Optimum management of inverted papilloma

Surgery offers the optimum modality of treatment for inverted papilloma although a considerable range of operative approaches have been described. The results are presented in a cohort of 37 cases treated by both endoscopic and combined endoscopic and external approaches with a recurrence rate of eight and 21 per cent respectively. This series is compared with those in the literature and demonstrates that it is extent of disease which primarily determines the choice of surgical approach, with previous treatment, individual patient factors and surgical expertise as secondary determinants

A case of rhinoscleroma treated with ciprofloxacin

Respiratory scleroma (often termed \'rhinoscleroma\') is a chronic inflammatory condition in which deforming masses of tissue distend the nasal cavity. Klebsiella rhinoscleromatis is the causative agent of this infection and the Mikulicz cell is specific to the lesion being a large macrophage with clear cytoplasm containing the bacilli. Antibiotic therapy has traditionally consisted of streptomycin and tetracycline long-term but this presents problems with adverse side-effects and poor patient compliance. We report on a young patient with nasal rhinoscleroma who achieved resolution after treatment with oral ciprofloxacin. As mentioned in a review of patients with rhinoscleroma at the Mayo clinic in 1993, the fluoroquinolones deserve further study as potentially highly effective agents for this condition. Ciprofloxacin is convenient for oral administration and has few adverse effects. It achieves good tissue penetration, is concentrated in macrophages and may prove to be useful in the therapy of rhinoscleroma

Closure of the nasal cavities in the treatment of refractory hereditary haemorrhagic telangiectasia

From a cohort of 35 patients with hereditary haemorrhagic telangiectasia (HHT), 12 patients have undergone closure of the one or both nasal cavities during the last three years for refractory epistaxis. All had failed other forms of treatment including hormone therapy, laser coagulation and septodermoplasty. All patients were available for follow-up at six months or longer. In all patients where complete closure was achieved (11 out of 12) bleeding ceased completely from the operated side

The role of midfacial degloving in modern rhinological practice

The midfacial degloving approach has been available for twenty five years and is slowly increasing in popularity in the management of extensive benign lesions of the sinonasal region, for selected malignancy in this area and to afford access to the nasopharynx and infra-temporal fossa. The advantages, applications and low complication rate are presented in a cohort of 86 patients, ranging from three to 79 years of age with a mean follow-up of 5.5 years. Seventy-seven per cent of the group had benign pathology of which juvenile angiofibroma was the commonest (40 cases). The 20 cases of malignant disease were a heterogeneous group histopathologically including adenoid cystic carcinoma (four cases), malignant schwannoma (two cases), rhabdomyosarcoma (two cases) and squamous cell carcinoma (two cases). Five underwent bilateral radical maxillectomies combined with orbital clearance in one patient. Complications include ore-antral fistula (three cases) and epiphora (three cases) all of which were successfully treated

The interactional work of configuring a mathematical object in a technology-enabled embodied learning environment

We present a detailed account of interactional mechanisms that support participation in STEM disciplinary practices as an adult and a child explore a technology-enabled embodied learning environment for mathematics. Drawing on ethnomethodological studies of technologyrich workplaces, we trace the process of transforming a vague reference into a mutually available mathematical object: a covariant variable. Our analysis reveals that this mathematical object is an interactional achievement, configured via a reciprocal process of instructing one another's attention. In particular, we demonstrate how participants' explicit responsiveness to indexical and multimodal resources achieves this object

Boundary interactions: Resolving interdisciplinary collaboration challenges using digitized embodied performances

Little is known about the collaborative learning processes of interdisciplinary teams designing technology-enabled immersive learning systems. In this conceptual paper, we reflect on the role of digitally captured embodied performances as boundary objects within our heterogeneous two-team collective of learning scientists and computer scientists as we design an embodied, animated virtual tutor embedded in a physically immersive mathematics learning system. Beyond just a communicative resource, we demonstrate how these digitized, embodied performances constitute a powerful mode for both inter- and intra-team learning and innovation. Our work illustrates the utility of mobilizing the material conditions of learning

Gesture enhancement of a virtual tutor via investigating human tutor discursive strategies: Forms and functions for proportions

We examine expert human mathematics-tutor gestures in the context of an interactive design for proportionality in order to design a virtual pedagogical agent. Early results implicate distinct gesture morphologies serving consistent contextual functionalities in guiding learners towards quantitative descriptions of proportional relations

Imaging for endoscopic sinus surgery in adults

Computerized tomography (CT) offers the gold standard in terms of imaging the extent of disease and the fine detailed anatomy, both pre-requisites to the safe practice of endoscopic sinus surgery. Neither plain X-rays nor magnetic resonance imaging (MRI) offer optimal information in this respect. A variety of protocols minimizing radiation dose to the lens whilst providing high quality images are presented together with a menu of anatomical features that require careful evaluation pre-operatively