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Biomedical subjects

D J Howard

Publications and source records attributed to D J Howard.

At least 19 recordsLinked to original sources
PubMed1992

Quality of life of patients treated surgically for head and neck cancer.

The quality of survival of 48 patients treated surgically for head and neck cancer was assessed using a problem-orientated self-administered questionnaire. The questionnaire was based on the European Organization for Research into the Treatment of Cancer (EORTC) core questionnaire to which a specific head and neck module was added. The following domains were studied: pain, fatigue, physical symptoms (gastrointestinal and 'other'), functional activity, psychological symptoms, overall physical condition and overall quality of life. For the analysis, five groups of patients were considered: laryngectomy (n = 15), pharyngolaryngoesophagectomy (n = 5), craniofacial procedure (n = 11), 'other operations' (n = 9) and patients with disease recurrence (n = 8). Each group identified different problem areas. Laryngectomees and 'other operation' patients reported relatively few problems, whereas patients with disease recurrence described difficulties in all of the domains examined. Symptoms of fatigue were common. Information collected in this way may facilitate improved rehabilitation and thus better quality of survival.

Adult↗
PubMed1992

Percutaneous tracheostomy in a head and neck unit.

A recent innovation in the technique of tracheostomy is now available as a commercial kit. A standard tracheostomy tube is inserted using a guidewire and dilator as in the Seldinger technique. The kit was used in nine cases in a unit with a head and neck oncology interest. Two failures were experienced but no serious or fatal complications. The technique is limited when applied to necks which are not anatomically 'ideal', and hence will have application in head and neck surgery only after careful patient selection.

Adolescent↗
PubMed1992

The midfacial degloving approach to sinonasal disease.

The midfacial degloving approach was first described by Casson et al. in 1974 but despite a number of papers in the American literature advocating its use, it has not gained popularity in Europe. The advantages and application of the technique are presented in 36 patients, ranging from 7-78 years of age. The approach is ideally suited for extensive benign lesions in the nasal cavity, ethmoid and sphenoid sinuses and enables access to the nasopharynx and infratemporal fossa whilst avoiding an external incision. These lesions have included angiofibroma (13 cases), inverted papilloma (five cases), a variety of cysts (three cases) and six miscellaneous cases of benign pathology. Malignant lesions which have not breached the anterior cranial fossa may also be removed, up to and including bilateral maxillectomy (nine cases) and this can be combined with orbital clearance. The approach may be repeated if necessary and is associated with few significant complications though vestibular stenosis, oro-antral fistula, nasolacrimal damage and upward rotation of the nasal tip may occur. Strategies to avoid these problems can be undertaken and long-term cosmetic results are excellent.

Adolescent↗
PubMed1991

Large-area plan-view sample preparation for GaAs-based systems grown by molecular beam epitaxy.

We describe a method for plan-view transmission electron microscopy (TEM) sample preparation that takes advantage of extreme etch-rate selectivity in GaAs and AlAs in HF/H2O solutions. GaAs/InxGa1-xAs/GaAs strained-layer films (x = 0.05, 0.10, 0.19, 0.22) were chemically lifted off using this technique and were mounted on Cu TEM grids such that TEM transparent areas of up to 1 x 2 mm of constant thickness (196.4 nm) could be viewed. This simple, large-area plan-view technique uses only chemical methods and significantly extends the usefulness of TEM for the evaluation of crystal quality in GaAs-based epitaxial systems. The method requires the growth of a release layer of AlAs (10 nm thick) prior to the layered structure of interest.

Microscopy, Electron↗
PubMed1991

Periorbital necrotising fasciitis.

Three cases of periorbital necrotising fasciitis are described, one occurring in a three-year-old child. The cases in adults required debridement of necrotic tissue, in one of whom there was extensive disease involving the face and orbital fat. It is probable that the early stages of this condition are under-recognised; the importance of early signs and intensive treatment of this life-threatening disease are illustrated.

Child, Preschool↗
PubMed1990

Head and neck cancer in the young: a prognostic conundrum?

A series of 116 young adults with cancer in the head and neck who had been followed up for five years or longer were reviewed. The study aimed to assess whether malignancy in this age group was increasing, whether their prognosis was worse and if so, why. They were compared with data available on the patient population as a whole treated during the same period. This demonstrated that it is the intrinsic characteristics of the tumour, its site and extent rather than the age of the individual which determines prognosis though the ratio of men to women was less in the young adults in several sites possibly due to a diminished impact of recognized aetiological factors.

Adolescent↗
PubMed1990

Recurrence in juvenile angiofibroma.

A potential for recurrence of juvenile angiofibroma exists after all treatment modalities, both surgical and medical but the methods of defining recurrence and failure to cure varies considerably from series to series. To evaluate factors which might influence successful treatment, a series of 33 patients have been reviewed retrospectively. All patients were treated by simple or extended lateral rhinotomy as a primary or secondary procedure. The final long-term disease control rate was 97% but during the treatment period the overall symptomatic recurrence rate was 50%. However, amongst those treated primarily the recurrence rate was 34%. Of the factors examined, the strongest predictor of recurrence was preoperative embolisation. This group exhibited both early and multiple recurrence when compared with the non-embolised group and the possible reasons for this are examined.

Adolescent↗
PubMed1989

Multiple synchronous carcinoma of the aero-digestive tract.

Multiple carcinoma of the upper aerodigestive tract is an increasingly recognized problem, and a concept of 'field cancerization' has been proposed to explain this phenomena. The initial assessment of a patient with an isolated aerodigestive carcinoma must be extensive so as not to miss any synchronous lesions, and may include radiography and endoscopy. Treatment cannot be standardised but must be tailored to suit individual problems and because of the high incidence of metachronous tumours, follow-up must be both thorough and 'lifelong'. A case of three primary synchronous squamous carcinomas of the upper aerodigestive tract is presented. The relevant literature is reviewed.

Carcinoma, Squamous Cell↗
PubMed1989

Wegener's granulomatosis, subglottic stenosis and antineutrophil cytoplasm antibodies.

Wegener's granulomatosis is difficult to diagnose, especially when the presentation is unusual, restricted to an isolated region. We report four cases of recurrent subglottic stenosis posing difficulty in diagnosis. In each case the finding of anti-neutrophil cytoplasm antibodies (ANCA) strongly suggested an underlying vasculitic pathology, Wegener's granulomatosis. We discuss reasons for the difficulty in diagnosis in the past, the possible role of the ANCA assay in such patients, and suggest it should be more widely used in the future.

Adult↗
PubMed1988

Tracheostomy service for ITU patients.

An account of experience of tracheostomy performed on patients in the intensive care unit situation is presented. Forty-seven operations were undertaken over a 5-year period and the advantages and disadvantages are discussed. The authors recommend tracheostomy under these circumstances as an acceptable alternative to the procedure performed in an operating theatre.

England↗
PubMed1987

Nursing the immobile: a preliminary study.

Permanent loss of mobility has profound physical and mental consequences for both sufferers and carers, and is a major challenge to the National Health Service. A recent study has shown that 42% of beds in departments of Geriatric Medicine are occupied by people with longstanding immobility. These people are highly dependent on nursing staff for their daily activities and quality of life. The assessment of mobility, as a single parameter of dependency, and the measurement of allocated nursing hours are both rapidly and easily performed on geriatric wards. It is felt that a simple correlation of these two variables might highlight areas where more detailed audit is desirable. This study demonstrates that the more immobile patients on a ward, the less the hours allocated to Registered and Learner grade nurses. Some possible reasons for this are suggested and the effects of this deployment on nursing practice and staff recruitment are discussed. It is felt that provision of appropriate nursing care to the most dependent patients in continuing care areas is essential, and that high levels of trained staff are needed to ensure this.

Activities of Daily Living↗
PubMed1987

Magnetic resonance imaging in the evaluation of nose and paranasal sinus disease.

Fifty patients with a wide range of sinus disease have been examined by magnetic resonance. These included congenital conditions, inflammatory and allergic sinus disease, fungus infection, and both necrotising and non-necrotising granulomas. A variety of benign and malignant tumours have been investigated, including eight examples of juvenile angiofibroma and 19 malignant sinus tumours. This experience of magnetic resonance scanning has shown that it is superior to computed tomography in showing the extent of malignant disease and, provided the correct pulse sequences are employed, it is always possible to distinguish tumour from retained secretion or inflamed mucosa. The extent of intracranial invasion can also be optimally demonstrated. One of the advantages of the method is the direct three-plane imaging and multislice technique, which gives total coverage of the head and neck for the assessment of malignant disease. Tissue diagnosis in the paranasal sinuses is less important than the demonstration of tumour extent and distribution. Only one tumour (juvenile angiofibroma) showed diagnostic spin-sequence characteristics, and no differentiation was observed between malignant tumours of epithelial and mesenchymal origin. The major drawback of magnetic resonance is the poor demonstration of bone and calcification in the sinuses, so that in some patients the scans need to be augmented by computed tomography studies.

Granuloma↗
PubMed1987

The bedfast.

Many geriatric beds are occupied by bedfast patients. Most were immobile from the time of admission and many were admitted from other hospital departments or residential care. More are discharged home than remain in hospital or are transferred to any other institution. Although a small minority of admissions become long-term bedfast inpatients this group require a disproportionate resource commitment. Reduction in the number of bedfast inpatients is more likely to be effected by changes in unit policy than by improvement in clinical practice.

Aged↗
PubMed1986

Thyroglossal ducts, cysts and sinuses: a recurrent problem.

A review of a series of 63 patients suggests that a high incidence of recurrence occurs following surgery for this condition. Histological examination demonstrates that this is due to failure to remove the central portion of hyoid bone and inadequate dissection of the tract into the tongue base. To overcome these problems, an en bloc anterior neck dissection is recommended which will encompass multiple duct formation associated with the tract.

Adolescent↗