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Biomedical subjects

N J Roland

Publications and source records attributed to N J Roland.

34 records · Page 2Linked to original sources
PubMed1995

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↗
PubMed1994

A comparison of cellular proliferation markers in squamous cell carcinoma of the head and neck.

Head and neck squamous cell carcinoma has a relatively good prognosis but treatment may be at the expense of function and quality of life. Various host and tumour parameters have been studied in an attempt to predict the course of the disease but without success. It has been hoped that laboratory based methods, particularly those based on molecular biology, may prove more useful. Cell kinetic parameters are studied in this paper. The present study includes 75 patients with a proven squamous cell carcinoma of the head and neck at various sites and undergoing various forms of treatment. The patient's mean age was 62 years and the median survival rate 45 months. Immunohistochemical techniques using Ki67 and PCNA were compared with flow cytometric analysis which included the BRDU labelling index, the duration of S phase, ploidy and potential doubling time. The median PCNA index was 560 and the Ki67 index 298. These indices varied between 980 and 150 for PCNA and 808 and 110 for Ki67. The BRDU labelling index measured by flow cytometry was 8.9 with a range from 25 to 1.6 and the duration of S phase was 14.8 hours. The PCNA index failed to correlate with any host or tumour factors and this failure was also seen in Ki67 indices and also in the flow cytometric parameters. There was a strong correlation between PCNA and Ki67 expression (p < 0.0001). Neither PCNA nor Ki67 values were significantly different between irradiated and nonirradiated tissues nor in sites or in patients who later developed lymph node metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Cervical node metastases presenting with features of branchial cysts.

For many years it has been recognized that seemingly benign neck cysts may contain carcinoma. The true incidence is unknown. This paper investigated nine out of 270 patients presenting with a neck mass--which proved to contain a squamous carcinoma. Records (from a 30-year period) of over 3400 patients with squamous carcinoma of the head and neck, were examined. The histology slides were reviewed, the number of cystic lesions was noted and also the clinical outcome. Out of the 270 patients nine presented with a cystic lesion and these were studied. Six cystic lesions were originally diagnosed as branchial cysts although the youngest age was 39 years. All patients underwent a simple excision. In six cases the tonsil was the primary site, in one the primary was in the base of tongue and in two the primary remained occult. One-third of the patients had died of their disease by the time this report was written and the maximum follow-up time for the remaining patients was 18 months. Therefore 16 per cent of branchial cysts in this series represented metastases from squamous cell carcinoma. At the Royal Liverpool University Hospital only 25 patients had branchial cysts excised between 1988 and 1993: out of these only four contained squamous carcinoma. In patients over 40 years of age panendoscopy and ipsilateral tonsillectomy is mandatory prior to cyst excision.

Adult↗
PubMed1994

Has the cellular proliferation marker Ki67 any clinical relevance in squamous cell carcinoma of the head and neck?

Over the years many laboratory factors have been studied with a view to predicting the course of head and neck cancer. The lack of success prompted the application of various measures of cell kinetics to this topic. The present study includes 79 patients with a proven squamous cell carcinoma of the head and neck at various sites and having various treatments. Ki67 staining was carried out using the avidin-biotin complex method and counts recorded per 1000 tumour cells. The patients' mean age was 61 years and the 5 year survival was 54% (95% CI, 29-73%). The median Ki67 index was 278 representing the number of cells stained positively per 1000 tumour cells. The minimum staining was 82 and the maximum 808 with a lower quartile of 95 and an upper quartile of 452. The Ki67 index failed to correlate with any host or tumour factors. In addition, median Ki67 values were not significantly different between irradiated tissue and non-irradiated tissue, between sites nor between patients who did and did not later develop lymph-node metastases. Of particular relevance is that Ki67 value did not correlate with survival. Data was further analysed using Cox's proportional hazards model for survival. Ki67 had no significant effect on survival. It is concluded that Ki67 index is of no value in predicting the course of squamous cell carcinoma of the head and neck.

Adult↗
PubMed1994

The level of cervical lymph node metastases: their prognostic relevance and relationship with head and neck squamous carcinoma primary sites.

It would seem logical that patients with nodal metastases low in the neck would fare less well than patients with disease high in the neck. The penultimate UICC classification suggested that neck node level was important although there was no mention of this in the most recent classification. In addition, patients with carcinomas at the various sites would be expected to have different patterns of nodal involvement. Of 3419 patients with head and neck squamous carcinoma on the Liverpool University Head and Neck Unit database, 947 had neck node metastases. The neck node levels were coded as (I) sub-mandibular, (II) above the thyroid notch, (III) below the thyroid notch and (IV) supra-clavicular/posterior triangle nodes. Levels II and III contained the deep jugular chain. The relationship between node level and site and sub-site and survival were analysed with particular emphasis on multivariate methods. The 5-year survival for the whole group was 51% and survival fell with decreasing node level (I-IV) being 37% for sub-mandibular nodes, 32% for deep cervical nodes and 25% for lower deep cervical nodes. The 18-month survival for supra-clavicular and posterior triangle nodes was 21%. The difference in survival was significant (chi 2(3) = 24.42, P < 0.001). Multivariate analysis confirmed that as the level of the nodes fell from the sub-mandibular region to the supra-clavicular region the prognosis worsened (estimate = -0.3378, P = 0.0003). Level II (upper deep cervical) nodes were the most commonly involved with regards to all primary sites and formed 69% of all neck node metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1994

Soft tissue cervical metastases of squamous carcinoma of the head and neck.

Some 497 of 3085 patients with squamous cell carcinoma of the head and neck treated between 1963 and 1990 had a later radical neck dissection at some time after initial treatment. The histological slides were all reviewed, firstly to confirm the presence of squamous cell carcinoma within the neck, and secondly to ascertain whether the metastasis was to soft tissue, to a lymph node or to both. The presence of extracapsular rupture in lymph node deposits was also assessed. Of the 497 patients, 138 had soft tissue deposits only, and 359 had nodal deposits only. Of the patients with nodal deposits 165 had extracapsular rupture and 194 did not. The 5-year survival of the 138 patients with soft tissue metastases was 27% compared with 33% for patients with extracapsular rupture and 50% for patients with no extracapsular rupture. Weighted logistic regression showed that soft tissue deposits were significantly more common in patients in poor general condition, plus poorly differentiated squamous cell carcinoma plus T4 tumours (P < 0.005), and in patients with poorly differentiated squamous cell carcinoma plus T4 tumours (P < 0.025). Cox's multivariate analysis with backward elimination showed that gender, histological differentiation, site of primary tumour and age of patient had no statistically significant effect on survival. The number of nodes (P < 0.0001), the presence of extracapsular rupture (P < 0.0001) and the presence of soft tissue free metastases (P < 0.001) were all highly significant. The N-status at recurrence also reached statistical significance (P < 0.0001).

Carcinoma, Squamous Cell↗
PubMed1993

Occult node metastases in head and neck squamous carcinoma.

The present study examined the Liverpool database in an attempt to determine what proportion of N0 necks for various head and neck primary sites harbored subclinical squamous cell carcinoma and whether empiric treatment of occult disease improved survival over and above a "wait-and-watch policy" (treatment when metastasis becomes manifest). One hundred seventeen neck dissections were carried out for N0 necks, with 32% of specimens found to contain squamous cell carcinoma. The risk of carcinoma was highest in the hypopharynx, with 50% of specimens associated with a pyriform fossa primary cancer. Twenty-nine percent of neck dissection specimens for oral cavity cancer contained carcinoma and this was commonly associated with lateral border of tongue or anterior floor of mouth carcinomas. Twenty-five percent of specimens when primary tumor was in the oropharynx contained carcinoma and were due to tonsillar carcinoma. Twenty-one percent of laryngeal cancers produced histologically positive nodes and were mostly associated with posterior epiglottic tumors. Two hundred forty-six patients had a pyriform fossa cancer and of these only 37 had N0 disease and surgical treatment. Of these, 23 patients had radical neck dissections, whereas in 14 the necks were not treated. There was no difference in survival between the two groups (chi 1(2) = 0.787, P = NS). The Liverpool database also contained 1631 previously untreated patients with no clinical evidence of neck node metastases. Of these only 107 had a neck dissection. There was no difference in survival (chi 1(2) = 2.79, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1993

Recurrent pleomorphic adenoma.

Of 209 cases of pleomorphic adenoma treated in a 30 year period, 38 were secondary referrals with recurrent disease following surgery. Of these, 25 were women and 13 men with a mean time to recurrence of 9 years 4 months. Thirty-four recurrences were in the parotid gland, three in the submandibular gland and one in the anterior faucial pillar. Seven patients were untreated due to poor general condition or refusal of further treatment. Of the remainder, 15 had superficial parotidectomy and excision of the scar and nine a total parotidectomy. Three of these had extensive surgery with local flap repair. Of the patients with submandibular gland recurrence, two had local excision and one was treated with radiotherapy alone. One patient had a recurrence in the faucial pillar. Three patients developed malignant change in the recurrent tumour, of whom one died of disease.

Adenoma, Pleomorphic↗
PubMed1993

Fine needle aspiration cytology of salivary gland lesions reported immediately in a head and neck clinic.

This paper describes the application of fine needle aspiration cytology (FNAC) performed on 92 patients with salivary gland lesions in a Head and Neck Surgery Clinic. The aspirates were immediately reported by a cytopathologist and the reports conveyed to the surgeon during the same clinic visit. FNAC results were then compared with histology in those patients who underwent surgery and with the clinical course of the disease at subsequent clinic visits in patients where surgery was not performed. The cytological diagnosis was incorrect in five cases, one of which was a false negative result. There were no false positive results. The sensitivity was 90.9 per cent and the specificity 100 per cent. This rapid report system of fine needle aspiration cytology has been found to be safe, free of complications, and helpful in the planning of treatment.

Adolescent↗
PubMed1993

Expression of the cell-cell adhesion molecule E-cadherin in squamous cell carcinoma of the head and neck.

The expression of the cell-cell adhesion molecule E-cadherin has previously been shown to be reduced in poorly differentiated squamous cell carcinoma of the head and neck and absent in nodal metastases. Twenty-eight patients with previously untreated squamous cell carcinoma of the head and neck, 22 of whom had nodal metastases at presentation, were investigated for E-cadherin expression using the monoclonal antibody 6F9, specific for human E-cadherin. Reduced expression was seen in the poorly differentiated primary tumours, compared with well differentiated tumours, but this trend was not statistically significant. E-cadherin expression was present at a reduced level in nodal metastases. It was also noted that, where both the primary tumour and corresponding nodal metastasis were investigated, E-cadherin expression was identical for both samples. The degree of E-cadherin expression did not correlate with survival. These data confirm a reduction in E-cadherin expression in poorly differentiated tumours. There was no correlation between E-cadherin expression and any of the host, tumour and treatment factors associated with malignancies of the head and neck region.

Antibodies, Monoclonal↗
PubMed1993

Electromagnetic stimulation as a treatment of tinnitus: a pilot study.

This paper reports the results of a study to determine whether pulsed electromagnetic stimulation, applied over the mastoid bone, caused an improvement in the level of tinnitus in long-standing tinnitus sufferers. Fifty-eight patients from the Liverpool Tinnitus Association volunteered to take part in a double-blind placebo controlled trial. Active and placebo devices were randomly allocated to these patients on their first visit. At the end of one week of treatment, each patient noted whether their tinnitus had completely disappeared, was improved, unchanged or made worse by the treatment Forty-five per cent of the patients who completed the trial were improved by the active device, but only 9% by placebo (P = 0.0013, Mann-Whitney test). We suggest that electromagnetic stimulation may be an effective treatment in some tinnitus sufferers.

Adult↗
PubMed1992

The use of ventilation tubes and the incidence of cholesteatoma surgery in the paediatric population of Liverpool.

Many surgeons believe that grommet insertion has reduced the incidence of cholesteatoma and thus radical mastoidectomy. Several causes for this trend have been postulated, including the increased use of ventilation tubes to treat otitis media with effusion. We have studied the number of operations for cholesteatoma, together with the number of ventilation tube insertions in the paediatric population of Liverpool, over a 28-year period between 1963 and 1990. There was a decline in the number of operations for cholesteatoma and an increase in the use of ventilation tubes, but there was no significant correlation between the two. This suggests that other factors are responsible for the decline in surgery for cholesteatoma.

Adolescent↗
PubMedDate not supplied

Value of grading squamous cell carcinoma of the head and neck.

We report a series of 3,294 patients with squamous cell carcinoma of the head and neck seen by one of us between 1963 and 1990. Two thousand and seven patients had a histologically proven and graded, but previously untreated, squamous cell carcinoma of the mucosal surfaces of the head and neck. These tumors had been graded previously by many different pathologists in many different hospitals, both in the United Kingdom and the United States, as well as continental Europe, over this period. Of the host factors both sex and age were associated with differentiation: 34% of patients less than age 50 had a well-differentiated tumor compared with 44% greater than age 50; 32% of women had a poorly differentiated tumor compared with 26% of men. General condition had no correlation with degree of differentiation. Site was closely associated with grading: well-differentiated tumors were more common in the mouth and larynx and poorly differentiated tumors in the pharynx. Furthermore, of poorly differentiated tumors, 19% arose from areas normally lined by keratinized squamous epithelium, 22% from a nonkeratinized area, 36% from respiratory epithelium, and 45% from areas normally covered by lymphoid epithelium. T stage had no significant correlation with differentiation. However, 46% of patients with poorly differentiated tumors had a nodal metastasis at presentation compared with only 28% of well-differentiated tumors. Distant metastases at presentation were found in 3.4% of poorly differentiated tumors compared with 1.8% of well-differentiated tumors. The survival fell significantly from 33% for well-differentiated tumors to 27% for poorly differentiated tumors. The recurrence rate at the primary site rose from 25% for well-differentiated tumors to 27% for poorly differentiated tumors, and recurrence in the lymph nodes rose from 26% to 30%. Both differences were just significant.

Adolescent↗
PubMedDate not supplied

Airway intervention in adult supraglottitis.

BACKGROUND: The timing of aggressive airway intervention in adult epiglottitis is controversial. AIMS: To correlate Friedman's staging of epiglottitis on admission with the airway interventions undertaken. METHODS: A retrospective study of 23 adult patients, mean age 51 years (range 29-81 years), who had been admitted with acute supraglottitis between March 1988 and December 2000 was undertaken. RESULTS: Three patients (13%) had airway interventions; two with tracheostomy and one with tracheal intubation. All were Friedman stage III and had rapid symptom progression during the 24 hours prior to admission. Three other stage III patients with symptom progression longer than 24 hours and all the remaining patients (stage II or less) were managed with observation and intravenous therapy. CONCLUSIONS: Friedman originally advocated airway intervention in any patient stage II or worse, but this intubation threshold should probably be lowered to those patients with rapid-onset stage Ill (moderate respiratory distress, stridor, respiratory rate > 30 per minute, pCO2 > 45mmHg) disease.

Acute Disease↗