Biomedical subjects

R J A England

Publications and source records attributed to R J A England.

11 recordsLinked to original sources

PubMed2006

Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer patients.

A gastrostomy feeding tube has become the most acceptable method for long-term feeding support in patients with head and neck cancer. The aim of this study was to compare the complications of percutaneous endoscopically inserted gastrostomy (PEG) tubes, radiologically inserted gastrostomy (RIG) tubes and surgically inserted gastrostomy (open/laparoscopic) (SUR) tubes in head and neck cancer patients and also to compare the mortality rates of these patients. Seventy-eight head and neck cancer patients underwent gastrostomy tube insertion (40 PEG, 28 RIG and 10 SUR) during the period February 2002 to February 2005. There were no significant demographic differences between the three groups. Thirty-six patients (46 per cent) developed complications, 32 minor and four major. All three groups were similar in their rate of minor complications, with the dislodgement and blockage rate being lowest in the PEG group (p > 0.05). The mortality rate was 4 per cent within 30 days of gastrostomy tube insertion. There were no deaths in the PEG group, two deaths in the RIG group and one in the SUR group. The PEG tube was considered superior to the RIG and SUR gastrostomy tubes, had fewer complications and was safer. Thus, PEG tube insertion is our first choice for head and neck cancer patients.

Aged↗

PubMed2006

How we do it: surgery should be considered equally with I131 and thionamide treatment as first-line therapy for thyrotoxicosis.

Radioiodine and thionamide treatment are the most frequently used treatment modalities for thyrotoxicosis in Europe and North America with surgery being reserved for selected cases. * In our clinic patients were offered all three modalities via simultaneous interview with an endocrinologist and a surgeon, with international risk benefit data for radioiodine and thionamide therapy, and local risk benefit data for total thyroidectomy provided. * When given the choice, at least 15% of patients opted for total thyroidectomy over the other modalities. * In our series of 100 consecutive surgical patients there was a 4% malignancy rate. * Total thyroidectomy should be offered equally, with radioiodine and thionamide treatment, as a first line treatment modality in the management of thyrotoxicosis.

Adolescent↗

PubMed2006

Intra-operative parathyroid hormone monitoring in secondary hyperparathyroidism: is it useful?

OBJECTIVES: To assess the use of intra-operative parathyroid hormone (PTH) level monitoring as a predictor of persistent hypoparathyroidism after total parathyroidectomy in renal hyperparathyroidism. SETTING: University Teaching Hospital Otorhinolaryngology and Head and Neck Surgery Unit. PARTICIPANTS: All patients with renal hyperparathyroidism undergoing parathyroidectomy between January 2004 and July 2005. Twenty-nine patients were identified. MAIN OUTCOME MEASURES: Comparison is made between pre- and intra-operative PTH levels (ioPTH) in patients who at 3 months postoperatively maintained hypoparathyroidism and patients who did not. Results were analysed to see whether ioPTH predicts maintenance of the hypoparathyroid state. RESULTS: The mean preoperative PTH level was 932 pg/L (range: 58-1808). The mean postoperative PTH level was 147 pg/L (range: 16-498). The mean 3-month PTH level was 47 pg/L (range: <1-515). The mean postoperative PTH level for patients with a persistently high PTH level at 3 months was 286 pg/L (range: 272-299), compared with 63 pg/mL (16-160) in patients remaining normparathyroid, and 159 pg/L (range: 39-498) for patients with persistent hypoparathyroidism. If the normoparathyroid state is strictly considered to be failure following total parathyroidectomy, ioPTH is not predictive of hypoparathyroidism. However, ioPTH is indicative of biochemical resolution of the hyperparathyroid state (normo- or hypoparathyroidism). CONCLUSION: We conclude that the use of ioPTH monitoring in the surgical management of secondary hyperparathyroidism fails to predict persistent hypoparathyroidism following total parathyroidectomy, but does predict biochemical resolution of hyperparathyroidism.

Adult↗

PubMed2005

Does thyroid subspecialization alter practice and outcome? A completed 4-year audit loop.

OBJECTIVE: To assess the effect of subspecialization on thyroid surgical practice and outcome. DESIGN: The multidisciplinary thyroid clinic was established in November 2000. A retrospective study of all thyroid surgery covering the period November 1998 to November 2000 was carried out. Best practice principles were implemented and prospective data were collected over a further 2 years to complete the audit loop. Practice and results were compared. SETTING: The project was carried out through the Hull and East Yorkshire Multidisciplinary Thyroid Clinic, a tertiary referral clinic for the management of thyroid disease. PARTICIPANTS: All patients who underwent thyroid surgery through the Department of Otolaryngology Head and Neck Surgery for 2 years before the establishment of the thyroid clinic (39 patients) and all patients who underwent thyroid surgery through the department for 2 years after the establishment of the clinic (108 patients) were included. MAIN OUTCOME MEASURES: Referral patterns, preoperative workup, types of surgery, histopathological diagnosis and complications rates were compared. RESULTS: The audit loop revealed that permanent vocal cord palsy rates had fallen from 8% to 0%, haematoma rates had fallen from 5% to 2% and permanent hypoparathyroidism rates had fallen from 8% to 2%. In addition, caseload had markedly increased, preoperative investigations were reduced and types of surgery standardized. CONCLUSION: It is clear that thyroid subspecialization is beneficial as far as overall outcome is concerned. However, this may lead to increased throughput which must be borne in mind for future activity planning.

Ambulatory Care Facilities↗

PubMed2005

A blinded in-vitro study to compare the efficacy of five topical ear drops in clearing grommets blocked with thick middle ear effusion fluid.

OBJECTIVE: To compare the efficacy of 5% NaHCO3, 3% H2O2, Sofradex (dexamethasone sodium metasulphobenzoate 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%), 0.33% acetic acid and 0.9% NaCl eardrops in clearing grommets blocked with harvested thick middle ear effusion fluid. STUDY DESIGN: A blinded in-vitro study. SETTING: District general hospital. PARTICIPANTS: A total of 473 grommets were blocked with freshly harvested unpooled thick middle ear effusion fluid obtained from 68 patients. MAIN OUTCOME MEASURES: Patency of the grommets before and 7 days after intervention was ascertained by tympanometry and close visual inspection. RESULTS: Instillation of eardrops leads to a statistically significant increase in the clearance of grommets as compared with not using any drops (chi2 = 14.3, d.f. = 5, P = 0.006). The numbers needed to treat were 2.8 for NaHCO3, 3.2 for 0.9% NaCl, 3.9 for 0.33% acetic Acid, 4.4 for Sofradex and 9.5 for H2O2 eardrops. Pair-wise comparison was only significant for comparison between 5% NaHCO3 and 3% H2O2 eardrops (Bonferroni corrected P = 0.01, odds ratio = 4.3, CI = 1.9-9.9). CONCLUSIONS: Use of eardrops leads to a clinically and statistically significant increase in the clearance of blocked grommets. Of the five drops used, 5% NaHCO3 was the most efficacious and 3% H2O2 the least efficacious. Limitations of this in-vitro study are recognized and a prospective in-vivo double blind randomized controlled trial is planned.

Acetic Acid↗

PubMed2005

Thyroidectomy does not cause globus pattern symptoms.

Post-thyroidectomy patients often complain of globus pharyngeus type symptoms. One of the organic pathologies recognized as causing globus pattern symptoms is goitre. We conducted a prospective questionnaire-based study in the thyroid clinic at Hull Royal Infirmary to examine the relationship between goitre, thyroidectomy and globus pattern symptoms by using the Glasgow-Edinburgh Throat Scale. A questionnaire-based study in which 41 consecutive patients due to undergo thyroidectomy prospectively completed the questionnaire pre-operatively and 12 months post-operatively. A subset of 25 randomly selected patients also completed the questionnaire three months post-operatively. Globus symptoms were not worsened by thyroidectomy at three or 12 months. Indeed two of the questioned parameters were significantly improved at three months, and six at one year (p < 0.023). In conclusion, thyroidectomy does not exacerbate globus pharyngeus symptoms. Indeed, in the absence of other clinical causes, when a patient has a World Health Organization (WHO) 2 goitre or greater, thyroidectomy may improve them.

Adult↗

PubMed2004

Somatostatin analogues have no role in the treatment of advanced differentiated thyroid cancer.

Somatostatins are neuropeptides that have a downregulatory effect on various physiological processes. Their use in the management of certain endocrine tumours is well recognized. Their use in thyroid cancer is not established, although there is some evidence to suggest that they have a role in advanced metastatic disease. We report a case of a patient with advanced metastatic follicular thyroid cancer which demonstrated strong octreotide uptake with reduced avidity for I(131). Treatment with the somatostatin analogue octreotide, however, failed to achieve a significant response. We feel this case is important as it suggests that although octreotide provides a useful further imaging modality in differentiated thyroid cancer, it has no therapeutic role.

Antineoplastic Agents, Hormonal↗

PubMed2004

Primary hyperparathyroidism in pregnancy.

Primary hyperparathyroidism during pregnancy carries significant risks to both mother and fetus. Parathyroidectomy remains the only definitive treatment for the condition. The timing of surgery remains controversial, with ongoing debate regarding the safety of surgery during the third trimester. A case of symptomatic primary hyperparathyroidism treated by parathyroidectomy in the third trimester is described. The clinical features, investigations and treatment options are discussed.

Adult↗

PubMed2002

Somatostatins and their role in thyroid cancer.

Somatostatins are neuropeptides that exert a downregulatory effect on various physiological processes. Somatostatin analogues are used in the imaging and management of various tumour types. Their role in thyroid cancer has not as yet been fully elucidated. A systematic review of the literature using the keywords thyroid, cancer and somatostatin revealed 263 references. This paper summarizes the current knowledge of the role of somatostatins in thyroid cancer and assesses their future potential.

Antineoplastic Agents↗

PubMed2002

Are topical antibiotics necessary in the management of otitis externa?

Otitis externa is an inflammatory disorder of the skin of the outer ear canal frequently associated with bacterial or fungal infection. It is normally treated with aural toilet and topical preparations containing antibiotic/antifungal and steroid preparations. A group of 39 patients presenting with otitis externa were randomized in a double-blind manner into those receiving drops containing an aminoglycoside and steroid preparation and those receiving the same preparation without the aminoglycoside. All patients were reviewed on days 0, 3, 7 and 11 of a 14-day course of drops and their response to medication monitored. Patients documented their symptoms at each appointment and clinical response was also measured by a blinded observer. The study suggests that an aminoglycoside antibiotic conveys no significant benefit in this condition.

Administration, Topical↗

PubMed2002

Subclavian vein compression in anaplastic carcinoma of the thyroid.

Anaplastic thyroid cancer is a condition with a dismal prognosis in most cases. We present a case of subclavian vein compression in a case of anaplastic thyroid carcinoma treated with subclavian venous stenting. Subclavian vein compression is a recognized complication in disseminated carcinomatosis particularly in carcinoma of the breast and bronchus. It has never been described in anaplastic thyroid carcinoma.

Aged↗