Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1994. / Source: Masters Abstracts International, Volume: 45-06, page: 2947. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 78-80).

Purpose: The management of head and neck squamous cell carcinoma (HNSCC) is complex and often involves multimodality treatment. Currently, most management decisions are based on clinical parameters with little appreciation of patient differences in underlying tumour biology. The identification of biomarkers that predict response to radiotherapy would be clinically useful in determining optimal management. The purpose of the thesis was to investigate potential biomarkers that might predict radiotherapy outcome in patients with HNSCC. Aims: 1) To investigate the hypoxia-associated biomarkers carbonic anhydrase 9 (CA9) and hypoxia-inducible factor -1α (HIF-1α) in patients with early glottis cancer who underwent radiotherapy as their primary mode of treatment, furthermore to investigate the role of accelerated hypofractionated radiotherapy in the management of T2 glottic cancer. 2) To investigate markers of hypoxia (CA9 and HIF-1α) and viral infection in oropharyngeal cancer, and in particular to test for an association between hypoxia markers and viral infection. 3) To investigate HIF-1 and CA9 in a series of patients undergoing surgery as their primary mode of treatment to explore whether they are associated specifically with radioresponsiveness or a general poor prognosis. Results: 1) Adverse prognostic factors for locoregional control were low pre-treatment haemoglobin (Hb; p = 0.010), advancing T stage (p = 0.001) and high CA9 expression (p = 0.032). Low Hb and high CA9 expression were independent factors on multivariate analysis; and combined predicted locoregional recurrence with an odds ratio of 8.0 (95% CI: 2.7-23.9), or either/or with an odds ratio of 3.3 (95% CI 1.5-7.1). In the subset of T2 patients, five-year locoregional control following radiotherapy was 82% and cancer specific survival was 90%. Serious morbidity occurred in 1.8% of patients. T stage subdivided by vocal cord movement was significant for local control. 2) Features associated with a poor locoregional control were older age (p=0.002), tongue base subsite (p=0.002), heavy alcohol use (p=0.004), heavy smoker (p=0.0002), low Hb level (p=0.001), advancing T (p=<0.0001), N (p=0.001) and AJC (p=0.001) stage, high CA9 expression (p=0.020) and high HIF-1α expression (p<0.0001). In multivariate analysis T stage (p=0.003) and high HIF-1α expression (p=0.001) remained significant. 3) Extracapsular spread was significantly associated with poor cancer specific survival (p=0.022). No other patient variables were associated with outcome. HIF-1α expression was significantly associated with poorly differentiated tumour (p=0.019) and the tumour having a cohesive front (p=0.026). Conclusion: 1) Hb and CA9 have potential to be used together as a biomarker to identify glottis cancer patients with a high probability of a poor outcome following radiotherapy, furthermore, vocal cord movement should be taken into consideration when managing glottis cancer. 2) As it does not appear to be influenced by HPV status, HIF-1α warrants further investigation as a biomarker in oropharyngeal patients treated with primary radiotherapy. 3) As HIF-1α and CA9 had no prognostic significance in patients undergoing surgery, they should be explored further as markers to help guide management decisions in patients with HNSCC.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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The present study was designed to obtain evidence as to whether the distorted images drawn by mentally retarded subjects are possibly due to perceptual variables, to the lower level of motor coordination they experience, or to an interaction of both.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Orthopaedic Surgery Johannesburg 31 January 2017 / Background Fractures of the radial head are classified according to the Mason System modified by Johnston. The fracture is managed according to its classification. Fractures of the Mason Type III and IV are complex and management is controversial. The early literature regarding the outcome of patients after arthroplasty of fracture dislocation of the elbow is limited by small patient numbers, short-term follow-up, and high complication rates. More recent literature has shown radial head replacement to have better functional outcomes in the short to medium term. Objectives To assess outcomes of radial head replacements in acute 3 and 4 radial head fractures by assessing elbow function, pain, elbow mobility post radial head arthroplasty and complications. Method A retrospective study design was used. Records were retrieved for all 40 patients who underwent a radial head replacement for a Mason III and IV fracture at Helen Joseph Hospital over a ten year period. Participants were traced and asked to complete a data sheet and undergo an examination by an interviewer. The data sheet included demographics, surgical and injury details, as well as details relating to function based on the Mayo Elbow Performance Score. Results Of a sample size n=16, 8 were male and 8 were female with an age range of 29 to 61 years and a mean age of 42.5 years. The length of follow up ranged from 2 to 8 years. When asked about daily functionality, 4 reported difficulty with one of the five tasks assessed on the Mayo Elbow Performance Score and 12 reported no difficulty with any of the tasks assessed. Moderate pain was reported by 8 with the other 8 patients reporting no pain.The flexion-extension arc ranged from 60º to 160º on examination with an average of 111º. An arc of greater than 100º was achieved in 11 out of 16 patients . A total of five patients had an arc of greater than 50º but less than 100. No patients had an arc less than 50º . Stability was assessed and scored. No study participants had any gross instability. Moderate instability was detected in 6 participants. Complications were noted in 2 of the 16 participants (One posterior interosseus nerve injury and one possible Essex-Lopresti injury). The final MEPS scores showed that 8 patients had good results and 8 patients had excellent functional outcomes with no fair or poor outcomes. Conclusions Good to excellent functional outcomes can be achieved with radial head replacement in Mason III and IV fractures with minimal complications however, longer term follow up with level one evidence is still needed. / MT2017