Neoplastic chemotherapy and head and neck cancer.
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Antineoplastic Agents, Alkylating↗
Biomedical subjects
A S Jones
Publications and source records attributed to A S Jones.
Prevalence of mucosotropic human papillomaviruses in squamous-cell carcinoma of the head and neck.
The prevalence of mucosotropic human papillomavirus (HPV) DNA in 63 squamous-cell carcinomas (SCC) from different anatomic sites in the head and neck was determined by general primer-mediated polymerase chain reaction (GP-PCR). HPV DNA was detected in 20.6% of SCC. Additional type-specific PCR for HPV 6, 11, 16, 18, 31 and 33 demonstrated the presence of HPV 16 alone in these carcinomas. HPV 16 was also detected in normal epithelium from the resection margins of the majority of HPV-positive SCC. HPV status did not correlate with tumour site, whether primary or recurrent, TNM stage, metastases, degree of differentiation, smoking or alcohol history, fate or survival.
Alcohol Drinking↗
Do positive resection margins after ablative surgery for head and neck cancer adversely affect prognosis? A study of 352 patients with recurrent carcinoma following radiotherapy treated by salvage surgery.
It is generally accepted by surgeons that failure to eradicate malignant disease at the primary site has an adverse effect on survival. The present study investigates 352 patients with squamous carcinoma of the head and neck treated by primary radical radiotherapy and who subsequently underwent surgical ablation for a recurrent carcinoma. A total of 303 (86%) patients had a negative resection margin and 49 (14%) had a positive resection margin. Oral carcinoma was 1.7 times more likely to be associated with a positive margin than other tumours (P = 0.0292). Actuarial calculations demonstrated that 47% of patients with negative margins and 66% of patients with positive margins developed a primary site recurrence (P = 0.0286). Neck node recurrence occurred in 10% of those patients with negative margins and 12% of patients with positive margins. Patients with positive margins had a significantly poorer survival than those with negative margins (P = 0.022). Multivariate analysis failed to confirm any independent adverse effect from a positive margin. The 5 year tumour-specific survival of patients with a positive margin was poorer by 12% than for those patients with a negative margin. The pattern of failure differed between the two groups, with patients having positive margins tending to die of local recurrence.
Combined Modality Therapy↗
MIB-1 and involucrin expression in laryngeal squamous carcinoma: the relationship to host and tumour factors and survival.
MIB-1 is an antibody which attaches to the Ki67 antigen expressed by proliferating cells. MIB-1 immunoreactivity may be used to quantify the proliferative component of a tumour. Involucrin is a protein expressed by mature keratinocytes and may be used as a marker of differentiation. The present paper studies the expression of these two markers in a group of patients with squamous carcinoma of the larynx. Tumour cell kinetics were studied in 49 patients with squamous cell carcinoma of the larynx using antibodies to "Ki67' and involucrin. The median potential follow-up for the group was 8.1 years with a minimum follow-up of 5 years. The median MIB-1 index was 32%. The median involucrin index was 56%. Fifteen patients had no or only slight involucrin staining whereas 34 stained intensely for this protein. Involucrin expression was found to be associated with histological grade with those patients expressing involucrin tending to have well differentiated tumours and those not expressing this parameter tending to have poorly differentiated tumours (P = 0.045). There were no other associations between host and tumour factors and the various biological parameters. Survival analysis demonstrated that patients with an involucrin count above the median value had a better 5-year survival than those below the median (89% and 56% respectively) (P < 0.05). In addition, patients with no (or poor) involucrin expression had an increased risk of developing a recurrence at the primary site (P < 0.05). Involucrin appears to be a promising marker of tumour differentiation and survival in squamous carcinoma of the larynx.
Biomarkers, Tumor↗
The nasal response to axillary pressure.
The changes in ipsilateral sympathetic tone in response to axillary pressure are well known. However, the response of the nasal mucosa is less well documented. We have attempted to demonstrate this response in normal individuals. Ten individuals with no history of nasal disease or allergy were studied. All subjects were exposed to sustained pressure, using a crutch, for a period of 5 min. Nasal cross-sectional area was measured on both sides of the nose using an acoustic rhinometer along with pulse and blood pressure. The individuals were then rested for at least 30 min and the test repeated with pressure applied to the opposite side. Statistical analysis was performed by non-parametric methods. There was a significant fall in nasal cross-sectional area on the side of pressure (median change = 0.09 cm2, P < 0.01) while cross-sectional area in the contralateral nasal passage increased (median change = 0.35 cm2, P = 0.01). There were no significant differences between these results and those obtained by axillary pressure on the opposite side. Pulse and diastolic blood pressure rose with axillary pressure while systolic blood pressure remained unaltered. There was no difference in the laterality in the blood pressure response. The results indicate that axillary pressure produces nasal congestion and both afferent and efferent arms of this reflex are side-specific.
Acoustics↗
Malignant tumours of the cervical oesophagus.
Forty-seven patients with malignancy of the cervical oesophagus are described and compared with a group of 647 patients with hypopharyngeal malignancy. There was a higher proportion of non-squamous malignancy in cervical oesophageal cancer compared with hypopharyngeal cancer. Cervical oesophageal malignancy tended to present earlier with significantly lower T stage and neck node metastases were relatively unusual at presentation. Patients with cervical oesophageal malignancy were frequently incurable at the time they are first seen and 21 had palliative treatment only, 26 patients had curative treatment, 12 underwent radical radiotherapy and 14 had surgery. Cervical oesophageal malignancy had a significantly worse prognosis than hypopharyngeal malignancy with an 18% 3 year survival compared with a 33% 3 year survival (chi (1)2 = 7.1089, P < 0.01). Those patients with oesophageal malignancy who were treated fared considerably better than the whole group with 30% being alive at 3 years (chi (1)2 = 10.5185, P < 0.01).
Carcinoma, Squamous Cell↗
The nasal response to isometric exercise in non-eosinophilic intrinsic rhinitis.
The exact pathophysiology of intrinsic rhinitis is not fully understood. The generally held belief is that it is due to an imbalance between the outflow of the nasal sympathetic and parasympathetic nervous systems, perhaps due to excessive parasympathetic or reduced sympathetic activity. In this study the nasal airway response to a predominantly sympathetic stimulus, isometric exercise, was studied in 19 patients with intrinsic rhinitis and compared with 16 normal patients. Isometric exercise took the form of a handgrip stimulus using a hand dynomometer. Following sustained handgrip, a small fall of nasal resistance in the normal group (0.058 kPas/1) and a moderate rise in nasal resistance in the rhinitis group (0.242 kPas/1) was found. Pulse and blood pressure changes were the same in both groups with a significant rise in pulse rate and diastolic blood pressure. The study shows that there is an abnormal response to isometric exercise in intrinsic rhinitis, perhaps due to relative nasal sympathetic hyposensitivity.
Airway Resistance↗
The role of the temperature of the nasal lining in the sensation of nasal patency.
The receptors and neural pathways involved in the common symptom of nasal blockage are of great interest. Studies to date suggest that the sensation of nasal patency may be related to the temperature of the nasal passages. Sixty-two subjects were asked to assess their own nasal patency subjectively and indicate this on a visual analogue scale. The temperature of the nasal lining was continuously recorded during quiet nasal respiration using a non-contact infrared thermometer. The cooler the nasal lining, the clearer the nose felt, and the greater the drop in temperature on inspiration again the clearer the nose felt. The study supports the previously proposed hypothesis that the sensation of nasal airflow is derived from a cooling of the nasal lining on inspiration, and this is probably detected by cold thermoreceptors in the mucosa.
Adult↗
Long-term results of trimming of the inferior turbinates.
The long-term benefit of trimming of the inferior turbinates for nasal obstruction is unclear and our aim was to assess this. Fourteen patients who had had pre-operative nasal symptom scores and anterior rhinomanometry prior to inferior turbinate resection were reassessed at least 7 years post-operatively. Both nasal symptom scores for obstruction and nasal resistance had increased significantly in the intervening time period. Nasal crusting and hypertrophy of the cut inferior turbinate are considered to be responsible for this. Patients should be warned some degree of nasal obstruction may recur postoperatively.
Adult↗
The diving reflex in non-eosinophilic non-allergic rhinitis.
The usual nasal response to head submersion in aquatic mammals is an increase in resistance to airflow, the so-called diving reflex. Although less well developed in humans, it is nevertheless present. It is likely to occur due to a relative increase of parasympathetic over sympathetic control of the nasal vasculature. Non-eosinophilic non-allergic rhinitis is thought to be due to a similar imbalance and we have attempted to establish whether the diving reflex is abnormal in this condition. Sixteen normal subjects and 18 subjects with non-eosinophilic non-allergic rhinitis (NENAR) underwent simulated diving using the "cold face test'. Expiratory total nasal airway resistance (ETR) was measured before and after the test by means of active anterior rhinomanometry. There was no significant increase in ETR in the normal group but a significant increase in ETR in the NENAR group (pre-test median ETR-0.464 kPa.s.l(-1). post-test median ETR 0.667 kPa.s.l(-1), (Wilcoxon's signed rank test P < 0.05). The change in median ETR in the NENAR group was also significantly higher than the median change in ETR in the normal group (Mann-Whitney, extract probability P = 0.04). We conclude the nasal airway response to simulated diving in NENAR is abnormal.
Airway Resistance↗
The treatment of recurrence following fast neutron therapy for head and neck malignancy.
Twenty-eight patients received fast neutron therapy for head and neck malignancy. Of these, seven had no recurrence, 13 had a recurrence at the primary site, five had a recurrence in the neck and three had a recurrence in the neck and at the primary site. Treatment of a primary site recurrence was difficult with seven of the eight patients submitted for major surgical resection developing serious complications. Of the six patients developing a fistula four required flap repair. The tumour specific 5-year survival for the whole group of 28 patients was 29%. The surgical treatment of locoregional recurrence following fast neutron therapy is fraught with problems and some type of flap repair is usually necessary.
Adult↗
The effect of intranasal fluticasone propionate on the diving reflex in patients with non-eosinophilic non-allergic rhinitis.
The usual nasal response to head submersion in aquatic mammals is an increase in resistance to airflow, the so-called "diving reflex". Although less well-developed in humans, it is nevertheless present. It is likely to occur due to a relative increase of parasympathetic over sympathetic control of the nasal vasculature. Non-eosinophilic non-allergic rhinitis is thought to be due to a similar imbalance and we have attempted to establish whether the diving reflex is abnormal in this condition and whether intranasal fluticasone propionate for 6 weeks has any effect in modifying the nasal response.
Administration, Intranasal↗
Free revascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: report of 90 patients.
Ninety patients with carcinoma of the hypopharynx underwent pharyngolaryngectomy and reconstruction with a jejunal free autograft. Fifty-five patients had primary surgery and 35 salvage surgery for recurrence after radiotherapy. Following primary surgery 28 patients had postoperative radiotherapy and 27 did not. Complications occurred in 51 per cent of patients, the most common being necrosis of the jejunal graft (19 per cent); 12 per cent developed significant stenosis and 4 per cent died in the perioperative period. Eleven per cent of patients developed a fistula. The total number of complications diminished as the experience of the unit increased. Median follow-up was 4.9 years. Of patients treated with primary surgery, 48 per cent developed primary site recurrence (at 3 years) and 53 per cent neck node recurrence (at 5 years). The tumour-specific 5-year survival rate for all patients was 42 per cent. Following primary surgery 28 per cent survived for 5 years and after salvage surgery the rate was 59 per cent. Positive resection margins and extensive neck disease adversely affected survival (P = 0.02 and P = 0.001 respectively). The free revascularized jejunal graft is a safe and predictable method of repair following total pharyngolaryngectomy.
Adult↗
Second primary tumors in patients with head and neck squamous cell carcinoma.
BACKGROUND: The concept that a patient could develop cancer twice was first put forward by Billroth. Second primary neoplasms are a particular feature of head and neck cancer. METHODS: This study examines the records of 3436 patients with squamous cell carcinoma of the head and neck, of whom 274 subsequently developed a second neoplasm. RESULTS: The actuarial second primary rate was 9.1% at 372 months, and median time to presentation for the second tumor was 36 months. Second tumors were more likely to occur in male patients younger than 60 years at the time of their index tumor, and who had laryngeal and oral cavity index tumors. Patients whose index tumor was small at diagnosis had a greater chance of developing a second tumor as did those with no cervical lymph node metastases to the neck. Radiotherapy to the index tumor was not associated with an increased risk of developing a second tumor. The commonest sites for second tumors were the head and neck (50%) and the lung (34%), and 86% were squamous cell carcinomas. The tumor-specific mortality for those who developed a second primary tumor was 20% after 15 years compared with 44% for patients who did not develop a second primary tumor. The 5-year survival for patients who developed a secondary tumor from the time of its diagnosis was 26%. CONCLUSIONS: Second primary tumors in the head and neck of patients with cancer are not uncommon. If the second tumor occurs in the head and neck region, the prognosis is reasonably good.
Actuarial Analysis↗
Parent-to-parent support initiated in the neonatal intensive care unit.
A preliminary quasi-experimental, longitudinal study was conducted to explore differences in maternal mood states, self-esteem, family functioning, maternal-infant interaction, and home environment between mothers of preterm infants who participated in a nurse-managed program of parent-to-parent support and those who served as a comparison group. Mothers who participated in the intervention scored significantly higher on the Barnard NCATS interaction measure and the HOME total scale and subscales of maternal responsiveness and organization (N = 58) at 12 months following discharge from a neonatal intensive care unit. Using repeated measures analysis for a subset of mothers (n = 32), there were significant differences between the two groups on the mood state anxiety-tension (POMS) during the first 4 months postdischarge, with the treatment group having less anxiety. There was also a group by time interaction effect on self-esteem during the first 4 months, with self-esteem of the treatment group mothers increasing and comparison mothers decreasing. Findings suggest that one-to-one veteran parent support, in a nurse-managed program, may influence maternal and maternal-infant interaction outcomes.
Adult↗
An alternative to regular dressings for otitis externa and chronic supperative otitis media?
Otitis externa and chronic otitis media often present to the otolaryngologist with a discharging ear. The conventional method of treatment is to perform regular aural toilet and insert medicated dressings into the external auditory canal. This treatment is either performed by trained nurses or medical staff, but in either case is time consuming. This study compares the efficacy of the above standard regimen with a novel treatment where a single aural toilet is carried out and medicated ointment instilled into the ear. Both regimens were evaluated at three weeks. Our results shows that there was no significant difference between the two treatment regimens with regard to the resolution of either of the conditions studied or the improvement in the symptom status of the patients. On the basis of this it would seem that a single aural toilet and instillation of medicated ointment is a valid treatment option, cuts down hospital attendance and could be performed in the community by general medical practitioners or trained practice nurses.
Administration, Topical↗
The treatment of node negative squamous cell carcinoma of the postcricoid region.
This study includes 155 patients with T1-4N0 carcinoma of the postcricoid region seen between 1963 and 1993. Sixty-seven were treated by primary surgery, 50 by primary irradiation therapy, 36 were unsuitable for curative treatment and two patients were lost to follow-up. Reasons for deciding against curative therapy were: advanced age, poor general condition and advanced disease at the primary site. This study included only those patients who had no neck node metastases at presentation. Patients receiving surgery tended to be in better general physical condition and tended to have more advanced disease than those treated by irradiation in this series. The tumour-specific five-year survival rate for those treated by surgery was 43 percent (95 percent confidence interval (CI) 23-60 percent). For those patients treated by irradiation the five-year survival rate was 48 percent (95 percent CI 27-66 percent) and for those receiving no treatment the median survival rate was three months (95 percent CI two-six months). The observed survival for the surgery group was only 18 percent and for the radiotherapy group 25 percent at five years. Multiple logistic regression showed no significant difference in proportions of host and tumour factors between the group receiving radiotherapy and the group receiving surgery. Recurrence at the primary site and the appearance of neck node metastases were not predicted by any host or tumour factor. Twenty-one patients out of 67 receiving primary surgery had recurrence at the primary site compared with 26 patients out of 50 receiving primary irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
A simple technique to measure body sway in normal subjects and patients with dizziness.
For many years vestibular testing has relied on measurements of the vestibulo-ocular reflex (VOR). More recently quantified assessment of balance, using fixed or moving force platforms and magnetometry have been applied to clinical research. These are objective attempts to quantify the vestibulospinal reflex (VSR). This study evaluates whether SwayWeigh, a simple device which measures lateral body sway, can provide an objective assessment of balance dysfunction. Forty patients with a balance disorder and 31 subjects with normal balance were tested with eyes opened and eyes closed whilst they were standing on a flat surface and then on an air bed. The lateral sway in patients with a balance disorder was compared to that in the normal subjects and highly significant differences (p < 0.0001) were observed. The results also confirmed the importance of vision and proprioception in the maintenance of posture. The SwayWeigh balance platform is a simple and economical device which objectively measures balance dysfunction.
Adult↗