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Biomedical subjects

D G John

Publications and source records attributed to D G John.

At least 19 recordsLinked to original sources
PubMed1997

Warfarin and epistaxis: should warfarin always be discontinued?

The object of this study was to determine whether warfarin could be safely continued in patients with epistaxis if the International Normalized Ratio (INR) was within the suggested therapeutic range. Twenty patients on warfarin treatment were compared with controls, matched for age and sex. Local measures for the control of epistaxis were undertaken appropriately in all the patients. In the warfarin group 17 patients (85%) did not discontinue warfarin as the INR was within the suggested range. There were no additional bleeding complications or failure of epistaxis control due to continuation of warfarin. There was no significant difference in the mean hospital stay between the warfarin and non-warfarin groups. It is concluded that warfarin can be continued safely in patients with epistaxis, in appropriate circumstances, and that the policy of stopping warfarin routinely in all patients with epistaxis should be reconsidered.

Aged↗
PubMed1994

Fibromatosis of the parapharyngeal space.

Tumours of the parapharyngeal space are not common. The majority arise from the deep lobe of the parotid gland or neurovascular structures. We describe a case of fibromatosis, which has not previously been reported at this site.

Adult↗
PubMed1994

Diagnosing nasopharyngeal cancer.

When nasopharyngeal carcinoma is suspected clinically, an adequate tissue sample should be taken at the patient's first visit. Should the initial tissue sample be nondiagnostic, depending on the index of suspicion in the individual case, the process may be repeated under either local or general anesthesia. It is important that a detailed examination of the nasopharynx be undertaken in the outpatient setting. Biopsy should be performed accurately under direct visualization. Large biopsy forceps are essential to obtain an adequate tissue sample. Biopsy under local anesthesia is safe, easy to perform, well tolerated by the patient, and should be undertaken in the outpatient clinic. This direct diagnostic approach achieves a rapid diagnosis in patients with nasopharyngeal carcinoma.

Anesthesia, Local↗
PubMed1993

Beware bleeding from the ear.

We present the case of a 55-year-old man who presented with intermittent, profuse bleeding from the ear five years following radiotherapy for a nasopharyngeal carcinoma. He had developed osteoradionecrosis of the temporal bone, and the bleeding was shown to originate from an aneurysm of the internal carotid artery within his temporal bone. This has not previously been reported as a complication of radiotherapy for nasopharyngeal cancer.

Aneurysm↗
PubMed1993

Palpation compared with ultrasound in the assessment of malignant cervical lymph nodes.

This prospective study compares the results of pre-operative clinical examination and simple ultrasound examination of the neck in 18 patients with proven head and neck primary tumours and palpable cervical lymphadenopathy, who then underwent 21 radical neck dissections. Neck palpation and ultrasound examination were compared with histological examination. Ultrasound did not add significantly to the information obtainable by simple neck palpation in this group of patients.

Carcinoma, Squamous Cell↗
PubMed1992

Multiple symmetrical lipomatosis in the neck.

Multiple symmetrical lipomatosis (Madelung's disease) is a very rare condition that is commonest in countries bordering the Mediterranean. The disease is associated with symmetrical unencapsulated fat deposits over the neck and upper trunk. We present the first reported occurrence in the Chinese. Although lesions can initially mimic a head and neck malignancy, management is essentially symptomatic, with conservative removals done as indicated clinically or for cosmesis.

China↗
PubMed1992

The otological status of patients with nasopharyngeal carcinoma after megavoltage radiotherapy.

A middle ear effusion is a common complication of nasopharyngeal carcinoma both before and after radiotherapy. An effusion was found in 38 per cent of patients before radiotherapy and 9 per cent developed an effusion after the start of radiotherapy. Surgical treatment by myringotomy with or without grommet insertion was associated with a high incidence of otorrhoea (26 per cent) which was often refractory to treatment. In view of the frequency of this complication and the fact that a middle ear effusion may not be of concern to an adult patient with nasopharyngeal carcinoma, a 'wait and see' policy may be appropriate in the management of a middle ear effusion in these patients.

Adult↗
PubMed1991

The treatment of squamous cell carcinoma of the paranasal sinuses.

Of 72 cases of paranasal sinus malignancy that were identified, 47 were biopsy proven squamous cell carcinomas. Actuarial analysis of these patients receiving both radical and palliative treatment revealed an overall 5-year survival of 37.4%, and a relapse-free survival of 31.6%. For patients receiving radical treatments (i.e. radiotherapy alone, or preoperative radiotherapy followed by elective surgery), the 5-year survival results were identical (46%). In this series radiotherapy alone is an effective treatment, and subsequent planned surgery did not improve the survival.

Adult↗
PubMed1991

Intermediate hearing tests as predictors of hearing aid acceptance.

This prospective study analyses the ability of several different intermediate hearing screening techniques to predict hearing aid acceptance in a pre-retirement population. In addition to the traditional methods of using sensitivity and specificity to analyse test performance, signal detection theory has been used to obtain a single detectability rate for each test. Questionnaires were able to identify individuals with hearing difficulties but included a significant group of people who ultimately would not accept a hearing aid. This group could be eliminated either clinically using free field speech testing, or audiometrically using warble tone thresholds, without the need for formal pure tone audiometry.

Aged↗
PubMed1990

Hearing aids for high-frequency hearing loss.

This cross-over study compares the relative benefits of a standard NHS contracted hearing aid with a high-frequency emphasis commercial aid in subjects with high-frequency hearing loss. Disability questionnaires and free-field speech-in-noise (FAAF II) tests were used to assess subjects unaided and after 6 weeks of wearing each aid. Total FAAF II test scores showed no significant difference with either aid, but analysis of frequency-specific subscores demonstrated less use of low-frequency information when using the high-frequency emphasis aid. Overall questionnaire responses relating to conversation showed more benefit with the high-frequency emphasis aid. Subjects generally preferred this aid, possibly due to less low-tone gain than the standard NHS aid.

Aged↗
PubMed1988

Tonsillar haemorrhage and measles.

A seven-year-old girl presented with life-threatening pharyngeal haemorrhage. This was subsequently found to arise from one tonsil, and a tonsillectomy eventually halted the bleeding. Two days later she developed measles, confirmed by serology and characteristic histology. Spontaneous tonsillar haemorrhage is extremely rare, and not previously reported in measles.

Child↗
PubMed1988

The effect of inferior turbinate outfracture on nasal resistance to airflow in vasomotor rhinitis assessed by rhinomanometry.

Twenty-eight patients with nasal obstruction due to vasomotor rhinitis were assessed using anterior rhinomanometry before and six weeks after the operation of out-fracture and amputation of the posterior ends of the inferior turbinates. It was found that the operation did not significantly improve the nasal airway. Though just over half the patients had an objective improvement in nasal airflow, only half of this group reported a subjective improvement in their symptoms.

Adolescent↗
PubMed1988

Chondrosarcoma of the epiglottis.

Malignant cartilaginous tumours of the larynx are very rare, and usually arise from the cricoid cartilage. We report the first documented case of a chondrosarcoma of the epiglottis. The diagnosis, histology and treatment of these tumours are discussed.

Chondrosarcoma↗
PubMed1988

Age, sex, ethnic origin and tonsillectomy.

The age-related sex ratios for patients undergoing adenotonsillectomy and tonsillectomy have been calculated in different populations. Differences in these sex ratios have been found at different ages, and differences between populations have also been found. Various reasons are proposed to account for these findings.

Adolescent↗
PubMed1988

Pseudosarcoma of the oesophagus.

The presentation, histology and management of a pseudosarcoma (or polypoid carcinoma) of the oesophagus are presented. Historical and modern theories of pathogenesis are discussed. Though rare, ENT surgeons should be aware of these tumours, as patients with such tumours present early and potentially have a much better prognosis than those with the more common oesophageal malignancies.

Aged↗