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Biomedical subjects

J V Soames

Publications and source records attributed to J V Soames.

At least 19 recordsLinked to original sources

Immunohistochemical detection of oestrogen and progesterone receptors in salivary tumours.

The purpose of this study was to determine the oestrogen and progesterone receptor status of a selection of salivary tumours. Using immunohistochemistry, we detected nine oestrogen receptor and six progesterone receptor positive tumours from a sample of 36. One acinic cell carcinoma and two mucoepidermoid carcinomas demonstrated positivity for both receptors. We suggest that there may be role for oestrogen manipulation in the management of some salivary tumours.

Female↗

Synchronous unilateral parotid neoplasms of different histological types.

The occurrence of multiple tumours in the salivary glands is an unusual phenomenon and the simultaneous development of tumours different types is extremely rare. Two cases are presented with synchronous tumours of the parotid gland of different histological types. The first was a Warthin tumour in combination with a metastatic lung carcinoma and the second was a pleomorphic adenoma in combination with non-Hodgkin's malignant lymphoma.

Adenolymphoma↗

Metastatic tumours of the parotid gland.

Twenty patients (12 men and 8 women, median age 69 years) with metastatic tumours in the parotid gland who presented over a 12-year period were evaluated retrospectively. Preoperative investigations included fine needle aspiration cytology (n = 11) and computed tomography or magnetic resonance imaging (MRI) (n = 14). Most tumours originated from the head and neck region, the two main types being squamous cell carcinoma (n = 10) and malignant melanoma (n = 7). All 20 presented with a parotid mass and 11/20 (55%) had associated lymphadenopathy. Eleven patients (55%) underwent superficial, five total, and four radical, parotidectomy. Neck dissection was required in 16 patients (80%), and all 11 patients with clinically palpable lymph nodes had evidence of tumour in the neck dissection specimens. Half of all patients (n = 10) received adjuvant postoperative radiotherapy. Three-quarters of the patients (n = 15) were alive after a mean follow-up of 31 months and only one developed a marginal recurrence. The cumulative 5-year survival rate was 51%, and there was no significant difference (P = 0.48) in the 3-year survival rates of patients who had radical compared with those who had modified neck dissections. Patients who had superficial parotidectomy had a longer overall survival compared with those who had total or radical parotidectomy (P = 0.04) perhaps reflecting the advanced nature of tumours that required total or radical excision of the gland. We conclude that superficial parotidectomy is usually an adequate treatment for secondary parotid tumours (when disease is clinically limited to the superficial lobe), and we suggest that patients in whom metastatic disease of the parotid gland is suspected do not require neck dissection if they have no palpable lymph nodes and MRI shows no evidence of spread. There seems to be no survival advantage in radical over modified neck dissection.

Adolescent↗

Chronic non-specific parotid sialadenitis.

Chronic non-specific sialadenitis of the parotid gland is an insidious inflammatory disorder which is characterised by intermittent, often painful, swelling of the gland. The disease tends to progress and may lead to the formation of a fibrous mass. The purpose of this paper is to review our experience in the surgical management of patients with chronic non-specific parotid sialadenitis. In a consecutive series of 100 patients treated for benign parotid disease, 19 were found to have chronic non-specific sialadenitis; 10 were male and 9 female. Mean age was 46 years and the mean duration of symptoms was 4.6 years. Sialography was performed in two-thirds of the patients and 17 patients were treated by superficial parotidectomy. Thirteen patients developed temporary facial nerve weakness and three Frey's syndrome. Three patients complained of temporary paraesthesia of the cheek, and two developed painful neuroma of the greater auricular nerve. Although there were two cases of infection of the parotid duct remnant, no recurrence of deep lobe sialadenitis or fistula formation was noted. Histologically, 3 lesions showed mild chronic sialadenitis, the rest had widespread involvement of the gland, and prolonged duration of symptoms was associated with extensive and severe involvement of the gland. Superficial parotidectomy has a very high success rate, with minimal long-term complications, and should be offered early in established cases, to reduce unnecessary morbidity.

Adult↗

Malignant tumours of the maxillary complex: an 18-year review.

Over an 18-year period, 147 patients with malignant tumours involving the maxillary complex were treated in a combined head and neck clinic, of whom 50 underwent surgery. There were 33 males and 17 females, the mean age was 57 years (range 11-87 years). The most common clinical presentations were either painful facial swelling, infraorbital anaesthesia, palatal ulceration or nasal obstruction. Preoperative investigations included EUA, biopsy and either CT or MRI scans. Of the 50 tumours, 62% were squamous cell carcinomas. Surgery consisted of either partial or total maxillectomy including craniofacial resection in nine patients. Reconstruction was by either split skin grafting or by free tissue transfer when the cranial contents had been exposed. Adjuvant radiotherapy was given in 82% of the patients. The mean follow-up was 5 years and 59% of patients are alive and disease free. The 5-year local control rate was 67%; it was greatly influenced by histological evidence of nerve invasion, local recurrence being the major cause of death. It was concluded that adequate surgical clearance, followed by planned postoperative radiotherapy, is the most effective treatment for malignant disease of the maxillary complex.

Adolescent↗

Malignant tumours of the parotid gland: a 12-year review.

Malignant parotid tumours are uncommon and present a significant management challenge. Fifty-one such patients (25 male, 26 female, median age 64 years) operated on in the Newcastle Plastic Surgery Unit between 1983 and 1994 were retrospectively evaluated. Preoperative investigations included FNA cytology (n = 20), and for staging CT and/or MRI scans (n = 21). Of the 35 primary tumours 32 were epithelial and three lymphomatous. Metastatic tumours were squamous cell carcinoma (7), melanoma (6), renal cell carcinoma (2) and sebaceous carcinoma (1). FNA cytology correctly diagnosed malignancy with an 88% sensitivity (false negatives = 2). A total or radical parotidectomy was required in 60% of patients, the rest undergoing superficial parotidectomy. In continuity neck dissection was undertaken in 23 (45%) cases. Postparotidectomy reconstruction included 10 free, 3 myocutaneous, and 4 local transposition/rotation flaps. Thirty-seven patients (73%) received postoperative radiotherapy. Seventy-two per cent of patients are alive after a mean follow-up of 42 months. The crude 5- and 10-year survival rates were 68% and 49% respectively while the loco-regional control rate (Kaplan-Meier method) at 10 years was 79%. Fifteen patients (30%) have permanent facial palsy. It is concluded that radical surgery with appropriate reconstruction followed by planned postoperative adjuvant radiotherapy gives effective control of malignant parotid tumours.

Adolescent↗

Adnexal adenocarcinoma of the upper lip.

A case of poorly differentiated adenocarcinoma of adnexal origin in the upper lip of a man aged 75 is reported which on presentation and initial biopsy was thought to be a salivary neoplasm. He had been aware of the lesion for 10 years but had sought treatment because of recent increase in size of the tumour. He subsequently developed bilateral metastases in cervical nodes. The histopathologic features and relationship of the tumour to the orbicularis oris muscle were consistent with a poorly differentiated adnexal adenocarcinoma of sweat-gland origin. Although carcinomas of skin adnexae are rare they should be considered in the differential diagnosis of tumours in the orofacial region.

Adenocarcinoma↗

Odontodysplasia, gingival manifestations, and accompanying abnormalities.

Regional odontodysplasia is an uncommon developmental dental disorder that may occasionally be accompanied by other abnormalities. A case is described in which the chief report was of a gingival enlargement arising in a female patient who also had dolichocephaly, thin calvarium, clinodactyly and transverse grooving of her fingernails, and a history of abnormal hair. Previously suggested etiologic factors and cases reported in association with other abnormalities are reviewed.

Abnormalities, Multiple↗

Fourth branchial arch fistula.

A case is presented of a rare congenital anomaly of the fourth branchial arch, which presented as an abscess in the anterior triangle, related to a fistula communicating with the pyriform fossa. Histopathological examination showed the fistula to be associated with thyroid tissue supporting the hypothesis that the ventral wing of the fourth pouch contributes to the thyroid gland.

Abscess↗

Sebaceous carcinoma of the parotid gland.

A report of an 87-year-old Caucasian female with an extensive sebaceous carcinoma of the parotid gland is presented. The computed tomographic characteristics of this rare neoplasm are reported for the first time.

Adenocarcinoma, Sebaceous↗

Ultrastructural changes in cultured human periodontal ligament cells exposed to dental materials.

The cytopathic effects of a range of dental restorative cements were examined by electron microscopy using an in vitro model with cultured test cells derived from human periodontal ligament. Monolayers were fixed and processed in situ after 2, 24, and 48 h exposure. Many cells showed lysis after two hours exposure consistent with immediate acute injury. Cultures subsequently recovered, reflecting different susceptibilities of cells to injury, and at later stages showed distinct patterns of cell damage in response to different restorative materials. These were related primarily to either cytoplasmic or nuclear damage and to changes resembling apoptosis.

Apoptosis↗

Morphological changes in cultured human periodontal ligament cells exposed to dental materials.

The cytotoxicity of a range of dental restorative cements was assessed by continuous observation of cultures with inverted microscopy and by light microscopic study of fixed preparations, using an in vitro model with cultured test cells derived from human periodontal ligament. The sequential morphological changes observed over a seven day period showed different degrees of cell loss and patterns of injury in response to different restorative materials, reflecting primarily either nuclear or cytoplasmic damage. Attempts at recovery were frequently identified as the culture period was extended and were characterized by recolonization of denuded areas of the culture well. It was concluded that differing dental cements damage cells through a variety of mechanisms and that the test cells exhibit differing degrees of susceptibility to injury. Assays based on short-term cultures may overestimate cytotoxicity by not allowing for cell recovery from reversible injury or repopulation of monolayers by proliferation of resistant cells.

Acrylic Resins↗

Morphometric analysis of orbital, buccal and subcutaneous fats: their potential in the treatment of enophthalmos.

Retro-orbital fat volume reduction has been reported in patients with enophthalmos but could be restored by a suitable fat autograft. Buccal and subcutaneous adipose tissues were identified as possible donor sites. Samples of these and of orbital fat were obtained from fresh cadavers, and the relative volumes of collagen and of endothelial cells and the numerical density of mast cells were compared since these might influence graft survival. The results demonstrated strong similarities between orbital and buccal fat which were significantly different from subcutaneous fat. It was concluded that the buccal fat pad would be a more suitable donor site than subcutaneous adipose tissue to replace orbital fat loss and that its use merits further investigation.

Adipose Tissue↗

Morphological and morphometric studies of exfoliated oral squames from chronic inflammatory oral ulcers using light and scanning electron microscopy.

The morphological and morphometric features of exfoliated squames from the margins of chronic oral ulcers were studied by light and scanning electron microscopy. A variety of features consistent with a mixture of degenerative changes and regenerative activity were observed. None was sufficiently reliable to distinguish chronic inflammatory from malignant ulcers.

Carcinoma, Squamous Cell↗

Feulgen hydrolysis profiles and acid-labile DNA in oral squamous cell carcinoma.

The full Feulgen hydrolysis profiles of healthy and malignant oral epithelial cells were compared by measuring the staining density of nuclei using microdensitometry after varying hydrolysis times. Malignant nuclei contained significantly increased levels of acid-labile DNA. The relative amounts of the rapidly hydrolysable fraction were compared after 5 min hydrolysis for exfoliating epithelial cells from healthy oral mucosa, healing chronic ulcers and squamous cell carcinomas. Although the latter exhibited a wide range of values, analysis of variance showed significant differences (P < 0.05) between healthy control and ulcer groups compared to oral carcinoma. The relative proportion of highly acid-labile DNA in malignant nuclei showed a significant positive correlation with mitotic score (P < 0.01) but no significant correlation with nuclear area. It was concluded that since the susceptibility of DNA to acid hydrolysis probably reflects functional differences in nuclear activity between cells, estimation of the highly acid-labile fraction may have diagnostic and/or prognostic value.

Carcinoma, Squamous Cell↗

Sialadenosis of the salivary glands.

Sialadenosis (sialosis) is an uncommon, non-inflammatory condition which usually causes bilateral, diffuse enlargement of the salivary glands, particularly the parotid. We present a series of 7 patients with sialadenosis. Two had bilateral and 4 unilateral parotid involvement. One patient had unilateral submandibular gland sialadenosis. One patient had bilateral parotid and bilateral submandibular gland sialadenosis. The clinicopathological features and management of the condition are reviewed.

Adult↗

MRI T staging of squamous cell carcinoma of the oral cavity: radiological-pathological correlation.

Fifty patients with primary or suspected recurrent squamous cell carcinoma of the oral cavity were examined pre-operatively with magnetic resonance imaging (MRI) to determine the tumour stage. Pathological correlation was available in all cases. Twenty-five of 35 patients with primary disease were correctly staged (MR Tstage 0-4). In another four patients there was good size correlation between MR and pathology, but two cases had false positive MR interpretation of bone invasion. MRI has proved accurate at excluding the presence of bone invasion (negative predictive value 97%), but a positive scan may not discriminate between tumour and other dental pathology (positive predictive value 67%). Assessment of local extent was otherwise good with invasion of muscles of the floor of the mouth and muscles of mastication always predicted correctly. Salivary gland abnormality was frequent, and MRI correctly distinguished between obstructive sialectasis and direct invasion. The results of MR staging in patients with recurrent disease were less accurate. Where diagnostic scans can be obtained MRI can provide useful information for the surgeon or radiotherapist regarding the local extent of tumour, and may assist in treatment planning. Assessment of cervical lymphadenopathy can be performed as part of same procedure.

Adult↗