Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy.

Background: Conventional treatment for painful peripheral diabetic neuropathy is largely symptomatic and often ineffective, with unacceptable side-effects. We tested electrical spinal-cord stimulation for the management of chronic neuropathic pain.

Methods: Ten diabetic patients who did not respond to conventional treatment (mean age 51 [SD 9.

A ventilation-exchange bougie for fibreoptic intubations with the laryngeal mask airway.

The ventilation-exchange bougie is a new airway device which can be mounted on a fibreoptic laryngoscope for passage through the larynx into the trachea via a laryngeal mask airway. Subsequent removal of the fibreoptic laryngoscope and laryngeal mask airway allows a tracheal tube to be railroaded into position over the ventilation-exchange bougie. This study described the use of this technique for elective tracheal intubation in two groups of 12 subjects in whom difficulty with intubation was not expected.

Menière's disease: evolution of a definition.

In 1861 Prosper Menière separated patients with episodic vertigo, hearing loss and tinnitus from a group previously described as having apoplectiform cerebral congestion. He suggested the cause was disease within the semicircular canals (Menière, 1861). Over the years it became apparent that within this group there were a number of patients with characteristic signs and symptoms and in 1938 a pathological correlate was found in the form of endolymphatic hydrops.

Prevalence and characteristics of brittle diabetes in Britain.

We investigated the prevalence and characteristics of 'brittle diabetes', defined as insulin-dependent diabetes mellitus associated with glycaemic instability of any type, leading to life disruption with recurrent and/or prolonged hospitalizations. A questionnaire was sent to all physicians and paediatricians running diabetic clinics in the UK, from lists held at the British Diabetic Association. A total of 414 brittle patients were reported (72% questionnaire return).

Gabapentin in generalized seizures.

The efficacy of gabapentin (Neurontin), in generalized seizures was evaluated in this 14 week, double-blind, placebo-controlled, parallel-group, add-on, multicenter study. A total of 129 patients with refractory generalized seizures were randomized to receive either placebo or 1200 mg/day gabapentin as add-on therapy. Patients received their standard regimens of antiepileptic drugs (AEDs) during a 12 week baseline period, and gabapentin or placebo was added-on in the subsequent 14 week evaluation period.

Postherpetic neuralgia and its treatment: a retrospective survey of 191 patients.

One hundred and ninety-one patients with postherpetic neuralgia (PHN) in whom treatment was begun 3 or more months after acute herpes zoster (HZ) were retrospectively considered. Relieved (> or = 75% fall in visual analogue score for worst pain within last 24 hr) and unrelieved groups were subdivided into those who had and those who had not received antiviral treatment for their acute shingles. More than 90% of all patients experienced allodynia with a clinically evident sensory deficit for temperature and/or pinprick sensation.

Aesthetic lip splits.

Both upper and lower lip splits, usually with osteotomy of the underlying jaw, improve access to the deep structures of the head and neck. A simple modification to the midline lip split is to incorporate a chevron in both the peri-oral skin and vermilion margin. The advantages are: accurate wound closure, no straight line contracture and a broken line of the peri-oral scar.

Hypogonadotrophic hypogonadism and primary amenorrhoea associated with increased melatonin secretion from a cystic pineal lesion.

A 17-year-old girl presented with primary amenorrhoea and failure to develop secondary sexual characteristics, although her height was above the 90th centile. Endocrine investigations revealed hypogonadotrophic hypogonadism (basal LH and FSH levels < 0.5 U/l; FSH rose to 2.

Otoplasty: the problem of the deep conchal bowl.

The correction of prominent ears requires a logical approach to address each of the anatomical defects present while bearing in mind the overall shape of the ear. The two most common problems encountered are the lack of an antihelix and a deep conchal bowl. We describe a method of reducing the depth of the conchal bowl which avoids some of the problems previously encountered such as occlusion of the external auditory meatus and visible irregularity on the external surface of the pinna.

Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect.

Background: A wide range of pedicled and free tissue transfer flaps have been described in the reconstruction of the complex maxillofacial defect, but no preferred reconstructive technique has so far emerged. The previous methods described may effectively close the oronasal fistula but reliable support for the cheek and orbit while providing a basis for an implant retained prosthesis is less likely to be achieved.

Methods: The methods of using the flap in low, high, and central maxillectomy defects as well as cases requiring orbital exenteration are described.

Aspiration pneumonia in a mentally handicapped patient due to a foreign body impacted in the pharynx: a near fatal outcome.

A case is reported of a mentally handicapped women with dysphagia caused by a foreign body impacted in the pharynx. The case illustrates a potential pitfall in the management of patients who are unable to communicate either verbally or in writing and who present with acute dysphagia.

Central pain: clinical and physiological characteristics.

Objectives: To study the clinical and pathophysiological features of central pain due to damage to the CNS.

Methods: 156 patients (mostly with ischaemic strokes, some with infarct after subarachnoid haemorrhage and other cerebral conditions; one with bulbar and others with spinal pathology) with central pain have been investigated clinically and varying numbers instrumentally with respect to quantitative somatosensory perception thresholds and autonomic function.

Results: Pain onset was immediate in a minority; and from a week or two up to six years in > 60%.

Functional endoscopic sinus surgery.

Functional endoscopic sinus surgery (FESS) is a minimally invasive dissection technique of in which the air cells and ostia of the paranasal sinuses are opened under direct vision via an endoscope. This article considers the relevant surgical anatomy, indications, techniques and potential complications of FESS.

Systemic effects of screening for retinopathy of prematurity.

Aims: To detect systemic complications of screening for retinopathy of prematurity (ROP), paying particular attention to the physical examination.

Methods: Oxygen saturation, pulse rate, and blood pressure were monitored before, during, and after 110 ROP screening examinations.

Results: Following topical mydriatics diastolic blood pressure was elevated by a mean of 6 (SD 7.

The development of healthcare services for diabetic prisoners.

The conditions experienced by people in custody in the UK have received considerable attention recently and there has been considerable debate concerning the standards of healthcare in British prisons. The Prison Health Care Service works under great pressure and difficulties and doctors have to deal with a large and ever-changing population, often with mental and physical disorders, who are frequently manipulative. This article highlights problems encountered in delivering diabetes care in prisons.

The development, reliability and validity of a disease specific quality of life model for adults with growth hormone deficiency.

Objective: Adults with GH deficiency frequently complain of lack of energy, fatigue, social isolation and problems with sexual relationships resulting in a low perceived quality of life. Previous studies of quality of life (QOL) in GH deficient adults have involved small numbers of patients and used measures not specifically designed for this patient population. We have devised a health related QOL model specifically designed for use in adults with GH deficiency and to assess the impact of future GH replacement therapy.

Clomiphene-induced pituitary apoplexy in a patient with acromegaly.

We describe the case of an acromegalic woman with primary infertility who was treated with clomiphene, and subsequently developed pituitary apoplexy.

Targeted screening for diabetes in community chiropody clinics.

Population screening for diabetes mellitus is of uncertain value. We therefore assessed the value of screening amongst community chiropody clinic attenders in Liverpool. All attenders aged between 40 and 75 years during a 3-month period were offered screening by urine glucose self-testing, 2 hours post-prandially, backed up with glucose tolerance tests (GTT) for positive respondents.

The maxillofacial surgeon and cranial base surgery.

The paper reviews the role of the maxillofacial surgeon, surgical approaches and osteotomies available to allow comprehensive access to cranial base tumours. Maxillo facial reconstruction using free vascularised flaps to rehabilitate the patients is highlighted. Such reconstruction may also require vascularised bone grafts.

A clinician friendly computerised head and neck oncology audit: the first year results.

Surgical audit is only as good as the information recorded and data entry is often onerous and the domain of the enthusiastic clinician or research follow. A head and neck oncology audit which incorporates a specific software program has been established in our department. The software interface increases the user friendliness of two conventional database systems, ACCESS and SUPERBASE and structures data input for the clinical situation.

A malignant pleural effusion infected with Salmonella enteritidis.

A patient is described with a unilateral pleural effusion persistently infected with Salmonella enteritidis. The infection was eventually eradicated with ciprofloxacin. A computed tomographic scan and mediastinal lymph node biopsy demonstrated an underlying small cell bronchogenic carcinoma.

Maxillofacial and associated injuries in severely traumatized patients: implications of a regional survey.

The aim of this paper was to study the incidence and causes of facial injuries occurring in conjunction with major trauma, and to examine the role of the maxillofacial surgeon in the management of severely injured patients. A prospective study was undertaken of 1088 patients seen in 16 hospitals over a 1-year period. A total of 161 (15%) patients sustained facial injuries.

Traumatic aneurysm of the maxillary artery: the role of interventional radiology. A report of two cases.

Two cases of post-traumatic aneurysm of the maxillary artery are described. The first patient was a 20-year-old man who sustained a Le Fort III type fracture in a road traffic accident. He experienced two episodes of significant maxillofacial haemorrhage, the first following admission and the second 5 days after initial reduction and fixation of his midfacial fractures.