Biomedical subjects

T Upile

Publications and source records attributed to T Upile.

10 recordsLinked to original sources

PubMed2006

The uncertainty of the surgical margin in the treatment of head and neck cancer.

We discuss our surgical philosophy concerning the subtle interplay between the size of the surgical margin taken and the resultant morbidity from ablative oncological procedures, which is ever more evident in the treatment of head and neck malignancy. The extent of tissue resection is determined by the "trade off" between cancer control and the perioperative, functional and aesthetic morbidity and mortality of the surgery. We also discuss our dilemmas concerning recent minimally invasive endoscopic microsurgical techniques for the trans-oral laser removal or co-ablation of aero-digestive tract tumours, which result in a minimal surgical margin of oncological clearance. By a process of inductive argument as to the nature of the surgical margin, we consider whether the risks of taking a lesser margin with adjuvant therapy is justified by the attendant gain in reduced surgical morbidity and the possible costs in tumour control.

Head and Neck Neoplasms↗

PubMed2006

Photodynamic therapy down-regulates the invasion promoting factors in human oral cancer.

Squamous cell carcinomas of the head and neck are characterized by their high tendency for invasion and metastasis. Several studies have identified the roles of matrix metalloproteinases (MMPs), vascular endothelial growth factors (VEGF) and urokinase plasminogen activators (uPA) in this process. Photodynamic Therapy (PDT) is an emerging treatment currently in clinical practice for the treatment of early cancer. Here we evaluate, in vitro, the influence of PDT on the expression of these molecules. A series of human keratinocyte cell lines derived from human oral squamous cell carcinomas (OSCC) were used as the PDT 'targets' in this study. Each cell line was subjected to sublethal dose of PDT. Activity of MMP-2, MMP-9, MMP-13, uPA and VEGF were evaluated at protein levels using zymography and ELISA on culture medium. For uPA, a chromogenic assay was performed. Gelatin zymography results revealed that, in control medium, MMP-9 and MMP-2 were secreted in proform. MMP-2 was highly expressed by H376 cells while VB6 and UP cells relatively show similar MMP-2 with comparatively low expression. For MMP-9, the latent type was highly expressed by VB6 cells and only slightly by H376, while active-MMP-9 was expressed by VB6 cell line only. Following PDT, both active and latent MMP-2 and MMP-9 were down regulated by UP and VB6 cells (p<0.001), while H376 showed an increase in active-MMP-2. These observations were supported by ELISA. This study has demonstrated that, PDT causes the suppression of factors responsible for tumour invasion which may be of therapeutic value.

Antineoplastic Agents↗

PubMed2006

Permanent sensory nerve impairment following third molar surgery: a prospective study.

OBJECTIVE: This prospective study reports the proportion of permanent sensory impairment of the inferior alveolar and lingual nerves and the factors influencing such prevalence after the removal of mandibular third molars under local anesthesia. STUDY DESIGN: There were 1,087 patients with 1,087 mandibular third molars removed under local anesthesia from 1998 to 2003. Standardized data collection included the patient's name, age, gender, radiographic position of extracted tooth, grade of surgeon, proximity of the inferior alveolar nerve, and the prevalence of lingual and/or inferior alveolar nerve paresthesia. RESULTS: Inferior alveolar nerve injury was 4.1% 1 week after surgery and decreased to 0.7% after 2 years of follow-up, and alteration in tongue sensation occurred in 6.5% of patients 1 week after surgery and decreased to 1.0% after 2 years of follow-up. CONCLUSION: The experience of the operator was found to be a significant factor in determining both permanent lingual nerve (P=.022) and permanent inferior alveolar nerve paresthesia (P=.026).

Adolescent↗

PubMed2005

A prospective randomized controlled trial evaluating alcohol on loudness perception in cochlear implant users.

AIM: The aim of this study was to determine the effects of alcohol on the psychophysical responses in patients with cochlear implants. This has not been previously studied. It was also hoped to provide information that could suggest possible sites of action of the known effects of alcohol on the auditory pathway. DESIGN: A prospective randomized placebo-controlled trial, with full ethical approval. PARTICIPANTS: Eight successful cochlear implant users were selected, of whom two had bilateral implants which were tested separately. In total 10 cochlear implants were tested. INTERVENTION: Alcohol was given in the form of vodka (50% alcohol, 1 mL/kg body weight) with 500 mL of orange and cranberry juice. The placebo control was given in the form of 500 mL of orange and cranberry juice alone. OUTCOME MEASUREMENT: The 'comfort level' (C level) was recorded before, and 1 h after alcohol or placebo ingestion for each patient's cochlear implant. Blood alcohol concentration was determined prior to alcohol or placebo consumption and then repeated after 45, 60, 90 and 180 min. RESULTS: The mean blood alcohol concentration 1 h after ingestion was 50 mg/dL. In the 'alcohol' arm the mean electrical unit increase in the C level was 19.9 with a standard deviation of 2.2. In the control arm the mean change in C level was 0.10 with a standard deviation of 0.3. CONCLUSIONS: In this first prospective randomized control study of the effect of alcohol on sound perception in cochlear implant users, alcohol significantly increased the upper end of the dynamic range (C levels) in comparison with placebo (P = <0.0001 using paired t-test analysis). This effect is likely to be the result of change in the auditory pathways proximal to the cochlea.

Adult↗

PubMed2005

How we do it: the anterior thoraco-cervical approach to tumours of the thoracic inlet.

KEYPOINTS: Tumours that arise in the thoracic inlet and superior mediastinum may be benign or malignant and present the surgeon with a difficult problem of access. The standard approach to the thoracic inlet from below offers limited exposure to the vascular and neural structures superior to the tumours. The anterior thoraco-cervical approach to the root of the neck and superior mediastinum combines the anterior cervical approach with a limited upper median sternotomy. If further access is required to achieve surgical clearance a full sternotomy split can be performed. The approach offers excellent exposure and helps to facilitate complete resection of benign and malignant tumours, which would otherwise be deemed inoperable or difficult to resect completely through other standard approaches. In contrast to previously described anterior transcervical thoracic approaches which required resection of part of the clavicle or manubrium as well as thoracotomy with increased morbidity, the anterior thoraco-cervical approach is associated with little morbidity and the postoperative stay is short.

Chylothorax↗

PubMed2004

Inferior turbinate reduction in children using Holmium YAG laser-a clinical and histological study.

BACKGROUND AND OBJECTIVES: To compare the efficacy and safety of inferior turbinate reduction in children using Holmium:YAG (Ho:Yag) laser and diathermy. Histological effects of these treatments on turbinate tissue are also studied. STUDY DESIGN/MATERIALS AND METHODS: A retrospective review and structured telephone interview of paediatric cases treated with Ho:Yag laser and diathermy to inferior turbinates. The complications, morbidity and efficacy were quantified. Histological sections of inferior turbinates treated with diathermy (surface and submucosal) and laser were compared. RESULTS: Efficacy in the laser (n = 8) and diathermy group (n = 11) was similar. The complication/morbidity score was lower in the laser group, 1.92 versus 3.48, (P = 0.04, CI: 0.01, 2). Long-term benefit was 50 and 36% in the laser and diathermy group respectively. Histology showed very limited tissue damage in all methods of treatment. CONCLUSIONS: Ho:Yag laser treatment is equally efficacious, but causes less complications and morbidity compared to surface diathermy. Both treatment methods have poor long-term efficacy, which may be related to limited tissue damage.

Adolescent↗

PubMed2002

Helicobacter pylori infection in surgical personnel.

Helicobacter pylori can be isolated from oro-gastric secretions. Surgical personnel through their clinical practice are exposed to oro-gastric secretions either directly or in aerosolized form during oro-gastric examination and are at an increased risk of this occupationally acquired infection. The sero-prevalence of Helicobacter pylori antibodies in 70 surgical personnel was examined and found to be higher than a published control group. This may suggest that surgical personnel, through their practice, are at increased risk of infection, which poses important public and occupational health problems and may call for precautionary guidelines in clinical practice to prevent occupational infection and vector carriage.

Adult↗

PubMed1998

Diagnostic pitfalls in sports related laryngeal injury.

The serious nature of laryngeal trauma sustained during sporting activity can be easily overlooked. Concomitant injury should not distract from the diagnosis of potential airway problems. The effects of head and neck trauma on the airway may be delayed. The assessment and management of a patient with suspected laryngeal injury should be carried out by experienced medical practitioners.

Adult↗

PubMed1997

Cochlear implantation in the presence of chronic suppurative otitis media.

Nine patients are presented who underwent cochlear implantation in the presence of chronic suppurative otitis media. Four had a simple tympanic membrane perforation, four had a pre-existing mastoid cavity and one had cholesteatoma in the ear chosen for implantation. Patients with a simple perforation had a staged procedure with myringoplasty followed by cochlear implantation after an interval of three months. Patients with cholesteatoma or with an unstable mastoid cavity were also staged. A mastoidectomy or revision mastoidectomy was performed with obliteration of the middle ear and mastoid using a superiorly pedicled temporalis muscle flap and blind sac closure of the external meatal skin. After a further six months a second stage procedure was performed to confirm that the middle-ear cleft was healthy and to insert the implant. Patients presenting with a stable mastoid cavity underwent obliteration of the cavity and implantation of the electrode as a one-staged procedure. To date there have been no serious problems such as graft breakdown, recurrence of disease or implant extrusion, and all patients are performing well.

Child, Preschool↗

PubMed1997

Aspergillus mastoiditis in a patient with acquired immunodeficiency syndrome.

We present the case history of a patient who was severely immunocompromised due to infection with the human immunodeficiency virus (HIV), and who subsequently developed acute mastoiditis due to Aspergillus fumigatus. Fungal otomastoiditis is a rarely reported complication of HIV infection. A high index of suspicion is required in these patients to facilitate early diagnosis and appropriate therapy.

AIDS-Related Opportunistic Infections↗