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Biomedical subjects

T W Matthews

Publications and source records attributed to T W Matthews.

13 recordsLinked to original sources
PubMed2000

Frey's syndrome and parotidectomy flaps: A retrospective cohort study.

Gustatory sweating, also known as Frey's syndrome, is a recognized phenomenon after parotidectomy. The incidence of clinically significant gustatory sweating may be dependent on the thickness of the skin flap that is elevated at the time of surgery. Dissection in the subcutaneous level or the deeper sub-superficial musculoaponeurotic system level are 2 commonly used techniques in the operation. Twenty-eight patients were prospectively evaluated for Frey's syndrome after superficial parotidectomy. Thirteen patients underwent subcutaneous and 15 patients sub-superficial musculoaponeurotic system flap elevation. The overall incidence of gustatory sweating was determined, and a comparison of the two surgical techniques was assessed subjectively by patient interview-questionnaire and objectively evaluated with starch-iodine testing.

Cohort Studies↗
PubMed1999

Role of percutaneous gastrostomy tubes in the postoperative care of patients with cancer of the oral cavity and oropharynx.

OBJECTIVE: The purpose of this study was to document the use and complications of gastrostomy tubes placed following surgery for oral cancer at our institution and to determine preoperative predictors of the procedure. METHOD: A retrospective chart review of 105 patients treated surgically for oral cancer between March 1990 and June 1995 at St. Joseph's Health Care Centre, London, Ontario was conducted. Twenty patients were studied with regard to timing, indication, and morbidity (n = 24) of the procedure. Regression analysis was performed regarding preoperative predictors of postoperative gastrostomy including tumour site and stage, and the percentage of tongue resected. Outcome measures included time from surgery to gastrostomy, length of postoperative hospital stay, time gastrostomy tube in situ, complications of gastrostomy, and the predicted risk of postoperative gastrostomy tube. RESULTS: The mean time to gastrostomy tube placement was 17.4 days, and the mean length of hospital stay in gastrostomy patients was 26.8 days. Gastrostomy was temporary in 55% of patients. No significant complications of percutaneous gastrostomy were encountered. Oropharyngeal tumour site and advanced T stage were predictive of the need for postoperative gastrostomy. CONCLUSIONS: In oral cavity and oropharyngeal cancer patients treated surgically, early postoperative percutaneous gastrostomy tube placement is indicated in those at high risk for significant postoperative dysphagia.

Administration, Cutaneous↗
PubMed1998

Epithelioid leiomyosarcoma of the larynx.

BACKGROUND: Tumors of smooth muscle origin are rare in the upper aerodigestive tract, due to the paucity of smooth muscle in the area. A review of the literature revealed 34 reported cases of leiomyoma, 9 cases of leiomyosarcoma, and only 2 cases of epithelioid leiomyoma arising in the larynx. METHODS: A case report of an epithelioid leiomyosarcoma arising in the right piriform fossa of a 38-year-old man is presented. RESULTS: The tumor was treated with conservative surgical resection and postoperative radiotherapy. There was no evidence of locoregional recurrence 2 years postsurgery, and laryngeal function was preserved. CONCLUSIONS: To our knowledge, this is the third case of a laryngeal epithelioid smooth muscle tumor to be reported in the world literature and the only documentation of an epithelioid leiomyosarcoma arising in the larynx.

Adult↗
PubMed1998

Tumour volume: implications in T2/T3 glottic/supraglottic squamous cell carcinoma.

OBJECTIVE: In this study, tumour volume was investigated to determine if it predicts locoregional control of T2/T3 glottic/supraglottic laryngeal carcinoma treated with radiotherapy or surgery. The effect of radiotherapy dosage was also assessed in those patients treated with primary radiotherapy. The ability to identify a subset of patients suitable for primary radiotherapy and, hence, voice preservation based on pretreatment computerized axial tomography (CT) would be valuable. METHOD: The charts of 55 patients referred to the London Regional Cancer Centre (LRCC) between 1988 to 1994 were reviewed. Each presented with a previously untreated T2 or T3 squamous cell carcinoma (SCC) of either the glottic or supraglottic larynx. Tumour volume was calculated from pretreatment CT scans by observers unaware of the clinical data associated with each radiograph. Wilcoxon t test and univariate and multivariate Cox regression analyses were performed. RESULTS: Mean tumour volume differed between those patients treated with radiotherapy and those treated surgically (4.5 cm3 and 11 cm3, respectively; p < .01). Mean tumour volume also differed between T2 and T3 tumours in the primary radiotherapy group (3.8 cm3 and 9.3 cm3, respectively; p < .01). Tumour volume > 4.0 cm3 was a significant predicator of local failure in T2 laryngeal tumours treated with radiotherapy (p < .05). This volume effect was not abolished with increasing radiotherapy dosage. Tumour volume was not a significant predictor of local control in the T3 tumours treated with radiotherapy or when all tumours, irrespective of T stage, that were treated with radiotherapy were considered together. There was no similar volume effect found in the surgical group. CONCLUSIONS: Tumour volume > 4 cm3 predicts local failure in T2 laryngeal tumours treated with radiotherapy regardless of radiotherapy dosage. This volume effect is not seen in those tumours treated with surgery. Inclusion of tumour volume data may eventually augment our current classification system.

Adult↗
PubMed1997

Endoscopic reduction and internal cyanoacrylate fixation of the zygoma.

OBJECTIVE: The objective of this study was to explore the feasibility of utilizing n-butyl-2 cyanoacrylate, a polymeric adhesive, for fixation of the zygoma after fracture displacement. DESIGN: A human cadaveric model was developed and used. SETTING: All experimentation was performed in the anatomy laboratory at the University of Western Ontario, London, Ontario. METHODS: The stability of zygomatic fractures endoscopically reduced and fixed with cyanoacrylate was compared to that of contralateral fractures treated by traditional closed reduction. The load to failure of each repaired fracture was established using a previously described linear-load applicator. MAIN OUTCOME MEASURES: The primary outcome measure was load to failure (kg). RESULTS: The technique was easily performed on all specimens and is described. Our data show that a zygoma, reduced and fixed in this manner, tolerates an 18-fold greater load to failure than does a zygoma treated by closed reduction alone. Traditional closed reduction of complete fracture dislocations at all three zygomatic suture lines tolerates a mean load to failure of 0.95 kg. The use of cyanoacrylate fixation increases the mean load to failure to 17.6 kg. CONCLUSIONS: Endoscopic reduction and cyanoacrylate fixation of zygomatic fractures deserve investigation in the clinical setting.

Cadaver↗
PubMed1996

Expression of dipeptidyl aminopeptidase IV activity in thyroid tumours: a possible marker of thyroid malignancy.

The role of dipeptidyl aminopeptidase IV (DAP IV) activity staining in the investigation of a thyroid mass was explored. The study consisted of two parts: the first part involved DAP IV staining performed on various thyroid lesions sampled from operative specimens. These included frozen tissues or cytologic smears. The second part of the study, which is ongoing, prospectively examines the DAP IV activity in fine-needle aspiration (FNA) specimens from patients with a thyroid mass. Results from part 1 of the study indicated that DAP IV activity staining was a useful adjunct in distinguishing differentiated carcinoma from benign lesions, particularly the "follicular lesions." Preliminary findings of the second part of the study suggest that DAP IV staining can be applied to FNA specimens. The measure of DAP IV activity and its influence on the diagnostic accuracy of FNA remain to be seen.

Biomarkers, Tumor↗
PubMed1996

Same-day admission thyroidectomy programme: quality assurance study.

OBJECTIVE: This study was conducted to evaluate the effectiveness of a same-day admission thyroidectomy programme. DESIGN: Prospective patient surveys and a retrospective quality assurance study were conducted. METHOD: Management of the initial 58 patients having a thyroidectomy at St. Joseph's Hospital, London, Ontario, after May 1992 when a same-day admission thyroidectomy programme was initiated, was evaluated. Early in the process, staff evaluation of the programme was also surveyed. RESULTS: The average length of stay for these patients was reduced from 4.5 to 3.2 days. No operative delays, cancellations, readmissions, or increased complications resulted from the new protocol. Also, patient and staff acceptance of the new programme was high. CONCLUSION: Our success with this programme has encouraged us to apply these concepts to more complex surgical patients.

Adolescent↗
PubMed1996

Fine-needle aspiration cytology of lymphoid lesions of the salivary gland: a review of 35 cases.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of fine-needle aspiration (FNA) in the diagnosis of primary lymphoid processes of the salivary gland. DESIGN: A retrospective study. METHOD: Between 1987 and 1994, 35 patients who underwent fine-needle aspiration (FNA) of the salivary gland had a diagnosis of a primary lymphoid process. Most presented with palpable parotid (28 patients) or submandibular (4 patients) gland masses which prompted a clinical diagnosis of pleomorphic adenoma. FNA was performed with immediate on-site evaluation. Flow cytometric cell-surface-marker analysis was performed in 28 of the 35 cases to determine the clonality of the B-cell proliferations. RESULTS: Sixteen cases of reactive hyperplasia and nine cases of malignant lymphoma diagnosed by FNA were confirmed by subsequent histopathologic examination. Lymphoma was confirmed in six of eight cases diagnosed as suspicious for lymphoma by FNA. Hodgkin's disease was suspected but not confirmed in one case and was diagnosed as a probable Warthin's tumour in another case. In all cases, the FNA diagnosis of either a reactive or malignant lymphoid process was unexpected and influenced the patient's further management. For patients diagnosed with an intraparotid lymph node, surgery could be deferred for a short period with the hope that the lymphadenopathy would spontaneously regress. For patients with a preoperative FNA diagnosis of lymphoma, a more limited biopsy could be performed, thereby reducing the operative risk to the patient and plans to process the tissue according to the institution's lymphoma protocol could be made. CONCLUSION: Clinically, reactive intraparotid lymph nodes and lymphomas present as parotid enlargements that are indistinguishable from pleomorphic adenomas. FNA is the only method of accurately establishing a preoperative diagnosis in these patients.

Adolescent↗
PubMed1995

Nutritional status in head and neck cancer patients.

The nutritional status of patients with head and neck cancer has been suspected as being a significant risk factor for surgical complications and cancer recurrence. Clinical dietary assessment was performed on a mixed group of 42 previously untreated, head and neck cancer patients scheduled to receive surgery with curative intent. Cox regression analysis was performed to investigate the relationship between demographic and tumour factors and nutritional status. Nutritional status correlated only with the locoregional stage of disease. A further regression analysis was performed to determine if nutritional status is an independent risk factor for early postoperative complications or recurrence. Nutritional status was not shown to influence surgical outcomes independent of tumour stage. Further study of the relationship between nutritional status and surgical results is required before recommending preoperative hyperalimentation in head and neck cancer patients.

Aged↗
PubMed1991

The use of fibrin tissue glue in thyroid surgery: resource utilization implications.

Current hospital resource limitations prompted efforts to shorten the postoperative in-hospital recovery time after thyroid and parathyroid surgery by hastening the removal of wound drains. Thirty patients' wounds were closed with fibrin tissue glue (Tisseel) and sutures. These were retrospectively compared with 30 randomly selected patients undergoing identical procedures and standard suture closures. Mean drainage the first postoperative night was 18 ml in the test group versus 39 ml in the controls. The average times to drain removal were 1.6 days and 2.2 days respectively. The mean test postoperative hospital stay was reduced by 0.9 days in test patients (2.8 days versus 3.7 days). There was no difference in the complication rate between the two groups. Using this technique, significant increases in the efficiency of resource utilization appear to be possible. A randomized prospective trial of fibrin glue versus traditional closure is required at this time to verify the usefulness of fibrin tissue glue in thyroid surgery.

Adult↗
PubMed1988

Morphological alterations of salivary gland parenchyma in chronic sialadenitis.

Ten cases of chronic nonspecific sialadenitis of the parotid and submandibular glands were studied by a combination of immunohistochemistry (to detect cytoplasmic filaments), morphometry, and electron microscopy in order to assess histological modifications that might reflect on the concepts for the induction of neoplasia in these glands. Histologically, the gradual atrophy of the glandular parenchyma results in the presence of many small ductules. Although structural alterations were apparent at all levels of the secretory/excretory glandular components, and in all types of cells, the fact that many such ductules resulted from gradual dedifferentiation of acinar cells was a major finding. The results suggest that no cell-type in salivary gland can be excluded as having a potential for neoplastic transformation and that the basis for the currently held reserve cell hypothesis is likely incorrect.

Actin Cytoskeleton↗
PubMed1987

Is there genetic heterogeneity in Usher's syndrome?

Usher's syndrome is an autosomal recessive disease characterized by congenital sensorineural hearing loss and retinitis pigmentosa (RP). Evidence for genetic heterogenicity within a single pattern of transmission of RP, be it autosomal recessive, dominant or sex-linked recessive, has been demonstrated by clustering patterns within and between families of specific clinical parameter weightings. Fishman, et al have noted corresponding evidence for subtypes of Usher's Syndrome, of paramount importance in mounting molecular level studies elucidating pathogenesis and management. Our study is of 25 consecutive patients studied by clinical investigation, including audiometric, vestibular and electro-ocular tests. Evidence for and against horizontal as well as proximal to distal receptors is weighed against loss of both visual and cochleo-vestibular systems. The clinical relevance is discussed.

Adolescent↗