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Biomedical subjects

A S Jones

Publications and source records attributed to A S Jones.

At least 19 recordsLinked to original sources
PubMed1992

A comparison of laser cautery and sub-mucosal diathermy for rhinitis.

A randomized prospective trial was conducted to compare the efficacy of laser cautery against sub-mucosal diathermy to the inferior turbinates in 29 patients with rhinitis. Laser diathermy was performed using an arthroscopic fitment to a CO2 laser. Subjective and objective measurement of airway obstruction were performed, using a linear analogue scale and a nasal peak inspiratory flow meter, before operation and at 3 days and 6 weeks afterwards. In both groups there was a similar and significant improvement in subjective scores at 6 weeks (SMD from 3.6 to 1.8, P less than 0.01; laser from 3.9 to 2.1, P less than 0.001), but only the laser group was significantly better at Day 3 (SMD from 3.6 to 3.5, n.s.; laser from 3.9 to 3.0, P less than 0.05). In addition, there was significantly more general subjective morbidity at Day 3 in the SMD group (P less than 0.01). The objective scores improved equally in both groups but were not significant. We conclude that laser cautery of the inferior turbinate is a superior alternative to SMD for the treatment of rhinitis.

Adult↗
PubMed1992

A double blind comparison of intranasal budesonide 400 micrograms and 800 micrograms in perennial rhinitis.

A randomized double blind placebo controlled cross-over study comparing budesonide 400 micrograms and budesonide 800 micrograms daily in 59 patients is presented. Nasal obstruction was the predominant symptom and was subjectively and objectively improved by both doses of budesonide (P less than 0.001). No significant difference was found between the two treatments. Both patient subgroups with non-allergic, non-eosinophilic rhinitis and perennial allergic rhinitis benefitted from therapy. Basal and stimulated plasma cortisol levels remained unchanged with either dose of budesonide, and no increase in adverse effects occurred with higher dose therapy.

Administration, Intranasal↗
PubMed1992

The role of mucosal receptors in the nasal sensation of airflow.

50 subjects were admitted into a randomized double-blind placebo controlled cross-over trial with 4% lignocaine as the active drug and normal saline as the placebo. Each subject had 2 ml of solution sprayed into each nasal cavity and all subjects had both sprays but on different occasions. The order in which the sprays were administered was randomized. The subjective sensation of nasal airflow was measured using a visual analogue scale before and after the spray. These measurements were made under conditions of the same airflow rate, which was monitored throughout the experiment using a reprogrammed NR6 rhinomanometer. Objective nasal patency was measured as peak nasal inspiratory flow rate. It was found that the nasal sensation of airflow decreased slightly after both lignocaine (difference between medians 5.0; 95% confidence interval -2.91 to 6.11) and normal saline (difference between medians 6.0; 95% confidence interval -1.02 to 7.21). Nonparametric analysis of variance showed this difference to be non-significant (P = 0.73). In addition there was no significant change in objective nasal patency. The results suggest that nerve endings in the nasal mucosa play no part in sensing nasal airflow during respiration.

Adolescent↗
PubMed1992

Nasal airflow receptors: the relative importance of temperature and tactile stimulation.

The receptors responsible for the nasal sensation of airflow have not been identified with certainty. Although both mechanoreceptors and thermoreceptors have been implicated, evidence suggests that the nose is more sensitive to cold air than to air at body temperature. The present study was designed to investigate the relationship between the velocity and the temperature of an airjet as regards its ability to stimulate the nasal lining. Both the nasal vestibule and the nasal cavum are more sensitive to cold air than to air at mean intranasal temperature (P < 0.001). A similar effect is seen with warm air which is as stimulating as cold air. The nasal vestibule is twice as sensitive as the nasal cavum to an airjet at mean intranasal temperature (P < 0.001). It is concluded that the nasal vestible is very sensitive to the tactile stimulation of an airjet. This effect is highly temperature dependent being much more pronounced for air temperatures above or below the mean intranasal temperature. The temperature effect is relatively more important in the nasal cavum which is very much less sensitive to stimulation than the vestibule.

Adult↗
PubMed1992

Treatment of T3 carcinoma of the larynx by surgery or radiotherapy.

T3 carcinoma of the larynx may be treated by surgery or by irradiation. A large number of oncologists feel that radical surgery offers a better chance of cure than does radiotherapy. We report a series of 147 patients with T3 N0 carcinoma of the larynx treated either by irradiation with salvage laryngectomy in the event of a recurrence, or by total laryngectomy. 109 patients had radiotherapy and 38 patients underwent surgery. The groups were well matched with no significant difference between the significant prognostic factors. The 5-year survival rate between the radiotherapy (70%) and surgery (40%) groups was significantly different (chi 2 = 4.48, d.f. = 1, P < 0.05). In spite of the well known problems associated with retrospective studies the present series suggests that radiotherapy combined with salvage surgery is an oncologically sound option for treating T3 laryngeal carcinoma.

Female↗
PubMed1992

Distribution of eosinophils in the nose in patients with perennial rhinitis.

The traditional method of classifying perennial rhinitis into eosinophilic and non-eosinophilic is by taking a single nasal smear from one nostril. In the light of personal experience it was felt that this method of sampling may be inadequate. The present study included 20 patients with perennial rhinitis undergoing nasal surgery. Serum total IgE levels were taken and those above 40 IU/ml had allergen specific IgE measured. Nasal smears and biopsies were taken from 5 sites on each side of the nose; middle and inferior turbinates and post nasal space. The smears significantly correlated with the biopsies (rs = 0.446, P < 0.001). The distribution of eosinophils between and within nasal cavities was found to differ. Representative sampling of the nose is important for accurate eosinophil expression. The definition of an eosinophil rich and poor nose requires greater clarification as it has great clinical relevance regarding management.

Biopsy↗
PubMed1992

A phase II study of cisplatinum versus cisplatinum + nifedipine in end-stage carcinoma of the head and neck.

Forty patients with end-stage carcinoma of the head and neck were admitted to a randomized double blind trial with cisplatinum in one arm and cisplatinum + nifedipine in the other. Nifedipine, a calcium channel blocking drug, inhibits the effect of acquired multidrug resistance in animal models. In the present study the addition of this agent had no effect on either response rate or survival in end-stage carcinoma of the head and neck. It is concluded that adding nifedipine to cisplatinum serves no useful purpose in the treatment of end-stage carcinoma of the head and neck.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Neck dissection for non-squamous malignancy.

Of 1030 patients who underwent neck dissection (radical, modified or selective) in a 27-year period 103 had malignant neck nodes from a primary site in the head and neck with a histological diagnosis other than squamous carcinoma. There were 71 men and 32 women in this group with a mean age of 55 years. 28 patients had neck dissection as part of their initial treatment and 75 for later nodal recurrence. Five-year survival was 52% (40-63%). Survival was site dependent, best for thyroid tumours and worst for tumours of the major salivary glands (chi 1(2) = 6.52, P < 0.05). Histology significantly affected survival, best for papillary tumours and worst for melanoma and undifferentiated tumours (chi 1(2) = 3.85, P < 0.05). Survival was worse with advanced N stage but varied little with node level. The number of nodes invaded had a highly significant effect on survival (chi 4(2) = 23.94, P < 0.001), but extracapsular rupture had no effect. Advanced T stage at the time of surgery had a significant adverse effect on survival using univariate analysis, but this effect disappeared using multivariate analysis. In the 75 patients who had neck dissections for nodal recurrence the presence of a simultaneous recurrence at the primary site had no significant effect on survival. These patients had a better 5-year survival than patients having neck dissection for squamous disease, but the usual predictors of survival in squamous carcinoma do not always apply to non-squamous malignancy.

Female↗
PubMed1992

The management of early hypopharyngeal cancer: primary radiotherapy and salvage surgery.

Carcinoma of the hypopharynx tends to present late and to occur in old age. Surgical treatment almost always involves a total laryngectomy as well as a major procedure to reconstruct the pharynx. Early tumours up to and including T3 tumours with no, or very early (nodes < 2 cm) nodal disease may be treated with radiotherapy with the option of salvage surgery if recurrence supervenes. In 106 previously untreated patients the 5-year recurrence rate was 50% and the 5-year survival rate was 41%. Sixty-nine patients were referred from other departments because of recurrent disease. The 5-year survival for those patients was 21%. The 5-year survival for those who developed a recurrence at the primary site was 23%. Seventy-eight patients had a resection and 42% suffered a major complication. Only 2 of the methods of reconstruction appear to be satisfactory: for disease confined to the neck free revascularized jejunal loop-repair is effective whereas for more extensive disease gastric transposition is recommended. Twenty-three per cent of patients developed neck node metastases and the 5-year survival rate for patients was 16%. Cox's regression showed that no host or tumour factors predicted survival. At 5 years, 46% of patients were alive with a larynx, 4% were alive without a larynx, 34% were dead of the original cancer and 16 were dead of other causes.

Aged↗
PubMed1992

Application of low magnification image analysis cytometry to prostatic tissue.

Determination of the volume percentage of epithelial tissue present in prostatic tissue samples obtained by transurethral resection presents difficulties for high magnification (0.2-0.5 microns per pixel) measurement techniques due to the random orientation of tissue fragments when sectioned and the necessity of having to select "representative" areas for measurement. A low magnification (110 microns per pixel) image analysis technique was used to overcome these difficulties by allowing measurement of the epithelial tissue component to be made from the entire area of tissue available for microscopic examination. This technique which utilizes standard hematoxylin and eosin preparations was applied to 89 consecutive cases of benign prostatic hyperplasia, with measurement times of four mins per slide being obtained. Replicate measurement of 20 of these samples showed an average absolute difference between replicates of +/- 5.1 percent epithelial tissue. This method thus offers a simple, fast and practical alternative to high magnification methods of estimating the volume percentage of epithelial tissue when the selection of "representative" areas for measurement is complicated by specimen heterogeneity or when large numbers of specimens must be examined.

Epithelium↗
PubMed1991

Benign prostatic hyperplasia--video image analysis and its relationship to androgen and epidermal growth factor receptor expression.

Androgens are essential for the development and maintenance of the prostate. However, prostatic growth may be mediated by epidermal growth factor (EGF) and the expression of the EGF receptor (EGFR) may be influenced by the androgenic milieu. We have characterized the expression of cytosolic androgen receptor (ARc), nuclear salt extractable androgen receptor (ARn) and EGFR in 89 consecutive cases of benign prostatic hyperplasia, 84 of which were treated by transurethral prostatic resections. Image analysis morphometry was performed on the histological sections to determine the epithelial content of the gland. Our results indicate that there is a vast heterogeneity of receptor expression in benign prostatic hyperplasia. Expression of ARc ranged from zero to 1312 fmol/gm. tissue (mean +/- SD 265 +/- 290), ARn ranged from zero to 531 fmol/gm. tissue (mean +/- SD 145 +/- 98) and EGFR ranged from zero to 316 fmol/gm. tissue (mean +/- SD 121 +/- 76). A statistically significant association was found between expression of ARn and EGFR, and these were both significantly correlated with the epithelial content of the gland.

Cell Nucleus↗
PubMed1991

Recurrence of oropharyngeal carcinoma after radiotherapy.

Two-hundred-and-twenty-one patients with squamous carcinoma of the oropharynx treated by irradiation are presented. The primary recurrence rate at five years in the previously untreated patients was 27%, but was dictated by neither host factors (age, sex and general condition) nor tumour factors (site, T-stage and histological grade). Pre-operative histological diagnosis had a very high sensitivity but a low specificity, indicating that false positives are common but false negatives unusual. Twenty per cent of patients with a recurrent primary tumour were untreatable. The five year survival after a primary recurrence was 31 per cent. Sixty-eight per cent of patients undergoing major surgery recovered without a major complication, and the hospital mortality rate was three per cent, due entirely to major medical catastrophes. The major complication rate in those undergoing flap repair after major resection was seven per cent. The metastatic rate in lymph nodes was 44 per cent at five years, and again this did not depend on any host or tumour factors. The survival at five years after node recurrence was a mere 19 per cent, and the length of survival was related to the primary site of the original tumour and the presence of extranodal disease. Two-thirds of patients had advanced disease (N2 and N3) when node recurrence was diagnosed and about 15 per cent were unsuitable for surgery.

Carcinoma, Squamous Cell↗
PubMed1991

Interpretation of maxillary sinus radiographs in children.

Nasal symptoms are a frequent cause of referral to paediatric ENT clinics. It is the policy of our unit to view sinus radiographs without a report at the initial clinic attendance. This study demonstrates there is no statistically significant difference in the interpretation of the radiographs between two ENT surgeons and a radiologist although there was a tendency for the radiologist to have a greater specificity. This finding may have financial implications. In addition a clear sinus radiograph is shown to be a significant negative finding.

Adolescent↗
PubMed1991

Is laterality important in neck node metastases in head and neck cancer?

We present a series of 2219 previously untreated squamous carcinomas of the head and neck, 141 (6.5%) of whom had bilateral nodes at presentation. Bilateral nodes became progressively less common with increasing age but were not related to other host factors. They were also strongly related to the site of the primary tumour, its T-stage and its histological grade, being more common in tumours of the oro or naso-pharynx, in poorly or moderately differentiated tumours, and in tumour stages T3 or T4 at presentation. There were also interactions between these tumour factors, and patients with all three factors had a 25% incidence of bilateral nodes. 126 of these patients could be matched for the main prognostic factors with 126 patients with unilateral neck node disease. The survival rate of the latter group was 9% better than that of the unilateral group. Further breakdown showed that the survival of patients with nodes smaller than 6 cm is not affected by laterality, whereas it is for patients with massive nodes.

Carcinoma, Squamous Cell↗
PubMed1991

Squamous carcinoma of the posterior pharyngeal wall.

We present 70 patients with tumours of the posterior pharyngeal wall, considering tumours of the posterior hypopharyngeal and posterior oropharyngeal wall as one unit. Almost half (45%) of the patients were in poor general condition at the time of presentation, and 60% had Stage III or IV tumours. One-third of the patients were untreated, and surgery was mainly reserved for patients with Stage I and II tumours. The larynx could be preserved in two-thirds of those undergoing surgery. The best current method of repair of the posterior pharyngeal wall after partial pharyngectomy appears to be a revascularized radial forearm flap. The median survival for patients with Stage I tumours was 236 weeks, but for patients with Stages II-IV tumours was only 33 weeks. There was no significant difference between the survival for II-IV stage groups, but there was between Group I and the rest. We identify 2 defects in the UICC classification system: lack of definition of the lateral limit of the posterior pharyngeal wall, and a gross discrepancy between size and T staging of tumours arising primarily from the posterior wall of the hypopharynx.

Carcinoma, Squamous Cell↗
PubMed1991

The objective assessment of nasal patency.

Nasal patency was measured by five techniques in 24 subjects and the results compared. In addition three pulmonary parameters were measured as well as height and weight. Nasal resistance to airflow measured by active anterior rhinomanometry was found to be highly correlated with peak nasal inspiratory flow rate. Other correlations were also noted. Peak nasal inspiratory flow was itself highly correlated with pulmonary peak expiratory flow rate as well as with several other parameters. The possible reasons for these correlations are discussed in terms of fluid mechanics.

Adult↗
PubMed1991

Patients with thick melanomas surviving at least 10 years: histological, cytometric and HLA analyses.

Survival for melanoma patients with thick primary tumours is notoriously short. A small number of patients with tumours greater than 5.5 mm thick do, however, have protracted survival intervals. Attempts were made to account for this phenomenon by means of histological, cytometric and HLA serotyping analyses. Patients with thick lesions surviving more than 10 years were matched--by sex, age, anatomical site of primary lesion, stage of disease and, whenever possible, by initial surgical therapy--to patients dying of their disease within 5 years. This case-control study on 13 long-term survivors and 13 short-term survivors did not show that any of the following attributes of the primary lesion were useful in predicting survival: Clark's level of invasion, ulceration, mitotic rate, host inflammatory response, tumour regression, tumour necrosis, vascular invasion, satellitosis, radial or vertical growth phase, predominant cell type, histogenetic type, borders, DNA quantification and cytomorphometry. HLA serotyping of long-term survivors showed an excess of antigen DQw1 compared with the general population, although this excess was not statistically significant.

Adult↗