Search PubMed⌕ Search

Biomedical subjects

A R Sinnathuray

Publications and source records attributed to A R Sinnathuray.

8 recordsLinked to original sources
PubMed2004

Aggressive treatment of metastasis to the parotid.

OBJECTIVES: Assess the value of aggressively treating metastatic lesions in the parotid, taking into account the histology of the disease. STUDY DESIGN: Retrospective analysis of 13 patients diagnosed with metastasis to the parotid treated by one surgeon in a tertiary referral head and neck unit in the United Kingdom. METHODS: The following variables were reviewed and tabulated: age, sex, histology, latent period to secondary tumour, treatment instituted, postoperative facial nerve outcome, follow-up and survival. RESULTS: Twelve patients were treated aggressively with at least total parotidectomy and adjunctive therapy, whilst one patient required only a superficial parotidectomy. Ten patients had metastatic cutaneous tumours, and three had metastatic adenocarcinoma. Seven of these 13 patients (53.8 %) are alive and well (six had metastatic cutaneous tumours, one had metastatic adenocarcinoma). Four patients succumbed to tumour (two had metastatic cutaneous tumours and two had metastatic adenocarcinoma), and two patients succumbed from unrelated medical causes (both had metastatic cutaneous tumours). The mean follow-up for those alive is 65.9 months and mean follow-up for those deceased is 15.3 months. CONCLUSIONS: In the absence of systemic spread, parotid metastases from primary cutaneous squamous cell carcinoma should be treated aggressively, while metastases from non-cutaneous primary tumours should be approached with caution.

Aged↗
PubMed2003

A review of cochlear implantation in mitochondrial sensorineural hearing loss.

OBJECTIVE: Mitochondrial sensorineural hearing loss (SNHL) may be nonsyndromic (occurring in isolation), associated with the A1555G mutation in the MTRNR1 gene. Mitochondrial SNHL may also be syndromic, associated with the A3243G point mutation in the MTTL1 gene. In syndromic cases-mitochondrial encephalopathy, lactic acidosis, and strokelike episodes (MELAS), maternally inherited diabetes and deafness, Kearns-Sayre syndrome, and chronic progressive external ophthalmoplegia-the SNHL compounds already existing disabilities. The genetic basis for mitochondrial SNHL and postulated sites of pathologic changes are discussed. DATA SOURCES: Sources used were relevant clinical and basic science publications. STUDY SELECTION: A search of the entire databases of Medline and Web of Science, using various subject headings and free-text terms, was used to identify patients with mitochondrial disease having cochlear implants. DATA EXTRACTION: The data from publications were critically reviewed and tabulated to assess implantation outcomes. DATA SYNTHESIS: The data were not amenable to formal meta-analysis or valid data summarization, other than descriptive statistics. CONCLUSIONS: There is an increasing awareness of the prevalence of mitochondrial SNHL and its progressive nature. High-risk candidates warrant genetic testing and family screening. Correlating the data for mitochondrial SNHL as a treatable entity is important, and the authors present an overview of these patients successfully rehabilitated by cochlear implantation.

Adult↗
PubMed2002

Bipolar scissors versus cold dissection for pediatric tonsillectomy--a prospective, randomized pilot study.

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.

Adolescent↗
PubMed2002

Soft tissue myoepithelioma: a case report.

Myoepitheliomas are tumours composed predominantly or exclusively of myoepithelial cells. They are well described, especially within the salivary gland, but their occurrence in soft tissues is less well known and this often results in diagnostic problems. We report a case involving the deep soft tissues of the lower neck behind the clavicle. Grossly, the tumour was well circumscribed with solid and cystic areas. Histology showed a richly vascularised tumour composed of bland round, ovoid or spindle-shaped cells. Various growth patterns were present including solid, nested, microcystic and trabecular arrangements. In some areas there was an alveolar pattern with tumour cells lining fibrous septae. Immunohistochemistry showed diffuse strong positivity for S100 protein, calponin, vimentin and glial fibrillary acidic protein and focal positivity for epithelial membrane antigen, 34betaE12 and AE1/AE3, in keeping with myoepithelial differentiation. Electron microscopy revealed tumour cells surrounded by basal lamina with subplasmalemmal densities and containing cytoplasmic myofilaments. This case report highlights the rare occurrence of myoepitheliomas in deep soft tissues. Pathologists should be aware of this and should consider a myoepithelioma in the differential diagnosis of a soft tissue spindle cell neoplasm.

Adult↗
PubMed2001

Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study.

OBJECTIVE: To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy. STUDY DESIGN: A prospective, randomized, multi-unit study. SETTINGS: Belfast City Hospital, Royal Victoria Hospital Belfast, and Ulster Hospital Dundonald. PATIENTS: Two hundred consecutive patients undergoing tonsillectomy for recurrent or chronic tonsillitis between March 2000 and September 2000. OUTCOME MEASURES: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain, and (4) complication rates, including primary and secondary hemorrhage. RESULTS: Seventeen patients were excluded from the study for various reasons. The mean age of the study population was 22 years (range, 10-54 y). Seventy-two percent of patients were female. Twenty-seven percent of patients were children aged 16 years or under. Median intraoperative blood loss was 5 mL for bipolar scissors tonsillectomy and 115 mL for cold dissection tonsillectomy (P < .001). The mean operative time was 13 minutes for bipolar scissors tonsillectomy compared with 20 minutes for the cold dissection method (P < .001). There was no statistically significant difference in the pain scores between the two methods (independent samples t = 1.35; P > .05). The overall primary hemorrhage rate was 2.1%, whereas the overall secondary hemorrhage rate was 16.9%. The hospital readmission rate was 10.3%. The primary and secondary hemorrhage rates were unaffected by the surgical method. CONCLUSIONS: Bipolar scissors tonsillectomy is a safe technique with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in both surgical time and blood loss compared with the cold dissection method.

Adolescent↗
PubMed2001

Metastatic breast carcinoma in the parapharyngeal space.

The parapharyngeal space is a complex anatomical area, which can give rise to a variety of both primary and metastatic neoplasms. We present an unusual case of metastatic adenocarcinoma of the breast, masquerading as a deep lobe parotid neoplasm, 15 years after the primary presentation. Metastatic breast carcinoma has been previously reported at other sites in the head and neck but this is the first report of metastases in the parapharyngeal space with an oropharyngeal presentation.

Adenocarcinoma↗