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Biomedical subjects

J J Homer

Publications and source records attributed to J J Homer.

At least 19 recordsLinked to original sources
PubMed2002

Circulating angiogenic cytokines as tumour markers and prognostic factors in head and neck squamous cell carcinoma.

This pilot study investigated the potential use of three circulating angiogenesis-related cytokines, basic fibroblast growth factor (bFGF), angiogenin (ANG) and endostatin, as tumour markers and prognostic factors in patients with head and neck squamous cell carcinoma (HNSCC). A total of 30 patients with HNSCC treated with curative intent and 15 healthy controls were studied. Serum (bFGF and ANG) and plasma (endostatin) was assayed by enzyme-linked immunoabsorbance assay (ELISA). None of the cytokines was raised in HNSCC patients when compared with controls. Serum bFGF was not associated with any clinico-pathological or outcome parameters, although there was a trend towards higher levels in more advanced and aggressive tumours. Lower serum angiogenin (sANG) levels were associated with loco-regional disease recurrence (P = 0.036). Using a cut-off level of 400 pg/mL, a low level of sANG predicted tumour recurrence with a relative risk of 4.0 (95% CI: 0.7-24.0). Plasma endostatin was associated with higher histological grade (P = 0.01) and with both disease recurrence (P = 0.045) and death from disease (P = 0.021). Plasma endostatin above a cut-off point of 70 ng/mL could predict tumour recurrence with a relative risk of 4.7 (95% CI: 1.1-19.7). These data suggest that plasma endostatin and sANG have potential roles as prognostic factors and require further investigation.

Adult↗
PubMed2002

Does flying after myringoplasty affect graft take rates?

Flying at altitude soon after myringoplasty may theoretically have an adverse effect on graft take rates owing to variation in external air pressure, together with suboptimal Eustachian tube function, causing graft displacement. We wished to assess the effect of flying after myringoplasty by comparing success rates of patients flying within a week postoperatively (n = 37) with a control group (n = 37) by carrying out a retrospective, controlled cohort study. The primary outcome measure was graft success, defined as a 100% closure at first outpatient follow-up (2.5 months). Our results showed that there was no difference in early graft success rates between the flying group (32/37: 86%) and non-flying group (29/37: 78%)(P = 0.32; 95% CI of difference: -9% to 27%). In conclusion, flying at altitude in a pressurized environment within a week of myringoplasty does not adversely affect early operative success.

Adolescent↗
PubMed2002

A quantitative analysis of the intranasal delivery of topical nasal drugs to the middle meatus: spray versus drop administration.

The delivery of nasal drugs specifically to the middle meatus is of critical importance in the medical treatment of rhinosinusitis. In this respect, topical nasal drug administration by drops has generally been perceived to be superior to nasal sprays, although there is a lack of evidence to support this notion. This study aims to compare the intranasal delivery of nasal sprays and drops to the middle meatus in vivo, using a novel quantitative method. A surgical patty was placed in the middle meatus. Radio-labelled topical nasal drops and aqueous sprays were administered in a standardized fashion in normal volunteers (10 nasal cavities). The subsequent absorption of administered radio-labelled saline on the patty was measured using a gamma counter. A randomized prospective crossover design was used for the study. The mean percentage (range) of absorbed administered saline on the swab was 8.7 (0.3-39.5) and 9.7 (0.03-20.4) for the spray and drop administration techniques respectively (p = 0.8). Thus, there is wide variation in the delivery of topical nasal drugs and the perceived superiority of nasal drop administration, in terms of delivery to the middle meatus, may be incorrect.

Absorption↗
PubMed2002

An audit of post-operative analgesia in children following tonsillectomy.

Pain following tonsillectomy in children is a significant problem that tends to be underestimated. We audited post-operative pain in 33 children and found significant proportions of children in moderately severe to severe pain, particularly at, or soon after returning to the ward. These findings led to changes in practice that included the administration of pre-operative paracetamol and diclofenac as well as the uniform post-operative prescription of them, with printed instructions to reduce the scope for mistakes by medical staff. Other changes included a uniform policy, with which the nursing staff could become familiar, and the regular formal recording of pain to assist in the recognition of pain and analgesic requirements. On re-auditing two years later, in a group of 100 children, post-operative pain was significantly improved. The proportion experiencing moderately severe to severe pain on returning to the ward, as their maximum pain score and pain score at discharge fell from 70 per cent to 48 per cent, 85 per cent to 56 per cent, and six per cent to two per cent respectively.

Acetaminophen↗
PubMed2001

The delivery of topical nasal sprays and drops to the middle meatus: a semiquantitative analysis.

The distribution of nasal drugs specifically to the middle meatus is of vital importance in the treatment of rhinosinusitis and nasal polyposis. It is widely assumed that the intranasal distribution is superior with nasal drops rather than spray delivery. However, a comparison of nasal spray and drop delivery specifically to this area has not been studied before. This study aims to compare semiquantitatively the intranasal distribution of nasal sprays and drops to the middle meatus in vivo. A novel method was used whereby a neurosurgical patty was placed in the middle meatus. Topical nasal drops and aqueous sprays dyed with methylene blue (0.1% v/v) were administered in a standardized fashion in normal volunteers. The subsequent absorption of administered dye was classified on a four-point scale. A randomized prospective cross-over design was used for the study. We found that there was no difference in the delivery of nasal drug to the middle meatus between either method of drug administration (P > 0.2). The perceived superiority of nasal drops may therefore be as a result of the acknowledged systemic effect of betamethasone drops.

Administration, Intranasal↗
PubMed2001

The effect of inferior turbinate hypertrophy on nasal spray distribution to the middle meatus.

The distribution of topical nasal sprays is suboptimal, the main obstruction to adequate delivery in normal volunteers being the nasal valve. We aimed to test the hypothesis that, in patients with rhino-sinusitis, hypertrophy of the inferior turbinate also limits the distribution of administered drug to the middle meatus. We modelled the effect of inferior turbinate hypertrophy and reduction by effecting congestion (by ipsilateral isometric exercise) and decongestion (topical oxymetazoline) in normal volunteers. The method chosen to estimate drug delivery to the middle meatus used endoscopic photography after the administration of dyed aqueous spray. A randomized cross-over study design was used and 20 nasal cavities were studied. The congestion/decongestion manoeuvres significantly altered nasal airflow, as measured by peak inspiratory nasal flow (P < 0.001). Congestion diminished significantly drug delivery to the middle meatus, as compared with decongestion (P = 0.026). This may support a clinical role for inferior turbinate reduction to improve the efficacy of topical nasal therapy, as well as improving nasal airflow.

Administration, Intranasal↗
PubMed2001

The expression of vascular endothelial growth factor (VEGF) and VEGF-C in early laryngeal cancer: relationship with radioresistance.

Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF-C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty-two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow-up was 2 years after radiotherapy. Expression of VEGF and VEGF-C was evaluated by immunohistochemistry of formalin-fixed, paraffin-embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF-C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF-C (P < 0.001). In addition, the expression of VEGF-C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF-C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF-C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.

Adult↗
PubMed2001

Audit of pain management at home following tonsillectomy in children.

The pain experienced at home and the burden this places on primary care resources is considerable following tonsillectomy in children. This was audited by postal questionnaire in 52 patients (36 responders). We found a significant proportion of patients experiencing moderately severe to severe pain and a high rate of consultation with general practitioners (50 per cent) for pain-related issues. These findings lead to changes in practice which included the provision of five days discharge medication (paracetamol/ibuprofen in non-asthmatics; paracetamol/dihydrocodeine in asthmatics) and improved written discharge advice. On re-auditing a year later in 100 patients (56 responders), we found reduced rates of consultation with general practitioners (27 per cent). However, the proportion of children experiencing moderately severe to severe pain was not reduced probably because most children were given the recommended analgesia during the first audit. We also found that paracetamol and ibuprofen was superior to paracetamol and dihydrocodeine for analgesia (p <0.05). Suggestions for further improvements are discussed.

Acetaminophen↗
PubMed2001

In-the-ear hearing aids within auricular prostheses.

We report a child with bilateral congenital microtia in whom cosmetic and auditory rehabilitation has been effected using in-the-ear hearing aids within prostheses overlying the rudimentary external auditory meati after canaloplasty. This novel method of auditory rehabilitation has not been reported before and is suitable in selected cases. The prostheses themselves were successfully secured using a prosthetic contact adhesive we have developed that offers excellent retention, little if any skin reaction, and high patient acceptability.

Audiometry, Evoked Response↗
PubMed2000

Tonsillectomy by guillotine is less painful than by dissection.

Most tonsillectomies are carried out by dissection. Only a small minority of otolaryngologists still routinely perform guillotine tonsillectomy. We carried out a prospective study on 86 children undergoing tonsillectomy utilising a standard anaesthetic and analgesic regimen to compare post-operative pain after dissection tonsillectomy and guillotine tonsillectomy using a Popper's hemostatic guillotine. Guillotine tonsillectomy was significantly less painful (P<0.001) than dissection tonsillectomy. The relative risk of experiencing moderately severe to severe pain was 0.36 (95% CI, 0.18-0.72) in the guillotine group. A significant proportion of children experience moderately severe to severe pain despite a comprehensive analgesic regimen confirming that post operative pain remains an important issue after this operation. On the basis of our findings we advocate tonsillectomy by guillotine in children. The less pain that arises within the first 24 h may be particularly important if performing tonsillectomy as a day-case procedure.

Adolescent↗
PubMed2000

Neonatal hearing screening using the auditory brainstem response.

A targeted screen of babies at risk of having a sensorineural hearing loss (SNHL) using the auditory brainstem response has been in place since 1987 in Bradford and Airedale. The aims of this paper were to ascertain what proportion of a 4-year cohort of children with SNHL should have been identified by the programme; was identified by the programme; and the reasons for failing when children were missed. The cohort of 49 children had moderate to profound SNHL (> 50 dB) and were born between 1 April 1991 and 31 March 1995. Although 92% had at risk factors (higher than in other series), 80% was the maximum that could have been prospectively detected by the programme and only 37% were actually diagnosed as a result of the screening programme. Apart from a generalised under-recruitment, children with risk factors arising because of in utero, perinatal and postnatal events (as opposed to family history, craniofacial abnormalities and syndromes) tended to be missed (P < 0.01). The overall yield of the screening programme was 0.5/1000/year. While the yield of a universal neonatal screening programme based on otoacoustic emissions should be double this, a targeted infant distraction test later in infancy will be an essential backup. Improved liaison with paediatricians in particular as well as simplification of the referral criteria should improve targeting children at risk.

Cohort Studies↗
PubMed2000

Hypoglossal-facial nerve anastomosis: assessment of clinical results and patient benefit for facial nerve palsy following acoustic neuroma excision.

Despite advances in neuro-otological techniques permanent complete facial palsy may still occur in up to 10% of patients undergoing removal of cerebellopontine angle tumours. Hypoglossal-facial nerve anastomosis is the procedure of choice in our unit for facial reanimation in such patients and below we report the results of hypoglossal-facial nerve anastomosis performed on 29 patients. Assessment of patient benefit from hypoglossal-facial nerve anastomosis was obtained using a questionnaire based on the Glasgow Benefit Inventory. The results showed all patients to have an improvement in their House Brackmann grade following hypoglossal-facial anastomosis with 65% achieving grade III or better. Of the 20 patients who completed the questionnaire, 18 showed a positive benefit (median score 59.5, range 40-77). There was a significant correlation (P < 0.045) between the Glasgow benefit inventory score and House Brackmann grade. Outcome was not affected by the time interval between the acoustic neuroma surgery and performing the hypoglossal-facial nerve anastomosis, sex or length of follow-up. However the Glasgow benefit score was significantly influenced by age (P = 0.023) with younger patients showing more benefit independent of improvement in facial nerve function.

Adolescent↗
PubMed2000

Angiogenesis in head and neck squamous cell carcinoma.

Tumour angiogenesis has recently attracted a great deal of attention as a critical part of oncogenesis and a necessary prerequisite for a malignant phenotype. Research into this process not only offers new insights into tumour biology but is also leading to the development of realistic novel and minimally toxic anti-tumour therapies. Various pro-angiogenic and anti-angiogenic cytokines and pathways have been characterized and their interrelationships are becoming increasingly complex as new findings are made. This article reviews the current understanding of tumour angiogenesis, the basic mechanisms involved and the more important and investigated pathways and proteins involved.

Angiogenesis Inducing Agents↗
PubMed2000

The effect of hypertonicity on nasal mucociliary clearance.

The effect of the tonicity of saline nasal douching solutions on mucociliary clearance was studied in order to ascertain whether hypertonicity conferred any advantage. Thirty-eight normal subjects were included in a randomised double-blind crossover trial. Saline douching solutions of 0.9%, 3% and 5% tonicity were used and mucociliary clearance was measured by the saccharin clearance time (SCT). The resultant SCT after administration of 5% saline was significantly reduced compared to both 0.9% (P = 0.005) and 3% saline (P = 0.04). There was no difference between 0.9% and 3% saline administration. Thus hypertonic saline solutions improve mucociliary clearance, although this was only observed with solutions of 5% tonicity. The effect is probably brought about by changes in mucus rheology.

Adult↗