Embryonic stem cells and tissue engineering: delivering stem cells to the clinic.
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Humans↗
Biomedical subjects
N S Tolley
Publications and source records attributed to N S Tolley.
The stem cell in orthopaedic surgery.
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Bone Regeneration↗
Scaffolds and biomaterials for tissue engineering: a review of clinical applications.
Tissue engineering is a multidisciplinary area of research aimed at regeneration of tissues and restoration of organ function. This is achieved through implantation of cells/tissues grown outside the body or by stimulating cells to grow into an implanted matrix. In this short review, we discuss the use of biomaterials, in the form of scaffolds, for tissue engineering and review clinical applications to otorhinolaryngology-head and neck surgery.
Biocompatible Materials↗
Stem cells: sources and applications.
Tissue engineering is a multidisciplinary area of research aimed at regeneration of tissues and restoration of function of organs through implantation of cells/tissues grown outside the body, or stimulating cells to grow into implanted matrix. In this short review, some of the most recent developments in the use of stem cells for tissue repair and regeneration will be discussed. There is no doubt that stem cells derived from adult and embryonic sources hold great therapeutic potential but it is clear that there is still much research required before their use is commonplace. There is much debate over adult versus embryonic stem cells and whether both are required. It is probably too early to disregard one or other of these cell sources. With regard to embryonic stem cells, the major concern relates to the ethics of their creation and the proposed practice of therapeutic cloning.
Animals↗
Gene expression: a review of clinical applications in otorhinolaryngology-head and neck surgery.
Tissue engineering is a multidisciplinary area of research aimed at regeneration of tissues and restoration of function of organs through implantation of cells/tissues grown outside the body or stimulating cells to grow into implanted matrix. In this short review, we aim to examine current techniques in gene expression analysis and their relevant clinical applications to the field of otorhinolaryngology-head and neck surgery.
Gene Expression↗
The disinfection of flexible fibre-optic nasendoscopes out-of-hours: confidential telephone survey of ENT units in England.
We present the results of a confidential telephone survey of ENT units in England on the disinfection of flexible fibre-optic nasendoscopes out-of-hours. The on-call residents of 124 units were contacted and questioned. In 35.1 per cent of units surveyed, the on-call resident was primarily responsible for cleaning the scopes after use. Only 46 per cent of these junior doctors had access to a chemical sterilant to allow for high-level disinfection of these scopes. Provision for disinfection of scopes was poorer in teaching hospitals and in units that served inner city populations. Only 12.1 per cent of Senior House Officers (SHOs) received any training in disinfection techniques and only 25.5 per cent of units kept a register of patients nasendoscoped out-of-hours for purposes of contact tracing.
Disinfection↗
Superficial parotidectomy under local anaesthesia.
We report a case of superficial parotidectomy performed under local anaesthesia. The patient presented with a parotid lump in which aspiration cytology showed cells consistent with mucoepidermoid carcinoma or adenocarcinoma ex pleomorphic adenoma. Despite counselling the patient refused general anaesthesia but accepted the need for removal of the pathology. We have been unable to find a single case report in the English literature since 1966 outlying this procedure being undertaken solely under local anaesthesia.
Adenoma, Pleomorphic↗
The laryngeal mask airway in tonsillectomy: the surgeon's perspective.
The laryngeal mask airway presents certain advantages in the management of the airway during general anaesthesia. However, from the surgeon's perspective, there have been reports of problems occurring when the laryngeal mask airway is used in tonsillectomy. This study of 90 patients undergoing tonsillectomy suggests that surgical access is inferior with a laryngeal mask airway and the weight of tonsillar tissue excised is less. In addition the laryngeal mask airway needs to be changed to an endotracheal tube during the procedure in 11.4% of patients.
Airway Obstruction↗
Fibrous dysplasia and ossifying fibroma of the paranasal sinuses.
Fibro-osseous lesions involving the paranasal sinuses, the mid-face and anterior skull base are uncommon. In addition, there appears to be no clear pathological or clinical classification that embraces the variety of lesions that exhibit such diverse pathological and clinical behaviour, yet may still be referred to as a fibro-osseous lesion. The diagnosis of fibrous dysplasia and ossifying fibroma is made on a combination of clinical, radiological and pathological criteria. This paper emphasizes the clinical and pathological differences between fibrous dysplasia and ossifying fibroma. The more aggressive clinical behaviour of the latter is highlighted and a more radical surgical approach is recommended. In contradistinction, fibrous dysplasia can exhibit a more benign behaviour and radical surgery is not always justified. A clinicopathological distinction between these two conditions is important from a management perspective despite the fact that they both may be encompassed under the 'umbrella' term fibro-osseous lesion.
Adolescent↗
Nuclear DNA content using computerized image cytometry of squamous cell carcinomas of the head and neck.
Ploidy status using flow cytometry of head and neck cancers may be of prognostic value. We describe the use of image cytometry in ploidy measurement of squamous cell carcinomas of the head and neck (SCCHN). This technique allows only tumour cells to be measured, thereby rejecting debris, artefact and benign cells. Tissue sections were cut from tumours and then Feulgen stained. A total of 60 patients were included in this study, 23 females and 37 males. The data reveals a relationship between ploidy status and the histological differentiation. However, the ploidy status and histological differentiation do not appear to correlate to the clinical stage of the disease. This method of measuring ploidy may be more accurate than flow cytometry and may have a prognostic role in head and neck cancer patients. A study comparing both methods may demonstrate this and we aim to evaluate this in the future.
Adult↗
Infectious pseudomonas subglottic stenosis occurring in a patient with acquired immunodeficiency syndrome.
Pseudomonas aeruginosa is emerging as an increasingly common opportunistic infective agent in the immunocompromised human immunodeficiency virus (HIV) positive patient (Kielhofner et al., 1992). Improvements in the prevention and treatment of opportunistic infections in HIV and acquired immunodeficiency syndrome (AIDS) has led to longer life expectancy (Graham et al., 1992), and this has changed the incidence of Pseudomonas aeruginosa infection in this population (Baron and Hollander, 1993). We present a case of a patient with AIDS who developed a fulminant Pseudomonas aeruginosa stenosing subglottic infection. We are unaware of any previous reports of this particular manifestation of Pseudomonas aeruginosa infection.
AIDS-Related Opportunistic Infections↗
Characterization of nasal airflow.
Nasal airflow and trans-nasal pressure difference was measured by active anterior rhinomanometry in 24 subjects. An analysis was undertaken to determine the 'goodness of fit' of two models used to characterize nasal airflow, one model by Broms and the other by O'Neill and Tolley. A judicious approach to choice of fit criterion led to the conclusion that the latter model provided a more accurate characterization of nasal airflow. Additionally this model may be useful to quantify alar valve stiffness. A portable computerized system incorporating the use of the model has been developed and is currently in use.
Airway Resistance↗
Laparoscopically-assisted total pharyngolaryngo-oesophagectomy.
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Esophagectomy↗
Subglottic stenosis secondary to tuberculosis.
Although the incidence of laryngeal tuberculosis has been declining over the past 30 years, it should still be considered in the differential diagnosis of patients with laryngeal pathology. In contrast to the pre-chemotherapy era, few, if any, signs of pulmonary tuberculosis are seen in such cases, and presentation is similar to either chronic non-specific laryngitis or carcinoma. The subglottis is a site rarely involved in laryngeal tuberculosis. Tissue biopsy and culture are diagnostic and a full course of antituberculous chemotherapy usually resolves the condition. Airway insufficiency due to fibrosis, however, often necessitates surgical intervention. We present a case where the only laryngeal manifestation of tuberculosis was subglottic stenosis.
Adult↗
Early diagnosis of Wegener's granulomatosis presenting with facial nerve palsy.
Wegener's granulomatosis is a multi-system disease characterized by granuloma formation and a necrotizing vasculitis. It classically presents with involvement of the upper and lower respiratory and renal systems. However locoregional disease is common and may include otological manifestations. Facial nerve palsy has been reported during the course of the disease process but it is extremely rare for it to be the presenting feature. Previously reported cases have involved a protracted diagnostic process including exploratory tympanotomy, mastoidectomy and facial nerve decompression. We report a case of Wegener's granulomatosis which presented with a facial nerve palsy. An early diagnosis was achieved by measurement of the erythrocyte sedimentation rate (ESR), followed by serological assay of cytoplasmic anti-neutrophil cytoplasmic antibody (cANCA). Histological examination of nasal mucosal biopsies confirmed granuloma formation consistent with a diagnosis of Wegener's granulomatosis. This allowed early treatment with immunosuppressive therapy and avoided unnecessary and potentially hazardous middle ear surgery.
Aged↗
Maxillary antral lavage using inferior meatal cannula anaesthesia.
Antral puncture and lavage through the inferior meatus is a minor but common otolaryngological procedure, usually performed under local anaesthesia. We describe a new method of introducing local anaesthetic into the inferior meatus, via the use of a soft intravenous cannula connected to a syringe containing 10 per cent cocaine paste. We have called this new technique inferior meatal cannula anaesthesia (IMCA).
Anesthesia, Local↗
Invasive candidiasis of a late presentation laryngeal chondroradionecrosis.
Laryngeal chondroradionecrosis is an unusual condition which may present many years after the initial radiotherapy. We present a case of late onset chondroradionecrosis which was complicated by invasive candidiasis of the arytenoid cartilages which had themselves been extruded through the laryngeal mucosa.
Adult↗
Laparoscopically assisted total laryngopharyngoesophagectomy with gastric transposition.
Pharyngolaryngoesophagectomy (PLO) for post-cricoid tumour offers opportunity for cure or reasonable paliation. However, it carries significant morbidity and mortality. We present two patients with post-cricoid carcinomas who underwent laparoscopically-assisted total PLO with gastric transposition without a laparotomy, thoracotomy or thoracoscopy. This technique appears promising for patients with post-cricoid or hypopharyngeal malignancy in reducing operative morbidity, and may represent improvement on conventional open and thoracoscopic techniques in selected patients.
Aged↗