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Biomedical subjects

T M Jones

Publications and source records attributed to T M Jones.

At least 19 recordsLinked to original sources
PubMed2001

Observer error in the assessment of nodal disease in head and neck cancer.

BACKGROUND: There is no previously published information on clinicians' abilities to accurately differentiate between different stages of node positive disease in head and neck cancer. METHODS: Forty-two surgeons examined standardized nodes in a model neck and estimated nodal size. Each recorded their confidence in their ability to perform the task using a visual analogue scale. Reference nodes of known size were provided for comparison during a second examination of each node. The study was repeated after 1 month. RESULTS: Accuracy was poor and was not dependent on experience or confidence. There was a tendency to underestimate the size of smaller nodes. Estimates were strongly influenced by volume independent of largest diameter (p <.001). Reference nodes aided accuracy (p =.031). Subjects were not consistent on repeated testing (p <.001). CONCLUSIONS: Both trainees and specialists are poor at accurately staging nodal disease using palpation alone.

Clinical Competence↗
PubMed2001

Tuberculous otitis media -- a diagnostic dilemma.

Tuberculous otitis media can provide a diagnostic challenge even to the most astute and experienced clinician. The rarity of the condition and its propensity to masquerade as commoner otological conditions further delays diagnosis and treatment. We present the case of a 22-year-old female who presented with chronic aural discharge, unilateral hearing loss and recurrent hemifacial paralysis. The paper highlights the difficulty in diagnosis and stresses the need for a high index of suspicion in cases resistant to the common methods of treatment.

Adult↗
PubMed2001

Objective assessment of hoarseness by measuring jitter.

The objective measurement of hoarseness by measuring 'jitter' (the average percentage pitch-period variation between consecutive pitch-cycles) using an inverse filtering technique is described. Twenty-five patients with a variety of causes of hoarseness were studied, together with five individuals who had mild hoarseness induced by histamine challenge and 12 normal individuals. The mean severity of jitter in the patient group (9.8%) was significantly different from the normals. (1.04%) In addition, there was a significant correlation (R2 = 0.53; P < 0.0001) between jitter and subjective assessment of hoarseness. The mean values of jitter with histamine challenge before and after recovery (1.03%, and 1.18%) were significantly different (P < 0.0001) to the mean maximum value during the challenge (2.64%). These data suggest that jitter is an objective and repeatable measurement of hoarseness-even small changes in hoarseness in individual patients. It is likely to prove most effective for monitoring treatment response.

Adult↗
PubMed2001

A randomized trial of the efficacy of a new micronized formulation versus a standard formulation of isotretinoin in patients with severe recalcitrant nodular acne.

BACKGROUND: Isotretinoin is very frequently the drug of choice for the management of severe recalcitrant nodular acne. Recently, a new micronized and more bioavailable formulation of isotretinoin has been developed that permits once-daily administration in lower doses than usually used with standard isotretinoin (Accutane), regardless of whether it is taken with or without food. OBJECTIVE: Our purpose was to determine whether micronized isotretinoin and standard isotretinoin are clinically equivalent. METHODS: In this multicenter, double-blind, double-dummy study, 600 patients with severe recalcitrant nodular acne were treated with either 0.4 mg/kg of micronized isotretinoin once daily without food (n = 300) or 1.0 mg/kg per day of standard isotretinoin in two divided doses with food (n = 300). Lesion counts were monitored over 20 weeks. RESULTS: Both treatment groups in this well-controlled clinical trial experienced an equivalent reduction in the number of total nodules (facial plus truncal). In addition, an equivalent proportion of patients achieved 90% clearance of the total number of nodules. Both formulations had similar results for other efficacy variables. CONCLUSION: Once-daily use of the micronized and more bioavailable formulation of isotretinoin under fasted conditions is clinically equivalent to the standard twice-daily formulation under fed conditions in the treatment of severe recalcitrant nodular acne.

Acne Vulgaris↗
PubMed2001

Safety of a new micronized formulation of isotretinoin in patients with severe recalcitrant nodular acne: A randomized trial comparing micronized isotretinoin with standard isotretinoin.

BACKGROUND: Isotretinoin is a very effective drug for treating severe recalcitrant nodular acne. A new micronized formulation of isotretinoin has been shown to be clinically equivalent to standard isotretinoin with improved bioavailability and minimal food effect. The safety profile of the micronized formulation has not been described previously. OBJECTIVE: The objective of this article is to report the incidence and intensity of adverse events found in a comparative, double-blind efficacy study that showed clinical equivalence of the new micronized formulation of isotretinoin and the standard isotretinoin formulation (Accutane). METHODS: Six hundred patients with severe recalcitrant nodular acne were treated with micronized isotretinoin (n = 300) under fasted conditions or standard isotretinoin (n = 300) under fed conditions. One cohort received single daily doses of 0.4 mg/kg of micronized isotretinoin without food and the other cohort received 1.0 mg/kg per day of standard isotretinoin in two divided doses with food. Adverse events were monitored during 20 weeks of drug therapy. RESULTS: The proportion of adverse events in most body systems was generally lower in patients receiving micronized isotretinoin than in those receiving standard isotretinoin. CONCLUSION: Micronized isotretinoin appears to have a safety profile similar to that of standard isotretinoin and to carry a lower risk of mucocutaneous events and hypertriglyceridemia.

Acne Vulgaris↗
PubMed2001

Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial.

BACKGROUND: Recurrent herpes simplex labialis (HSL) occurs in 20% to 40% of the US population. Although the disease is self-limiting in persons with a healthy immune response, patients seek treatment because of the discomfort and visibility of a recurrent lesion. OBJECTIVE: Our purpose was to determine whether docosanol 10% cream (docosanol) is efficacious compared with placebo for the topical treatment of episodes of acute HSL. METHODS: Two identical double-blind, placebo-controlled studies were conducted at a total of 21 sites. Otherwise healthy adults, with documented histories of HSL, were randomized to receive either docosanol or polyethylene glycol placebo and initiated therapy in the prodrome or erythema stage of an episode. Treatment was administered 5 times daily until healing occurred (ie, the crust fell off spontaneously or there was no longer evidence of an active lesion) with twice-daily visits. RESULTS: The median time to healing in the 370 docosanol-treated patients was 4.1 days, 18 hours shorter than observed in the 367 placebo-treated patients (P =.008; 95% confidence interval [CI]: 2, 22). The docosanol group also exhibited reduced times from treatment initiation to (1) cessation of pain and all other symptoms (itching, burning, and/or tingling; P =.002; 95% CI: 3, 16.5); (2) complete healing of classic lesions (P =.023; 95% CI: 1, 24.5); and (3) cessation of the ulcer or soft crust stage of classic lesions (P <.001; 95% CI: 8, 25). Aborted episodes were experienced by 40% of the docosanol recipients versus 34% of placebo recipients (P =.109; 95% CI for odds ratio: 0.95, 1.73). Adverse experiences with docosanol were mild and similar to those with placebo. CONCLUSION: Docosanol applied 5 times daily is safe and effective in the treatment of recurrent HSL. Differences in healing time compared favorably with those reported for the only treatment of HSL that has been approved by the Food and Drug Administration.

Acute Disease↗
PubMed2001

Once-daily oral gatifloxacin versus oral levofloxacin in treatment of uncomplicated skin and soft tissue infections: double-blind, multicenter, randomized study.

This was a double-blind, multicenter study in which 410 adults (> or =18 years of age) with uncomplicated skin and soft tissue infections (SSTIs) were randomized to receive either 400 mg of gatifloxacin orally once daily or 500 mg of levofloxacin orally once daily for 7 to 10 days. The study protocol called for four assessments-before and during treatment, at the end of treatment, and posttreatment. Efficacy evaluations included clinical response and bacterial eradication rates. Of 407 treated patients, 202 (108 women, 94 men) received gatifloxacin and 205 (111 women, 94 men) received levofloxacin. For clinically evaluable patients, the cure rates were 91% for gatifloxacin and 84% for levofloxacin (95% confidence interval [CI] for the difference, -2.0 to 15.2%). Clinical cure rates for microbiologically evaluable patients were 93% for gatifloxacin and 88% for levofloxacin (95% CI for the difference, -6.5 to 16.8%). The bacterial eradication rate was 92% for each group, with gatifloxacin eradicating 93% of the methicillin-susceptible Staphylococcus aureus isolates and levofloxacin eradicating 91% of them. Both drugs were well tolerated. Most of the adverse events were mild to moderate, and nausea was the most common adverse event in each treatment arm. Once-daily oral gatifloxacin (400 mg) is clinically efficacious and well tolerated compared with once-daily levofloxacin (500 mg) for the treatment of patients with uncomplicated SSTIs.

Administration, Oral↗
PubMed2001

Otology in ancient India.

Sushrutra Samhita is essentially a multi-volume textbook reporting the surgical practices of ancient India. It covers all aspects of surgery. However, specific references are made to otorhinological conditions, their description and subsequent treatments often being described in some detail. In this paper we outline the structure of the document and attempt to explain its underlying philosophies. We highlight the specific references to otological diseases and their treatment and draw the obvious comparisons with modern otological practice.

Female↗
PubMed2001

Tracheal paraganglioma: a diagnostic dilemma culminating in a complex airway management problem.

A 41-year-old man presented to his general practitioner (GP) with a wheeze and dyspnoea on exercise. Asthma was diagnosed and treatment with inhaled corticosteroid and a beta(2)-agonist commenced. Despite this, his condition deteriorated over three weeks culminating in stridor, requiring emergency admission to hospital. Nasendoscopy revealed a polypoidal lesion in the upper trachea, acting like a ball valve. A local anaesthetic tracheostomy, secured his airway. Subsequent direct laryngoscopy allowed avulsion of the lesion. Alternative methods of airway management are discussed. Histology revealed a paraganglioma. The aetiology of paragangliomas is described and a literature review of tracheal paraganglioma is presented. Post-operative recovery was unremarkable. However, tumour recurrence occurred at nine months. A subsequent revision tracheostomy and laser resection has ensured disease-free survival, one year later. We recommend that acute onset wheeze, refractive to appropriate therapy, should be referred for urgent examination of the upper aerodigestive tract.

Acute Disease↗
PubMed2001

Therapeutic studies with a new combination benzoyl peroxide/clindamycin topical gel in acne vulgaris.

Three independent clinical studies were conducted in more than 1250 patients with moderate to moderately severe acne vulgaris to evaluate the efficacy and safety of a new combination gel that stably combines 5% benzoyl peroxide and 1% clindamycin. The results indicated that the benzoyl peroxide/clindamycin combination product was an effective treatment for reducing the inflammatory and noninflammatory lesions of acne vulgaris. In overall improvement as rated by the physicians and patients, the combination gel was superior to clindamycin alone, and in 2 of the 3 studies, to benzoyl peroxide alone. The antimicrobial activity of the combination gel was significantly (each P < .01) superior to that seen with topical application of its individual constituents, 5% benzoyl peroxide or 1% clindamycin, and was numerically better than that found with topical application of a 5% benzoyl peroxide/3% erythromycin combination product. As with benzoyl peroxide, dry skin was the most frequent side effect with use of the combination gel, with isolated incidences of other localized irritation. No other safety or tolerability concerns were identified.

Acne Vulgaris↗
PubMed2001

A combination benzoyl peroxide and clindamycin topical gel compared with benzoyl peroxide, clindamycin phosphate, and vehicle in the treatment of acne vulgaris.

A topical gel combining 5% benzoyl peroxide and 1% clindamycin as phosphate was evaluated in a 10-week randomized double-blind trial involving 287 patients with moderate to moderately severe acne. The combination agent demonstrated significantly greater reductions in inflammatory lesions than either of its active constituents (5% benzoyl peroxide and 1% clindamycin) or vehicle when used alone. Significantly greater reductions in comedos and improvements, as measured by both physicians' and patients' global evaluations, were obtained with the combination agent than with clindamycin or vehicle. The reduction in comedos and the global improvements were similar between the combination agent and benzoyl peroxide. The combination agent was well tolerated; the incidence of dry skin was similar to that found with benzoyl peroxide, and other adverse events were similar to that with vehicle. The improved efficacy obtained with combination therapy was accompanied by a safety profile similar to that of either constituent used alone.

Acne Vulgaris↗
PubMed2000

Adaptive female choice for middle-aged mates in a lekking sandfly.

Most theoretical models of age-related mate choice predict that females should prefer older males because they have proven survival ability. An alternative view is that older males represent inferior mates because of negative genetic correlations between early and late fitness components, or because older males have traded off longevity against other fitness components, have accumulated deleterious germ-line mutations, or are less well adapted to current conditions than more recently born individuals. While numerous studies have reported female choice for older males, few have explicitly examined the fitness consequences of such a preference. We present evidence from a lekking sandfly, Lutzomyia longipalpis, showing that choosy females discriminate against older males and gain a fitness benefit from their choice. When permitted free choice from an aggregation consisting of males aged zero to two days (young), four to six days (middle-aged) and eight to ten days (old), females preferentially mated with middle-aged males, but all measures of female reproductive success were independent of male age. In contrast, when a second set of females was randomly assigned single virgin males of known age, the eggs of those paired to old mates exhibited lower hatching success than the eggs of females mated to young or middle-aged males. These results suggest that females avoid mating with older males because they represent poorer quality mates. Age-related differences in male quality may have a genetic basis, but could equally well arise through a phenotypic decline in sperm quality or sperm transfer ability with male age. The lack of evidence of female discrimination against older males from other studies may be because these did not explore the reproductive success of the full age range of males.

Adaptation, Physiological↗
PubMed2000

A modified spacer device for inhalational drug therapy for chronic bronchitis/asthma in laryngectomised patients.

Following total laryngectomy, patients who need to continue their inhalational drug therapy for chronic pulmonary conditions experience a great deal of difficulty in administering the drugs. We describe a new spacer device to deliver inhalational drug therapy to laryngectomized patients which is simple to use and does not interfere with the patient's life style. The device involves a standard metered dose inhaler, a paediatric face mask and a small volume spacer. This device was used successfully in six laryngectomised patients for 12-18 months, who needed to continue their inhalational drug therapy for their pulmonary condition.

Administration, Inhalation↗
PubMed2000

Snoring: recent developments.

Despite limited evidence validating its efficacy, surgery to overcome snoring is commonly undertaken. This article looks at the development of snoring surgery to present day, highlighting its limitations and outlining current methods being used to target the surgery more effectively.

Adult↗
PubMed1999

Does adenotonsillectomy cure hypoxaemia in children with sleep apnoea and congenital cardiac pathology?

INTRODUCTION: Adenotonsillectomy usually cures obstructive sleep apnoea in otherwise healthy children. When children, with congenital cardiac pathology, suffer sleep hypoxaemia following their corrective cardiac surgery, they are referred to an otolaryngologist for adenotonsillectomy. Hardly any studies have been published to show how effective this operation is for these children. OBJECTIVE: To determine whether adenotonsillectomy significantly improves hypoxaemia in children with congenital cardiac pathology following corrective cardiac surgery. METHODS: Thirty children with sleep apnoea (aged 2-8 years) were recruited. Fifteen children with congenital cardiac pathology (Gp I) and 15 children who were otherwise healthy (Gp II). All children were assessed pre-operatively and at 1 and 3 months post-operatively with transcutaneous oxygen saturation monitoring. Tonsillar size, base oxygen saturation level, apnoeic episodes and snoring were recorded. Sleep apnoea and snoring was graded on a 5 point scale from I (no apnoea/snoring) to V (severe apnoea and snoring). RESULTS: All children had an initial sleep grade of IV or V. Tonsillar size did not appear to be a significant factor on sleep grade in Gp I and Gp II. The median base line oxygen saturation was 88 and 93%, respectively in Gp I and II pre-operatively and improved to 90.1 and 99.2%, post-operatively. Following surgery, snoring and sleep apnoea disappeared in group II. In group I, there was significant reduction in the number of apnoeic episodes at 3 months, but the majority of children were still snoring with hypoxaemic episodes. CONCLUSION: This study shows that adenotonsillectomy significantly reduces the apnoeic episodes in children with cardiac pathology but does not abolish it. At 3 months after surgery there was significant overall improvement in the baseline oxygen saturation.

Adenoidectomy↗
PubMed1999

Cyclooxygenase-2 inhibition by rofecoxib reverses naturally occurring fever in humans.

Cyclooxygenase (COX) exists as constitutive (COX-1) and inducible (COX-2) isoforms. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen and diclofenac inhibit both COX-1 and COX-2. The role of COX-2 in the genesis of fever in monkeys and humans was examined with use of the specific COX-2 inhibitor rofecoxib. Rofecoxib was administered to monkeys made febrile by 6 microg/kg intravenous lipopolysaccharide. Induced pyrexia was followed by oral rofecoxib (1 or 3 mg/kg), diclofenac (3 mg/kg), or vehicle. Rofecoxib and diclofenac rapidly reversed the elevated temperature (P < .05 versus vehicle for 3 mg/kg rofecoxib and diclofenac at 70 to 90 minutes after dosing). A single-dose, parallel-group, double-blind randomized trial was conducted in 94 patients with fever caused by a viral-type illness. Mean baseline temperature was similar for all groups (-38.5 degrees C). Patients received oral doses of 12.5 mg rofecoxib, 25 mg rofecoxib, 400 mg ibuprofen, or placebo and the mean +/- SE change in oral temperature at 4 hours after dosing was -0.97 degrees C +/- 0.11 degrees C, -1.19 degrees C +/- 0.09 degrees C, -1.20 degrees C +/- 0.11 degrees C, and 0.01 C +/- 0.17 C, respectively (P < .001 for active treatments versus placebo). Specific inhibition of COX-2 by rofecoxib results in antipyretic activity in monkeys and humans comparable to dual COX-1/COX-2 inhibitors such as diclofenac or ibuprofen. The data support the hypothesis that it is the COX-2 isoform that is primarily involved in the genesis of fever in humans.

Administration, Oral↗
PubMed1999

Manipulation of the fractured nose: a comparison of local infiltration anaesthesia and topical local anaesthesia.

Reduction of simple nasal fractures under local anaesthetic is now an accepted practice. The anaesthetic is usually administered using an external percutaneous approach, coupled with topical intranasal cocaine. Topical local anaesthetic with intranasal cocaine is an alternative method. Fifty-four adult patients with simple displaced nasal fractures were randomised to three different groups prior to fracture reduction in the outpatient department. Group A received external local infiltration, Group B received topical EMLA cream whilst Group C received topical AMETOP gel. All patients received topical intranasal cocaine. The cosmetic result and airway patency were comparable in all groups. However, patients in group A perceived the procedure as significantly more painful than the patients of groups B and C. Despite the increased procedure time, we recommend topical anaesthesia as the method of choice to reduce simple nasal fractures in the outpatient department. It offers a similar outcome, whilst being significantly less painful than external infiltration.

Administration, Intranasal↗