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Purpose: To demonstrate the manifestations and complications of uveitis, and their medical and surgical management, in a very large group of patients attending the Manchester Uveitis Clinic (MUC), a specialist uveitis clinic in the Northwest of England, UK. Methods: Retrospective retrieval of data on a computerized database incorporating all new referrals to MUC from 1991 to 2013. Results: A total of 3000 new patients with uveitis were seen during a 22-year period, of which 25.2% had a single acute episode, 13.6% had acute recurrent uveitis, 20.2% had chronic fluctuating uveitis, and 41.0% had chronic unremitting uveitis. The commonest complications were cataract (35% of patients), macular edema (20.5%), and glaucoma (19.5%). Oral steroids were required in 36% of patients, oral immunosuppression in 16%, and biologic treatment in 2%. Major intraocular surgery was required in 28%. Conclusions: Oral steroid usage is not an independent risk factor for cataract formation in patients with uveitis. Oral immunosuppression usage has increased 4-fold during this study period. [ABSTRACT FROM AUTHOR]

Objective:We report a case of cholesterol granuloma of the petrous apex which was surgically treated via an endoscopic trans-sphenoidal approach.Methods:Case report and review of the literature concerning cholesterol granulomas of the petrous apex and their management.Results:The lesion was approached endoscopically via a bilateral sphenoidotomy with removal of the vomer. A large cholesterol granuloma was evacuated and marsupialised. The patient made an uneventful recovery.Conclusion:Trans-sphenoidal access to the petrous apex represents an alternative route for the drainage and ventilation of cholesterol granulomas. This approach is the technique of choice when the cholesterol granuloma abuts the posterior wall of the sphenoid sinus. The trans-sphenoid approach, unlike other lateral approaches to the petrous apex, spares cochlear and vestibular function and allows post-operative endoscopic follow up. [ABSTRACT FROM PUBLISHER]

Cerebrospinal fluid (CSF) rhinorrhoea has been managed by both neurosurgeons and otorhinolaryngologists, with neurosurgeons often choosing an intracranial approach and otorhinolaryngologists an extracranial approach. Recently, transnasal endoscopic techniques have been introduced that significantly reduce the morbidity of surgical repair when compared with previous techniques. The sense of smell was preserved in all patients who underwent an endoscopic repair of their CSF leak where it was present preoperatively. The results of transnasal endoscopic repair now make it the treatment of choice for most anterior cranial and sphenoid CSF leaks, with the exception of defects in posterior wall of the frontal sinus or defects larger than 5 cm. It is vital that a diagnosis of a CSF leak is confirmed by immunofixation of beta 2 transferrin as unilateral rhinorrhoea can masquerade as a CSF leak. We illustrate our experience with 78 patients who were referred with a diagnosis of CSF rhinorrhoea. [ABSTRACT FROM AUTHOR]

Medication and surgery are often complementary in the treatment of rhinosinusitis. Surgery is often reserved for patients who have not responded to medical treatment. Where there is a significant mechanical obstruction of the airway or sinus ostea medical management is unlikely to succeed on its own. For those with a coexisting allergic rhinitis who need surgery, the maintenance of any improvement in the nasal airway or sinus drainage will partially depend on good compliance with medical treatment postoperatively. No condition illustrates the adage that ‘to be a good surgeon you have to be a good physician’ better than allergic rhinitis. Perhaps it should also be said that ‘to be a good physician you should recognize when surgery has a role to play’. [ABSTRACT FROM AUTHOR]

Purpose: To describe inferior peripheral retinal elevations associated with intermediate uveitis. Methods: Retrospective review. Results: Eleven eyes of 7 patients developed inferior retinal elevation secondary to intermediate uveitis. Six eyes (54.6%) were believed to have tractional retinoschisis, 2 (18.2%) had tractional retinal detachment, and the remaining 3 (27.3%) had flat retinal elevation of indeterminate type. In 10 eyes there was no evidence of progression during a mean 4-year follow-up. One eye developed extended tractional elevation with macular pucker and failed to respond to surgery. At the most recent visit, visual acuity ranged from 6/5 to NPL with a median of 6/12. Conclusion: Intermediate uveitis may cause inferior peripheral retinal elevation. The authors propose that preretinal and pars plana gliosis resulting from chronic pars planitis exerts traction on peripheral retina, causing elevation, but infer that such elevation removes traction and is self-limiting. Surgery should be reserved only for macula threatening lesions. [ABSTRACT FROM AUTHOR]

This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa. [ABSTRACT FROM AUTHOR]

Objective:To report our experience of the management of patients with primary sinonasal malignant melanoma, and to review the relevant medical literature.Method:Retrospective review examining treatment and outcomes.Results:Twenty-four patients were treated between 1982 and 2007. The mean age at presentation was 67.5 years. The overall five-year survival was 30 per cent; mean survival was three years and eight months.Conclusion:Sinonasal malignant melanoma is associated with a poor outcome, and survival statistics have not improved over the last 40 years. Treatment should include radical surgery wherever possible. Local recurrence is common; radiotherapy may help control this but does not appear to affect overall survival. The limited evidence available suggests that endoscopic removal of sinonasal malignant melanoma is as effective as other local surgical means, but that craniofacial resection remains the ‘gold standard’ for tumours that contact or traverse the skull base. Novel biological treatments are emerging and hold promise for the future. [ABSTRACT FROM PUBLISHER]

This guidance for the management of patients with rhinosinusitis and nasal polyposis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The recommendations are based on evidence and expert opinion and are evidence graded. These guidelines are for the benefit of both adult physicians and paediatricians treating allergic conditions. Rhinosinusitis implies inflammation of the nose and sinuses which may or may not have an infective component and includes nasal polyposis. Acute rhinosinusitis lasts up to 12 weeks and resolves completely. Chronic rhinosinusitis persists over 12 weeks and may involve acute exacerbations. Rhinosinusitis is common, affecting around 15% of the population and causes significant reduction in quality of life. The diagnosis is based largely on symptoms with confirmation by nasendoscopy. Computerized tomography scans and magnetic resonance imaging are abnormal in approximately one third of the population so are not recommended for routine diagnosis but should be reserved for those with acute complications, diagnostic uncertainty or failed medical therapy. Underlying conditions such as immune deficiency, Wegener's granulomatosis, Churg-Strauss syndrome, aspirin hypersensitivity and allergic fungal sinusitis may present as rhinosinusitis. There are few good quality trials in this area but the available evidence suggests that treatment is primarily medical, involving douching, corticosteroids, antibiotics, anti-leukotrienes, and anti-histamines. Endoscopic sinus surgery should be considered for complications, anatomical variations causing local obstruction, allergic fungal disease or patients who remain very symptomatic despite medical treatment. Further well conducted trials in clearly defined patient groups are needed to improve management. [ABSTRACT FROM AUTHOR]

This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research. [ABSTRACT FROM AUTHOR]

Objectives: To define the relationship of the anterior ethmoid artery to the frontal recess and secondly whether the degree of pneumatisation of the suprabullar recess/supraorbital cell correlates with the distance between the anterior ethmoid artery and the skull base thus making it more vulnerable to damage during surgery. Method: Thirty-four cadaver head sides were perfused with pink latex. All specimens had high-resolution computed tomography (CT) scans using bone windows in the axial, coronal and sagittal planes. The specimen's nasal septum was removed and the ethmoid sinuses dissected to locate the anterior ethmoid artery. Calipers were used to measure distance between the artery and the frontal recess and from the skull base. Results: The anterior ethmoid artery was found in all the specimens and scans. The distance between the anterior ethmoid artery and the posterior wall of the frontal recess was 11 mm (range 6–15 mm). In all specimens, the artery was seen between the second and third lamella. The commonest location of the artery was in the suprabullar recess (85.3%). Supraorbital cells were seen in 16 specimens. The ethmoid sinuses were well pneumatised with a large supraorbital cell in 10 of these specimens and in these the artery was lying 3.7 mm (range 1–8 mm) away from the skull base. Six specimens had poor pneumatisation and a small supraorbital cell and in these the artery was found close to or with in the skull base. In specimens without a supraorbital cell, the artery lay at the skull base in all but one. Conclusions: The position of the anterior ethmoidal artery is very variable. The artery is found between the second and third lamella. When the ethmoid sinuses are more pneumatised and in particular when there is a supraorbital cell, the artery lies below the skull base. A good strategy is to identify the degree of pneumatisation of the ethmoid sinuses from CT scans preoperatively to see if the artery is at an increased risk of being damaged. [ABSTRACT FROM AUTHOR]

Investigates the effectiveness of surgical and radiological intervention of vascular disease. Different types of the combined procedure performed; Need for coordination between surgeons and radiologist; Reasons for the failure of the combined operation.