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Biomedical subjects

Stephen Lo

Publications and source records attributed to Stephen Lo.

10 recordsLinked to original sources
PubMed2006

Patient satisfaction with NHS elective tonsillectomy outsourced to the private sector under the Patient Choice Programme.

RATIONALE, AIMS AND OBJECTIVES: An interim goal of the NHS 'Extending choice for patients' initiative was that, by 2004, patients who had been on the NHS waiting list for elective surgery for 6 months were provided with a choice of staying on the waiting list or being treated faster by opting to have their operation with an alternative provider. The aim of this study was to examine patient satisfaction in a cohort of patients who travelled out-of-region to undergo routine tonsillectomy performed by an NHS consultant at a private hospital. METHOD: A questionnaire survey was conducted of adult patients undergoing elective tonsillectomy in 2002 and 2003 at The Hampshire Clinic, Basingstoke, UK. RESULTS: Our results showed that 95% (n = 123) of patients were happy to travel considerable distances from their local hospital to have their operation. Overall 71% (n = 92) of patients rated the overall experience of having the operation performed at the private hospital as excellent and 25% (n = 32) rated it as satisfactory. CONCLUSION: We conclude that tonsillectomy performed by a consultant in an out-of-region private hospital is associated with a high level of patient satisfaction and is an acceptable way to reduce waiting times for tonsillectomy provided clear guidelines and safeguards are in place.

Adult↗
PubMed2005

Retropharyngeal and parapharyngeal infections in children: the Toronto experience.

OBJECTIVE: To review the Hospital of Sick Children, Toronto's experience of the diagnosis and management of retropharyngeal and parapharyngeal infections with particular emphasis on the role of computed tomography (CT) imaging in diagnosing the presence of an abscess. METHODS: A retrospective analysis of all patients diagnosed with retropharyngeal and parapharyngeal infections from 1987 to 1999 was performed. Demographic data, presenting symptoms, season of presentation, management and complications were reviewed. The CT scans of 27 patients who underwent surgical treatment were retrospectively examined by two neuroradiologists who were blinded to the patient's history and outcome. The sensitivity, specificity and predictive values for the specific features and overall assessment were calculated. RESULTS: Fifty-four children were identified. There were 46 retropharyngeal infections, 6 parapharyngeal infections and 2 patients had both retropharyngeal and parapharyngeal infections. All patients were treated with parenteral antibiotics. Thirty-seven patients underwent surgical drainage and in 27 there was a positive finding of pus. The retrospectively assessed CT scans of the 21 patients who underwent surgery were found to have a sensitivity of 81% in detecting an abscess by CT scan but the specificity was 57%. There were four complications including mediastinitis, aspiration pneumonia, internal jugular vein thrombosis and common carotid artery aneurysm. All patients recovered but abscess recurred in five patients. CONCLUSION: Not all patients with retropharyngeal and parapharyngeal abscesses require surgery. Whilst CT scans are helpful in diagnosing and assessing the extent of these infections they are not always accurate in detecting an abscess. A decision to drain an abscess should therefore not be made based solely on the CT findings.

Abscess↗
PubMed2005

Does hydrogen peroxide mouthwash improve the outcome of secondary post-tonsillectomy bleed? A 10-year review.

OBJECTIVE: To determine whether hydrogen peroxide (H(2)O(2)) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. STUDY DESIGN: Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. SETTING: Tertiary otolaryngology center. RESULTS: Of the 156 patients, 59 received H(2)O(2) and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H(2)O(2) group) and 1.6 days (control group). In the H(2)O(2) group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H(2)O(2) group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration (P = 0.49), rate of surgical intervention (P = 0.85), and rate of readmission with further hemorrhage (P = 0.92). CONCLUSION: Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. SIGNIFICANCE: This study does not support the common practice of treating post-tonsillectomy hemorrhage with H(2)O(2).

Case-Control Studies↗
PubMed2005

Constitutive (HO-2) and inducible (HO-1) haem oxygenase in pleomorphic adenomas of the human parotid: an immunocytochemical study.

This study examines the expression HO-1 and HO-2 isozymes in human parotid pleomorphic adenomas. They are members of the heat shock protein family, and are thought to play a role in the regulation of tumoral blood flow. Immunocytochemistry using antibodies specific for HO-1 and HO-2 were undertaken in 12 pleomorphic adenoma specimens, all sections of which contained adjacent normal salivary tissue. Normal salivary gland acini and ducts displayed significantly stronger immunoreactivity for HO-2 compared to tumour cells (p < 0.001). Expression for HO-1 was minimal in both normal salivary gland acini and tumour cells with no difference (p = 1.000). However, positive staining for HO-1 was seen in normal salivary ducts and in pleomorphic adenomas showing ductal differentiation. In conclusion, this is the first study to examine the expression of HO-1 and HO-2 within normal salivary glands and pleomorphic adenomas. Our findings suggest that HO may be implicated in the pathogenesis of salivary pleomorphic adenomas.

Adenoma, Pleomorphic↗
PubMed2004

Localisation of heme oxygenase isoforms in allergic human nasal mucosa.

Carbon monoxide (CO) is an endogenously produced gas mediator produced by heme oxygenase (HO). Like nitric oxide (NO), CO is produced in the nasal mucosa. Given that induced NO synthase (iNOS) expression in nasal mucosa has been found to be up-regulated in allergic rhinitis, the current study investigated the expression of HO isoforms in allergic human nasal mucosa. Immunohistochemical staining for type 1 and 2 HO isoforms were carried out in nasal inferior turbinate mucosa from six patients with persistent allergic rhinitis, and compared with six control patients without nasal allergy. Focal and weak expression of HO-1 was observed in seromucous glands, with no difference between allergic and control specimens. Vascular endothelium, erythrocytes, smooth muscle and inflammatory cells (except macrophages) in the allergic group exhibited stronger HO-1 immunoreactivity compared to the control. Minimal expression was found in the respiratory epithelium in either group. Intravascular HO-1 expression was found in the allergic mucosa only. Intense HO-2 immunoreactivity was observed in the respiratory epithelium, vascular endothelium and seromucous glands in both allergic and control groups with no differences in intensity. In conclusion, unlike iNOS, HO-1 is minimally expressed in the nasal respiratory epithelium of either group. However, our findings suggest that it may be involved in the inflammatory process of allergic rhinitis at the submucosal level.

Adolescent↗
PubMed2004

Outcome of patients with positive Epstein-Barr virus serologic status in the absence of nasopharyngeal carcinoma in Hong Kong.

OBJECTIVE: To evaluate the current clinical practice of follow-up and the outcomes of patients with raised Epstein-Barr virus (EBV) antibody levels but without pathological evidence of nasopharyngeal carcinoma (NPC) for a possible risk of developing NPC in the future. DESIGN: Retrospective review of prospectively collected database. SETTING: Tertiary referral otorhinolaryngology center. PATIENTS: The study population comprised 66 patients (27 male and 39 female; median age, 43.5 [range, 9-78] years) who presented in 1997 with a positive EBV IgA viral capsid antigen titer but a negative nasopharyngeal biopsy result. MAIN OUTCOME MEASURES: The detection of NPC and EBV seroconversion rate. RESULTS: Of the 66 patients studied, 14 had a positive family history of NPC. Fourteen patients (27%) were excluded because of loss of contact or refusal of follow-up. The median follow-up period of the remaining 52 patients was 54.5 months (range, 12-64 months). Of these 52 patients, 39 (75%) had initial nasendoscopic finding described as completely normal. During the follow-up period, NPC was diagnosed in 1 patient (2%) 18 months after first biopsy. The initial nasendoscopy and histological findings in this patient were normal despite the patient having a raised EBV IgA VCA titer of 1:640. Overall, the EBV serologic status of 36 patients (69%) reverted to normal within the studied period (median interval of 54.5 [range, 12-64] months). CONCLUSIONS: In the median follow-up period of 54.5 months, only 1 patient (2%) developed NPC. A significant proportion of the patients seroconverted back to normal, none of whom developed NPC.

Adolescent↗