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Vitamin C deficiency has been a historical disease rarely seen nowadays. We illustrate a case of a boy with autism presenting with severe pulmonary hypertension and refusal to walk secondary to vitamin C deficiency. Initiating treatment with high-dose vitamin C reversed his symptoms and he regained full power of his lower limbs with total normalisation of his pulmonary pressures.
Curcuma cinnabarina and C. eburnea (Curcuma subg. Ecomatae, Zingiberaceae), two new species from Thailand, are described and illustrated here. They are compared with the morphologically closest species Curcuma rubrobracteata and C. pierreana, respectively. Detailed descriptions, colour plates, and information on their distribution, ecology, phenology and uses are also provided. Preliminary IUCN conservation assessments of these species are proposed.
This chapter provides a discussion of multicultural issues in clinical psychological assessment. The first two sections discuss best practice–related issues in assessment in relation to (1) clinical diagnosis and (2) psychological testing and assessment. For example, in terms of clinical diagnosis, the Cultural Formulation approach in DSM-5 represents the current major framework for conducting diagnosis with culturally diverse patients. At the same time, we also highlight the importance of cultural threats to validity. In the third and final section, we discuss the remaining challenges and the future directions related to multicultural issues in clinical psychological assessment. These challenges include the evaluation of cultural validity and measurement invariance of our psychological tests and measures. Future directions for the field involve achieving greater representation and generalizability in light of the WEIRD sample bias, that is, most of the psychological research has been conducted in Western Industrialized Rich Democracies.
Curcuma prasina (Zingiberaceae), a stenoendemic species from Thailand, is described and illustrated here. It differs from other similar species in Curcuma subgenus Hitcheniopsis in Thailand in its inflorescences composed of fertile green bracts only (lacking any white coma bracts), purple staminodes, and purple labellum with a bright yellow centre extending from the base to about two-thirds of the labellum towards the apex.
Regression discontinuity (RD) designs enable researchers to estimate causal effects using observational data. These causal effects are identified at the point of discontinuity that distinguishes those observations that do or do not receive the treatment. One challenge in applying RD in practice is that data may be sparse in the immediate vicinity of the discontinuity. Expanding the analysis to observations outside this immediate vicinity may improve the statistical precision with which treatment effects are estimated, but including more distant observations also increases the risk of bias. Model specification is another source of uncertainty; as the bandwidth around the cutoff point expands, linear approximations may break down, requiring more flexible functional forms. Using data from a large randomized experiment conducted by Gerber, Green, and Larimer (2008), this study attempts to recover an experimental benchmark using RD and assesses the uncertainty introduced by various aspects of model and bandwidth selection. More generally, we demonstrate how experimental benchmarks can be used to gauge and improve the reliability of RD analyses.
This report discusses the approach to teaching undergraduate radiation therapy students in New Zealand using the Virtual Environment for the Radiotherapy Training (VERT) system. In conjunction with VERT being used to teach clinical skills, integration of conceptual knowledge occurs across all 3 years of the programme; this report gives examples of how this is achieved in practice.
Obstructive sleep apnoea syndrome has been linked to obesity, nasal obstruction and adenotonsillar hypertrophy, but rarely to large thyroid goitres.
To study the possible association between multinodular retrolaryngo-pharyngeal or retrosternal goitres and obstructive sleep apnoea syndrome.
Subjects and methods:
Retrospective case series at a tertiary referral centre (2000–2010). Study parameters included body mass index, Epworth sleep score and polysomnographic index.
Five patients were diagnosed with obstructive sleep apnoea syndrome and managed with nasal continuous positive airway pressure ventilation. Computed tomography showed a retrolaryngo-pharyngeal or retrosternal goitre with significant tracheal compression, displacement and laryngeal oedema. After total thyroidectomy, obstructive sleep apnoea resolved in all patients.
Large, multinodular goitres with retrolaryngo-pharyngeal extension can cause obstructive sleep apnoea syndrome due to laryngeal compression and oedema. In such cases, total thyroidectomy enables resolution of symptoms. Patients with obstructive sleep apnoea syndrome should be screened for thyroid goitre.
A new plasma deposition system was built with the capability of varying the electrode spacing in the DC Saddle Field plasma enhanced chemical vapor deposition system. An ion mass spectrometer was installed just below the substrate holder to sample the ion species travelling towards the substrate. Silane plasma and amorphous silicon film studies were conducted to shed light on the impinging ion species, ion energy distributions, and film properties with varying electrode spacing. The results indicate that decreasing the distance between the substrate and cathode leads to a reduction in the high energy ion bombardment.
Tritiated amorphous and crystalline silicon is prepared by exposing silicon samples to tritium gas (T2) at various pressures and temperatures. Total tritium content and tritium concentration depth profiles in the tritiated samples are obtained using thermal effusion and Secondary Ion Mass Spectroscopy (SIMS) measurements. The results indicate that tritium incorporation is a function of the material microstructure rather than the tritium exposure condition. The highest tritium concentration attained in the amorphous silicon is about 20 at.% on average with a penetration depth of about 50 nm. In contrast, the tritium occluded in the c-Si is about 4 at.% with a penetration depth of about 10 nm. The tritium concentration observed in a-Si:H and c-Si is higher than reported results from post-hydrogenation experiments. The beta irradiation appears to catalyze the tritiation process and enhance the tritium dissolution in silicon material.
Laryngopharyngeal reflux is perhaps the most extensively researched laryngology topic of the last decade. It has been suggested that some supraoesophageal symptoms, most notably asthma and laryngospasm, may be associated with night-time, or supine, reflux. The aim of this review was to assess the levels of evidence regarding a correlation between night-time reflux, snoring and apnoea.
A Medline search was performed using the terms ‘reflux’, ‘night-time’, ‘larynx’, ‘gastroesophageal’, ‘laryngopharyngeal’, ‘sleep’, ‘apnoea’, ‘snoring’ and ‘ear nose throat’. The retrieved literature was reviewed, focusing on randomised and non-randomised, controlled, prospective trials. Papers on both paediatric and adult populations were included. Non-English language papers were excluded.
We found no randomised, controlled trials or meta-analyses addressing the possible correlation between reflux and snoring and/or apnoea.
The role of night-time reflux in paediatric and adult snoring and apnoea is well described in the literature, but is based on poor levels of evidence from uncontrolled studies and case reports.
Inverted nasal papilloma is a benign tumour with variable biological behaviour. It is a unique neoplasm and is often difficult to manage, being characterised by a tendency to recur following excision, an association with malignancy and an ability to destroy bone. Radiological diagnosis has traditionally been based on computed tomography, but it is often impossible to differentiate between polyps with entrapped debris and inverted nasal papilloma. Magnetic resonance imaging, especially T2-weighted images, is perhaps a better tool in differentiating inverted nasal papilloma from other nasal lesions, and has recently been advocated as the imaging modality of choice.
To review the evidence on the ideal imaging modality for pre-operative planning of surgery for patients with histologically proven inverted nasal papilloma.
Materials and methods:
A systematic review of studies was undertaken, focusing on radiological assessment of inverted nasal papilloma (primary and recurrent). All English language articles were potentially included in the review. However, we excluded single case reports, case series, pictorial essays, ‘teaching’ reviews and reviews of inverted nasal papilloma not focusing on pre-operative imaging.
Sixteen studies were identified based on our search strategy. Only 10 fulfilled our criteria. Computed tomography scanning was the standard imaging modality of choice for assessing sinus involvement of inverted papilloma and for planning the extent of surgery. T2-weighted magnetic resonance imaging scans were able to distinguish tumour (intermediate signal) from inflammatory tissues (bright signal), but not post-operative scarring from recurrent tumour. No studies were found which compared the specificity and sensitivity of magnetic resonance imaging and computed tomography in the accurate pre-operative identification of the extent of inverted papilloma.
There is currently not enough evidence to suggest one sole modality as providing optimum imaging for inverted nasal papilloma. Computed tomography remains the imaging modality of first choice for inverted nasal papilloma, despite certain disadvantages. Magnetic resonance imaging is able to distinguish tumour from inflammation and is advocated as a better tool for recurrent tumour, but bone destruction of sinus walls is less easy to recognise, compared with computed tomography. Evaluation of sinus tumours usually involves both imaging modalities, and inverted nasal papilloma should be included within this pathological group. The cohort of patients is usually small, so cost-effectiveness should not generally be an issue when considering whether to use computed tomography, magnetic resonance imaging or both. A well structured, prospective study is needed to evaluate the efficacy of magnetic resonance imaging versus computed tomography for pre-operative planning of histologically proven inverted nasal papilloma.
The aim of this paper is to describe a novel technique of improving the nasal airflow in patients in whom, despite reduction surgery to the inferior turbinates (either alone or with septal surgery), the nasal airways remain compromised because of obstruction occurring anterior to the inferior turbinate, due to a prominent nasal process of the maxilla at the pyriform aperture.
We describe a novel approach to resection of the nasal process of the maxilla, a technique performed in 40 patients with either: residual obstructive symptoms following septal surgery with or without turbinate surgery; and significant inspiratory alar collapse. The same technique was also used in two patients to improve the intranasal approach to the medial and anterior maxilla during endoscopic medial maxillectomy for recurrent inverted papilloma.
Patients reported a subjective improvement in their nasal airways, with resolution of inspiratory alar collapse. This technique significantly improved intranasal access in the two patients with inverted papilloma.
This technique confers significant subjective improvement of nasal airways patency in selected patients, and improves endoscopic surgical access to clear inverted papilloma.
To demonstrate the importance of a detailed history when assessing patients with a repeated pattern of foreign body ingestion.
A 19-year-old woman presented to our department following accidental ingestion of a teaspoon. On further questioning, she admitted to a habit of binge-eating followed by self-induced vomiting, in order to avoid weight gain; she blamed this behaviour on a stressful relationship with her partner. She also had one previous episode of accidental ingestion of a plastic spoon, which had been removed by oesophagogastroduodenoscopy. The patient underwent an uneventful rigid oesophagoscopy and foreign body removal. During post-operative recovery, she admitted that she had suffered for years with bulimia and anorexia nervosa. She was discharged home after appropriate psychiatric counselling, and follow up was arranged.
Oesophageal foreign bodies are commonly encountered in otolaryngology practice. Such circumstances are often compounded by pre-existing psychiatric problems such as bulimia and/or anorexia nervosa. Patients with bulimia may often present with a very similar pattern of multiple episodes of ingestion of large foreign bodies. Identification of this eating disorder (especially when there is a recurrent history of large, accidentally ingested foreign bodies) and prompt psychiatric referral is essential for efficient long-term management of this condition.
Introduction: Adenotonsillectomy is successful at eliminating airway obstruction in the majority of otherwise normal children with obstructive sleep apnoea syndrome. Children with this condition are at significantly higher risk of post-operative respiratory complications. Identifying children at risk of post-operative respiratory complications after adenotonsillectomy for obstructive sleep apnoea syndrome remains a challenge for clinicians, especially those at district general hospitals.
Aim: To review the evidence and to proffer a pragmatic approach to diagnosis and management, by classifying those at risk of post-operative respiratory complications into different risk subsets, with guidelines for management.
Conclusion: Patients in the high risk group should be operated upon at paediatric specialist centres with intensive care facilities. Those in the moderate risk group may undergo adenotonsillectomy at their district general hospital, provided facilities for administering continuous positive airway pressure are available on-site. Most children with obstructive sleep apnoea syndrome may be classified as low risk candidates and may safely be operated upon at their local district general hospital.
Nasal bone fractures are the commonest type of bony facial injury causing aesthetic deformity. The aim of this study was to identify the effect of nasal trauma and fracture manipulation on the aesthetic proportions of the nose, by comparing pre- and post-treatment nasal aesthetics. Thirty-two patients (26 men and 6 women) underwent aesthetic assessment prior to treatment of the injury by closed nasal manipulation, 7 to 10 days after the initial injury. Standard facial aesthetic photographic assessments were performed prior to and following manipulation. Assessment involved measurement of standard nasal aesthetic parameters. In the nasal trauma cohort, the main anomalies in nasal aesthetics were nasal deviation and differences in the nasal aesthetic profile. Nasal fracture manipulation successfully reduced deviation from an average of 35° pre-manipulation to an average of 9° post-manipulation.