Individual differences in personality, in particular cognitive activation, withdrawal and hypnotic susceptibility were examined in a study of self‐hypnosis training in patients with chronic and severe herpes simplex virus (HSV‐2), genital herpes, along with depression, anxiety and activation ratings. Immune parameters were assayed before and after the six‐week training. Self‐hypnosis almost halved recurrence rate, benefiting 65% of the patients. Furthermore clinical responders demonstrated an increase in natural killer cell (NKC) cytotoxicity of herpes infected cells as well as up‐regulation of nonspecific immune parameters. In replication of a student exam stress study (Gruzelier, Smith, Nagy and Henderson, 2001a) cognitive activation was positively associated with immune function; with improvement in herpes recurrence, improvements in specific NKC cytotoxicity, baseline functional NKC activity and energy ratings, and was unrelated to frequency of practice. No other measure of personality or affect was associated with immune system up‐regulation and improvements in health. Depression and, to a lesser extent, anxiety improved independently of herpes outcome. Depression and/or anxiety at baseline were positively associated with withdrawal, particularly the affective aspects, and neuroticism, which were associated with immune down‐regulation seen in NKC counts and NKC functional activity at baseline. Hypnotizability was associated positively with aspects of immune system up‐regulation and negatively with clinical depression. Immune system up‐regulation in clinical responders correlated positively with frequency of self‐hypnosis practice. This is possibly the first evidence for the efficacy of self‐hypnosis training for a chronic medical illness. Evidence (1) of the benefits to health and (2) of the viral specificity of the immune changes, here in the form of increased cytotoxicity of NKC for cells infected with the herpes virus, gives credence to the value of a psychological intervention for immunity; evidence for which is scarce in the field of psychoneuroimmunology. The predictive ability of cognitive activation for response to hypnotherapy is in keeping with the preferential effects on both immune parameters and health of hypnosis instructions which require the generation of dynamic imagery in contrast to instructions of passive relaxation imagery (Gruzelier, Levy, Williams and Henderson, 2001b). Copyright © 2002 British Society of Experimental and Clinical Hypnosis

Adult ingestion of caustic substances is an unusual but serious surgical problem, with injuries likely to be more extensive than those in the corresponding paediatric population. After initial stabilisation and airway management, clinicians are presented with a complex multisystemic problem, frequently requiring a multidisciplinary approach involving several surgical disciplines and associated therapies. A new multidisciplinary team was convened to discuss complex ingestion injury in adults and established techniques were used to bring forward a proposed treatment algorithm. An algorithm may potentially improve clinical efficacy and risk in the management of these complex patients.

Patients were recruited for hypnotherapy from a clinic for patients with frequently recurrent genital herpes simplex virus (rgHSV). Psychological and immunological parameters were measured 6 weeks prior to hypnotherapy and 6 weeks afterwards, during which time each patient kept a diary of symptoms of rgHSV. Following hypnotherapy there was a significant overall reduction in the number of reported episodes of rgHSV, accompanied by an increase in the numbers of CD3 and CD8 lymphocytes, which may represent a non specific effect of hypnosis. The improvers showed significant rises in natural killer (NK) cell counts, HSV specific lymphokine activated killer (LAK) activity, and reduced levels of anxiety when compared to non-improvers. NK cell numbers and HSV specific LAK activity may therefore be important in the reduction in rgHSV following hypnotherapy.

No abstract

Introduction Nasal fracture is a common form of ear, nose and throat (ENT) trauma with prompt referral required for assessment and potentially manipulation of nasal bones. The aetiology of nasal fracture is multifactorial, and injury occurs across all ages. Previous study has suggested a temporal relationship between nasal injury and major sporting events. Methods A total of 1966 adult patients with nasal injuries referred to emergency clinics across three London ENT centres between September 2016 and August 2019 were analysed. Results The majority of those referred were male (66.58%). Mean age at referral was 36.29±18.38 in males and 49.14±21.43 in females; 10.27% were 75 years and over. Incidence was highest during April–September 2018 (p=0.02). Mean incidence was higher in this period in the male 16–35 subgroup (p=0.039), with 53.1% of their injuries concentrated between Friday and Sunday. Conclusions Most nasal injuries occurred in young males. Mean age at referral was higher in females, and there was slightly increased incidence in over-75s, predominantly females. This incidence could be due to increased longevity or greater tendency to injury in females of this age. The injury patterns across the week also differed, with males injured proportionately more at the weekend. Nasal injury referrals of young men increased around the 2018 summer period, coinciding with the 2018 FIFA World Cup. This lends support to the association between major sporting events and the incidence of nasal injury, particularly in young males.

When faced with the clinical question of what period of watchful waiting would be appropriate in monitoring a perforated tympanic membrane, before intervention may reasonably be recommended; there seems to be little advantage in waiting longer than 2.5 years.

An overall moderate improvement in the safety of out-of-hours endoscopy in the past 10 years cannot obscure the urgent need for universal compliance with national guidelines.

Ann RC oll Surg Engl 2008; 90:6 89-691 689Fractured nose is one of the more common acuted iagnoses managed by ENTd epartments: 9400 manipulations under anaesthesia were undertaken in England during 2005-2006. 1 Whiled etailed national figureso na etiology ared ifficult to obtain, it is generallya ccepted that violent trauma between individuals is the mostcommoncausative factor in adults.Patients with this conditionwill commonly present to their local ear,n ose and throat (ENT) service via an accidenta nd emergency (A&E)d epartment or their general practitioner (GP). Ac areful internal and external nasal examination is required to assesst he degree of injury or dislocation of nasal bones and cartilages, and thereby plan appropriate intervention. Within hours of injury,t he area will be obscured by swelling; therefore, accepted ideal practicef or the receiving ENT servicei st ou ndertake af ull assessment 7d aysp ostinjury,o nce swelling has reduced.T his allowsaf urther 8-12 days forintervention before any fractured facial bonesbecome fixed in an abnormal position.An unusual pattern of referrals was noted during 2006, prompting am ore thorough examination of these referral patterns in recent years. Patients and MethodsData were obtained from two similarly-sizedENT centres in west London, based at Charing Cross Hospital in Fulham, andN orthwick Park Hospital in Harrow.E ach receives referrals directly from three A&E departments, and an umber of NHS walk-in centres; takentogether,they serve apopulation of approximately one million. Both operate asystemwhereby oncalls taff may make appointments for subsequent emergency clinics by recording the details of an acutely-referred patient in ah ard-back diary; figures wereo btainedf rom these diaries. The recorded datac oncerned only adults, as both centres make alternative arrangements for paediatric patients. Regrettably,a sd emographic data were not recorded to any consistent standard, these could not be included.