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Biomedical subjects

P J Dawes

Publications and source records attributed to P J Dawes.

At least 19 recordsLinked to original sources
PubMed2001

Adenoid cystic carcinoma of the head and neck.

Adenoid cystic carcinoma (ACC) is a rare malignant tumour believed to arise from the epithelial cells of mucous-secreting glands. It is a slow-growing but aggressive tumour with a propensity for perineural invasion. A 10 year review of 45 patients (19 males and 26 females with a median age of 56 years) treated for ACC at a single institution between 1989 and 1999 was performed to analyse factors involved in treatment failure, local control, treatment-related morbidity and mortality. The data collected were treated for survival curves according to the Kaplan-Meier method and the log-rank test was used to assess the statistical significance of the various groups. The overall survivals at 3 years and 5 years were 71% and 65%, respectively, while the disease-free survivals at 3 years and 5 years were 73% and 63% respectively. Out of the 45 patients, only six had local recurrences, yielding an 87% locoregional freedom from relapse; 16 patients (35.6%) developed distant metastases, with the lung (8/16) being the commonest site. Patients treated for tumours of the nose and paranasal sinuses experienced more morbidity than those with tumours at other sites. Positive margins, perineural invasion and solid histology of ACC were associated with increased morbidity and treatment failure. Patients treated with combined therapy did better than those who underwent a single treatment modality.

Adolescent↗
PubMed2001

Vestibular schwannoma screening: closing the audit loop.

Completion of an audit loop assessing vestibular schwannoma screening practice in a sub-regional ENT centre shows good agreement between the guidelines given and indications used for selecting patients to undergo screening MRIg. The proportion of cerebellopontine angle tumours diagnosed is consistent with other reports from the United Kingdom. During the audit period the proportion of patients screened because of unilateral tinnitus increased, but not beyond a reasonable estimate of the proportion that could expect to be screened because of this symptom. There was a reduction in the number of inappropriate scan requests after introduction of a guideline reminder. During the initial period after introducing screening guidelines there is increased screening activity, but this plateaus at a steady level.

Adolescent↗
PubMed2001

The management of severe infectious mononucleosis tonsillitis and upper airway obstruction.

Acute tonsillectomy has been advocated for severe infectious mononucleosis (IM) pharyngotonsillitis with upper airway obstruction (UAO) and not responding to corticosteroids. This paper reviews and rationalizes our management. A five-year chart review was carried out with a follow-up telephone survey. There were 36 admissions. Nine had UAO of whom 89 per cent (eight of nine patients) had a tonsillectomy. The diagnosis of UAO was not standardized. Twenty-seven patients did not have UAO and only a small proportion of these patients, 16 per cent (four of 25) went on to have an elective tonsillectomy. Corticosteroids made no significant difference to the tonsillectomy rate. UAO appears to identify patients with more severe disease who are likely to suffer recurrent tonsillitis. Acute tonsillectomy is an appropriate treatment option for this subgroup. The diagnosis of significant IM UAO is not defined and a schema is proposed. Recurrent tonsillitis is an uncommon sequela of severe IM pharyngotonsillitis without UAO.

Adolescent↗
PubMed2000

Screening for vestibular schwannoma: magnetic resonance imaging findings and management.

We report the contrast-enhanced magnetic resonance imaging (MRIg) findings from a series of 1139 patients who underwent screening to exclude a diagnosis of vestibular schwannoma. An acoustico-facial nerve bundle tumour was found in 3.1 per cent of patients imaged and vestibular schwannoma incidence is estimated at 1.4 per 100,000 population per annum. MRIg showed an abnormality in 14 per cent of patients; about one third of the findings may have accounted for the presenting symptom(s). A small number of patients had unexpected pathology revealed that required onward referral for further active management.

Cerebellopontine Angle↗
PubMed1999

Verruciform xanthoma of the nose.

We report a case of verruciform xanthoma of the nasal skin. The case is unique because the lesion both bled and has shown evidence of multicentricity.

Adult↗
PubMed1999

Early complications of surgery for chronic otitis media.

This audit report details early post-operative complications following surgery for chronic otitis media. One hundred and forty-five cases were assessed. There were no facial nerve palsies, a bone conduction threshold elevation occurred in 4.6 per cent of cases. A wound infection occurred in six per cent of cases as did BIPP allergy. Twenty-six per cent of patients reported symptoms consistent with chorda tympani trauma. Short-lived symptoms of jaw discomfort were reported by 46 per cent of patients and imbalance or vertigo by 10 per cent of patients. The findings are compared with other published reports of complications following ear surgery.

Arthralgia↗
PubMed1999

Outcome of using magnetic resonance imaging as an initial screen to exclude vestibular schwannoma in patients presenting with unilateral tinnitus.

The improved cost-effectiveness of gadolinium-enhanced magnetic resonance imaging (MRIg) as a diagnostic tool for vestibular schwannoma has resulted in smaller tumours being diagnosed. There has been a change in the clinical presentation of these tumours and up to four per cent may present with unilateral tinnitus. The limitation of auditory brain stem response (ABR) as a screening tool that detects small tumours is recognized and there is a strong argument for using MRIg as the initial investigation. Various screening guidelines have been proposed, some include submitting patients with unilateral tinnitus for MRIg. This report describes the findings in a group of 174 patients presenting with unilateral tinnitus who underwent MRIg as part of a guideline-directed screen to exclude vestibular schwannoma. Five patients had a cause for their tinnitus diagnosed, one a vestibular schwannoma. Two had intracranial aneurysms and another three had pathology revealed that merited onward referral. A further nine patients had incidental findings that neither accounted for their symptoms nor needed further investigation or referral. The rationale for screening these patients with MRIg is discussed.

Adult↗
PubMed1999

The smell map: is there a commonality of odour perception?

The normal perception of odour quality is poorly understood, so formulating meaningful tests of olfaction is difficult. While tests of odour discrimination and odour detection threshold have helped quantify olfactory dysfunction, there are not yet predictive relationships between sensitivity to particular odours and particular forms of olfactory dysfunction. Using 11 commonly encountered odours, 20 normosmics performed similarity ratings of odour pairs. Multidimensional scaling, a standard behavioural sciences data analysis method, was used to explore the perceptual relationships between the odours based on their pair-wise similarity ratings. Smell maps were created for each individual as was a common or archetypal map which indicated a commonality in individuals' odour perception, far greater than chance alone (P < 10(-6)). A preliminary analysis of four hyposmics suggests that they do not conform to the normosmic archetype. Future studies assessing the relationship between odours in the archetype should improve the selection of odours to be included in tests of odour discrimination.

Adult↗
PubMed1999

Informed consent: British otolaryngologists surveyed.

A repeat postal questionnaire of British otolaryngologists has been carried out to assess changes in their practice of obtaining informed consent. The previously reported high level of good practice is maintained. Currently informed consent is more often obtained in outpatients or the preadmission clinic than it was in 1991. Consultants and specialist registrars are more involved in this process. Although there is little evidence given to support a persistent increase in a defensive approach towards gaining informed consent, there is some change in the reporting of surgical complications that may reflect an increased awareness of the concept of 'material risk'.

Ethics, Medical↗
PubMed1999

MRI appearances of the axilla in treated breast cancer.

Differentiation between recurrent axillary disease and changes due to radiotherapy or surgery has major implications for management in patients following breast cancer treatment, but clinical examination of the axilla may be difficult. This study was undertaken to correlate the MRI appearances of the axilla following breast cancer treatment with clinical outcome. 74 women with treated breast cancer were evaluated by MRI (0.5 T) and the appearances defined by consensus. Outcome was assessed by long-term clinical follow-up. 62 women had symptoms related to the axilla while 12 were scanned to stage the axilla. None of the axillary staging group had abnormal MRI appearances and none of these subsequently developed recurrence. The 62 symptomatic women were subdivided according to MRI appearances. 22 had normal axillary appearances, 18 had an axillary mass and 22 women had abnormal axillary appearances (rated mild, moderate and severe) in the absence of a mass. Normal axillary appearances on MRI excluded recurrent disease as the cause of symptoms with a specificity of 94.7% and a positive predictive value (PPV) of 95.5%. The presence of an axillary mass was commonly but not exclusively due to recurrent disease (sensitivity 68.4%, specificity 88.4%, PPV 72.2%). Sensitivity for diagnosis of axillary recurrence was increased to 89.5% with a specificity of 76.7% if the criteria for recurrent disease were taken as either the presence of an axillary mass or severe axillary changes in the absence of a mass lesion.

Adult↗
PubMed1998

Audit of regional screening guidelines for vestibular schwannoma.

An audit of 334 patients who underwent magnetic resonance imaging (MRI) as investigation for a possible diagnosis of vestibular schwannoma was carried out to assess adherence to previously agreed screening guidelines. This represents one year's activity. A posterior fossa tumour was identified in 12 patients. Scan requests were judged to be inappropriate for 28 cases. The issues surrounding the screening for acoustic neuroma are discussed.

Adult↗
PubMed1997

Tracheostomy and radiotherapy in the management of laryngeal carcinoma causing airway obstruction.

Between 1977 and 1985, 66 patients presenting with airway obstruction due to laryngeal squamous cell carcinoma were treated by tracheostomy and subsequent radiotherapy. Female survival (64% at 2 years and 35% at 5 years) was significantly better than male survival (19% at 2 years and 10% at 5 years). When four forms of management were compared, it appeared that 40 Gy in ten fractions over 21 days was associated with better survival. Because two of the treatment groups contained few patients, these were excluded from further analysis. When adjustments were made for sex, delay between tracheostomy and treatment, and residual disease, the difference in treatment response between those receiving 60+ Gy in 28-30 fractions over 42 days and those receiving 40 Gy in ten fractions over 21 days was not significant (hazard ratio 1.37; 95% CI 0.64-3.91).

Adult↗
PubMed1997

CHOP-based chemotherapy is as effective as alternating PEEC/CHOP chemotherapy in a randomised trial in high-grade non-Hodgkin's lymphoma. Scotland and Newcastle Lymphoma Group.

The aim of this study was to test whether survival for patients with high-grade non-Hodgkin's lymphoma (NHL) can be improved with a non-cross-resistant regimen as compared to a CHOP-based regimen. This is a multicentre study comprising 325 adult patients, median age 58 years, with high-grade non-Hodgkin's lymphoma: patients of any age and performance status were eligible provided they were able to receive the drugs in the regimens. Patients were randomised to either B-CHOP-M (bleomycin, cyclophosphamide, doxorubicin, vincristine, prednisolone and methotrexate) or PEEC-M (methylprednisolone, vindesine, etoposide, chlorambucil and methotrexate) alternating with B-CHOP-M. At a median follow-up of 9 years, there was no significant difference in overall survival or disease-free survival between the two arms. Toxicities for the two regimens were equivalent. This study confirms that for relatively unselected patients with high-grade non-Hodgkin's lymphoma, an alternating multidrug regimen does not improve upon the results obtained with B-CHOP-M.

Adult↗
PubMed1996

Early post-operative brachytherapy and free flap reconstruction in the management of sarcomas.

Brachytherapy delivered within the early post-operative period has been associated with delayed healing and wound breakdown. The objective of this study was to determine whether reconstruction with a microvascular free flap reduced the incidence of wound breakdown after early post-operative brachytherapy and wide excision of soft tissue sarcomas. Four patients with sarcomas underwent excision and free flap reconstruction. Brachytherapy was administered in the early post-operative period using Iridium-192 wires via tubes inserted intraoperatively. In three of the four patients the wounds healed uneventfully, demonstrating that brachytherapy can be delivered in the early post-operative period following free flap reconstruction without an increase in the frequency of wound breakdown. There has been no local recurrence to date in this group of patients.

Aged↗
PubMed1996

Validation of the combined olfactory test.

A new test of olfactory function, the combined olfactory test, has been designed to assess odours easily recognizable by the test population. The test consists of an odour recognition test of nine odours, where an odour in a bottle is chosen from a list of four possible odours in a forced choice manner. This is followed by a threshold test using a series of three-fold dilutions of 1-butanol. The mean of the two scores is the combined olfactory score. The test was subjected to a validation study. It was performed on 133 participants with a normal sense of smell and a normal rhinological examination and on 94 participants who said that they did not have a sense of smell. There was a highly significant difference between the combined olfactory score in the normal and 'anosmic' groups (P < 0.001). This significant difference was the same between the two groups for the threshold and odour recognition arms of the test. There was a highly significant difference (P < 0.001) between the two subgroups of 'completely anosmic' and 'almost anosmic' participants, indicating that the test could grade the degree of olfactory dysfunction.

Adult↗