Wondreacties in het kraakbenige neustussenschot : een experimenteel onderzoek bij groeiende konijnen

Het doel van het hier te rapporteren onderzoek is het inzicht te verdiepen en te verbreden in de wondgenezing van het kraakbenige neustussenschot na het aanbrengen van een defect. Verder zal het gedrag van autologe kraakbeenimplantaten bestudeerd worden. Ook wordt aandacht besteed aan het tot stand komen van de aansluiting van een implantaat aan in situ gebleven septurndelen c.q. het ontstaan van deviaties en duplicaturenReeds lang is bekend. dat operaties aan het neustussenschot bij kinderen nadelige gevolgen kunnen hebben voor de verdere uitgroei van de neus. zodat soms jaren later de vorm van de neus in toenemende mate afwijkt en bijvoorbeeld een "ingezakte" neusrug (zadelneus) zichtbaarwordt (Hayton 1916, Ombrédanne 1942). Tevens kunnen later opnieuw septurndeviaties onstaan (Pirsig 1974). Met de introductie van de reconstructies van het septurn bij de septurncorrectie is wel gedacht dat ook de normale uitgroei van de neus gewaarborgd zou zijn. Ernstige neuspassagestoornissen met een habituele mondademhaling en hardnekkige ontstekingen van de neus. neusbijholten en middenoren. veroorzaakt door deviaties van het neustussenschot. vormen volgens verscheidene auteurs een indicatie tot het verrichten van een septurncorrectie op de kinderleeftijd: Fischer (1957), Jennes (1964), Goldman (1963), Huizing (1966, 1979) en Pirsig (1974, 1977). Op korte termijn geven deze ingrepen goede resultaten. de septurndeviaties worden opgeheven zonder dat de uitwendige vorm van de neus verandert. de neusademhaling verbetert en de ontstekingen verminderen. De beoordeling van de resultaten op langere termijn met betrekking tot de uitgroei van de neus en het opnieuw optreden van septurndeviaties wordt echter bemoeilijkt doordat (in de meeste gerapporteerde ziekte-geschiedenissen) de kinderen niet lang genoeg. d.w.z. tot ruim na de puberteitsgroeispurt (16-18 jaar). zijn vervolgd. Incidenteel is beschreven dat een uitwendige afwijking van de neus meer dan 10 jaar na de ingreep en pas aan het eind van de groeispurt in de puberteit zichtbaar wordt (Huizing 197

A new applicator design for endocavitary brachytherapy of cancer in the nasopharynx

Introduction: In attempting to improve local tumor control by higher doses of radiation, there has been a resurgence of interest in the implementation of brachytherapy in the management of primary and recurrent cancers of the nasopharynx. Brachytherapy with its steep dose fall-off is of particular interest because of the proximity of critical dose limiting structures. Recent developments in brachytherapy, such as the introduction of pulsed-dose-rate and high-dose-rate computerized afterloaders, have encouraged further evolution of brachytherapy techniques. Materials and methods: We have designed an inexpensive, re-usable and flexible silicone applicator, tailored to the shape of the soft tissues of the nasopharynx, which can be used with either low-dose-rate brachytherapy or high (pulsed)- dose-rate remote controlled afterloaders. Results and conclusions: This Rotterdam nasopharynx applicator proved to be easy to introduce, patient friendly and can remain in situ for the duration of the treatment (2-6 days). The design, technique of application and the first consecutive 5 years of clinical experience in using this applicator are presented

A New Proposal for Adequate Resection Margins in Larynx and Hypopharynx Tumor Surgery—:Are the RCP Guidelines Feasible?

Background: Resection margins are an important prognostic factor for patients with head and neck cancer. In general, for head and neck surgery, a margin &gt;5 mm is advised by the Royal College of Pathologists. However, this cannot always be achieved during laryngeal and hypopharyngeal surgery. The aim of this study is to identify the resection surfaces and measure the maximum feasible margins per subsite. The clinical relevance of these maximum feasible resection margins were analyzed in this descriptive anatomical study. Methods: head and neck surgeons and a pathologist from the Erasmus MC performed a total laryngectomy and laryngopharyngectomy on a head and neck specimen specifically available for research. Results: For a total laryngectomy, resection margins &gt;5 mm were not feasible for the ventral and dorsal resection surface. For a total laryngopharyngectomy, resection margins &gt;5 mm were not feasible for the ventral, dorsal and lateral resection surface. Conclusion: Clear resection margins, defined as a margin &gt;5 mm, are not always feasible in laryngeal and hypopharyngeal surgery, due to the anatomy of the larynx and tumor location. However, striving for a maximum feasible margin is still the main goal. We propose a new guideline for maximum feasible but adequate resection margins in larynx and hypopharynx tumor surgery.</p

Raman spectroscopy to discriminate laryngeal squamous cell carcinoma from non-cancerous surrounding tissue

As for many solid cancers, laryngeal cancer is treated surgically, and adequate resection margins are critical for survival. Raman spectroscopy has the capacity to accurately differentiate between cancer and non-cancerous tissue based on their molecular composition, which has been proven in previous work. The aim of this study is to investigate whether Raman spectroscopy can be used to discriminate laryngeal cancer from surrounding non-cancerous tissue. Patients surgically treated for laryngeal cancer were included. Raman mapping experiments were performed ex vivo on resection specimens and correlated to histopathology. Water concentration analysis and CH-stretching region analysis were performed in the high wavenumber range of 2500–4000 cm−1. Thirty-four mapping experiments on 22 resection specimens were used for analysis. Both laryngeal cancer and all non-cancerous tissue structures showed high water concentrations of around 75%. Discriminative information was only found to be present in the CH-stretching region of the Raman spectra of the larynx (discriminative power of 0.87). High wavenumber region Raman spectroscopy can discriminate laryngeal cancer from non-cancerous tissue structures. Contrary to the findings for oral cavity cancer, water concentration is not a discriminating factor for laryngeal cancer.</p

Multicenter randomized crossover trial evaluating the provox luna in laryngectomized subjects

Objectives: The aim of this study was to compare the relative compliance and the dermatological and pulmonary outcomes when the Provox Luna system (Atos Medical, Malmö, Sweden) is added during the night to the usual tracheastoma care of laryngectomized subjects. Methods: This wa

Early and long-term morbidity after total laryngopharyngectomy

To determine the early and long-term morbidity of patients treated with a total laryngopharyngectomy and reconstruction using a jejunum interposition or gastric pull-up procedure. It is a retrospective study; and it is conducted in tertiairy referral center. Sixty-three patients were included in whom 70 reconstructions were performed (51 jejunum interpositions and 19 gastric pull-up procedures) between 1990 and 2007. The studied parameters were success rate of the reconstruction, early and long-term complication rate, and functional outcome including quality of life. Subjective quality of life analysis was determined by two questionnaires: the EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, and the EORTC-Head and Neck (H & N 35). The success rates were 84 and 74%, respectively. The procedures were associated with a high complication rate (63% after jejunum interposition and 89% after gastric pull-up), and a lengthy rehabilitation. Surviving patients were found to have a good long-term quality of life. Complete oral intake was achieved in 97%, and speech rehabilitation in 95%. These procedures are associated with significant morbidity, high complication rates, lengthy rehabilitation, but a good long-term quality of life

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Background: Specimen-driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen. Methods: During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair-wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed. Results: The method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved. Conclusion: Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery

Intraoperative Assessment of the Resection Specimen Facilitates Achievement of Adequate Margins in Oral Carcinoma

Background: Inadequate resection margins in oral cavity squamous cell carcinoma have an adverse effect on patient outcome. Intraoperative assessment provides immediate feedback enabling the surgeon to achieve adequate resection margins. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010–2012 vs period 2013–2017). Methods: A cohort of patients surgically treated for oral squamous cell carcinoma at the Erasmus MC Cancer Institute, Rotterdam, between 2010–2012 was studied retrospectively and compared to results of a prospectively collected cohort between 2013–2017. The frequency, type and results of intraoperative assessment of resection margins were analyzed. Results: One hundred seventy-four patients were included from 2010–2012, 241 patients were included from 2013–2017. An increase in the frequency of specimen-driven assessment was seen between the two periods, from 5% in 2010–2012 to 34% in 2013–2017. When performing specimen-driven assessment, 16% tumor-positive resection margins were found in 2013–2017, compared to 43% tumor-positive resection margins overall in 2010–2012. We found a significant reduction of inadequate resection margins for specimen-driven intraoperative assessment (p < 0.001). Also, tumor recurrence significantly decreased, and dise