Patients’ experiences of adverse symptoms, emotions, and coping strategies in connection to treatment of head and neck cancer - an interview study

Abstract Purpose This study aimed to increase the understanding of emotions and coping strategies used by head and neck cancer patients before cancer treatment, and to explore their emotions and coping strategies in relation to symptoms and side effects after treatment. Furthermore, we aimed to investigate the patients’ perceptions of received treatment and support. Methods Semi-structured in-depth interviews were conducted with 10 patients who had been treated for head and neck cancer, which included radiotherapy, at the Department of Oncology and the Department of Oral and Maxillofacial Surgery at Sahlgrenska University Hospital in Gothenburg. The interviews were analyzed in accordance with the method for Qualitative Content Analysis. Results The result picture revealed three head themes. The first theme “Management of simultaneously influencing mind-sets before cancer treatment” described the patients experiences of feeling “Scared and worried,” “Lonely and disappointed,” and “Relieved and confident”, and how they tried to handle the diagnosis and preparations for treatment by “Applying a positive mind-set”, “Searching for support,” and “Trusting the healthcare system”. The second theme “Experiences of becoming a pale shadow of oneself”, illustrated experiences of affecting post-treatment symptoms and side effects. To which, the last theme “Handling contextual influencing experiences after cancer treatment” displayed post-treatment emotions of being “Shocked and disappointed” and “Concerned and unsupported” but also “Grateful and forward-thinking”, where strategies such as “Appreciating Life”, “Networking socially,” and “Adapting to the new life” were used. Conclusions The results indicated the need for a more patient-centered care approach, with clearer structures and improved individual support both before and after treatment and in connection to rehabilitation. Patients’ cognitive changes after cancer treatment should be considered in the aftercare, which should also include adaptation to situation and strengthening of patients’ self-management as a goal

Computer assisted assessment of progressing osteoradionecrosis of the jaw for clinical diagnosis and treatment

Osteoradionecrosis (ORN) is a serious side effect of oncologic radiation therapy. Often, surgical removal of the affected skeletal tissue is indicated. In cranio-maxillofacial surgery, partial or total resection of the upper or lower jaw implies a severe impairment of the patient‘s quality of life. Up to now, clear display of ORN is still a challenge. This part of the project is dedicated to medical visualization of progressing ORN for clinical diagnosis. Currently, clinical diagnosis of ORN is mostly based on computer tomography (CT). With regard to its high advantages as e.g. reduced radiation dose, we additionally evaluate cone beam computer tomography (CBCT). After registration on a suitable reference and refined image processing and segmentation, all patient’s CT-/CBCT-data are subjected to various rendering techniques configured for the respective purpose, namely visualization of destructive and/or sclerotic skeletal alterations, consideration of cortical or trabecular bone, and analysis based on CT or CBCT. Recent achievements within the project were demonstrated with special focus on evaluation of both, CT and CBCT as well as on close cooperation with the clinical setting

Computer assisted assessment of progressing osteoradionecrosis of the jaw for clinical diagnosis and treatment

Osteoradionecrosis (ORN) is a serious side effect of oncologic radiation therapy. Often, surgical removal of the affected skeletal tissue is indicated. In cranio-maxillofacial surgery, partial or total resection of the upper or lower jaw implies a severe impairment of the patient‘s quality of life. Up to now, clear display of ORN is still a challenge. This part of the project is dedicated to medical visualization of progressing ORN for clinical diagnosis. Currently, clinical diagnosis of ORN is mostly based on computer tomography (CT). With regard to its high advantages as e.g. reduced radiation dose, we additionally evaluate cone beam computer tomography (CBCT). After registration on a suitable reference and refined image processing and segmentation, all patient’s CT-/CBCT-data are subjected to various rendering techniques configured for the respective purpose, namely visualization of destructive and/or sclerotic skeletal alterations, consideration of cortical or trabecular bone, and analysis based on CT or CBCT. Recent achievements within the project were demonstrated with special focus on evaluation of both, CT and CBCT as well as on close cooperation with the clinical setting.PeerReviewe

Electron Beam Melting Manufacturing Technology for Individually Manufactured Jaw Prosthesis: A Case Report

In the field of maxillofacial reconstruction, additive manufacturing technologies, specifically electron beam melting (EBM), offer clinicians the potential for patient-customized design of jaw prostheses, which match both load-bearing and esthetic demands. The technique allows an innovative, functional design, combining integrated porous regions for bone ingrowth and secondary biological fixation with solid load-bearing regions ensuring the biomechanical performance. A patient-specific mandibular prosthesis manufactured using EBM was successfully used to reconstruct a patient's mandibular defect after en bloc resection. Over a 9-month follow-up period, the patient had no complications. A short operating time, good esthetic outcome, and high level of patient satisfaction as measured by quality-of-life questionnaires-the European Organisation for Research and Treatment of Cancer QLQ-C30 (30-item quality-of-life core questionnaire) and H&N35 (head and neck cancer module)-were reported for this case. Individually planned and designed EBM-produced prostheses may be suggested as a possible future alternative to fibular grafts or other reconstructive methods. However, the role of porosity, the role of geometry, and the optimal combination of solid and porous parts, as well as surface properties in relation to soft tissues, should be carefully evaluated in long-term clinical trials. (C) 2016 American Association of Oral and Maxillofacial Surgeon

Achieving harmonized port security training in Europe : a critical review of EU legislative frameworks

Abstract Ports are complex, multiple-stakeholder environments representing the entrance point of intercontinental sea shipments into a country. Because ports are areaswhere large amounts of goods converge, they play a strategic role in a country’s securityand economic sustenance. Consequently different stakeholders interact to ensure thatcargo handling operations are optimized and cost-effective, e.g. international shipping,logistics companies, trading communities, and regulatory bodies. In this context securitythreats assume a special relevance, since ports could be exploited by criminal organizations to smuggle illicit goods into a country or by terrorists planning an attack. Toeliminate or mitigate these risks human resources need to be correctly trained andeducated. In addition, the competent authorities need to ensure that the same level andquality of training is delivered to all port facilities providing access to a country or acontinent. Unfortunately, experts believe that in the EU there is a lack of harmonizationof courses and quality assurance systems. Hence, the aim of this study is to reviewexisting regulatory frameworks and assess whether guidance is provided to harmonizesecurity training and education in port facilities. Thereafter, based on the experiencedeveloped within other sectors, where harmonization of training and education coursesin the EU has been successfully achieved, we make recommendations for improvementof the existing frameworks. The article concludes by summarizing the findings andindicating implications for managers and researchers.Sponsorship:EU Leonardo Da Vinci</p

Autogena stamceller för benrekonstruktion av defekter i käkarna- en fallpresenration

Abstract Denna fallbeskrivning visar två patienter med större defekter i mandibeln vilka initialt fick ben transplanterade, men där transplantaten inte läkte in. Patienterna erbjöds att pröva en kombination av autogena stamceller och ß-trikalciumfosfat. Efter cirka ett år fick patienterna titanimplantat i de rekonstruerade områdena, och resultatet var gott vid uppföljningen efter tre månader

Surgical treatment of recurring ameloblastoma, are there options?

Our aim was to evaluate the treatment given to patients with intraosseus ameloblastomas with special emphasis on recurrence and the outcomes of primary and secondary resection. Forty-eight patients who were treated for intraosseous ameloblastoma at 8 centres across Sweden met the inclusion criteria. They showed typical distribution of age, sex, site of lesion, and characteristic presenting features. Eleven of the 48 were initially treated with radical resection and none recurred. Twenty-two of the remaining 37 who were initially treated by conservative resection presented with recurrences. Sixteen of the 22 then had conservative secondary resections, which resulted in further recurrence in 6 patients. Initial radical resection is therefore superior to conservative management as far as recurrences are concerned. We argue, however, that a conservative surgical approach is adequate for many intraosseous ameloblastomas with limited extension, because relapse can be followed by radical resection if clinically indicated in selected cases

Expression of p53, p63, podoplanin and Ki-67 in recurring versus non-recurring oral leukoplakia

Abstract Oral leukoplakia (OL), a potentially malignant disorder, recurs in 40% of cases after surgical removal. Recurrence is a risk factor for malignant transformation. We aimed to examine the prognostic significance of four biomarkers related to cell proliferation: p53, p63, podoplanin (PDPN) and Ki-67 in predicting recurrence. Formalin-fixed-paraffin-embedded specimens from excised OL (n = 73, 33 recurrent; 40 non-recurrent) were collected in a prospective study. Immunohistochemistry was used to visualise expression of p53, p63, PDPN and Ki-67. Image analysis software was used for quantification of p53-, p63- and Ki-67-expressing cells, while PDPN was analysed visually. The expression of all four proteins were higher in recurrent compared with non-recurrent OL, only expression of p53 was statistically significant. In uni- and multivariable Cox regression analyses of individual markers, expression of p63 was significantly associated with higher recurrence risk ( p  = 0.047). OL with a combined high expression of both p53 and p63 had a significantly higher risk to recur [Log Rank, p  = 0.036; multivariate Cox, HR: 2.48 (1.13–5.44; p  = 0.024)]. Combination of p53 and p63 expression may be used as a prognostic biomarker for recurrence of OL

Patient-reported pain after surgical removal of leukoplakia : an observational 1-year follow-up study

Objective Oral leukoplakia (OL) presents as a white lesion of the oral mucosa and is not typically associated with the sensation of pain. OL should be surgically removed when possible because it is considered a potentially malignant oral disorder (PMOD). This study assessed the pain sensations experienced by patients in association with the occurrence and surgical treatment of OL. Methods Inclusion criteria were: a clinical diagnosis of OL; biopsy excision; and observation for at least 12 months in the ORA-LEU-CAN study. At the first visit, all the patients were asked about the occurrence of symptoms within the lesion. Ninety-four subjects were assessed over a period of 1 year. All patients underwent complete removal of OL. The patient cohort was divided into three sub-groups: (i) no pain before excision and at the 1-year follow-up; (ii) pain before excision; and (iii) pain at the 1-year follow-up. Results Overall, pain was reported by 21.3% of the patients at the study start whereas 13.8% of the patients reported pain 1 year after surgical treatment. Patient-reported pain from the lesion at study inclusion was significantly associated with lesions found on the lateral side of the tongue (p=.002). Pain reported by patients one year after surgery was significantly related to female gender (p=.038) and the presence of epithelial cell dysplasia (p=.022). Conclusion We conclude that surgical removal of OL results in a low risk of long-term post-surgical pain. However, OL located on the lateral side of the tongue and in OL with dysplasia are more likely to be associated with pain

Recurrence rates after surgical removal of oral leukoplakia : A prospective longitudinal multicentre study

Oral leukoplakia (OL) is a potentially malignant oral disorder. The Gold Standard treatment is to remove surgically the OL. Despite optimal surgery, the recurrence rates are estimated to be 30%. The reason for this is unknown. The aim of this study was to investigate the clinical factors that correlate with recurrence after surgical removal of OL. In a prospective study data were collected from 226 patients with OL. Forty-six patients were excluded due to incomplete records or concomitant presence of other oral mucosal diseases. Overall, 180 patients proceeded to analysis (94 women and 86 men; mean age, 62 years; age range, 28-92 years). Clinical data, such as gender, diagnosis (homogeneous/non-homogeneous leukoplakia), location, size, tobacco and alcohol use, verified histopathological diagnosis, and clinical photograph, were obtained. In patients who were eligible for surgery, the OL was surgically removed with a margin. To establish recurrence, a healthy mucosa between the surgery and recurrence had to be confirmed in the records or clinical photographs. Statistical analysis was performed with the level of significance set at P&lt;0.05. Of the 180 patients diagnosed with OL, 57% (N = 103) underwent surgical removal in toto. Recurrence was observed in 43 OL. The cumulative incidence of recurrence of OL was 45% after 4 years and 49% after 5 years. Fifty-six percent (N = 23) of the non-homogeneous type recurred. Among snuff-users 73% (N = 8) cases of OL recurred. A non-homogeneous type of OL and the use of snuff were significantly associated with recurrence after surgical excision (P = 0.021 and P = 0.003, respectively). Recurrence was also significantly associated with cancer transformation (P&lt; 0.001). No significant differences were found between recurrence and any of the following: dysplasia, site of lesion, size, multiple vs. solitary OL, gender, age, use of alcohol or smoking. In conclusion, clinical factors that predict recurrence of OL are non-homogeneous type and use of snuff