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Background: An ACTH-secreting pituitary adenoma is the most common cause of excessive endogenous glucocorticoid production resulting in Cushing's Syndrome. A multidisciplinary approach is paramount. Selective adenomectomy is the treatment of choice. Method: Endoscopic transnasal transsphenoidal approach to the tumour, along with techniques for resection, are demonstrated. Conclusion: Endoscopic transsphenoidal approaches with its magnified view of the pituitary gland allows precise microsurgical dissection during selective adenomectomy. This technique increases the possibility of proving a gross total resection, leading to clinical and biochemical cure in these patients. [ABSTRACT FROM AUTHOR]

Background: Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown. Methods: Data from patients who underwent endoscopic TSS for a NFPMA (2009–2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes. Results: Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004). Conclusion: Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth. [ABSTRACT FROM AUTHOR]

Background: Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown. Methods: Data from patients who underwent endoscopic TSS for a NFPMA (2009–2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes. Results: Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004). Conclusion: Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth. [ABSTRACT FROM AUTHOR]

The article looks at a study regarding the of pituitary surgery of the endoscopic skull base and the endoscopic endonasal route has gradually expanded to allow surgery in all regions of the anterior skull base anterior to the foramen magnum. It mentions that surgical procedure for the removal of the pituitary lesion the nasoseptal with the cerebrospinal fluid (CSF). It also mentions that procedures were performed jointly with a neurosurgeon and an otolaryngologist.

Objectives:Very little up-to-date information is available on the microbiology of complicated acute bacterial rhinosinusitis. Reliable microbiology testing is necessary to inform current empirical antimicrobial treatments. This study was conducted in response to recent US guidelines on antimicrobial treatments for acute bacterial rhinosinusitis. It aimed to describe the pathological micro-organisms involved in complicated acute bacterial rhinosinusitis in the UK and their antimicrobial susceptibility.Methods:This study collected retrospective data on cases of complicated acute bacterial rhinosinusitis with sinogenic orbital and/or intracranial infections from 2007 to 2012. Bacteria identified in paranasal sinus pus were compared with those identified in orbital and/or intracranial infections.Results:Streptococcus anginosus group bacteria were isolated from 61.3 per cent of paranasal sinus pus samples, 83.3 per cent of orbital infections and 77.8 per cent of intracranial infections. All S anginosus isolates were sensitive to penicillin; no penicillin-resistant organisms were isolated.Conclusion:S anginosus was the predominant organism isolated from complicated acute bacterial rhinosinusitis samples at our UK centre. S anginosus is sensitive to penicillin, suggesting that penicillin can be used as an appropriate first-line empirical antibiotic for uncomplicated acute bacterial rhinosinusitis. [ABSTRACT FROM PUBLISHER]

Background: This technical note describes a novel method of cauterising the posterior nasal cavity through the use of a plastic straw and silver nitrate. Objective: This technique aims to prevent unwanted damage to surrounding nasal mucosa. Methods: Once the nasal cavity has been prepared for cauterisation, the silver nitrate stick is navigated to the bleeding point covered by the plastic straw. The silver nitrate stick is then advanced onto the bleeding point allowing precise cauterisation of the nasal mucosa, without effecting surrounding healthy mucosa. [ABSTRACT FROM AUTHOR]

Background:The role of total thyroidectomy in the management of patients with Graves' disease remains controversial. However, there is increasing evidence to support the role of the procedure as a safe and definitive treatment for Graves' disease.Method:Patients were identified from a prospective thyroid database of the multidisciplinary thyroid clinic at Hull Royal Infirmary. All case notes were independently reviewed to confirm the data held on the database.Results:Over a 7-year period, the senior author has performed 206 total thyroidectomies for Graves' disease. The incidence of temporary recurrent laryngeal nerve palsy and hypoparathyroidism was 3.4 per cent and 24 per cent respectively. There was one case of permanent unilateral recurrent laryngeal nerve palsy, and 3.9 per cent of patients developed permanent hypoparathyroidism. There has been no relapse of thyrotoxicosis.Conclusion:In the context of a multidisciplinary thyroid clinic, total thyroidectomy should be offered as a safe and effective first-line treatment option for Graves' disease. [ABSTRACT FROM PUBLISHER]

Aim: To survey antibiotics prescribed for patients admitted with acute tonsillitis and peritonsillar abscess to UK ENT departments. Materials and methods: An anonymous postal questionnaire was sent to UK ENT consultants. Results: Intravenous benzylpenicillin alone was preferred significantly more often for acute tonsillitis (n = 175) than for peritonsillar abscess (83) (p < 0.001). Acombination of benzylpenicillin andmetronidazolewas preferred significantly more often for peritonsillar abscess (n = 131) than for tonsillitis (62) (p < 0.001). Conclusions: In this survey, penicillin was the commonest antibiotic choice for tonsillitis; this is in accordance with published guidelines. For cases of peritonsillar abscess, benzylpenicillin with metronidazole was the most common antibiotic combination chosen. However, the high resolution rate of peritonsillar abscess following drainage and treatment with penicillin alone suggests that multiple antibiotics are unnecessary and inappropriate in this setting. [ABSTRACT FROM AUTHOR]

Aims: Patients complaining of a dry mouth can present themselves to various clinicians such as the primary care physician, dentists, otolaryngologists and/or oral surgeons. The aim of our review is to provide a systematic method of assessing and managing these patients based on current best evidence published in the literature. Methods: A literature search was performed on 20th April 2009 using MEDLINE and EMBASE using the terms dry mouth and xerostomia in combination with diagnosis, management, investigations and treatment. Results: There appears to be little correlation between patient symptoms and objectives tests of salivary flow. Therefore clinical management should be based on patient symptoms. There is good evidence to support that xerostomia is commonly associated with anticholinergic drugs, and altering such agents plays an important role in the management of these patients. In patients with residual salivary gland function, the use of salivary stimulants appears to be more beneficial than salivary substitutes. Conclusion: Xerostomia can be debilitating and primarily affects the middle aged and elderly population. The most common causes of xerostomia include medications with anticholinergic properties, dehydration, diabetes and radiotherapy for head and neck cancer. Treatment of xerostomia essentially involves addressing the cause followed by salivary substitutes and/or salivary stimulants. [ABSTRACT FROM AUTHOR]

Background: Endoscopic endonasal surgery to access the anterior skull base has evolved in many centres worldwide and provides a minimally invasive alternative, with better patient experience, to open techniques. Method: We present a basic approach to a midline lesion that is the fundamental starting point for wider access to the skull base. Conclusion: The nuances of this technique illustrated here have been developed in many centres to provide a safe procedure that has a low incidence of complications and excellent potential. [ABSTRACT FROM AUTHOR]

This is the last of the three review articles dealing with thyroid cancer. Over 90% of thyroid cancer is of the differentiated type associated with a very good 10-year disease-free survival rate. In contrast, the rare forms of thyroid cancer which comprise medullary thyroid cancer arising from parafollicluar C cells, Hurthle cell carcinoma, anaplastic carcinoma, thyroid lymphoma and squamous cell carcinoma are typically associated with a poorer survival rate. Management is based upon small retrospective cohort studies. [ABSTRACT FROM AUTHOR]

This is the second review article on thyroid cancer dealing with the common differentiated types that comprise 90% of thyroid cancers. Despite clinical management guidelines offered by a number of organisations including the British Association of Otolaryngologists and Head and Neck Surgeon, The British Thyroid Association, The American Association Of Endocrinologists, The American Thyroid Association and the National Cancer Centre Network, debate regarding the management of differentiated thyroid cancer continues. This is because of the absence of good quality research evidence as a consequence of the natural history of this disease. [ABSTRACT FROM AUTHOR]

Thyroid cancer is uncommon with an estimated lifetime risk of 0.8% for women and 0.3% for men. The incidence appears to be increasing by 4% per year and is currently the eighth commonest cancer in women. Managing thyroid cancer is challenging, as no prospective randomised trials exist. Most of the information is derived from large patient cohorts in which therapy has not been randomly assigned. This is the first of the three review papers we have written on the management of thyroid cancer. [ABSTRACT FROM AUTHOR]

Early stage laryngeal cancer can be effectively cured by radiotherapy or conservative laryngeal surgery. In the UK, radiotherapy is the preferred first line treatment. However, up to 25% of patients with T2 tumours will demonstrate locally persistent or recurrent disease at the original site, requiring salvage surgery to achieve a definitive cure. Patients experiencing treatment failure have a relatively poor prognosis. A retrospective analysis was conducted consisting of 124 patients with early stage (T1-T2, N0) laryngeal squamous cell carcinoma. In total, 62 patients who failed radiotherapy were matched for T stage, laryngeal subsite and smoking history to a group of 62 patients successfully cured by radiotherapy. Using immunohistochemistry the groups were compared for expression of apoptotic proteins: bcl-2, bcl-X(L), bax, bak and survivin. Radioresistant laryngeal cancer was associated with bcl-2 (P < 0.001) and bcl-X(L) (P = 0.005) expression and loss of bax expression (P = 0.012) in pretreatment biopsies. Bcl-2 has an accuracy of 71% in predicting radiotherapy outcome. The association between expression of bcl-2, bcl-X(L) and bax with radioresistant cancer suggests a potential mechanism by which cancer cells avoid the destructive effects of radiotherapy. Predicting radioresistance, using bcl-2, would allow the clinician to recommend conservative laryngeal surgery as an alternative first line treatment to radiotherapy. [ABSTRACT FROM AUTHOR]

Clin. Otolaryngol. 2005, 30, 164–168 Radiotherapy is one of the principal treatment modalities for many types of head and neck tumour; what effects the dendritic cell (DC) population may have on treatment outcome have not been critically evaluated in laryngeal cancer. Retrospective, case-controlled study using immunohistochemistry to investigate the presence of S-100 positive DC in pre-treatment, archival biopsy tissue of early stage laryngeal cancers. Patients with laryngeal cancer treated with radiotherapy in Head and Neck Departments in England. Patients diagnosed with early stage laryngeal cancer, treated with single modality radiotherapy with curative intent. Radioresistant tumours ( n = 22), defined as recurrent tumours within 12 months of therapy. Radiosensitive tumours ( n = 22), defined as no recurrence with a minimum follow-up of 36 months. Density of S-100 staining DC on three×200 magnified microscopic fields. DC were present in approximately equal numbers in both radioresistant and radiosensitive laryngeal tumour pre-treatment biopsies and therefore density did not correlate with radiotherapy treatment outcome ( P = 0.420). There is no intrinsic deficiency in DC number in radioresistant laryngeal tumours meaning that such tumours could potentially benefit from vaccination strategies that enhance the specific anti-tumour immune response. [ABSTRACT FROM AUTHOR]

The article focuses on the use resazurin reduction tests as an estimate of heterotrophic bacteria and coliform in environmental samples. It employed several materials and methods including use of coliform equivalent (CE) test, assessment of heterotrophic bacteria activity in sand filter and most probable number (MPN) tests. Results show that sand resazurin reduction tests indicate that most heterotrophic bacterial activity is at the top 1-7 millimeter (mm) layer.

The article presents a study on the utilization of sediment bags to monitor pollution of fecal material in streams. It states that water and sediment in creeks in North Vancouver, British Columbia were tested for Clostridium perfringens and fecal coliforms as fecal indicators. It concludes that sediment bags proved to a more sensitive monitor for extent and sources of fecal contamination in upstream areas.

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A letter to the editor is presented in response to the article "Panel-based testing inherited colorectal cancer: a descriptive study of clinical testing performed by a US laboratory," by D. Cragun and colleagues in the 2014 issue.