Titanium prosthesis with malleus notch: a study of its 'user-friendliness'.

'User-friendliness' is an important factor in the choice of ossicular prosthesis. The current titanium prostheses have a flat, open head plate and are designed to sit under the tympanic membrane. Previously, the author had designed titanium prostheses with a malleus notch extension at the head plate.

Neurofibroma of the pinna.

Neurofibromas are relatively common lesions of the nervous system, but only a few cases involving the pinna have been reported. The emphasis in most of these reports was on the cosmetic deformity; functional impairment in the form of hearing loss has been mentioned in only a few reports. We report a case of pinnal neurofibroma in which the primary complaint was otitis externa; hearing loss and cosmetic deformity were also present.

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

Objective: To identify the 'stapedotomy' learning curve of 2 UK otolaryngologists.

Study Design: A retrospective review of the outcome of the first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by UK otolaryngologists.

A prospective multicentre otology database.

Unlabelled: WHY IS AN INTERNATIONAL OTOLOGY DATABASE IMPORTANT? There are many reports on the outcome of otological interventions in the literature. However, it is difficult to make direct comparisons between these reports because of the lack of uniformity in reporting outcomes and patient selection. The aim is to create an interactive otology database for surgeons in the UK and Europe.

How we do it: the viability of free mucosal grafts on exposed bone in lacrimal surgery - a prospective study.

To ascertain viability of free mucosal of grafts on bare bone and degree of contracture in vivo. Prospective study to ascertain graft survival where a small piece of mucosa, with a single centrally placed prolene suture for future identification, removed during endoscopic dacrocystorhinostomy (DCR) was replaced to cover exposed bone at the end of the procedure. The presence of the graft and the degree of contracture was assessed endoscopically in outpatients at the second and fourth weeks.

Impact of delay on survival in patients with ruptured abdominal aortic aneurysm.

Rupture of the abdominal aortic aneurysm (RAAA) is a common surgical emergency. Surgical treatment of this condition carries a high morbidity and mortality rate. For successful outcome, an early diagnosis and prompt treatment are essential.

Long-term results in ossiculoplasty: an analysis of prognostic factors.

Objectives: The aim of the present study is to examine the prognostic factors based on 6-month and 5-year results of ossiculoplasty.

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

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.

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.

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.

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.

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.

Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT.

Pancreatic adenocarcinoma is the fourth most frequent cause of cancer-related death. The incidence is increasing and the overall survival has altered little in recent years. Moreover, patients usually present late with inoperable disease and curative resection by standard pancreatico-duodenectomy (Whipple's procedure) is associated with significant morbidity.

Successful treatment of chronic anal fissure with diltiazem gel.

OBJECTIVE: Diltiazem is a calcium channel blocker that has shown potential to heal chronic anal fissures. We have prospectively evaluated the treatment of patients with anal fissure with diltiazem gel (SLA Pharma, UK). PATIENTS AND METHODS: All patients with chronic anal fissure from September 1999 to May 2000 were treated topically with 8 mg 2% diltiazem hydrochloride gel (equivalent to 2 cm of gel supplied by SLA Pharma) three times daily.

Ipswich lacrimal tube: pedicle nasal septal tube for the reconstruction of lacrimal drainage passage.

Canalicular blockage of the lacrimal system still remains a major challenge for oculoplastic surgeons. The conventional treatment of conjunctival dacryocystorhinostomy using the Lester Jones bypass tube is often associated with tube migration and foreign body reaction. The authors report a new technique to reconstruct the lacrimal passage on a single patient with severe canalicular obstruction following repeated failures from previous Lester Jones tube operations.

Orthopaedic Specialist Registrar training and attitudes to spine surgery in the United Kingdom: reasons for poor recruitment and suggestions for improvement.

In order to improve the provision of spinal surgery in the United Kingdom, the number of Specialist Spinal Surgeons and Surgeons with an Interest in Spinal Surgery needs to increase by 25% from the existing 175 surgeons. A survey of Specialist Orthopaedic Registrars was performed, which quantifies the predicted shortfall in the number intending to practise spinal surgery. The attitudes towards and perceptions of this field were obtained to identify factors that could be discouraging an interest in spine surgery.

Nasal polyposis in children with cystic fibrosis: a long-term follow-up study.

The incidence of nasal polyposis among children 5 to 18 years of age with cystic fibrosis (CF) was investigated with a systematic examination of all children on the local CF register. Out of 23 children with CF, 13 had endoscopic evidence of nasal polyposis. Four children had grade 2 polyposis, and 9 children had grade 3 polyposis.

Delayed hypersensitivity reaction to topical aminoglycosides in patients undergoing middle ear surgery.

Repeated exposure to a topical aminoglycoside in patients with ear discharge can induce a delayed hypersensitivity reaction eventually. A postal survey conducted by the authors showed that 75% of UK otolaryngologists routinely prescribe topical aminoglycosides to their patients following ear surgery. This is a prospective study on the result of skin patch testing on 119 patients with chronic otitis media and 30 patients with otosclerosis who were scheduled for otosurgery.

A study of the intra-operative effect of the Argon and KTP laser in stapes surgery.

The intraoperative effect of the Argon and KTP laser was studied on 20 patients who had primary stapes surgery under local anaesthetic; 10 had Argon and 10 had KTP laser stapedotomy. Symptoms of inner ear disturbance such as dizziness and tinnitus were systematically recorded during the laser procedure. Both dizziness and tinnitus were relatively uncommon when the laser was used on the promontory.

A comparison of the user-friendliness of hydroxyapatite and titanium ossicular prostheses.

Both hydroxyapatite (Ha) and titanium (Ti) are well-accepted alloplastic materials for ossicular prostheses. Many different designs of Ha and Ti prostheses are presently available. Fourteen surgeons of different seniority and surgical experience were asked to 'test-drive' four different types of ossicular prostheses in cadaveric temporal bones to investigate the user-friendliness of these protheses.

Adult-onset otitis media with effusion: results following ventilation tube insertion.

The outcome of otitis media with effusion (OME) in children is generally good. However, it is less clear in adults. All adult patients who had a ventilation tube inserted for OME at the Ipswich Hospital between 1996 and 1997 were studied.