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Histone modifications occur during DNA damage and repair in eukaryotes. These modifications were analysed in wheat seedlings exposed to 60Co-γ radiation. Seedling height was not significantly affected in the first 2 days after irradiation up to 150 Gy. Subsequently, in the next 2 weeks, there was 30-40% reduction in seedling height, indicating that there were late effects of irradiation. The histones isolated from irradiated seedlings were analysed in the initial stages for modifications of H3 and H4 using antibodies. Global acetylation of H3 decreased and H4 increased in a dose-dependent manner till 100 Gy. The time course of individual modifications showed that for H3K4 and H3K9, acetylation decreased, whereas for H3S10 phosphorylation increased. There were fluctuations in acetylation of H4K5, H4K12 and H4K16, whereas H4K8 showed hyper-acetylation. The results indicate that γ radiation induced DNA damage and repair in wheat seedlings and initiated differential acetylation of H3 and H4. This is the first report in plants on site-specific H3 and H4 modifications in response to exposure to ionizing radiation. [ABSTRACT FROM AUTHOR]

Background: After primary total hip replacement, aseptic loosening of the acetabular cup is more common than loosening of the femoral stem. Removal of a well-fixed stem adds to operative time, blood loss, risk of bone loss and fracture. There is limited evidence that isolated cup revision can be a safe option in revision hip arthroplasty. We question the following regarding the unrevised cemented stem after isolated cup revision: 1) Does the unrevised stem require revision after isolated cup revision? 2) When is the stem subsequently revised? 3) Why is the stem subsequently revised? 4) Do unrevised stems exhibit radiographic loosening?, Hypothesis: We hypothesise that after isolated cup revision most unrevised stems do not need subsequent revision, and that most do not exhibit evidence of radiographic loosening., Patients and Methods: A retrospective analysis of all patients who underwent revision of the acetabular component only during revision hip arthroplasty between March 1970 and July 2013 was carried out. We assessed survival of the unrevised stem, reasons for subsequent revision, plus radiographic analysis for stem loosening., Results: Two hundred and twenty-seven hips were included [215 patients with an average age at the time of primary surgery was 47 (13-70) years]. The Charnley stem was used in 161 cases; C-stem 65, Howse 1. Average time between primary surgery and cup revision was 15.9 (1.6-33.4) years. Average follow-up for all stems post-isolated cup revision was 6.1 (0.1-30.7) years. Twenty-eight stems (12.3%) were subsequently revised 5.1 (0.1-12.6) years after the isolated cup revision. Reasons for subsequent revision were: aseptic loosening (10); infection (8); dislocation (6); unreconstructable joint post-loose cup removal (2); fracture (2). Radiographic review was possible on 140 cases. Five femoral stems were revised and 2 others showed evidence of possible radiological loosening but were not revised., Conclusion: To our knowledge this is the largest series showing that isolated cup revision in the place of a well-fixed cemented stem is safe and is associated with ongoing good long-term survival of the stem., Level of Evidence: Level IV, retrospective case series., (Copyright © 2015. Published by Elsevier Masson SAS.)

Histone modifications occur during DNA damage and repair in eukaryotes. These modifications were analysed in wheat seedlings exposed to (60) Co-γ radiation. Seedling height was not significantly affected in the first 2 days after irradiation up to 150 Gy. Subsequently, in the next 2 weeks, there was 30-40% reduction in seedling height, indicating that there were late effects of irradiation. The histones isolated from irradiated seedlings were analysed in the initial stages for modifications of H3 and H4 using antibodies. Global acetylation of H3 decreased and H4 increased in a dose-dependent manner till 100 Gy. The time course of individual modifications showed that for H3K4 and H3K9, acetylation decreased, whereas for H3S10 phosphorylation increased. There were fluctuations in acetylation of H4K5, H4K12 and H4K16, whereas H4K8 showed hyper-acetylation. The results indicate that γ radiation induced DNA damage and repair in wheat seedlings and initiated differential acetylation of H3 and H4. This is the first report in plants on site-specific H3 and H4 modifications in response to exposure to ionizing radiation., (© 2011 German Botanical Society and The Royal Botanical Society of the Netherlands.)

Objective: Analysis of the one year results of Kurz titanium ossicular prosthesis and the factors affecting the outcome from this prosthesis. The hearing results of titanium partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP) were compared., Methods: This is prospective study of 97 Kurz prosthesis ossiculoplasties, performed by the same senior author (VVR) between 2004 and 2006. All patients undergoing ossiculoplasty using Kurz prosthesis between 2004 and 2006 were included. All patients had minimum follow-up period of one year. There were 97 patients in total. 65 patients had PORP's and 32 had TORP's. The mean preoperative and postoperative air-bone gaps for the frequencies (500, 1000, 2000, and 3000Hz) were calculated. The improvement of the mean air-bone gap (ABG) and air conduction over the same frequencies were measured. A postoperative ABG less than or equal to 20dB was considered a successful result. Statistical analysis was used to identify the factors which affect the postoperative results., Results: The mean preoperative ABG was 27.89dB (SD=11.71). The mean postoperative ABG for the entire series was 11.39dB (SD=10.47). The mean improvement in ABG was 16.50dB (SD=14.00). 81.4% (79 patients) had postoperative ABG< or =20dB. 56.7% (55 patients) of the patients had postoperative ABG< or =10dB. The mean postoperative ABG for all PORP patients was 10.6dB (SD=9.7). The mean postoperative ABG of TORP was higher in this study (14.84dB, SD=12.86) but it was not statistically significant (p=0.10, 2-tailed t-test, 95% CI -9.35 to 0.924). There was no significant effect of age, presence or absence of cholesteatoma or retraction pocket, type of mastoid surgery and thickness of the cartilage graft used on the results. The effect of the preoperative ossicular condition on the postoperative hearing results was also analysed., Conclusion: Titanium ossicular reconstruction gives stable short-term results. There was no statistically significant difference between the total and partial replacement prostheses. The preoperative status of the stapes superstructure did influence the mean postoperative ABG., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Titanium has been shown to be a highly biocompatible material and recently interest has been raised by its use as a prosthetic material in the ear. Our objective was to prospectively assess the early results of titanium partial and total ossicular replacement prostheses in chronic ear disease. Thirty-three consecutive patients (20 titanium partials and 13 total ossicular replacement prostheses) were analysed and data from pre and post-operative pure tone audiograms were collected and compared at six months over a four frequency range (0.5-4 kHz) as well as using the American Academy of Otolaryngology-Head and Neck Surgery criteria (0.5-3 kHz). Closure of the air-bone gap and improvement in air conduction at six months was also calculated. 69% of patients obtained an air-bone gap of < or = 20 dB, with titanium partial ossicular replacement prostheses (85 per cent) doing better than total ossicular replacement prostheses (46 per cent). There have been no cases of sensorineural hearing loss or extrusion. In conclusion, titanium prostheses are easy to use, allow good visibility and have shown good short-term results in our hands.

The last 30 years have seen a gradual change in the management of otosclerosis. The aim of this study is to evaluate the current practice amongst Irish otolaryngology consultants by a questionnaire and to compare it with the practice currently followed in Great Britain. Thirty-eight responses (67.9%) were available for analysis. The overall trend is towards centralisation with a reduction in the number of surgeons undertaking stapes surgery (39%). The majority of consultants (67%) who undertake stapes surgery would operate for a unilateral conductive loss and 67% would undertake bilateral stapes surgery. Stapedotomy is the only operation performed (100%) with none of the consultants performing partial or total stapedectomies.

Objective: To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy. The outcome measures used were: (1) intra-operative bleeding; (2) operative time; (3) post-operative pain; and (4) complication rates including reactionary and secondary hemorrhage., Method: A prospective, randomized multiunit study involving three teaching hospitals in Belfast. Fifty consecutive children aged 10-16 years undergoing tonsillectomy for recurrent or chronic tonsillitis, between March 2000 and September 2000 were recruited as a subgroup of 200 patients selected for this study. These children were analysed separately from the adults, in a pilot study for the above parameters., Results: The mean age of the study population was 14.3 years. Sixty-eight percent of the children were girls. Median intra-operative blood loss was 6 ml for bipolar scissors tonsillectomy and 86 ml for cold dissection tonsillectomy (P<0.001). The median operative time was 10.5 min for bipolar scissors tonsillectomy compared to 14.5 min for the cold dissection method (P=0.001). There was no statistically significant difference in the pain scores between the two methods (P>0.05). The overall reactionary hemorrhage rate was 4% while the overall secondary hemorrhage rate was 14%. The hospital readmission rate was 4%. The reactionary and secondary hemorrhage rates were unaffected by the surgical method., Conclusions: This pilot study has shown that bipolar scissors tonsillectomy is a relatively safe technique in children aged 10-16 years with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in surgical time and blood loss compared to the cold dissection method. These advantages make it a favourable instrument for pediatric tonsillectomy especially in this age group.

The last 30 years has seen a gradual change in the management of otosclerosis. The aim of this study is to evaluate the current practice among British otolaryngology consultants using a questionnaire, and to compare it with the practice reported in a survey 8 years ago. A total of 353 valid responses (64.5%) were available for analysis. The overall trend is towards centralization, with a reduction in the number of surgeons undertaking stapes surgery (49.9%). The majority of consultants (81.3%) who undertake stapes surgery would operate for a unilateral conductive loss and 75.1% would undertake bilateral stapes surgery. Stapedotomy is the operation of choice (82%), with a few consultants performing partial or rarely total stapedectomies. Postoperative restrictions and follow-up times vary widely amongst surgeons, with the senior surgeons tending to be more conservative than the younger consultants.

Objective: Hearing loss, both sensorineural and conductive, has been reported in patients with rheumatoid arthritis (RA). The aim of this study was to try and ascertain the type of hearing loss and to determine the cause for any conductive element noted in these cases., Design and Setting: A prospective case-control study in the otolaryngology department of a university teaching hospital in the United Kingdom., Methods and Outcome Measures: This study compared 35 patients with RA with 35 age- and sex-matched controls. All patients had pure-tone audiometry, speech discrimination, tympanometry, acoustic reflex, and acoustic reflex decay carried out. Statistical analysis of the two groups was carried out using the F test for differences in variation and the t-test for independent samples., Results: Sensorineural hearing loss that was statistically significant (p < .05) at 500 Hz, 1 kHz, and 2 kHz in both ears was found in 60% of the RA group and in 34.29% of the control group. A conductive hearing loss that was statistically significant (p < .05) at 250 Hz, 500 Hz, 1 kHz, and 2 kHz in the right and left ears was found in 17.14% of the RA patients and in 5.71% of the control group. Speech discrimination did not show a statistically significant difference between the two groups. Tympanometry showed that the conductive element was probably owing to laxity of the middle ear transducer mechanism. Acoustic reflex and reflex decay did not show statistically significant differences between the two groups., Conclusion: Sensorineural hearing loss of the cochlear variety is a common finding in patients with RA, whereas conductive loss, although seen, is much less common. Increased laxity of the middle ear transducer mechanism is the likely cause of the conductive element.

The influence of food bolus consistency on the pharyngeal wave during swallowing was investigated using a four-sensor manometry probe in 22 healthy volunteers. Pharyngeal pressures were recorded for 5 ml boluses of water, pudding and buttered bread via a manometry probe placed transnasally. The distal sensor was sited within the upper oesophageal sphincter (UOS); the three proximal sensors were then located 2, 4 and 6 cm above the UOS. The amplitude and timing of the swallow waveforms for pudding and buttered bread were recorded and compared with those for water. Increased bolus viscosity led to increased amplitude of the bolus wave and clearing contraction within the pharynx. In the UOS, increased bolus viscosity was associated with a larger pressure nadir (sub-atmospheric pressure) on opening and intra bolus pressure during transit. Bolus consistency also influenced the coordination of the swallow response with delayed pharyngeal clearance. The putative relevance of these findings to dietary modification for patients with neurological and neuromuscular dysphagia is discussed.

Although peritonsillar abscess (quinsy) and peritonsillitis are common ENT emergencies, management strategies in the United Kingdom still vary among otolaryngologists. In order to obtain data on the success of the various strategies, we conducted two surveys--one concerned itself with patient outcomes, while the other sought information on physician preferences. The survey of 571 practicing ENT surgeons revealed that 83% advise interval tonsillectomy only for patients who have a history of tonsillitis; they prefer to take a wait-and-see approach for a single attack of quinsy. Conversely, 15% advise a routine interval tonsillectomy following even a single isolated attack of quinsy/peritonsillitis. Only 6.8% still perform a quinsy tonsillectomy in selected cases. Survey responses from 192 adults and 15 children who had been hospitalized for the treatment of quinsy/peritonsillitis revealed that the vast majority of patients who did not undergo an interval tonsillectomy were still asymptomatic 2 to 8 years later. These results indicate that a wait-and-see policy is indeed suitable for most patients who present with an isolated attack of quinsy/peritonsillitis without a history of tonsillitis. We recommend that tonsillectomy be performed as a definitive treatment for quinsy/peritonsillitis in patients who have a history of tonsillitis. Such a history is a reliable indicator of recurrent quinsy or tonsillitis following an attack of quinsy/peritonsillitis in both children and adults. Quinsy tonsillectomy should be reserved for those few patients who do not respond to conservative measures.

Dacryocystorhinostomy is the surgical treatment for nasolacrimal blockage. In recent years, the endoscopic approach has become more popular due to the development of nasal endoscopes and the ease of surgery in comparison to the external approach. In order to identify the lacrimal duct during surgery, surgeons insert a light pipe into the lacrimal duct and then drill or chisel the hard bone of the frontal process of the maxilla to remove the bony covering of the sac and duct. It is obvious that knowledge of the anatomy of the lacrimal sac/duct within the nose is essential for the surgeon. The lacrimal apparatus in the nose was studied using 10 cadaveric half-heads (5 males and 5 females) to establish the anatomical landmarks and most accessible part of the lacrimal duct from within the nose. Although there was solid bone covering the whole length of the sac and the duct, the posteromedial aspect of the lower sac and upper duct was covered by the ultra thin lacrimal bone (average thickness 0.057 mm) which was consistently found to be lying immediately anterior to the uncinate process in the middle meatus, thus constituting a "surgical window" (average size 2.5 mm x 7.2 mm) whereby surgical entry into the lacrimal duct becomes relatively easy. The lower part of the lacrimal sac and the upper part of the lacrimal duct can therefore be easily accessed from within the nose by following this anatomical approach, thus avoiding the need to drill or chisel the dense frontal process of the maxilla.

Peritonsillitis and peritonsillar abscess (quinsy) are commonly encountered emergencies in day to day ENT practice. However the value of a tonsillectomy as well as its timing in these cases is debatable amongst Otolaryngologists. A postal survey performed amongst practising ENT surgeons in the U.K. revealed that 475 out of 571 ENT surgeons (83%) prefer to "wait and observe" for a single isolated attack of peritonsillitis/peritonsillar abscess while 86 surgeons (15%) would routinely advocate interval tonsillectomy after an attack of peritonsillitis/quinsy. In patients without a background history of tonsillitis, 432 of the 475 ENT surgeons (90.9%) would advise a tonsillectomy after the second attack of peritonsillitis/quinsy whereas 30 surgeons (6.3%) would do so only after a third attack. A retrospective study of 207 patients was performed to evaluate the safety of a "wait and observe" policy. One hundred and four of the 129 adults (88.3%) and 5 out of the 6 children (83.2%) who did not undergo a tonsillectomy remained asymptomatic after the single isolated attack of peritonsillitis/quinsy. Four adults (3.1%) and 1 child (16.6%) required a tonsillectomy eventually for recurring attacks of tonsillitis. Recurrence of peritonsillitis/peritonsillar abscess was observed in 11 patients (8.5%). These results suggest that a "wait and observe" policy is safe for most patients presenting with a single attack of peritonsillitis/peritonsillar abscess without a background history of tonsillitis.

Three hundred ninety-nine cemented stem revision total hip arthroplasties performed in cases with mechanical stem failure without infection and having a minimum follow-up period of 3 years were prospectively studied. Two hundred eighty-three were revised for aseptic stem loosening and 116 were revised for fractured stem. Bone-grafting was not performed in any of the cases. The average follow-up period was 7 years 5 months. At the last follow-up evaluation, 70.4% of the patients were pain free and 20.6% had only mild or occasional discomfort. On radiographic evaluation, 31 stems (7.8%) were loose. Thirty-five hips (8.8%) required a rerevision, of which only 20 (5.0%) were for recurrence of mechanical stem failure. Clinical survivorship of the revised stem was 93.9% at 10 years, whereas radiographic survivorship was 91.5% at 10 years. On radiographic analysis, the mechanical failure rate at the last follow-up evaluation was greater after revision for fractured stem than after revision for aseptic stem loosening. Prerevision femoral cortical bone stock did not appear to adversely affect the outcome of the procedure. The clinical and radiologic results achieved with cemented stem revision arthroplasty for mechanical stem failure are excellent.

We assessed 41 patients with rheumatoid arthritis (47 hips) who had had revision hip arthroplasty, at an average follow-up of 7 years 4 months (2 to 19). The clinical results were excellent or satisfactory in 43 hips. Radiologically, 45 stems were secure. Fifteen sockets (36.6%) were radiologically loose. Three hips required rerevision. Socket failure is the predominant problem in rheumatoid patients after cemented revision arthroplasty.

We report a prospective study of 57 one-stage cemented revisions of total hip replacement for deep infection with an actively discharging sinus. The average follow-up was 7 years 4 months. Seven patients had required rerevisions, but at latest follow-up, infection was under control in 49 (86%). A discharging sinus is not, in itself, a contraindication to one-stage revision of a hip replacement.

The authors assessed 40 hips in 36 patients where a bulk femoral head autograft was used to supplement deficient acetabulum while performing Charnley low-friction arthroplasty. The majority of the hips were congenitally dysplastic or dislocated with secondary arthritis. The average age at surgery was 47.5 years and the average follow-up period was 4 years. The graft provided a cover between 10 and 42% (mean, 23%) of the socket hemisphere. Union of the graft was evident on the radiograph in 35 hips. There was no graft resorption in 28 hips. Mild graft resorption was seen in 11 cases, and moderate graft resorption was seen in 1 case. In 24 cases, there was no demarcation at the bone-cement interface of the socket. Asymptomatic demarcation of 1 mm thickness or less was seen in 16 hips, of which only 2 showed demarcation at the cement-graft interface. All 40 cases were clinically asymptomatic and successful thus far, with the mean d'Aubigne and Postel score improving from 3.1, 2.8, and 2.9 before surgery to 5.9, 5.4, and 4.9 after surgery for pain, function, and movement, respectively.

Fifty-six patients over the age of 80 undergoing revision hip arthroplasty in 57 hips were reviewed. The average age of the patients at the time of surgery was 81 years 6 months and the mean follow-up period was 2 years 6 months. No complications were seen in 21 patients. The complication encountered in the others were medical in 35 and procedure-related in 15. The preoperative risk factor rating (American Society of Anesthesiologists classification) correlated very well with the incidence and grading of medical complications. This correlation was significant, emphasizing the importance of strict preoperative medical and anesthetic assessment in this group of patients. The mean d'Aubigne and Postel hip score improved from 2.8, 2.2, and 3.4 to 5.6, 4.8, and 4.9 after revision surgery.

Fifteen cases of proved gas gangrene infection were studied to assess the rapidity of control of infection and associated toxaemia, by hyperbaric oxygen therapy at 2 1/2 atmospheres pressure. Within 3-5 sittings, all the cases (100%) were found to become devoid of clostridial organisms as judged by smear and culture methods.