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Biomedical subjects

J C Watkinson

Publications and source records attributed to J C Watkinson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Solitary fibrous tumour of the thyroid gland.

Solitary fibrous tumours of the thyroid gland are rare; only five cases have been reported in the literature. Clinically, they present as a long-standing firm mass in the thyroid. Histologically, they show a range of appearances including so-called 'patternless growth pattern', spindle-cell morphology, alternating hypo- and hyper-cellular areas, keloid-like hyalinization and a prominent haemangiopericytoma - like architecture. The behaviour of extrathoracic solitary fibrous tumours is unpredictable and requires careful, long-term follow-up.

Humans↗
PubMed2001

Fourth branchial arch fistula and suppurative thyroiditis: a life-threatening infection.

A potentially life-threatening case of recurrent left-sided thyroid abscess formation secondary to a fourth branchial arch sinus fistula is presented. The patient developed a reversible left vocal fold palsy during an acute episode of suppurative thyroiditis requiring a temporary tracheostomy due to a compromised airway. Investigations commonly used to demonstrate this anomaly may fail to confirm the diagnosis as in the case presented and exploratory surgery with excision of the fistulous tract should still be considered. We describe a method of repairing the pharyngeal opening to reduce the risk of recurrence or pharyngeal leak.

Adult↗
PubMed1999

Reconstructive techniques currently used following resection of hypopharyngeal carcinoma.

There is no general consensus as to the best method of reconstruction following total laryngopharyngectomy for hypopharyngeal carcinoma. The aim of this study is to attempt to establish the current practice amongst British ENT Consultants and to ascertain the reasons for their choice of reconstructive technique. An anonymous questionnaire was sent to 546 consultants in the UK and the results of 363 (66.5 per cent) were analysed. One hundred and twenty-eight (35.3 per cent) consultants replied that they performed surgery for hypopharyngeal carcinoma. Sixty-five (50.8 per cent) performed a stomach pull-up procedure, 23 (18 per cent) used a jejunal free flap, 36 (28.1 per cent) used both and four (3.1 per cent) used other techniques. In the stomach pull-up group, the main reasons given for their choice were because there was no lower resection margin (48 out of 65) and because of tradition in the way they were trained (37 out of 65). In the group using the jejunal free flap, lower morbidity (18 out of 23) and mortality (14 out of 23) were the main reasons for their choice. The questionnaire also found that amongst the 60 consultants who would consider using a jejunal free flap, the majority (39) aimed for a lower clearance margin of 2-4 cm, while 17 aimed for > 4 cm clearance. This study provides a good indication of the current practice in the UK of reconstruction following resection for hypopharyngeal carcinoma. It appears that the stomach pull-up remains the most commonly used method of reconstruction, but the jejunal free flap is becoming increasingly more popular because of its lower morbidity and mortality.

Humans↗
PubMed1999

Parotid duct carcinoma arising in bilateral chronic sialadenitis.

It is well recognized that, in general, chronic inflammation can predispose to malignant change. There is however, to our knowledge, no previously reported association between chronic obstructive sialadenitis and salivary gland epithelial malignancy. We describe here the first reported example in the English literature of a salivary duct carcinoma arising in a parotid gland with a long history of chronic obstructive sialadenitis. It is possible that a causal relationship exists between the two conditions. If this were the case then non-surgically treated chronic obstructive sialadenitis patients may well warrant careful clinical follow-up.

Carcinoma↗
PubMed1999

Gender, clinical findings, and serum thyrotropin measurements in the prediction of thyroid neoplasia in 1005 patients presenting with thyroid enlargement and investigated by fine-needle aspiration cytology.

One thousand five euthyroid patients (870 females and 135 males, mean age 47 years), who presented with thyroid enlargement were evaluated by fine-needle aspiration cytology (FNAC) of the thyroid as the first-line investigation. The final cytological or histological diagnosis was determined after surgery (n = 312) or clinical follow-up for a minimum period of 2 years (range 2-14 years, mean 6.7 years). Goiter type was assessed clinically and was classified as diffuse in 147, multinodular in 247, or solitary nodule in 611. The overall sensitivity and specificity of the procedure in the detection of thyroid neoplasia was 88% and 89%, respectively. Males who presented with thyroid enlargement had significantly higher rates of malignancy (p = 0.007) and neoplasia (benign + malignant) (p = 0.002) than females, as did subjects with solitary nodule compared with diffuse or multinodular goiters (malignancy p = 0.001, neoplasia p < 0.001). Subjects with normal thyrotropin (TSH) (>0.4 mU/L) at presentation had a nonsignificantly increased risk of thyroid neoplasia (p = 0.07) and malignancy, in contrast to those with low TSH (<0.4 mU/L). We confirmed FNAC of the thyroid to be an accurate test in the detection of thyroid neoplasia. Gender and goiter type at presentation both contribute significantly to the prediction of the diagnosis of thyroid neoplasia.

Adolescent↗
PubMed1998

Dysphagia secondary to invasive candidiasis of a jejunal free flap.

The presence of a mass in a jejunal free flap that causes dysphagia less than two years after a pharyngolaryngectomy for carcinoma usually indicates tumour recurrence. We present a case of invasive candidiasis of a jejunal free flap presenting with dysphagia and a mass. To our knowledge this is previously unreported. Such a cause should always be considered in the differential diagnosis, as early recognition and treatment are likely to result in a favourable outcome.

Aged↗
PubMed1998

Fibroblast growth factors 1 and 2 and fibroblast growth factor receptor 1 are elevated in thyroid hyperplasia.

We have previously reported increased expression of fibroblast growth factor (FGF-1 and FGF-2) in benign and malignant human thyroid neoplasia. To determine the role of these factors in thyroid hyperplasia we have examined their expression in multinodular goiter and compared findings with those in normal thyroid tissue. Because the effects of FGF-1 and FGF-2 are predominantly mediated through the FGF receptor-1 (FGFR-1), its expression has also been examined. Immunocytochemistry was performed on sections from multinodular goiters (n = 18) and normal thyroid (n = 7). Cytoplasmic staining for FGF-1, FGF-2, and FGFR-1 was scored on a scale of 0 (no staining) to 3 (heavy staining) and expressed as a percentage of total cells stained. Confocal microscopy of immunofluorescent staining for FGF-1, FGF-2, and FGFR-1 in sections of multinodular goiter (n = 3) and normal thyroid (n = 3) provided quantitation of immunostaining. FGF-1 expression was significantly increased in multinodular goiter when compared with normal. A mean of 74% of follicular cells in multinodular goiter compared with 9% of follicular cells in normal thyroid expressed FGF-1 (P < 0.0001). When expression of FGF-2 was examined, 77% of the follicular cells in multinodular goiter compared with 5% in normal thyroids were immunopositive (P < 0.0001). Confocal microscopy revealed that the intensity was 160 times greater in follicular cells in sections of multinodular goiters when compared with normal. When expression of FGFR-1 was analyzed, 89% of the follicular cells in multinodular goiter stained positively, compared with 15% of follicular cells in sections of normal thyroid. Confocal microscopy revealed a 6-fold increase in intensity of FGFR-1 expression in follicular cells of multinodular goiter (P < 0.05). In addition, there was significant nuclear expression of FGFR-1 in multinodular goiter contrasting with negligible expression in normal thyroid. These data show that enhanced expression of FGF-1, FGF-2, and FGFR-1 accompany thyroid hyperplasia and are not exclusively associated with the neoplastic state. These factors may be involved in the pathogenesis of uncontrolled thyroid growth observed in these conditions.

Case-Control Studies↗
PubMed1995

Papillary carcinoma arising in a thyroglossal duct cyst: a case report and literature review.

Papillary carcinoma arising in a thyroglossal duct cyst is a rare finding. Less than 100 cases have been reported in the English literature. In most cases the diagnosis is only established after excision of a clinically benign thyroglossal duct cyst. The aetiology of such tumours is unclear but de novo origin and spread from a primary thyroid gland tumour has been suggested. This has important implications for therapeutic approaches. A further case of thyroglossal duct carcinoma is presented and the management is discussed on the basis of the current rationale for treatment of thyroid cancer.

Adult↗
PubMed1994

Primary malignant melanoma of the pharynx.

A case of primary malignant melanoma of the pharynx is presented. Mucosal melanomas of the upper respiratory tract are rare. They tend to present late and therefore the prognosis is generally poor. The initial mainstay of treatment is adequate surgical resection. Prognostic factors are less well documented than in cutaneous melanoma.

Humans↗
PubMed1991

Free flaps in head and neck reconstructive surgery: a review of 77 cases.

Recent advances in surgical technique and instrumentation have ensured that success rates for microvascular free transfer can now exceed 90%. This paper reviews a prospective study of 77 free flaps performed at the Royal Marsden Hospital under the care of one surgeon (NMB) over a 2-year period. 76 patients who underwent 77 free flaps were studied. 68 patients had malignant tumours and 8 had benign lesions. The flap success rate was 95% and the mortality rate 0%. The major complication rate was 20% and the most common complication was a salivary fistula (12%). Microvascular free transfer to the head and neck is not associated with increased morbidity and mortality. It offers single stage, reliable, effective reconstruction using a wide variety of donor sites and tissues.

Head↗