Tobacco smoke and the upper airway.
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Airway Resistance↗
Biomedical subjects
D E Phillips
Publications and source records attributed to D E Phillips.
Atypical lipoma of the tongue.
We report an atypical lipoma arising in the tongue of a 43-year-old man who presented with an indolent dorsal lingual swelling. Atypical lipomas contain multivacoulated lipoblasts, which distinguishes them from benign lipomas. The superficial location in this case distinguishes this tumour from well-differentiated liposarcoma, which is biologically similar in lacking the propensity for metastasis. The superficial location of atypical lipoma allows a complete resection, which is often not possible for the deep-seated counterpart. Atypical lipoma and well-differentiated liposarcoma, if left in situ, may undergo transition to de-differentiated liposarcoma. Atypical lipoma should be completely excised with a cuff of normal tissue in order to prevent repeated local recurrence and the possibility of de-differentiation.
Adult↗
Prenatal alcohol exposure decreases the number of nitric oxide synthase positive neurons in rat superior colliculus and periaqueductal gray.
Because nitric oxide (NO) is involved in the development and refinement of axonal projections and synapses, it is of interest to know if developmental alcohol exposures affect NO producing neurons. Pregnant rats were fed artificial liquid diet throughout gestation as the only fluid or caloric source. The diet for experimental dams contained ethanol (6.7% v/v) while the pair-fed diet for control dams contained isocaloric maltose-dextrin instead of ethanol. This ethanol diet regime is known to produce peak blood alcohol concentrations of approximately 140 mg%. Cells stained histochemically for nitric oxide synthase (NOS) were counted at postnatal day 15 (P15) and 35 (P35) in cross-sections of the stratum griseum superficiale (SGS) of the superior colliculus (SC) and in the dorsolateral column of the periaqueductal gray (dlPAG). Compared to control tissues, alcohol caused the following effects: In the SC, the areal density of NOS+ neurons was decreased 24% at P15 but a similar decrease in means at P35 was not statistically significant (P=0.10); soma size was unaffected at either P15 or P35. In the dlPAG, both the areal density and the total number of NOS+ neurons per section were unaffected at P15 but were decreased at P35 (33% and 37% decreases); soma size was unaffected at either P15 or P35. The decrease in NOS+ neurons in the SC at P15 could be expected to have a negative impact on the refinement of neuronal connections while the decreases in NOS+ neurons in the dlPAG at P35 likely represent more permanent effects that could alter the function of that nucleus.
Aging↗
Diaminobenzidine as a myelin stain in semithin plastic sections.
A diaminobenzidine (DAB) stain for myelin in glutaraldehyde fixed, osmicated, semithin epoxy sections is described. One or 1.5 microm sections, dried onto slides, are first etched with a 1:2 dilution of saturated sodium ethoxide:absolute ethanol, then incubated in 0.05% aqueous DAB with 0.01% hydrogen peroxide. DAB specifically stains osmium fixed myelinated nerve fibers. This permits high resolution light microscopic study of myelinated nerve fibers in semithin sections of tissues that also can be studied by electron microscopy.
3,3'-Diaminobenzidine↗
Dental care for homebpund and geriatric patients.
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Aged↗
Best practices: charting the course.
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Evidence-Based Medicine↗
Special care dementia units: the nature of existing knowledge.
Individuals with dementia have been widely studied over the past decade. However, most of what is known about special care dementia units comes from anecdotal reports and case studies, which are considered to be insufficient for characterizing unit features or care practices (Leon & Siegenthaler, 1994). Consequently, only tentative conclusions based on experiences to date can be made (Meyer et al., 1991).
Aged↗
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↗
Effects of prenatal alcohol exposure on the postnatal morphology of the rat oculomotor nucleus.
Morphological development of the rat oculomotor nucleus was investigated on postnatal day 15 following a prenatal ethanol exposure. Analysis of toluidine blue stained plastic sections showed that the prenatal alcohol exposure caused a decrease in the density of neurons and an increase in the density of astrocytes in the center of the nucleus. There was an alcohol-induced reduction in the overall size of the cross-sectional region of the oculomotor nucleus, but no effect on the number of neurons per unit area of that total oculomotor region, indicating a delay or alteration of the migration of neurons to their normal clustered position in the center of the nucleus. The areas of the neuronal cell nucleus and nucleolus were not affected by the alcohol exposure. Analysis of Golgi-Cox-impregnated multipolar neurons showed that the alcohol exposure caused a reduction in area of the cell soma; a reduction in the number of dendritic branches; and a reduction in the complexity of the dendritic arbor relative to distance from the soma, based on concentric ring analysis. The results of this study demonstrate that gestational alcohol exposure can retard the maturation of the oculomotor nucleus.
Abnormalities, Drug-Induced↗
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↗
The accuracy of acoustic rhinometry using a pulse train signal.
The signal used in the original acoustic rhinometers was an impulse of short duration and wide energy spectrum. A rhinometer utilizing a new signal of a similarly broad energy but different time course has been developed. We investigated the accuracy of area reconstructions computed using this signal by comparing them with the original areas of simple models. This study demonstrates that, at present, acoustic rhinometry using a pulse train signal is subject to significant systematic errors. Some of these are intrinsic to the rhinometer. Others are caused by the geometry of the models. Areas reconstructions beyond narrow constrictions are particularly inaccurate. The findings are significant because the nasal valve can act as such a constriction. The errors can cause the parameters used in the clinical application of acoustic rhinometry to deviate substantially from the true values.
Acoustic Stimulation↗
Limitations of acoustic rhinometry determined by a simple model.
To determine the accuracy of a commercially available transient signal acoustic rhinometer we constructed simple models from tubing of known dimensions. A series of models was constructed in which the main cylinder was constant whilst the aperture of an included constricted area was varied from 0.07 cm2-0.95 cm2. The area reconstruction for each model was then compared with the true area. Two parameters based on those used in clinical practice of acoustic rhinometry were employed to evaluate the error. The results demonstrate that the measurement of both the volume beyond a constriction and the area of the constriction may be associated with systematic errors. The reconstructed profile of each model is similarly erroneous. As the nose presents a proximal constriction, these findings are of considerable relevance to the clinical use of acoustic rhinometry.
Acoustics↗
Combined pre- and postnatal ethanol exposure alters the development of Bergmann glia in rat cerebellum.
The development and maturation of Bergmann glial cells in the rat cerebellum was evaluated on postnatal day 15 by glial fibrillary acidic protein (GFAP) immunocytochemistry, following combined gestational and 10-day postnatal ethanol exposure (a full three trimester human equivalency). GFAP-positive Bergmann glial fibers of lobules I, III, VIb, VII and X of the cerebellar vermis were examined and counted in the molecular layer (ML), the external granular layer (EGL) and the external limiting membrane (ELM). Ethanol exposure reduced: (1) the number of GFAP-positive fibers (per unit length of folia surface) at all three levels; (2) the percentage of mature fibers; and (3) the cross-sectional area in all lobules examined. When data from the five lobules were pooled, there were 7% fewer GFAP-positive fibers in the ML, 15% fewer in the EGL and 20% fewer in the ELM; the percentage of mature fibers was reduced by 16%; and the cross-sectional areas of lobules were reduced by 16%. The altered development of Bergmann glia could be one of the factors causing delayed migration of granular neurons and reductions in the number of granule cells reported in other studies following developmental ethanol exposures and could help to explain some of the motor dysfunctions reported in FAS victims.
Alcohol Drinking↗
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↗
The treatment of early squamous cell carcinoma of the piriform fossa.
The treatment of early piriform fossa cancer can be either primary radiotherapy with salvage surgery, if necessary, or with primary surgery. The present study investigates 65 patients with T1, > or = 2 or T3 stage disease with no cervical lymph node metastases at presentation. Of this group, 17 were treated by primary irradiation, 34 underwent primary surgery and 14 were unsuitable for any curative treatment. The adjusted actuarial 5-year survival rate for those patients receiving primary radiotherapy was 55% (95% CI 16-78%) and for the surgery group it was 44% (95% CI 18-67%). This difference was not significant (chi 2(1) = 1.29). The median survival for untreated patients was 7 months (4-12 months). There was no significant differences in the time to recurrence at the primary site or in the neck, or in survival after recurrence at these sites. Thirty-five per cent of patients treated by primary irradiation were controlled at the primary site compared with 68% in the surgical group. Failure in the neck was similar for the two groups at 12% and 15% respectively. Salvage surgery was effective for the radiotherapy group with eight out of 11 patients being suitable for treatment. In the final analysis in the radiotherapy group two patients were alive and with their larynx and two alive without their larynx, the remainder of patients having died from the original tumour, intercurrent disease or second primary tumours. The survival figures for the surgery group were proportionately similar except of course, that all patients had lost their larynx.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Heparin-induced thrombotic thrombocytopenia.
OBJECTIVE: To report a case of heparin-induced thrombotic thrombocytopenia (HITTS) and discuss the incidence, possible mechanisms, complications, and treatment for this syndrome. DATA SOURCES: Case reports and review articles identified by MEDLINE from 1980 through 1991. Older articles located by manual searches. DATA EXTRACTION: Data were extracted and reviewed from published sources. Cases were selected on the basis of case presentation, time of disease onset, pathophysiology of disease, and therapeutic options. SETTING: A 600-bed university teaching hospital and an affiliated community hospital. PATIENT: A 36-year-old woman with insulin-dependent diabetes mellitus, sepsis, adult respiratory distress syndrome, diabetic ketoacidosis, oliguric renal failure developed HITTS and subsequent gangrene of her right arm. INTERVENTION: Immediate cessation of all heparin use and amputation of the patient's right arm. RESULTS: The patient's condition improved progressively over the following 60 days and she was discharged to outpatient care. CONCLUSIONS: Heparin has been associated with thrombocytopenia and thrombotic events. Laboratory tests for HITTS are unreliable and the diagnosis is usually suspected by the clinical presentation of the patient. Platelet counts should be monitored closely during heparin use. In the event of a marked decrease in platelet count associated with venous or arterial thrombosis, heparin therapy should be stopped immediately. If further anticoagulation is necessary, oral anticoagulants such as warfarin may be used instead. As the onset of warfarin may take several days to become therapeutic, aspirin, dipyridamole, or both may be used effectively. Healthcare workers should be aware that in these patients, the use of even small amounts of heparin can produce catastrophic results.
Adult↗
Reliability of clinical examination in the diagnosis of parotid tumours.
This study included 128 superficial lobe parotid tumours seen over a 27-year period. Using data stored in a prospective manner the sensitivity and specificity of regarding every lump in the tail of the parotid as being either a pleomorphic adenoma or other benign tumour was assessed. We found that 71% of all lumps in the tail of the parotid with no facial palsy were pleomorphic adenomas, sensitivity 0.88 and specificity 0.50. We also found that 96% of lumps in the tail of the parotid with no facial palsy, pain, trismus or fixation were benign, sensitivity 0.91 and specificity 0.84. We feel this information is useful in managing elderly patients and those reluctant to undergo surgery. It provides additional evidence as to the nature of the tumour and can be considered with the results of fine needle aspiration cytology (if available).
Aged↗