PubMed Health⌕ Search

Biomedical subjects

D E Phillips

Publications and source records attributed to D E Phillips.

At least 37 records · Page 2Linked to original sources
PubMed1994

How far to pass a nasogastric tube? Particular reference to the distance from the anterior nares to the upper oesophagus.

The length of the nasogastric tube inserted into a patient is frequently ill-considered. If an inappropriate length of tubing is passed this may result in feeding difficulties or inadequate aspiration of gastric contents. This study assessed the optimal length by assuming that the oesophagus is 25 cm long and that the tip of a nasogastric tube should lie 10 cm below the gastro-oesophageal junction. The portion of tubing from the anterior nasal spine to the cricopharyngeus was calculated by superimposing a Ryles tube over a soft tissue lateral neck radiograph. Two hundred and forty cases were reviewed by three independent observers. The median distance was found to be 21 cm. It is recommended that nasogastric tubes are marked at 56 cm and this point be secured level with the nasal vestibule.

Enteral Nutrition↗
PubMed1993

Squamous carcinoma presenting as an enlarged cervical lymph node.

BACKGROUND: Patients presenting with an enlarged cervical lymph node containing squamous cell carcinoma are a difficult problem for head and neck surgeons. In most cases, the primary site lies in the head and neck region. The advent of fine-needle aspiration cytologic study means that this group of patients can be accurately identified in the clinic and investigated accordingly. METHODS: The current report studies the records of 267 such patients presenting to the Head and Neck Unit at The University of Liverpool over a 29-year period. RESULTS: The 5-year survival rate for all patients presenting with a cervical lymph node metastasis was 27%. The 5-year survival rate for patients with a detected primary in the head and neck was 31% and the primary site was identified during the patient's life time in all but 36 patients (13%). In 53% of patients, the primary site was discovered during routine clinical examination, and in a further 16% it was discovered at panendoscopy. Most diagnostic tests proved relatively unhelpful but 10 patients in our series had the primary site discovered by radiograph and 9 of these had carcinoma of the lung. In the current study when the primary site was discovered it was in the head and neck region in 74% of patients. Primary sites other than head and neck occurred in 11% of the patients and no 5-year survivors existed. Multivariate analysis suggested that open biopsy of the lymph node metastasis appeared to have an adverse effect on survival as did advanced age and advanced N stage. The late diagnosis of the primary site, if it proved to be in the head and neck region, on the other hand, had a positive association with survival. CONCLUSIONS: Patients presenting with a lymph node metastasis in the head and neck region from an unknown primary have a prognosis identical to that of other patients with head and neck squamous carcinoma with neck node metastases. The prognosis for patients in whom the primary site is never discovered or in whom the primary site is not head and neck, however, is disastrous. If the primary tumor proves to be in the head and neck region, treatment is worthwhile since almost a third of patients are cured of their disease. When the primary carcinoma is not in the head and neck region, treatment must be considered palliative.

Age Factors↗
PubMed1993

Injury: the medical and related costs in New Zealand 1990.

AIM: To describe the cost of inpatient admissions and emergency department attendances for injury at a major New Zealand hospital; and to extrapolate to indicative national costs for injury, with a view to facilitating decision making, in relation to injury prevention programs. METHODS: By using data from the patient management system database and the resource utilisation system operating at Dunedin Hospital to describe the utilisation spectrum for injury related events. RESULTS: The institutional cost of inpatient care for injury cases for the year ending 31 December 1990 amounted to $7,378,000, at an average of $3,020 a case. The costs for emergency department attendances (not resulting in admission) amounted to $2,585,000, at an average of $93 a case; the total of $9,963,000 equated to 15% of the hospitals annual operating budget. The most expensive causes of admission with injury were falls and motor vehicle traffic crashes. The commonest resulting injury was fractures of the lower limb, and the commonest and cumulatively most expensive injuries presenting at the emergency department were cuts, and sprains and strains. If these costs were extrapolated to New Zealand as a whole it would suggest hospital costs of approximately $457 million per annum; when taken in conjunction with other known medical and welfare costs this approximates to an annual bill to the state of approximately $1.2 billion per annum. CONCLUSION: Injuries are a significant, costly, potentially preventable, element of health care. The use of hospital data for the allocation of resources to preventive efforts to date, has been based primarily on hospital admission numbers. This study suggests that this is not however indicative of the costs to the state, and the use of financial and other utilisation data would assist in rationalising resource allocation to preventive programs.

Emergency Medical Services↗
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

Alterations in neuronal development in the substantia nigra pars compacta following in utero ethanol exposure: immunohistochemical and Golgi studies.

The effects of gestational ethanol exposure on the development of dopaminergic neurons of substantia nigra pars compacta were investigated in the rat. Pregnant rats were either fed an ethanol-containing liquid diet (6.7% v/v) or pair-fed an isocaloric diet throughout gestation. The morphology of neurons in both ethanol-exposed and pair-fed control offspring was assessed on postnatal day 15 by using tyrosine hydroxylase immunohistochemistry and Golgi impregnation methods. Alterations in the development of neurons were indicated in ethanol-exposed offspring compared with control offspring by the following: (i) tyrosine hydroxylase-positive cell bodies were smaller and appeared more closely packed; (ii) the numbers of second-, third- and fourth-order dendrites and total dendritic segments per cell were reduced; (iii) the dendritic branching pattern relative to distance from the soma was altered; and (iv) some dysmorphic neurons with irregular cell body contours and spheroidal enlargements in the dendrites were encountered in both tyrosine hydroxylase-immunostained and Golgi-stained specimens. The results of the present study suggest that gestational ethanol exposure causes retardation in the development of substantia nigra pars compacta neurons, especially in their dendritic growth and branching, and also causes pathological changes in some neurons. The underdevelopment of dendrites could result in altered development of neuronal circuitry which, in turn, could result in abnormal motor function.

Animals↗
PubMed1993

A randomised phase II trial of epirubicin and 5-fluorouracil versus cisplatinum in the palliation of advanced and recurrent malignant tumour of the salivary glands.

Sixteen patients with advanced and recurrent malignant salivary gland tumours were admitted to a randomised trial and the response assessed. Seven patients received Epirubicin/5-Fluorouracil and none of these patients responded. Nine patients received Cisplatinum and only one patient had a partial response. The trial suggests that chemotherapy has no place in the treatment of advanced salivary gland malignant tumours.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Implications of tumour in resection margins following surgical treatment of squamous cell carcinoma of the head and neck.

Presence of tumour at the resection margin following primary surgical treatment for squamous cell carcinoma of the head and neck is thought to adversely affect prognosis. To confirm this we performed a review of 478 patients treated by primary surgery for squamous cell carcinoma of the head and neck and sub-divided them into those exhibiting positive margins and those with negative margins following resection. Uni-variate and multi-variate statistical methods were used to analyse survival figures and a variety of parameters associated with the presence of positive resection margins. We found 5-year survival was decreased if resection margins were found to be positive (P < 0.025). The presence of positive resection margins was also significantly associated with time to tumour recurrence (P < 0.001) and survival with nodal recurrence (P < 0.001). Other factors which were significantly associated with survival using Cox's multi-variate analysis were site of tumour (P < 0.005), nodal extracapsular rupture (P < 0.05), histology (P < 0.05) and pathological T-stage (P < 0.05). Uni-variate analysis revealed no significant associations between the presence of positive margins and the patient's age, sex, tumour site, degree of tumour differentiation, and nodal status, though using multiple logistic regression, the general condition of the patient (P < 0.01) and the tumour site P < 0.05) were significantly related. The results support the concept that every effort should be made to obtain negative resection margins when undertaking primary ablative surgery for squamous cell carcinoma of the head and neck.

Carcinoma, Squamous Cell↗
PubMed1993

Non-squamous malignancy in lymph nodes: the occult primary.

The present study presents 105 patients seen at a head and neck specialist clinic with a neck gland which subsequently proved to be a non-squamous malignancy. Of the 105 patients, 50 patients were eventually found to have a tumour in the head and neck region, 30 to have a distant primary and in 25 no primary site was ever found. The majority of patients were diagnosed in the clinic after careful examination and most of the remainder were diagnosed during endoscopy/biopsy. Chest radiography was the most useful investigation for diagnosing primary tumours of the lung. The 5-year-survival for the whole group of 105 patients was 28% (95% CI 17-39). The 5-year-survival for the head and neck primary tumour group was 44% (95% CI 25-60). The median survival of patients with a distant primary tumour was only a 6 months, there was one 5-year-survivor. The median survival for those in whom the primary was never discovered was 18 months. However, a reasonable proportion of these patients survived, five being alive at 5 years. The difference between survival for the three groups was statistically significant (P < 0.001). The most common histological type was undifferentiated/anaplastic tumours (37 out of 105) and this was followed by adenocarcinoma (33 out of 105). There was a significant difference in the survival between these two groups (chi 2 = 2.02, d.f. = 1, P = NS). Multi-variate analysis suggested that survival was better in the older age group and was affected by histology (P = 0.0093, P = 0.0332 respectively). The present study suggests that the treatment of patients in whom the primary site is eventually found to be in the head and neck region is rewarding with the same survival as a similar group of patients with squamous cell carcinoma. Sixty of the group of 105 patients had excision biopsies of the neck node and this did not affect survival.

Adenocarcinoma↗
PubMed1992

Diabetes--inpatient utilisation, costs and data validity. Dunedin 1985-9.

AIM: to describe the impact of diabetes on the public hospital inpatient services in one New Zealand region over the period 1985-9, from one 450 bedded university teaching hospital in a major urban centre in New Zealand serving a population of approximately 125,000 people. METHODS: by the analysis of routinely collected hospital discharge data and the application thereto of the resource utilisation system (RUS). Data validation was performed by means of a survey of clinical notes. RESULTS: admission, bed utilisation rates and associated costs for diabetes rose over the period by factors of 3.2, 3.8 and 2.8 respectively; due primarily to the management of macrovascular disease in the elderly. The rise was most marked in those 75 years and over; admission rates, bed utilisation rates and costs in this age group being respectively 1.9, 4.3 and 2.9 times greater than the 60 to 74 year age group. For admissions with diabetes as principal diagnosis, admissions for glycaemic control showed a significant decrease in lengths of stay over the period. Admissions with diabetic peripheral vascular disease were cumulatively, and per case, the most costly, the mean cost, at $16,000 per case, being 5.1 times greater than the mean cost of all admissions with diabetes as principal diagnosis. In 1989 diabetes accounted for 5% of the cost of all inpatient care provided by the hospital. These results are an underestimate, as 45% of admissions of people where diabetes should have been cited as a subsidiary diagnosis were omitted from the discharge data. CONCLUSION: diabetes is a major consumer of hospital resources in this region. As the majority of diabetes associated resource use is in the elderly, a population projected to increase significantly, consideration needs to be given to the options for the provision of care. More work also needs to be done on the reasons underlying these changes. If routinely collected data is to be used for these purposes then audit of the data must be performed or use should be restricted to certain defined groups, eg, diabetes as principal diagnosis only.

Adult↗
PubMed1992

Effects of prenatal ethanol exposure on the development of Bergmann glia and astrocytes in the rat cerebellum: an immunohistochemical study.

The consequences of prenatal ethanol exposure on the postnatal development of Bergmann glia and astrocytes in the rat cerebellum were investigated by using glial fibrillary acidic protein (GFAP) immunolabeling. Pregnant rats were either fed with an ethanol containing liquid diet (6.7% v/v) or pair-fed with an isocaloric diet throughout gestation. On postnatal day (PD) 15 and 22, parasagittal sections of the cerebellar vermis from female offspring were processed for GFAP immunohistochemistry to assess the development of Bergmann glia and astrocytes in lobules I, VII, and X and astrocytes in the central core of white matter. On PD 15, compared to control animals, ethanol exposed animals had fewer GFAP positive Bergmann glial fibers per unit length of molecular layer; a significantly greater percentage of morphologically immature Bergmann fibers; a significantly greater GFAP positive astrocytic area per unit area of internal granular layer and central white matter; and the astrocytic processes were wider and more closely packed. These glial changes were associated with significantly thicker external granular layer in all 3 lobules. However, no significant differences were seen between the ethanol exposed and control animals on PD 22, indicating "catch-up growth" in the ethanol exposed animals during the third postnatal week. These results suggest that prenatal ethanol exposure causes (1) delayed maturation of Bergmann glia, which in turn contributes to the delayed migration of granule cells; and (2) alterations in the normal postnatal development of astrocytes.

Animals↗
PubMed1992

The effect of employment status and household composition on health care utilisation in a general practice.

OBJECTIVE: to investigate the effect of employment status and family composition on general practice and secondary health care utilisation rates of a New Zealand general practice population. METHODS: the study practice's health care records were electronically interrogated and pooled data on utilisation rates was obtained for a 12 month period. Individual records were grouped according to the number of people in the family and families were further categorised according to the employment status of the adults in the family. Comparisons were made between family groups in rates of general practice and secondary care activities. Costs were attributed to each activity and a cost analysis undertaken. RESULTS: families of four or more people depending on government benefits had a lower primary care cost per person than equivalent families where an adult was in paid employment, but higher costs in secondary care resulted in a higher total health care cost. Overall, for the year reviewed, the mean cost per person for public health care was $365 for people in families where at least one person was in the paid workforce, $568 for those in families depending on government support, and $1438 for people over 60 years of age. CONCLUSION: in this practice the increased use of secondary care facilities by those who have lower rates of general practice activity resulted in a higher overall cost of health care to those patients. This study indicates the need for further analyses of activities by differing patient groupings to facilitate rational and equitable health care planning.

Adult↗
PubMed1992

Effects of combined pre- and postnatal ethanol exposure (three trimester equivalency) on glial cell development in rat optic nerve.

This study evaluated the effects of a combined gestational and 10 day postnatal alcohol exposure (human three trimester equivalency) on the development of glial cells in the rat optic nerve. Pregnant rats were exposed to alcohol via a liquid diet, then their pups were artificially reared and further exposed to alcohol for 10 postnatal days via a gastrostomy fed liquid diet. Control animals, born of pair fed dams, were artificially reared on pair fed isocaloric diets. Optic nerve tissues were prepared for light and electron microscopic studies from animals on gestational days (G) 15 and 20 and postnatal days (P) 5, 10, 15, 20 and 90. There were fewer glial cells per cross-section on day 15 and the cross-sectional areas of optic nerves were smaller on days G20, P15 and P90 in the ethanol exposed animals. There was an alcohol-induced delay in the appearance of immature cells within the oligodendroglia lineage and a decrease in the number of oligodendroglia present at 15 and 20 days, indicating a delay in the maturation of oligodendroglial cells. These effects were compensated for by 90 days. Maturation of the astrocytic cell lineage was generally unaffected by the alcohol although there was evidence of increased numbers of cells in the lineage. There was no consistent indication of alcohol-induced degeneration of glial cells or their organelles. Thus, alcohol exposure for all of gestation and 10 postnatal days in the rat causes a delay in oligodendrocyte maturation but appears to have no long-term effects on the glial cell population of the optic nerve. Such a delay, by contributing to delays in myelin development, could help to explain some of the neurological dysfunctions associated with developmental alcohol exposures.

Aging↗
PubMed1992

The role of calcium alginate swabs in adenotonsillectomy.

A randomized controlled study using swabs of calcium alginate versus gauze was undertaken to evaluate the haemostatic capabilities and the shortening of operative time. Haemostasis in adenoidectomy was shown to be more effective and the operating time shortened (P = 0.05) by the use of calcium alginate. Haemostasis and operating time for tonsillectomy were not affected.

Adenoidectomy↗
PubMed1992

Treatment of T3 carcinoma of the larynx by surgery or radiotherapy.

T3 carcinoma of the larynx may be treated by surgery or by irradiation. A large number of oncologists feel that radical surgery offers a better chance of cure than does radiotherapy. We report a series of 147 patients with T3 N0 carcinoma of the larynx treated either by irradiation with salvage laryngectomy in the event of a recurrence, or by total laryngectomy. 109 patients had radiotherapy and 38 patients underwent surgery. The groups were well matched with no significant difference between the significant prognostic factors. The 5-year survival rate between the radiotherapy (70%) and surgery (40%) groups was significantly different (chi 2 = 4.48, d.f. = 1, P < 0.05). In spite of the well known problems associated with retrospective studies the present series suggests that radiotherapy combined with salvage surgery is an oncologically sound option for treating T3 laryngeal carcinoma.

Female↗
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↗
PubMed1992

Distribution of eosinophils in the nose in patients with perennial rhinitis.

The traditional method of classifying perennial rhinitis into eosinophilic and non-eosinophilic is by taking a single nasal smear from one nostril. In the light of personal experience it was felt that this method of sampling may be inadequate. The present study included 20 patients with perennial rhinitis undergoing nasal surgery. Serum total IgE levels were taken and those above 40 IU/ml had allergen specific IgE measured. Nasal smears and biopsies were taken from 5 sites on each side of the nose; middle and inferior turbinates and post nasal space. The smears significantly correlated with the biopsies (rs = 0.446, P < 0.001). The distribution of eosinophils between and within nasal cavities was found to differ. Representative sampling of the nose is important for accurate eosinophil expression. The definition of an eosinophil rich and poor nose requires greater clarification as it has great clinical relevance regarding management.

Biopsy↗
PubMed1992

A phase II study of cisplatinum versus cisplatinum + nifedipine in end-stage carcinoma of the head and neck.

Forty patients with end-stage carcinoma of the head and neck were admitted to a randomized double blind trial with cisplatinum in one arm and cisplatinum + nifedipine in the other. Nifedipine, a calcium channel blocking drug, inhibits the effect of acquired multidrug resistance in animal models. In the present study the addition of this agent had no effect on either response rate or survival in end-stage carcinoma of the head and neck. It is concluded that adding nifedipine to cisplatinum serves no useful purpose in the treatment of end-stage carcinoma of the head and neck.

Antineoplastic Combined Chemotherapy Protocols↗