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Biomedical subjects

S F Hall

Publications and source records attributed to S F Hall.

At least 19 recordsLinked to original sources
PubMed2001

A comparison of published head and neck stage groupings in carcinomas of the tonsillar region.

BACKGROUND: The combination of T, N, and M classifications into stage groupings was designed to facilitate a number of activities including: the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. The authors tested the UICC/AJCC 5th edition stage grouping and seven other TNM-based groupings proposed for head and neck cancer to determine their ability to meet these expectations in a specific site: carcinoma of the tonsillar region. METHODS: The authors defined four criteria to assess each stage grouping scheme: 1) The subgroups defined by T and N comprising a given group within a grouping scheme have similar survival rates (hazard consistency); 2) The survival rates differ across the groups (hazard discrimination); 3) The prediction of cure is high (outcome prediction); and 4) The distribution of patients among the groups is balanced. The authors identified or derived a measure for each criterion and the findings were summarized using a scoring system. The range of scores was from 0 (best) to 7 (worst). Data were from a retrospective chart review on 642 cases of carcinoma of the tonsillar region treated with radiotherapy for cure at the Princess Margaret Hospital from 1970-1991. None of the patients had distant metastases. RESULTS: The scheme proposed by Synderman and Wagner, which was published in Otolaryngology Head and Neck Surgery in 1995 (vol.112, pages 691-4), scored best at 1.2. The UICC/AJCC scheme scored worst at 6.1. The hazard consistency ranged from a 3.1% average survival difference to 6.7% across the 8 schemes. The hazard discrimination measure varied by 28% from the best to worst scheme. Prediction varied by up to almost twofold across the schemes assessed. The distribution of patients varied from expected by between 0.13% and 0.57%. CONCLUSION: UICC/AJCC stage groupings were defined without empirical investigation. When tested, this scheme did not perform as well as any of seven empirically-derived schemes the authors evaluated. The results of the current study suggest that the usefulness of the TNM system can be enhanced by optimizing the design of stage groupings through empirical investigation.

Carcinoma, Squamous Cell↗
PubMed2001

Barrel pattern formation requires serotonin uptake by thalamocortical afferents, and not vesicular monoamine release.

Thalamocortical neurons innervating the barrel cortex in neonatal rodents transiently store serotonin (5-HT) in synaptic vesicles by expressing the plasma membrane serotonin transporter (5-HTT) and the vesicular monoamine transporter (VMAT2). 5-HTT knock-out (ko) mice reveal a nearly complete absence of 5-HT in the cerebral cortex by immunohistochemistry, and of barrels, both at P7 and adulthood. Quantitative electron microscopy reveals that 5-HTT ko affects neither the density of synapses nor the length of synaptic contacts in layer IV. VMAT2 ko mice, completely lacking activity-dependent vesicular release of monoamines including 5-HT, also show a complete lack of 5-HT in the cortex but display largely normal barrel fields, despite sometimes markedly reduced postnatal growth. Transient 5-HTT expression is thus required for barrel pattern formation, whereas activity-dependent vesicular 5-HT release is not.

Aging↗
PubMed2001

A comparison of published head and neck stage groupings in carcinomas of the oral cavity.

BACKGROUND: The combination of T, N, and M classifications into stage groupings is meant to facilitate a number of activities, including the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. We tested the UICC/AJCC 5th edition stage grouping and seven other TNM-based groupings proposed for head and neck cancer for their ability to meet these expectations in a specific site: carcinomas of the oral cavity. METHODS: We defined four criteria to assess each grouping scheme: (1) the subgroups defined by T, N, and M that make up a given group within a grouping scheme have similar survival rates (hazard consistency); (2) the survival rates differ among the groups (hazard discrimination); (3) the prediction of cure is high (outcome prediction); and (4) the distribution of patients among the groups is balanced. We identified or derived a measure for each criterion, and the findings were summarized by use of a scoring system. The range of scores was from 0 (best) to 7 (worst). The data are population based from a prospectively gathered series in Southern Norway, with 556 patients diagnosed from 1983 through 1995. Clinical stage assignment was used, and the outcome of interest was cause-specific survival. RESULTS: Summary scores across the eight schemes ranged from 1.66 for TANIS-3 to 6.50 for UICC/AJCC-5. The TANIS-7 staging scheme performed best on the hazard consistency criterion. The Kiricuta scheme performed best on the hazard discrimination criterion. Synderman predicted outcome best overall and Berg produced the most balanced distribution of cases among its groups. CONCLUSIONS: UICC/AJCC stage groupings were defined without empirical investigation. When tested, this scheme did not perform as well as any of seven empirically derived schemes we evaluated. Our results suggest that the usefulness of the TNM system could be enhanced by optimizing the design of stage groupings through empirical investigation.

Carcinoma, Squamous Cell↗
PubMed2000

Cancers of the upper aerodigestive tract in Ontario, Canada, and the United States.

BACKGROUND: Squamous cancers of the upper aerodigestive tract (UADT) are related to the use of tobacco and/or alcohol, and in North America they are more common among the poor. They are usually locoregionally confined at diagnosis, and local treatment with surgery and/or radiation therapy is often curative. This study compares the incidence and survival of this group of diseases in Canada and the U.S., two North American neighbors with many cultural similarities but significant differences in their health care and social programs. METHODS: To describe and compare the case mix, incidence, and outcome of squamous cancers of the UADT in Ontario, Canada, and the U.S., we used the Ontario Cancer Registry (OCR) and the Surveillance, Epidemiology, and End Results (SEER) registries in the U.S. to identify all cases of cancer with International Classification of Disease (ICD) codes 141, 143-9, 160-1, and a subset of 140, which were diagnosed between 1982 and 1994. ICD-O histology codes were placed into clinically relevant groupings, and ICD-9 site codes were grouped into sites as defined by the International Union Against Cancer and the American Joint Committee on Cancer. Age-adjusted incidence rates were calculated for each site. For the SEER registry, race specific incidence rates were also calculated. Observed and expected survival were plotted by site and registry, and from these, relative survival was calculated. Survival was compared during the first 5 years after diagnosis and during the next 5 years among patients who had survived the first 5 years. RESULTS: Of the 16,577 and 42,990 cases identified in the OCR and SEER registries, respectively, squamous cancer was by far the most common histology (94.1% in OCR, 94.6% in SEER) and will form the main subject of this report. The distribution of squamous cancers by site, subsite, age, and gender were remarkably similar in the two populations. Overall, the incidence was about 17% higher in the U.S. than in Ontario, and this difference was seen for all sites except the nasopharynx, which was more common in Ontario. The higher incidence in the U.S. in part reflects the much higher rate for African Americans than for Americans of other ethnic backgrounds. During the first 5 years after diagnosis, when most deaths from UADT cancer occur, there was a significant relative survival difference in favor of the U.S. for cancer of the supraglottis, and in favor of Ontario for cancer of the oral cavity. There was a nonsignificant trend in favor of Ontario for cancer of the nasopharynx. Within the SEER population, for all sites except the nasopharynx, 5-year relative survival was considerably worse for African Americans than for Americans of other ethnic backgrounds. Examination of survival beyond 5 years after diagnosis for patients who had survived the first 5 years revealed that for all sites, the observed survival continued to diverge markedly from the expected survival. The excess mortality ranged from less than 20% for glottic and nasopharyngeal cancers to about 30-40% for oropharyngeal and supraglottic cancers. CONCLUSIONS: Despite remarkable similarities in case mix between the two countries, UADT cancers were more frequent in the SEER population of the U.S. than in Ontario, and this was partly attributable to the much higher incidence among African Americans. Significant differences between the registries in 5-year survival were seen for several sites. African Americans with UADT cancers had much worse prognoses than did Americans of other ethnic backgrounds. Patients who survive their UADT cancer remain at a higher-than-expected risk of death even after they have been cured.

Disease-Free Survival↗
PubMed2000

The impact of comorbidity on the survival of patients with squamous cell carcinoma of the head and neck.

BACKGROUND: In North America, cigarette smoking and/or alcohol consumption not only cause head and neck cancer, they also cause many of the other diseases, illnesses, and conditions, also known as comorbidities, frequently found in our patients. Comorbidities can influence treatment decision making and treatment outcome. The aim of this study is to quantify the increased risk of comorbidity in our patients. METHOD: The survival of 655 consecutive patients with squamous cell carcinoma from a regional cancer center is analyzed. We compare the survival curves for all-cause death, death from cancer, and death from noncancer causes to the expected survival of age/sex-matched populations of Ontario residents, Canadian smokers, and Canadian nonsmokers. RESULTS: Of those patients who had not survived 5 years, 59% died of their index tumor, 23% would have been expected to die if they did not have head and neck cancer, and 18% died of the increased comorbidity associated with being a patient with head and neck cancer. DISCUSSION: Comorbidity, and specifically the increased comorbidity found in patients with head and neck cancer, is an important factor in overall survival.

Actuarial Analysis↗
PubMed2000

Time to first relapse as an outcome and a predictor of survival in patients with squamous cell carcinoma of the head and neck.

OBJECTIVE: To identify patterns and predictors of relapse and to determine whether the time to relapse influences survival. STUDY DESIGN: Multivariate anal. ysis of prospective database. METHODS: We present findings in 446 consecutive prospective patients from a regional cancer center with invasive squamous cell carcinoma who were treated for cure and were declared disease free. Time to relapse, site of relapse, and survival are reported by stage and site using bivariate and multivariate analysis. RESULTS: Thirty-six percent of patients relapsed. The median time to relapse was 8.3 months, and 95% of relapses occurred within 3 years. T stage in the TNM staging system was associated with relapse, and N stage was not. In patients who relapsed before the median time to relapse, prognosis was worse than in those who relapsed after that time.

Adult↗
PubMed2000

Management and outcome of glottic cancer: a population-based comparison between Ontario, Canada and the SEER areas of the United States. Surveillance, Epidemiology and End Results.

OBJECTIVE: We compared treatment practice and outcome in glottic cancer in Ontario, Canada to that in the Surveillance, Epidemiology and End Results (SEER) program areas in the United States to determine whether the Ontario emphasis on the use of delayed combined therapy was associated with similar survival and better laryngectomy-free survival than the U.S. approach, which emphasizes greater use of surgery. METHODS: Electronic, clinical, and hospital data were linked to cancer registry data. The study groups compared on survival comprised all patients diagnosed from 1982 to the end of 1991 in Ontario (2324 patients) and in the SEER areas (5715 patients). Comparisons on initial treatment, laryngectomy rates, and laryngectomy-free survival were limited to subsets of these study populations due to data availability. Initial treatment data were provided by the SEER registries in the U.S. and by the cancer clinic and hospitalization data in Ontario. Information about laryngectomies performed subsequent to initial treatment was available from Medicare hospitalization data in the U.S. and from Canadian Institute for Health Information hospitalization data in Ontario. RESULTS: Although radiotherapy was the most common initial treatment in both areas, it was used more often in Ontario (84.4% versus 63.2% in the U.S. [p < 0.001]). Relative survival was not statistically different with a relative risk comparing SEER to Ontario of 1.09, 95% confidence interval (CI) (0.93, 1.29). Laryngectomy rates were similar with a relative risk of 1.01, 95% CI (0.67, 1.52), and it follows from the survival and laryngectomy rate comparisons that the laryngectomy-free survival was not statistically different (p = .95). CONCLUSIONS: There are large differences in the management of glottic cancer between the U.S. and Ontario and no corresponding differences in survival or laryngectomy-free survival. This work highlights a need for more clinical investigation into the relative merits of differing management policies in glottic cancer.

Aged↗
PubMed1999

Using TNM staging to predict survival in patients with squamous cell carcinoma of head & neck.

BACKGROUND: There is a need for a classification system for prognosis based on the TNM system for patients with squamous cell carcinoma of the head and neck such that patient groupings are homogeneous within and heterogeneous between. METHODS: Six hundred fifty-five consecutive patients with invasive squamous cell carcinoma of the head and neck followed prospectively are split into a training set and a test set. Using the training set, the Cox Proportional Hazards Model and the outcome of dead with disease, we created homogeneous prognostic levels (PLs) based on RR. Using the test set, we compare our model to others in the literature. RESULTS: Using the training set, we identified five PLs, and using the test set, we demonstrated that our model is superior to others for both within-group homogeneity and between-group heterogeneity. CONCLUSIONS: A simple classification system can be used to group patients for survival and is valid for future study in prognostication.

Adult↗
PubMed1997

Does TANIS (T And N Integer Score) help predict survival?

OBJECTIVE: This study was conducted to validate the TANIS model as a predictor of survival. DESIGN: Using Cox Proportional Hazards model, we examined the subgroups of the TANIS score levels to see if they were homogeneous on survival. SETTING: The Departments of Otolaryngology and Oncology and the Radiation Oncology Research Unit at Queen's University in Kingston, Ontario. METHODS: Five hundred and ninety-four patients with cancer of the head and neck classified by TNM and TANIS were analyzed for the outcome dead of disease using estimates of relative risk. RESULTS AND CONCLUSION: The stages of TNM and the levels of TANIS contain subgroups of patients with different survival rates.

Adult↗
PubMed1996

Particle repositioning maneuver: effective treatment for benign paroxysmal positional vertigo.

OBJECTIVE: To assess short-term and long-term outcomes of the particle repositioning maneuver (PRM). DESIGN: This is a prospective study of 68 cases of benign paroxysmal positional vertigo (BPPV) in 65 consecutive patients. RESULTS: Initially, 57 (83.8%) cases had no evidence of residual symptoms, 10 (14.7%) had a partial improvement, and only 1 (1.5%) failed treatment. In the long-term (18.7 month mean follow-up period), 43 (67.2%) cases had no history of recurrence, and 22 (34.4%) cases had recurrences, of which 14 (21.9%) experienced only mild symptoms, and 8 (12.5%) were no better than before the PRM. Of the eight who were no better, five had repeat PRMs that successfully relieved their symptoms. The final overall outcome was that 59 (95.2%) patients had either mild symptoms or no symptoms, and 3 (4.8%) patients were treatment failures. Factors that did not seem to be predictive of outcome were secondary nystagmus, gender, and duration of symptoms. In both the short and long terms, the self-limited form of BPPV was found to have the best outcome, the episodic type had an intermediate outcome, and the prolonged type had the worst outcome. CONCLUSIONS: We postulate that outcomes are best in those cases where free-floating canaliths are the mechanism of disease, which includes patients with self-limited BPPV. Patients with episodic or prolonged BPPV may have varying degrees of underlying cupulolithiasis that cannot be entirely corrected with PRM alone.

Adult↗
PubMed1996

Does N stage predict survival?

OBJECTIVE: To examine the relationship between N stage and survival in head and neck cancer to see if N stage has prognostic value. DESIGN: Database analysis using the Cox Proportional Hazards Model. METHOD: Five hundred and twenty-three consecutive patients with squamous cell carcinoma of the head and neck prospectively entered into a clinical database are analyzed for the outcome of dead with disease. RESULTS: There is no difference in survival between some increments of N stage, specifically N1 and N2, controlling for T stage and site. CONCLUSION: A modified N stage system consisting of N0, N(limited), and N(extended) appears to have a better prognostic value.

Carcinoma, Squamous Cell↗
PubMed1994

What we learn from a clinical database.

A clinical database documents caseload, assesses treatments, compares treatments, follows patients, and can be used for effective teaching. The database and software used at Kingston Regional Cancer Clinic are described, and a few pertinent findings are presented.

Database Management Systems↗
PubMed1993

Cystic cervical metastases are not branchiogenic carcinomas.

This paper examines the issues of the existence, the diagnosis and the management of carcinoma in a cervical cyst. Five cases highlight a discussion of the problems facing the pathologist and the surgeon. Patients with a cystic squamous carcinoma in the neck likely have a primary in the oropharynx and a meticulous investigation is warranted.

Adult↗
PubMed1992

Is head-shaking nystagmus a sign of vestibular dysfunction?

It has been proposed that head-shaking nystagmus is a reliable test or indicator of vestibular dysfunction. Using a series of 340 patients and 20 controls, this paper compares the vestibular test data to head-shake test data to answer some of the questions about this poorly understood response. Head-shaking nystagmus appears to reflect the underlying spontaneous nystagmus and its direction has no relationship to the side of the vestibular asymmetry.

Caloric Tests↗
PubMed1990

Peritonsillar abscess: the treatment options.

Peritonsillar abscess is the second most common ENT emergency admission at our hospital. The optimal management has been a subject of discussion for years. This paper reviews 51 patients and the literature to question the traditional medical/surgical managements.

Adolescent↗
PubMed1984

Ludwig's-like angina (pseudo-angina Ludovici).

Ludwig's angina and its variants (referred to as pseudo or Ludwig's-like angina) are a group of classical space infections in the head and neck. Recent papers have emphasized the bacteriology and complications. This paper, using three case studies, further examines relevant investigations and treatment.

Adult↗