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This paper discusses three cases of tracheal agenesis that presented within a six-week period to the Norfolk and Norwich University Hospital. By reviewing the available literature on tracheal agenesis, the report aims to outline a protocol for future prenatal and postnatal management.
A case series and a literature review.
Three cases of tracheal agenesis presented in the classical manner, with respiratory distress and unsuccessful intubation following delivery. A literature review confirmed that prenatal diagnosis requires future innovation; survival is rare and is predominately reliant on intubation of the oesophagus when a patent tracheoesophageal fistula is present. In most cases, tracheal agenesis represents part of the ‘VATER’ association: vertebral defects, anal atresia, tracheoesophageal fistula with oesophageal atresia, and radial or renal dysplasia. Complex, multiple-stage surgical procedures have been described; however, no survival to adolescence is documented.
There is a call for improved prenatal diagnosis to allow both adequate counselling of parents and preparation for multi-specialty management at delivery. In addition, these cases highlight the ongoing need for improved congenital anomaly data within the UK, with currently only 49 per cent of England's births being registered.
There are many reports of operations performed to successfully close ear drum perforations. Hearing deterioration after myringoplasty is not a widely published topic. This paper presents an audit of this complication.
A six-year retrospective analysis of a series of myringoplasty operations was performed using electronic patient records. Patients with post-operative hearing loss were identified and those with hearing loss greater than 10 dB were further scrutinised.
Out of 187 patients who underwent myringoplasty procedures, 44 (23.53 per cent) experienced a reduction in hearing thresholds. In seven cases (3.74 per cent), the hearing loss was greater than 10 dB. A case note review revealed no obvious predictive factors, although posterior perforations and the possibility of ossicular chain manipulation were considered.
Hearing loss following myringoplasty is not rare, and this may alter the consent process for this procedure.
Synonymous with finely crafted wood engravings of the natural world, Thomas Bewick (1753–1828) perfected an instantly recognisable style which was to influence book illustration well into the nineteenth century. Begun in November 1822, at the behest of his daughter Jane, and completed in 1828, Bewick's autobiography was first published in 1862. The opening chapters recall vividly his early life on Tyneside, his interest in the natural world, his passion for drawing, and his apprenticeship with engraver Ralph Beilby in Newcastle, where he would learn his trade and then work in fruitful partnership for twenty years. Later passages in the work reveal Bewick's strongly held views on religion, politics and nature. The work also features illustrations for a proposed work on British fish. Bewick's General History of Quadrupeds (1790) and History of British Birds (1797–1804), the works which secured his high reputation, are also reissued in this series.