Twenty patients aged 56-92 years who underwent surgical correction of pharyngeal pouches at Queen Alexandra Hospital, Portsmouth were asked to fill in a detailed questionnaire. They were then interviewed and barium swallow studies performed from 3 months to 4 years post-operatively. Nineteen patients in the sample were found to have reflux and 20 had dysmotility. These findings suggest that pharyngeal pouches are not a purely localized inco-ordination of the cricopharyngeal sphincter but are associated with a generalized oesophageal muscle dysfunction.
A new established pilot husky voice clinic with agreed referral protocols for patients at risk of developing laryngeal malignancy was audited. Thirty-four patients were seen, 41.2 per cent having abnormal findings on flexible nasendoscopy, 29.4 per cent requiring rigid endoscopy, 38.1 per cent were discharged after the initial visit. One case of early laryngeal cancer was picked up during this period from this group of patients. The data for the remaining population in Portsmouth was examined, and a further eight cases of laryngeal cancer were diagnosed in keeping with national incidences. A rapid access clinic with agreed protocols that referring practitioners adhered to, was useful for diagnosing laryngeal cancer and should meet the requirements of the government's 14-day rule.
Parathyroid carcinoma is a rare tumour, which is often difficult to diagnose. This is especially true in patients with pre-existing tertiary hyperparathyroidism of end-stage renal disease. A case is presented of parathyroid carcinoma in a haemodialysis patient with unusual thymic involvement. After demonstrating the difficulty in pre-operative diagnosis and risk of recurrence, the importance of non-surgical treatment options is discussed and the investigation of individual tumour chemosensitivity is introduced, which is new to this type of cancer.
Le Fort I osteotomy is proposed as an alternative approach in the management of choanal atresia in the adult. It offers excellent access with full exposure of the atresia and the funnelling of the nasal cavity to the bony septum.
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