Alessandro Panarese

Fine needle aspiration cytology of salivary gland lesions reported immediately in a head and neck clinic.

This paper describes the application of fine needle aspiration cytology (FNAC) performed on 92 patients with salivary gland lesions in a Head and Neck Surgery Clinic. The aspirates were immediately reported by a cytopathologist and the reports conveyed to the surgeon during the same clinic visit. FNAC results were then compared with histology in those patients who underwent surgery and with the clinical course of the disease at subsequent clinic visits in patients where surgery was not performed. The cytological diagnosis was incorrect in five cases, one of which was a false negative result. There were no false positive results. The sensitivity was 90.9 per cent and the specificity 100 per cent. This rapid report system of fine needle aspiration cytology has been found to be safe, free of complications, and helpful in the planning of treatment.

Conservative management of sporadic unilateral acoustic neuromas.

Our objective was to review retrospectively patients with a unilateral acoustic neuroma managed by observation. One hundred patients with tumours (<24 mm) were followed a median 25.5 months. Thirty-six acoustic neuromas grew with four growth patterns. No factors were associated with growth. Eighty percent of growing tumours grew in the first year. Eleven patients proceeded to surgery. Twenty-two patients were eligible for hearing preservation surgery; five of the 15 available for analysis subsequently lost eligibility. In conclusion, selected patients can be safely observed with serial imaging and follow up. Size increase in the first year may predict future growth. Delaying surgery until required by symptoms or tumour growth does not result in more morbidity for the patient. Some may lose the opportunity for hearing preservation surgery but operating on all would result in more sustaining a loss of hearing in the first few years after diagnosis.

Renal carcinoma metastasis: an unusual cerebellopontine angle tumor.

Of all intracranial tumors, 8% to 10% arise in the cerebellopontine angle. The majority of these tumors are vestibular schwannomas, followed by meningiomas, primary choleasteatomas, and facial nerve schwannomas. Metastatic lesions to the cerebellopontine angle are rare (0.2% of all lesions)1 and are known to arise from primary neoplasms of lung, breast, prostate, nasopharynx, and oropharynx and cutaneous melanoma.2 In the literature only one case arising from the kidney has been previously reported, and in this, there was gross involvement of the temporal bone as well.3 We describe a case of renal carcinoma metastatic to the cerebellopontine angle. Clinical presentation and diagnostic problems are discussed.

A simple and reliable predictor for an adequate laryngeal view with rigid endoscopic laryngoscopy

OBJECTIVES: It is sometimes impossible to obtain an adequate laryngeal view during rigid endoscopic laryngoscopy. This may be due to a high tongue base. Our study seeks to determine a correlation between tongue base level and the adequacy of laryngeal view obtained with a 70-degree rigid endoscope. STUDY DESIGN AND SETTING: Over a period of 4 months, patients from a voice clinic were gathered and categorized into class I to III according to Mallampati et al (1985). Rigid laryngo-videostroboscopy was conducted to assess the larynx and the adequacy of the view was recorded. RESULTS: 74 patients were recruited. The number of adequate views were: class I = 18/20 (90%); class II = 20/33 (60.6%); class III = 7/21 (33.3%). χ2 analysis demonstrated significance trend in all 3 classes. CONCLUSION: The level of the tongue base correlated well with the adequacy of laryngeal view obtained from a 70-degree rigid endoscope. This can be used to predict the success of obtaining adequate views during rigid laryngoscopy.

The efficacy of fruit juices in disimpacting meat bolus obstruction

Problem: Impacted meat bolus in the oesophagus carries an increased risk of morbidity and mortality if it requires retrieval by endoscopic procedures. Certain naturally occurring fruit juices and Coke have been implicated to dissolve meat boluses but without conclusive evidence. This study aimed to ascertain the efficacy of various fruit juices and Coke in dissolving and dislodging meat boluses in vitro. Methods: Eighty 10 mL syringes were modified by removing the tapered ends and pistons. Boiled chicken meat was tightly packed between the 8 mL and 10 mL markers of each syringe. Syringes were positioned vertically with the 10 mL marker above. Two mL each of 8 reagents (fresh pineapple juice (FPJ), frozen-thawed fresh (FTPJ), fresh kiwi juice (FKJ), commercially pasteurized pineapple juice, fresh papaya juice, fresh lemon juice, Coke, and saliva) were poured over the bolus of each syringe, thus dividing them equally into 8 separate groups (n = 10 in each group). Bolus movements were observed over a 23-hour period at 37°C ambient temperature. Movements were noted by recording the upper border of the meat bolus periodically in arbitrary syringe units. Results: At 4 hours and 30 minutes, mean movements (99% CI) for the FPJ, FTPJ, FKJ groups were 3.4 (1.2–5.6), 4.5 (0.9–8.0), and 3.9 (1.1–6.8), respectively. At 23 hours, they were 1.3 (0.6–2.1), 0.3 (0–1.1), and 0.9 (0.5–2.3), with the saliva group (control) being 9.5 (8.9–10.1). The differences in the mean bolus movement between FPJ, FTPJ, FKJ, and saliva were 8.15 (7.1–9.2), 9.15 (8.1–10.2), and 8.55 (7–10.1), respectively. Mann-Whitney U test showed P < 0.001 for all 3 groups. The papaya and Coke groups showed some bolus movement but did not reach statistically significant levels. Conclusion: Fresh pineapple and kiwi fruit juices, which contain proteolytic enzymes bromelain and actinidin respectively, appeared to dissolve chicken boluses effectively. The freezing process for 24 hours preserved Bromelain activity. Significance: Natural pineapple and kiwi fruit juices may be used to disimpact chicken bolus obstruction prior to endoscopic procedures. Support: We wish to thank Mr Bijoux and his team of microbiologist technicians at the Department of Medical Microbiology, Duncan Building 8th floor, University of Liverpool, UK, for their support.

A current survey on the use of intranasal splints among uk consultants

Objectives: A survey 12 years ago revealed that 64% of UK consultants routinely use intranasal splints primarily to prevent postoperative adhesions. There is increasing evidence that routine intranasal splints does not reduce postoperative intranasal adhesion rates and instead may increase patient morbidity. We conduct a similar survey to assess the current practice amongst UK consultants with regards to the application of splints. Methods: Postal questionnaires were sent out randomly to UK consultants asking about their usage of postoperative intranasal splints. The questions included the frequencies of splint usage in various intranasal operations, indications and types of splint used, and how long they were used for. Results: A total of 135 (68%) questionnaires were returned. Only 123 (62%) were completed and analyzed. Majority (72%) felt that the main indication of the splints was prevention of reformation of adhesions in patients who required adhesion division. Almost 70% of consultants performing division of adhesions would routinely apply splints. Although overall 80% rarely or never use intranasal splints, nearly half (48%) still believe that splints could prevent postoperative adhesions. An average 26% routinely use splints for operations involving both the septum and lateral wall of nasal cavity (eg, septoplasty+submucous resection). The most common splints used are flat silicone rubber (69%). Most would leave the splints intranasally for 1–2 weeks; 71% advocate saline nasal douching. Conclusion: The current practice among UK consultants regarding intranasal splint application appears to be leaning toward evidence-based practice.