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Data quality and documentation of variance are key for urodynamics studies to be valid, and symptoms must be reproduced to be able to make a diagnosis. Accurate reporting requires knowledge of pathophysiological parameters and the ability to detect artefacts. If inaccuracies are discovered, they should be corrected contemporaneously. Spurious and inaccurate observations are known as artefacts. The Oxford dictionary defines artefacts as something observed in a scientific investigation or experiment that is not naturally present but occurs as a result of the preparative or investigative procedure.’
This manual is a concise, straightforward guide for learning how to perform high-quality urodynamic investigations. Experienced editors and contributors provide easy-to-follow practical information on pre-test assessment of urodynamic function, how to set up urodynamic equipment, and how to perform individual urodynamic techniques, including cystometry, videocystourethrography and ambulatory monitoring. The book covers modern equipment and its use, and outlines the new national standards in urodynamics, allowing readers to check their knowledge and standard operating procedures are adequate. It also gives valuable information on how to set up and run a urodynamics service. With clear illustrations and clinical case studies woven into the text, this is a must-have resource to facilitate training in urodynamics. It is also a refresher of the standards and protocols required for good urodynamic practice for gynaecologists and continence nurses.
We sought to establish the impact on vaccine uptake of sending out a single appointment letter inviting patients to attend a vaccine clinic.
Coeliac disease is associated with splenic dysfunction and so patients with coeliac disease are at a higher risk of overwhelming infection. Additional vaccinations are recommended for these individuals to provide additional protection against infection.
We retrospectively identified 54 patients with diagnosed coeliac disease, and all vaccines previously received by these patients. By comparing this to the Green Book [Department of Health (2013) Immunisation of individuals with underlying medical conditions: the green book, chapter 7, London: Department of Health. Retrieved 26 February 2019 from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/566853/Green_Book_Chapter7.pdf], we determined the patients who were due vaccinations and the specific vaccines they were due. An invitation letter was then sent out to patients requiring further vaccinations and vaccine uptake for these patients was re-audited six months later.
Our results show a mild increase in the total uptake of vaccines six months after the letter was sent out, from 38.6% to 49.2%.
To recount experience with cerebrospinal fluid otorrhoea and temporal bone meningoencephalocele repair in a tertiary care hospital.
A retrospective review was conducted of 16 cerebrospinal fluid otorrhoea and meningoencephalic herniation patients managed surgically from 1991 to 2016.
Aetiology was: congenital (n = 3), post-traumatic (n = 2), spontaneous (n = 1) or post-mastoidectomy (n = 10). Surgical repair was undertaken by combined middle cranial fossa and transmastoid approach in 3 patients, transmastoid approach in 2, oval window plugging in 1, and subtotal petrosectomy with middle-ear obliteration in 10. All patients had successful long-term outcomes, except one, who experienced recurrence after primary stage oval window plugging, but has been recurrence-free after second-stage subtotal petrosectomy with middle-ear obliteration.
Dural injury or exposure in mastoidectomy may lead to cerebrospinal fluid otorrhoea or meningoencephalic herniation years later. Congenital, spontaneous and traumatic temporal bone defects may present similarly. Middle cranial fossa dural repair, transmastoid multilayer closure and subtotal petrosectomy with middle-ear obliteration were successful procedures. Subtotal petrosectomy with middle-ear obliteration offers advantages over middle cranial fossa dural repair alone; soft tissue closure is more robust and is preferred in situations where hearing preservation is not a priority.
The need for perineal repair after childbirth affects millions of women worldwide. In the United Kingdom, approximately 85% of women sustain some form of perineal trauma during vaginal delivery, and 69% of these will require stitches.
The need for perineal repair after childbirth affects millions of women worldwide. In the United Kingdom, approximately 85% of women sustain some form of perineal trauma during vaginal delivery, and 69% of these will require stitches. It is difficult to gauge the true prevalence of perineal trauma, owing to variation in obstetric practice globally. There is considerable variation in the reported national as well as international rates of obstetric anal sphincter injury (OASI). In the UK, the overall mean reported national rate of OASI is 2.9% (range 0–8%), and 6% (range 0–15%) of women having their first vaginal delivery will sustain an OASI. Similar variations in the incidence of OASIs have also been noted in the 22 Organisation for Economic Cooperation and Development (OECD) countries: 1.6% (range 1–3.7%) with normal vaginal deliveries and 6% (range 1–17%) with instrumental deliveries.
There is evidence that the OASI rate is rising globally, and in England the rate tripled from 1.8% to 5.9% between the years 2000 and 2012. This observation has raised concern, and it has been suggested that OASI rates should be a performance indicator and a measure of obstetric quality outcomes. The reason for this is that it has been shown in one study that a number of OASIs believed to be “occult” (only seen by endoanal ultrasound) were in fact clinically missed OASIs. While the rising OASI rate has been attributed to improvements in training and diagnosis, there is also emerging concern that there may be an element of overdiagnosis. Hands-on workshops using models, animal tissue, and audiovisual aids have been shown to be effective in improving knowledge, recognition of the full extent of the injury, better classification, and improvements in repair techniques.
Until recently, the concept of pelvic floor trauma was confined largely to perineal, vaginal, and anal sphincter injuries. However, in recent years, with advances in magnetic resonance imaging (MRI) and three-dimensional ultrasound, it has become evident that levator ani muscle (LAM) injuries form an important component of pelvic floor trauma. During vaginal delivery the LAM has to stretch up to 3.3 times its initial length to enable the fetus to pass through the pelvis.
Sinonasal undifferentiated carcinoma is a rare aggressive tumour arising from the Schneiderian epithelium lining the sinonasal tract. Although considered the cornerstone of therapy, surgical resection can only be performed in a limited number of patients. This report describes the experience of treating sinonasal undifferentiated carcinoma with a multimodality approach.
The treatment charts of sinonasal undifferentiated carcinoma patients treated at a tertiary care centre from 2004 to 2012 were retrospectively reviewed.
A total of 16 sinonasal undifferentiated carcinoma patients with a median age at diagnosis of 47.5 years (range 8–65 years) were included: 19 per cent had neck nodal metastasis at presentation. Four patients (25 per cent) underwent surgery: of these, two had post-operative radiotherapy, one had pre-operative radiotherapy and one had adjuvant chemotherapy alone. Six patients (38 per cent) received definitive radiotherapy: five had received neoadjuvant chemotherapy to reduce tumour size and help in radiotherapy planning, while four (25 per cent) received palliative radiotherapy. The median follow up was 10.4 months (range 1–42.5 months). The estimated median progression-free survival time was 29.3 months. One- and three-year progression-free survival rates were 77 per cent and 41 per cent, respectively.
Surgery is the best treatment option for sinonasal undifferentiated carcinoma, although most patients require post-operative radiotherapy for advanced disease and close tumour margins. Definitive radiotherapy with or without chemotherapy may be suitable for patients with inoperable locally advanced disease. Elective nodal irradiation to address the high nodal involvement rates should be considered to improve the survival rate.
Laboratory experiments indicate that changes in retinal image size result in adaptive recalibration or suppression of the vestibulo-ocular reflex. Myopia correction with spectacles or contact lenses also leads to retinal image size changes, and may bring about similar vestibulo-ocular reflex alterations.
A hypothesis-generating preliminary investigation was conducted. In this cross-sectional study, findings of electronystagmography including bithermal caloric testing were compared between 17 volunteer myopes using spectacles or contact lenses and 17 volunteer emmetropes (with no refractive error).
Bilateral hypoactive caloric responses were demonstrated in 6 of 11 spectacle users, in 1 of 6 contact lens users and in 1 of 17 emmetropes. Hypoactive caloric responses were significantly more likely in spectacle users than in emmetropes (p < 0.01; relative risk = 9.3).
A significant proportion of myopes using spectacles have vestibulo-ocular reflex suppression, as demonstrated by the caloric test. This has implications for the interpretation of electronystagmography and videonystagmography results, and highlights spectacle use as a possible cause of vestibular impairment. Further corroboration of these findings is warranted, with more precise and direct vestibulo-ocular reflex tests such as rotational tests and the head impulse test.
Archaeologists studying shell assemblages from prehistoric sites along the Pacific coast of North America have been interested in the influences of collecting intensity and environmental variability on California mussel (Mytilus californianus) size. To determine the variation in mussel size within a shell assemblage, researchers have developed a variety of proxies of mussel valve length based on measurements of morphological features occurring at or near the valve’s umbo. We propose four additional measurements that can serve as proxies and evaluate their correlation with valve length using regression analysis. Of the four, anterior adductor scar length has the strongest correlation, and we present two examples of its application. We also evaluate a popular visual technique based on a set of outline drawings of valves of varying lengths, and we found that it systematically underestimated valve length but could be useful under certain circumstances. We conclude that the selection of a particular proxy of mussel valve length depends on the nature of the mussel shell assemblage being studied and the research context.
To present the profile of patients undergoing surgical treatment for vertigo at a contemporary institutional vertigo clinic.
A retrospective analysis of clinical charts.
The charts of 1060 patients, referred to an institutional vertigo clinic from January 2003 to December 2012, were studied. The clinical profile and long-term outcomes of patients who underwent surgery were analysed.
Of 1060 patients, 12 (1.13 per cent) were managed surgically. Of these, disease-modifying surgical procedures included perilymphatic fistula repair (n = 7) and microvascular decompression of the vestibular nerve (n = 1). Labyrinth destructive procedures included transmastoid labyrinthectomy (n = 2) and labyrinthectomy with vestibular nerve section (n = 1). One patient with vestibular schwannoma underwent both a disease-modifying and destructive procedure (translabyrinthine excision). All patients achieved excellent vertigo control, classified as per the American Academy of Otolaryngology – Head and Neck Surgery 1995 criteria.
With the advent of intratympanic treatments, surgical treatments for vertigo have become further limited. However, surgery with directed intent, in select patients, can give excellent results.
Animate foreign bodies in the ear are frequent occurrences in otology practice. Such foreign bodies may lead to hazardous complications.
This paper describes a retrospective study of six patients with a recent history of an insect in the ear who presented with various complications following intervention received elsewhere.
An insect was retrieved from the external auditory canal in four cases and from the antrum in two cases. The patients presented with progressive otological complications: two patients who presented with orbital apex syndrome and cavernous sinus thrombosis succumbed to the disease; three patients suffered sensorineural hearing loss; and two patients had persistent facial palsy. One patient with sigmoid sinus thrombosis, who presented early, experienced complete recovery.
Insects in the ear can lead to hazardous complications. Animate foreign bodies should preferably be managed by a trained otologist, even in an emergency setting. Patients with delayed presentation and complications have a guarded prognosis.