Head and Neck Center

Hamburg, Germany

Head and Neck Center

Hamburg, Germany
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Jerjes W.,University College London | Hamdoon Z.,Head and Neck Center | Hopper C.,University College London | Hopper C.,Head and Neck Center
Photodiagnosis and Photodynamic Therapy | Year: 2017

Introduction Photodynamic therapy (PDT) is a relatively new method of treating various kinds of pathologies. In this retrospective study, a total of 148 patients with basal cell carcinoma (BCC) were treated with surface illumination methyl aminolevulinate – photodynamic therapy (MAL-PDT) or meta-tetrahydroxyphenylchlorin (mTHPC-PDT). Comparisons with the clinical features, rate of recurrence and overall outcome were made. Materials and methods Surface illumination PDT was offered under local or general anaesthesia. For thin BCCs, the 16% strength cream (MAL) was applied topically 3 h prior to tissue illumination. A single-channel 628 nm diode laser was used for illumination and light was delivered at 100J/cm2 per site. For thick BCCs, 0.05 mg/kg mTHPC was administered intravenously prior to tissue illumination. A single-channel 652 nm diode laser was used for illumination and light was delivered at 20J/cm2 per site. Lesion response evaluation was carried out according to RECIST. Results The MAL-PDT sub-group included 86 patients with 127 thin BCCs; 80 patients had complete response (CR) after one round of treatment. The mTHPC-PDT sub-group included 62 patients with 116 thick BCCs; 60 patients had complete response after one round of treatment. Statistically significant factors associated with complete response to MAL-PDT included superficial BCC histotype (P < 0.001), ≤0.5 mm tumour thickness (P < 0.001) and lack of ulceration (P < 0.001). While for the mTHPC-PDT sub-group, both superficial and nodular types responded significantly better than invasive type (P < 0.001); the lack of ulceration was insignificant factor in achieving complete response. Conclusion PDT achieved high efficacy in the treatment of basal cell carcinomas with greatly reduced morbidity and disfigurement. The technique is simple, can commonly be carried out in outpatient clinics, and is highly acceptable to patients. © 2017 Elsevier B.V.

Cannady S.B.,Head and Neck Center | Dean N.,University of Alabama at Birmingham | Kroeker A.,Oregon Health And Science University | Albert T.A.,Oregon Health And Science University | And 2 more authors.
Head and Neck | Year: 2011

Background. The purpose of this study was to determine factors to predict the success of free flap surgery in the treatment of osteoradionecrosis (ORN). Methods. Univariate analysis of overall and flap complications was performed. The effect of time to ORN, and the time interval between ORN to reconstruction was evaluated. Results. Fifty-five flaps on 53 patients for ORN were done with a 90% resolution rate. Univariate parameter analysis was significant for infield mandibulotomy. An increased time interval from radiation therapy (XRT) to ORN development significantly predicted for flap-specific complications and flap loss (p <.05). Increased time from ORN diagnosis to flap surgery resulted in greater length of bone involvement (p =.01). Anastomotic complications occurred in 13 cases resulting in 7 complete flap losses. Conclusion. An increased risk of complication was encountered with greater time from XRT to ORN. Thus, in patients developing ORN long after treatment, surgery should be accordingly more aggressive. Copyright © 2009 Wiley Periodicals, Inc.

Furr M.C.,Oregon Health And Science University | Furr M.C.,Head and Neck Center | Cannady S.,Oregon Health And Science University | Cannady S.,Head and Neck Center | And 2 more authors.
Laryngoscope | Year: 2011

Objectives/Hypothesis: To understand when interposition vein grafting may be needed in head and neck reconstruction and become familiar with the factors associated with use of interposition grafts and their effect on free flap survival. Study Design: Descriptive case-series design in a tertiary referral center. Methods: Charts were reviewed in patients undergoing interposition vein grafts for microvascular reconstruction of head and neck defects between August 1998 and February 2009. Results: In a 10-year period, interposition vein grafts were used in 20 free tissue transfers, representing 1.7% of all microvascular reconstruction cases (n = 1,143). Seventy percent of vein grafts were used in cases of secondary reconstruction or prior radiotherapy. Free flap survival in the interposition vein graft group was 95%, compared with 96% overall flap survival. Conclusions: Interposition vein grafts are used most often in cases involving a threatened flap, prior free flap, flap failure or radiation, and tumor recurrence. The use of interposition vein grafting in microvascular reconstruction is not associated with decreased flap survival. © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

PubMed | Royal National Throat Nose and Ear Hospital, Aristotle University of Thessaloniki, Head and Neck Center and Core Trainee
Type: Journal Article | Journal: Acta medica (Hradec Kralove) | Year: 2016

Disease phobia refers to a psychological state when the person continuously thinks that he/she is sick and improvement from the condition is impossible. Disease phobia in patients suffering from pain, secondary to temporomandibular disorders (TMDs), is usually the consequence of long-term problems; diagnosis and treatment of this group is a real challenge for healthcare professionals.The purpose of this prospective study was to objectively evaluate the role of Illness Attitude Scale (Kellner or IAS) in measuring cancerophobia and heart disease phobia in patients suffering from pain, as a consequence of TMDs.The cohort included 22 patients with TMDs who underwent evaluation of these phobias; pain was acute in 7 and chronic in 15. The patients were asked to complete the Kellner questionnaire, and this was followed by full clinical examination of the temporomandibular region.When measuring the correlation between the cancerophobia and heart disease phobia patients, the outcome was found significant in the total cohort, p<0.01. Comparisons were carried out in the chronic group (n=15) and was significant (p=0.034 and r=0.549); while in the acute group no significance was identified.Cancerophobia and heart disease phobia in TMD patients are factors that need to be taken in consideration when managing chronic pain in this group.

Gould J.,St Louis Sinus Center | Alexander I.,New Mexico Sinus Institute | Tomkin E.,Head and Neck Center | Brodner D.,Center for Sinus
American Journal of Rhinology and Allergy | Year: 2014

Background: The objective of this prospective, multicenter study was to assess 1-year changes in sinonasal symptoms and health care use after office-based multisinus balloon dilation. Methods: Adults diagnosed with chronic or recurrent acute rhinosinusitis per the 2007 adult sinusitis guidelines were enrolled in this Institutional Review Board-approved study. Balloon dilation of the maxillary sinuses/ethmoid infundibula with or without frontal or sphenoid ostial dilation was performed in the physician's office under local anesthesia. Intraoperative procedure technical success and subject procedure tolerance were recorded. Efficacy was assessed using the patient-reported 20-item Sino-Nasal Outcome Test (SNOT-20) and Rhinosinusitis Symptom Inventory (RSI). Complications and revision surgeries were also recorded. Results: A total of 313 ostial dilations were attempted and 307 were successfully completed (98.1%) in 81 subjects. Mean procedure tolerance was 2.8 ± 2.2 (0 = no pain; 10 = severe pain). Clinically meaningful and statistically significant (p < 0.0001) mean SNOT-20 symptom improvement was observed at 1 and 6 months and sustained through 1 year. The RSI treatment effect for all major rhinosinusitis symptoms was "large" and improvement in each was significant (p < 0.0001). Compared with the previous 1-year period, patients reported an average of 2.3 fewer acute sinus infections (p < 0.0001), 2.4 fewer antibiotic courses taken (p < 0.0001), and 3.0 fewer sinus-related physician visits (p < 0.0001) after balloon dilation. No serious device or procedure-related adverse events occurred. One subject (1.3%) underwent revision surgery. Conclusion: In-office, multisinus balloon dilation is safe, effective, and well tolerated. Patients reported significant reductions in both sinonasal symptoms and health care use after balloon dilation. Efficacy observed at 1 and 6 month follow-up was sustained through 1 year with a very low rate of revision surgery. This study was a part of the clinical trial NCT01612780 registered at www.clinicaltrials.gov Copyright © 2014, OceanSide Publications, Inc.

PubMed | Head and Neck Center, University College London and University of Birmingham
Type: | Journal: Photodiagnosis and photodynamic therapy | Year: 2016

Photodynamic therapy (PDT) is a minimally invasive intervention used in the management of tissue disorders. In this retrospective study, a total of 62 patients with actinic keratosis (AKs) were treated with surface illumination PDT. Comparisons with the clinical features, rate of recurrence as well as malignant transformation and overall outcome were made.The medical records of 62 consecutive patients who presented with suspicious skin lesions and diagnosed with AKs were examined. These patients with 178 AKs lesions were treated with surface illumination methyl aminolevulinate - photodynamic therapy (MAL-PDT). The 16% strength cream (MAL) was applied topically 3hours prior to tissue illumination. A single-channel 628nm diode laser was used for illumination and light was delivered at 100J/cmEight recurrences were reported after the first round of MAL-PDT, and two recurrences after the second round. Malignant transformation to squamous cell carcinoma (SCC) was noted in 2 patients only. The 3-year outcome resulted in 60 patients with complete response (CR), and this was maintained at the final outcome (last clinic review). Assessment of lesional outcome vs. response showed that 175/178 treated lesions had complete response (CR) at 3-year follow-up, which increased to 176/178 lesions at the last clinic follow-up.MAL-PDT offers an effective treatment for AKs lesions with excellent cosmetic outcome.

Jerjes W.,University of Baghdad | Jerjes W.,University College London | Jerjes W.,Leeds Institute of Molecular Medicine | Jerjes W.,Leeds Teaching Hospitals NHS Trust | And 5 more authors.
Head and Neck Oncology | Year: 2012

Photodynamic therapy (PDT) is a minimally-invasive surgical tool successfully targeting premalignant and malignant disorders in the head and neck, gastrointestinal tract, lungs and skin with greatly reduced morbidity and disfigurement. The technique is simple, can commonly be carried out in outpatient clinics, and is highly acceptable to patients. The role of photodynamic therapy in the management of oral potentially malignant disorders and early oral cancer is being discussed. © 2012 Jerjes et al.; licensee BioMed Central Ltd.

PubMed | Johns Hopkins University and Head and Neck Center
Type: | Journal: Journal of voice : official journal of the Voice Foundation | Year: 2016

Most agree that education about vocal health and physiology can help singers avoid the development of vocal disorders. However, little is known about how this kind of education is provided to singers as part of their formal training. This study describes the amount of instruction in these topics provided through graduate-level curricula, who provides this instruction, and the kinds of affiliations such graduate singing programs have with medical professionals.This is an online survey of music schools with graduate singing programs.Survey questions addressed demographics of the programs, general attitudes about vocal health instruction for singers, the amount of vocal health instruction provided and by whom it was taught, perceived barriers to including more vocal health instruction, and any affiliations the voice program might have with medical personnel.Eighty-one survey responses were received. Instruction on vocal health was provided in 95% of the schools. In 55% of the schools, none of this instruction was given by a medical professional. Limited time in the curriculum, lack of financial support, and lack of availability of medical professional were the most frequently reported barriers to providing more instruction. When programs offered more hours of instruction, they were more likely to have some of that instruction given by a medical professional (P=0.008) and to assess the amount of instruction provided positively (P=0.001).There are several perceived barriers to incorporating vocal health education into graduate singing programs. Opportunity exists for more collaboration between vocal pedagogues and medical professionals in the education of singers about vocal health.

Hamdoon Z.,Head and Neck Center | Jerjes W.,Head and Neck Center | Jerjes W.,University College London | Upile T.,Head and Neck Center | And 3 more authors.
Photodiagnosis and Photodynamic Therapy | Year: 2011

Photodynamic therapy (PDT) has been identified as a successful therapy for skin cancer. This case study investigates the role of optical coherence tomography (OCT) in lesion (squamous cell carcinoma) mapping, assisting the surgeon to correctly deliver PDT and monitor the outcome. Optical coherence tomographic images were acquired pre-treatment to assess tumour extent and margins to enable guidance of the PDT. Tomographic images taken post-PDT up to 6 months revealed complete response to the treatment and no recurrence. OCT-guided PDT is one of the promising approaches to efficiently discriminate between tumor involved and noninvolved margins. It reduces the untoward healthy tissue necrosis and provides an encouraging monitoring of the healing process. © 2010 Elsevier B.V.

Matthess Y.,Goethe University Frankfurt | Raab M.,Goethe University Frankfurt | Raab M.,Head and Neck Center | Knecht R.,Head and Neck Center | And 2 more authors.
Molecular Oncology | Year: 2014

Caspase-8 is crucial for cell death induction, especially via the death receptor pathway. The dysregulated expression or function of caspase-8 can promote tumor formation, progression and treatment resistance in different human cancers. Here, we show procaspase-8 is regulated during the cell cycle through the concerted inhibitory action of Cdk1/cyclin B1 and polo-like kinase 1 (Plk1). By phosphorylating S387 in procaspase-8 Cdk1/cyclin B1 generates a phospho-epitope for the binding of the PBD of Plk1. Subsequently, S305 in procaspase-8 is phosphorylated by Plk1 during mitosis. Using an RNAi-based strategy we could demonstrate that the extrinsic cell death is increased upon Fas-stimulation when endogenous caspase-8 is replaced by a mutant (S305A) mimicking the non-phosphorylated form. Together, our data show that sequential phosphorylation by Cdk1/cyclin B1 and Plk1 decreases the sensitivity of cells toward stimuli of the extrinsic pathway during mitosis. Thus, the clinical Plk1 inhibitor BI 2536 decreases the threshold of different cancer cell types toward Fas-induced cell death. © 2013 Federation of European Biochemical Societies.

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