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Objective: Sudden hearing loss is a common presentation to ENT. In the authors' practice, patients often wait many weeks for formal hearing testing. This study aimed to assess whether a tablet-based hearing test, hearTest, could aid clinical decision-making within secondary care ENT. Method: This was a multi-centre, prospective, non-randomised study to assess the feasibility, usability and accuracy of hearTest. Results: In the sample, hearTest was shown to be an acceptable method of testing for hearing loss by both patients and clinicians. The 0.5–4 kHz range had an average clinical agreement rate of 95.1 per cent when compared with formal pure tone audiometry, deeming it an accurate test to diagnose hearing loss. Conclusion: The authors propose that hearTest can be used within ENT as a clinical decision support tool when manual audiometry is not immediately available. Within the authors' practice, hearTest is used to aid diagnosis and management of sudden sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop and evaluate a low-cost orbital prosthesis for simulation of endoscopically assisted intra-orbital anterior ethmoidal artery ligation. Methods: A low-cost orbital prosthesis was built and evaluated by ENT surgical trainees. Feedback was given following the assessment in the form of a face validity questionnaire. Results: Results were scored on a Likert scale of 1–7 (low to high). Trainees had limited exposure to the procedure (40 per cent) and predominantly low levels of confidence (mean, 3.67) that correlated with a lack of first-hand experience. The anatomy and likeness to human tissue of the prosthesis were both ranked highly, with mean scores of 5.0 and 4.93, respectively. Conclusion: The results of this study support the idea that a simple anatomical prosthesis for the simulation of endoscopic anterior ethmoidal artery ligation can be created with potential value to otolaryngology surgical training. To the authors' knowledge, this is the first documentation of simulated surgical epistaxis management using an artificial anatomical model. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess UK otorhinolaryngology trainees' perceptions of their septorhinoplasty training. The possible effects that the COVID-19 pandemic may have on current and future training opportunities are also discussed. Methods: A cross-sectional survey of members of the Association of Otolaryngologists in Training was conducted in March 2019. Results: A total of 64 trainees responded to the survey. All deaneries were represented. A variety of challenges regarding septorhinoplasty training were highlighted. The most common hurdle was the low number of cases being undertaken. A third of the ST7–ST8 trainees in this sample (8/25, 32%) had not yet performed a single septorhinoplasty even though they were into the final two years of their training. Conclusions: The COVID-19 pandemic is a new additional threat to septorhinoplasty training for otorhinolaryngology trainees, particularly those in the final two years of the programme. In the short term, clarification is needed regarding what level of operative proficiency is required for the Certificate of Completion of Training. In the longer term, threats to training can be mitigated by providing cadaveric courses, embracing simulation and considering private sector placements in areas of low NHS volume. [ABSTRACT FROM AUTHOR]

The coefficients that appear in uniform asymptotic expansions for integrals are typically very complicated. In the existing literature, the majority of the work only give the first two coefficients. In a limited number of papers where more coefficients are given, the evaluation of the coefficients near the coalescence points is normally highly numerically unstable. In this paper, we illustrate how well-known Cauchy-type integral representations can be used to compute the coefficients in a very stable and efficient manner. We discuss the cases: (i) two coalescing saddles, (ii) two saddles coalesce with two branch points, and (iii) a saddle point near an endpoint of the interval of integration. As a special case of (ii), we give a new uniform asymptotic expansion for Jacobi polynomials [ABSTRACT FROM AUTHOR]

Objective: To evaluate current UK practice of periprocedural haematological management for image-guided procedures in relation to Cardiovascular and Interventional Radiological Society guidelines, which provide recommendations according to bleeding risk of procedures from Category 1 (lowest) to 3 (highest). Methods: Survey of practice in UK radiology departments conducted over a 1-year period Results: 48 radiology departments responded. The percentage of departments that stop antithrombotics preprocedurally are as follows (for Category 1, 2 and 3, respectively): aspirin (31.3%, 43.8%, 54.2%); clopidogrel (54.2%, 68.8%, 72.9%); therapeutic low-molecular-weight heparin (56.3%, 77.1%, 75.0%). The percentage of departments that perform pre-procedural laboratory testing are as follows (for Category 1, 2 and 3, respectively): international normalized ratio (INR; 81.3%, 95.8%, 93.8%); activated partial thrombin time ratio (APTTR; 60.4%, 75.0%, 93.8%); platelet (77.1%, 91.7%, 95.7%); haemoglobin (70.8%, 85.4%, 87.5%). Mean threshold (standard deviation) of laboratory results for conducting procedures (Level 1, 2 and 3, respectively) are as follows: INR [1.53 (0.197), 1.47 (0.186), 1.47 (0.188)]; APTTR [1.50 (0.392), 1.50 (0.339), 1.48 (0.344)]; platelet count (x103 cells per microlitre) [74.4 (28.7), 79.9 (29.1), 80.5 (29.3)]; haemoglobin (grams per decilitre) [9.05 (1.40), 9.00 (1.33), 8.92 (1.21)]. No department practices conformed to current recommendations for (1) pre-procedural cessation of antithrombotics and (2) pre-procedural laboratory testing. Two (4.2%) department practices conformed to recommendations for thresholds of haematological parameters. Conclusion: Current peri-procedural haematological management is variable and often does not conform to existing recommendations. Further research into the impact of this variation in practice on patient outcome is required Advances in Knowledge: This study demonstrates wide variation in practice in haematological management for image-guided procedures. [ABSTRACT FROM AUTHOR]

In this paper, we obtain asymptotic expansions for the Gauss hypergeometric function , where ej = 0, ± 1, j = 1, 2, 3, as |λ| → ∞. We complete the results of three previous publications [Uniform asymptotic expansions for hypergeometric functions with large parameters I, Anal. Appl. ( Singap.) 1 (2003) 111-120; Uniform asymptotic expansions for hypergeometric functions with large parameters II, Anal. Appl. ( Singap.) 1 (2003) 121-128; Uniform asymptotic expansions for hypergeometric functions with large parameters III, Anal. Appl. ( Singap.) 8 (2010) 199-210], discuss all cases and, what is new, we consider now all critical values of z. For one case, the full details of the well-known Bleistein method are given, since a new technical detail is observed. [ABSTRACT FROM AUTHOR]

Objective:We report the rare case of a 55-year-old woman with an asymptomatic left sphenoid sinus pseudomeningocele mimicking a mucocele.Case report:A 55-year-old woman was found to have an incidental mass in the left sphenoid sinus on computed tomography. Magnetic resonance imaging confirmed the presence of a mucocele. A left endoscopic sphenoidotomy was performed to drain the mucocele. Despite an anatomical puncture through a stenosed sphenoid ostium, alarmingly, the opening leaked cerebrospinal fluid. A dehiscent lateral wall was identified with a dural opening communicating with the sphenoid sinus. This was immediately repaired with a free nasal septal mucosal graft. Six months post-operatively, the patient remained free from cerebrospinal fluid leakage.Conclusion:Pseudomeningoceles are extremely rare in the absence of trauma or iatrogenic injury. Surgeons should be alert to their presence as they can mimic a unilateral mucocele or nasal polyp. Endoscopic management lends itself to a single-stage repair. [ABSTRACT FROM PUBLISHER]

IntroductionIn long-standing facial palsy, muscles on the normal side overcontract causing difficulty in articulation, eating, drinking, cosmetic embarrassment, and psychological effects as patients lack confidence in public.MethodsWe injected botulinum toxin A (BTXA) into the normal contralateral smile muscles to weaken them and restore symmetry to both active and passive movements by neutralising these overacting muscles.ResultsA total of 14 patients received BTXA (79% women, median age 47 years, average length of palsy 8 years). They were all difficult cases graded between 2 and 6 (average grade 3 House-Brackmann). All 14 patients reported improved facial symmetry with BTXA (dose altered in some to achieve maximum benefit). Average dose was 30 units, but varied from 10 to 80 units. Average time to peak effect was 6 days; average duration of effect was 11 weeks. Three patients had increased drooling (resolved within a few days).ConclusionThe improvement in symmetry was observed by both patient and examining doctor. Patients commented on increased confidence, being more likely to allow photographs taken of themselves, and families reported improved legibility of speech. Younger patients have more muscle tone than older patients; the effect is more noticeable and the benefit greater for them. BTXA improves symmetry in patients with facial palsy, is simple and acceptable, and provides approximately 4 months of benefit. The site of injection depends on the dynamics of the muscles in each individual patient. [ABSTRACT FROM AUTHOR]

We obtain uniform asymptotic approximations for the monic Meixner-Sobolev polynomials Sn(x). These approximations for n → ∞, are uniformly valid for x/n restricted to certain intervals, and are in terms of Airy functions. We also give asymptotic approximations for the location of the zeros of Sn(x), especially the small and the large zeros are discussed. As a limit case, we also give a new asymptotic approximation for the large zeros of the classical Meixner polynomials. The method is based on an integral representation in which a hypergeometric function appears in the integrand. After a transformation, the hypergeometric functions can be uniformly approximated by unity, and all that remains are simple integrals for which standard asymptotic methods are used. As far as we are aware, this is the first time that standard uniform asymptotic methods have been used for the Sobolev-class of orthogonal polynomials. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the shoe splint surgical technique to prevent synechiae post-endoscopic sinus.

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We previously showed that mice with a null mutation in syndecan-1 (Sdc1; CD138) were resistant to Wnt1-induced mammary tumor initiation. The absence of Sdc1 inhibited the increase in the mammary stem cell fraction that is characteristic of preneoplasia in this model. As the tumor precursor cells are recruited from the stem/progenitor cell compartment, tumor development was also inhibited (Liu et al., 2004; PNAS 101, 4158). Although Sdc1−/− mice are grossly normal, they are systemically smaller, suggesting that developmental abnormalities may extend further than their mammary glands. We have therefore evaluated the multi-organ response of Sdc1−/− mice to carcinogen-induced tumor development (7,12-dimethylbenz[a]anthracene, DMBA), and find these mice to be resistant to tumorigenesis in all the predominant carcinogen-susceptible lineages. Thus, Sdc1−/− mice administered DMBA during juvenile development are resistant not only to epithelial tumors, including liver (60–80%) and lung tumors (C57BL6 mice, 60–80%), but also to lymphoma (over 70%, depending upon strain and carcinogen dose). We demonstrate that CD138 is expressed (heterogeneously) in the hematopoietic stem cell fraction (and not only in pre-B and plasma cells), and that tumors arise in both myeloid and lymphoid lineages. Furthermore, carcinogen-induced mammary tumors are bilineal, implying a bipotent precursor cell. Both observations imply that the DMBA-induced tumor precursor cells are drawn from the stem/progenitor fraction, and we suggest that pathogenic activation of these cells could be abnormal in Sdc1−/− mice.Oncogene (2007) 26, 1407–1416. doi:10.1038/sj.onc.1209930; published online 4 September 2006 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Patients infected with HIV have an increased propensity for developing thoracic empyemas secondary to their susceptibility to polymicrobial pulmonary infections. We performed an assessment of the clinical outcomes of HIV patients undergoing surgical treatment of thoracic empyemas and reviewed the microbiology of these infections. METHODS: We completed a retrospective analysis of the patients who had been referred for surgical treatment of thoracic empyemas over an 11-year period, ending in 2002. The patients were treated at a major metropolitan medical teaching facility that cares for a substantial number of HIV-positive patients. RESULTS: Twenty-one HIV-infected patients underwent surgical treatment of thoracic empyemas. There were no immediate deaths. Sixty-two percent of the patients had CD4 counts of < 200 cells/microL. Eight patients had postoperative complications. Six of the patients with complications had CD4 counts of < 200 cells/microL. Patients with lower CD4 counts were at risk for mycobacterial and fungal infections. Additionally, they often had complex empyemas that were not favorable for treatment by video-assisted thoracic surgery. Therefore, these patients often required surgery with lung resection, which necessitated longer periods of postoperative chest tube drainage. CONCLUSIONS: Surgeons can obtain satisfactory operative outcomes when treating thoracic empyemas in HIV patients; however, the treatment strategy should be individualized. Patients with CD4 counts of < 200 cells/microL more commonly have complex empyemas that require surgery with open decortication and drainage. Although these patients have a higher incidence of postoperative complications, we think that HIV patients with thoracic empyemas can be safely and effectively treated with surgical techniques. [ABSTRACT FROM AUTHOR]

Two new macrocyclic ligands 1,4,7,9,12-pentaaza-10,11-dioxo-8,9,12,13-bis-(1'-oxo-3'-thio-2'-hydropyrimidine)-trideca-7,13-diene, (L1) and 1,4,7,9,12-pentaaza-10,12-dioxo-8,9,13,14-bis-(1'-oxo-3'-thio-2'-hydropyrimidine)-tetradeca-7,14-diene, (L2) and their complexes with CrIII, MnII, FeIII, CoII, NiII, CuII and ZnII have been synthesized, and characterized by elemental analysis, i.r., 1H-n.m.r., e.p.r., u.v.–vis. spectroscopy, magnetic susceptibility and conductance measurements. The conductivity measurements suggest that the complexes of divalent metal ions are 1:1 electrolytes whereas the trivalent metal ions are non-electrolytes. On the basis of electronic spectra and magnetic moment measurements the CrIII and FeIII complexes are octahedral, while the divalent metal complexes are tetrahedral except for the NiII and CuII complexes which are proposed to have square planar geometry. All the ligands and their complexes have been screened against gram-positive bacteria Staphylococcus aureus and gram-negative bacteria E. coli. The results show that they inhibit the growth of bacteria. [ABSTRACT FROM AUTHOR]

Reports on a case of cervical sarcoma botyroides, the malignant neoplasm of the lower female genital tract in infants and young children. Prognosis of sarcoma botyroides; Symptoms of the disease; Prognostic factors of rhabdomyosarcoma; Treatment of cervical sarcoma botyroides.

Presents the case of a 17 year old nulliparous Saudi housewife who had acquired pure amegakaryocytic thrombocytopenic purpura of uncertain etiology.