Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic.There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes.A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.

The synthesis, isolation, and characterization of generation 3 poly(amidoamine) (G3 PAMAM) dendrimer containing precise ratios of 5-carboxytetramethylrhodamine succinimidyl ester (TAMRA) dye (n = 1–3) per polymer particle are reported. Stochastic conjugation of TAMRA dye to the dendrimer was followed by separation into precise dye-polymer ratios using rp-HPLC. The isolated materials were characterized by rp-UPLC, MALDI-TOF-MS, and 1H NMR spectroscopy, UV–vis, and fluorescence spectroscopies.

In the third article in our series on trauma, Omar Mukhtar and Kirsten Jones explain how to assess and manage ballistic trauma

SUMMARYA patient with localized, reactive tendinitis secondary to tuberculosis presented to the accident and emergency (A&E) department. Tendinitis is a relatively common complaint, and it is important to consider uncommon systemic causes, including tuberculosis.Key A 34-year-old Indian male presented to the A&E department complaining of bilaterally painful Achilles tendons, worse on the left. There was no recent overuse or trauma. He also complained of intermittent night sweats over the previous week. On examination there were bilateral tender, swollen Achilles tendons and paratendons. He was apyrexial. Treatment was commenced with Diclofenac, and the most painful leg placed in a below knee plaster for comfort.On review 5 days later the painful tendinitis and night sweats were persisting. Swinging fevers were confirmed by home temperature recording. A tender cervical lymph node was found on further examination. An elevated C-reactive protein (57) and a plasma viscosity (1.85) were the only abnormal blood tests. A chest radiograph was normal.A working diagnosis of atypical sero-negative arthritis (Reiter's Disease) was made, although he had no urethritis or iritis, and had tendinitis rather than arthritis. He was referred to the Department of Medicine as an out-patient, where this presumptive diagnosis was supported. A Mantoux test performed in the last 2 years was negative and he had received a BCG as a baby his native home of India. He had left India 12 months previously to work in the UK. Two weeks after the patient's initial presentation a rigor precipitated an emergency admission by his general practitioner under the care of the general physicians. Further investigation showed a 3/4 positive Heaf Test, and an excision biopsy of the cervical node showed active tuberculosis. The patient made good general progress on triple therapy.However, after starting therapy he developed further flitting tendinitis in his shoulder (requiring steroid injection), patella tendon, extensor pollicis longus, flexor carpi ulnaris and toe extensors.