropicamide for annual retinal screening in diabetic adolescents.

Aims: To determine whether there is any difference between 0.5% and 1% tropicamide in ocular discomfort and mydriatic efficacy in adolescents with Type 1 diabetes.

Methods: In a double-blind study, one drop of 0.

Atopic dermatitis and the hygiene hypothesis: a case-control study.

Background: The notion that lack of exposure to infection in early life leads to development of atopic disease has come to be known as the hygiene hypothesis. It has arisen from observations of the rapidly rising prevalence of atopic diseases in recent decades and the lower prevalence of atopy with rising birth order. Direct evidence for the hypothesis to date is inconsistent.

Practical experience with intensity-modulated radiotherapy.

At the Ipswich Hospital implementation of intensity-modulated radiotherapy (IMRT) commenced in February 2001 based on an established 3D conformal radiotherapy (3D CRT) service. This paper describes our experiences as we commissioned a fully-integrated IMRT planning and delivery system, and established IMRT within the department. Commissioning measurements incorporated a series of tests to ensure the integrity of the system and form the basis of routine quality assurance (QA) procedures.

Mastoid obliteration with hydroxyapatite cement: the Ipswich experience.

Objective: This article reports the outcomes of a series of patients who underwent obliteration of the mastoid cavity using hydroxyapatite cement. A comparison is made with a group of patients who underwent similar surgery in the same period using hydroxyapatite granules.

Study Design: Nonrandomized observational analysis.