Citation for published version (APA): Mellerio, J. E., Robertson, S. J., Bernardis, C., Diem, A., Fine, J. D., George, R., Goldberg, D., Halmos, G. B., Harries, M., Jonkman, M. F., Lucky, A., Martinez, A. E., Maubec, E., Morris, S.,... more
Citation for published version (APA): Mellerio, J. E., Robertson, S. J., Bernardis, C., Diem, A., Fine, J. D., George, R., Goldberg, D., Halmos, G. B., Harries, M., Jonkman, M. F., Lucky, A., Martinez, A. E., Maubec, E., Morris, S., Murrell, D. F., Palisson, F., Pillay, E. I., Robson, A., Salas-Alanis, J. C., & McGrath, J. A. (2016). Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines. The British journal of dermatology, 174(1), 56-67. https://doi.org/10.1111/bjd.14104
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Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy... more
Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralater...
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Purpose Distant metastasis (DM) in patients with head and neck squamous cell carcinoma (HNSCC) is uncommon, but strongly deteriorates prognosis. Controversy exists regarding age as a predictor for the presence and development of DM. The... more
Purpose Distant metastasis (DM) in patients with head and neck squamous cell carcinoma (HNSCC) is uncommon, but strongly deteriorates prognosis. Controversy exists regarding age as a predictor for the presence and development of DM. The aim of this study was to investigate age and other predictors for DM in HNSCC patients. Methods From 1413 patients diagnosed with a primary HNSCC between 1999 and 2010 in a tertiary referral centre, patient, disease and pathological characteristics were extracted from patient files. Uni- and multivariable Cox regression analyses were performed to identify risk factors for DM as primary outcome. Results DM occurred in 131 (9.3%) patients, of which 27 (1.9%) were diagnosed simultaneously with the primary tumour, 27 (1.9%) were diagnosed synchronous, and 77 (5.4%) were diagnosed metachronous. The most common site of DM was lung (51.1%), followed by bone (19.1%) and liver (11.5%). Multivariable analysis identified male gender (HR = 1.95, 95% CI 1.23–3.10...
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ObjectivesGiven the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is... more
ObjectivesGiven the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is that all patients of the partner should be discussed in a multidisciplinary team meeting (MDT) with the head-and-neck centre as part of a Dutch health policy rule. In this mixed-method study, we evaluate the value that the video-conferenced MDT adds to the MDTs in the care pathway, quantitative regarding recommendations given and qualitative in terms of benefits for the teams and the patient.DesignA sequential mixed-method study.SettingOne oncology centre and its partner in the Northern part of the Netherlands.ParticipantsHead-and-neck cancer specialists presenting patient cases during video-conferenced MDT over a period of 6 months. Semistructured interviews held with six medical specialists, three from the centre and three from the partner.Primary a...
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We aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position. 3D models of commercially available cannula were... more
We aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position. 3D models of commercially available cannula were positioned in 3D models of the airway. In study (1), a cohort that underwent tracheostomy between 2013 and 2015 was selected (n = 26). The cannula was virtually placed in the airway in the pre-operative CT scan and its position was compared to the cannula position on post-operative CT scans. In study (2), a cohort with neuromuscular disease (n = 14) was analyzed. Virtual cannula placing was performed in CT scans and tested if problems could be anticipated. Finally (3), for a patient with Duchenne muscular dystrophy and complications of conventional tracheostomy cannula, a patient-specific cannula was 3D designed, fabricated, and placed. (1) The 3D planned and post-operative tracheostomy position differed significantly. (2) Three groups of patients we...
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To identify predictive factors for the presence of viable tumor and outcome in head and neck cancer patients who undergo therapeutic salvage neck dissections. Retrospective analysis of 76 salvage neck dissections after radiotherapy alone... more
To identify predictive factors for the presence of viable tumor and outcome in head and neck cancer patients who undergo therapeutic salvage neck dissections. Retrospective analysis of 76 salvage neck dissections after radiotherapy alone (n = 22), radiotherapy in combination with carboplatin/5-fluorouracil (n = 42) or with cetuximab (n = 12). Viable tumor was detected in 41% of all neck dissections. Univariate analysis revealed initial treatment with radiotherapy without systemic therapy (OR 6.93, 95%CI: 2.28-21.07, p < .001), increased lymph node size after initial treatment compared to pretreatment CT scan (OR 20.48, 95%CI: 2.46-170.73, p = .005), more extensive neck dissections (OR 8.40, 95%CI: 2.94-23.98, p < .001), and human papillomavirus negative cancer (OR 4.22, 95%CI: 1.10-16.22, p = .036) as predictors of viable tumor. Patients with decreased or stable, but persistently enlarged lymph node size after chemoradiation had a significantly lower chance of viable tumor (OR...
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Lymph node ratio (LNR) is increasingly reported as a potential prognostic tool. The purpose of this review was to analyze the available literature on the prognostic significance of LNR in head and neck squamous cell carcinoma (HNSCC). A... more
Lymph node ratio (LNR) is increasingly reported as a potential prognostic tool. The purpose of this review was to analyze the available literature on the prognostic significance of LNR in head and neck squamous cell carcinoma (HNSCC). A PubMed internet search was performed and articles meeting selection criteria were reviewed. Twenty-eight studies were identified in the literature dealing with the prognostic value of LNR. The published results are variable with a range of cutoff values of LNR associated with prognosis (overall survival [OS] and/or disease-specific survival [DSS]) between 0.02 and 0.20, with an average of 0.09. The LNR is reported to be of value in assessing prognosis in the patients with HNSCC. Although it is easy to calculate and could be considered in the staging of these patients, the currently available evidence in the literature does not yet provide a solid base for implementation.
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The purpose of this study was to validate the prognostic value of adding narrow-band imaging (NBI) during transoral laser surgery (TLS) for early glottic cancer. In 84 patients, 93 transoral laser resections were performed for carcinoma... more
The purpose of this study was to validate the prognostic value of adding narrow-band imaging (NBI) during transoral laser surgery (TLS) for early glottic cancer. In 84 patients, 93 transoral laser resections were performed for carcinoma in situ (Tcis), T1, or T2 glottic cancer. TLS was preceded by intraoperative evaluation using traditional white-light imaging (WLI) in 51 cases. In 42 cases, NBI was used in addition to WLI. Local recurrence rate and recurrence-free survival were retrospectively compared between both groups. Local recurrences developed in 14% of the 93 cases: 12 of 51 patients (24%) were treated by TLS based on WLI alone, and in 1 of 42 patients (2%) in the NBI group (P &lt; .01). Two-year recurrence-free survival was 82% in the WLI group and 98% in the NBI group (P &lt; .05). Additional use of NBI during TLS for early glottic cancer significantly improves clinical outcome.
Research Interests: Dentistry, Risk assessment, Humans, Female, Male, and 15 moreNetherlands, Clinical Sciences, Aged, Middle Aged, Neoplasm Invasiveness, Retrospective Studies, Prognosis, Chi Square Distribution, Laser Therapy, Risk Assessment, Glottis, Cohort Studies, narrow band imaging, Disease Free Survival, and Neoplasm staging
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We sought to assess the effect of age on overall survival (OS), cancer-specific survival (CSS), and non-cancer-related death (NCRD) in elderly (aged ≥70 years) head and neck squamous cell carcinoma (HNSCC) patients treated with definitive... more
We sought to assess the effect of age on overall survival (OS), cancer-specific survival (CSS), and non-cancer-related death (NCRD) in elderly (aged ≥70 years) head and neck squamous cell carcinoma (HNSCC) patients treated with definitive radiation therapy. The results were compared with those of younger patients, and the most important prognostic factors for survival endpoints were determined. Treatments may be better justified based on identification of the main differences in survival between young and elderly patients. Data were analyzed from all consecutive HNSCC patients treated with definitive radiation therapy (66-70 Gy) in our department between April 2007 and December 2014. A total of 674 patients, including 168 elderly patients (24.9%), were included in the study. Multivariate association models were constructed to assess the effect of age on survival endpoints. Multivariate analysis was performed to identify potential prognostic factors for survival in elderly patients. ...
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To compare cumulative cisplatin dose and toxicity between patients who received 3-weekly versus weekly cisplatin during adjuvant radiotherapy for high-risk head and neck squamous cell carcinoma (HNSCC). Consecutive HNSCC patients with... more
To compare cumulative cisplatin dose and toxicity between patients who received 3-weekly versus weekly cisplatin during adjuvant radiotherapy for high-risk head and neck squamous cell carcinoma (HNSCC). Consecutive HNSCC patients with involved resection margins and/or extra-capsular extension in two tertiary cancer centers with different institutional practices were identified. Cumulative cisplatin dose was calculated and information on toxicity reviewed and compared between patients who received 3-weekly versus weekly cisplatin. Of 270 high risk patients, 60 received 3-weekly 100mg/m(2) and 48 received weekly 50mg/m(2) cisplatin during adjuvant radiotherapy (60-66Gy in 30-33 fractions). Fourteen patients received other chemotherapy schedules and 148 received no chemotherapy. Mean cumulative cisplatin dose was 199.4mg/m(2) (standard error (SE) 5.4) in 3-weekly versus 239.8mg/m(2) (SE 11.0, P=0.001) in weekly treated patients. Cumulative cisplatin ⩾200mg/m(2) was given to 67.7% of pa...
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The purpose of this study was to evaluate active surveillance strategy in the clinically negative neck in maxillary squamous cell carcinoma (SCC). One hundred fourteen consecutive patients diagnosed with oral maxillary SCC were analyzed... more
The purpose of this study was to evaluate active surveillance strategy in the clinically negative neck in maxillary squamous cell carcinoma (SCC). One hundred fourteen consecutive patients diagnosed with oral maxillary SCC were analyzed retrospectively from 3 centers in The Netherlands. Analysis parameters included regional disease-free survival of N0 patients stratified for T classification, elective radiotherapy (RT) of the neck; and overall survival of the whole cohort, stratified by N classification; salvage neck surgery rates. Within the N0 cohort, 26.0% of the patients developed neck metastasis in the follow-up visits. Regional recurrence was not related to T classification or postoperative RT of the neck. Regional and locoregional recurrence were associated with diminished overall survival (p < .05). Regional metastasis was operable in 22 of 26 cases (85%). Only 1 patient presented with inoperable neck metastasis without local recurrence. Watchful waiting was feasible in t...
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Visualization by endoscopy is essential in the diagnosis of upper aerodigestive tract lesions. Recent studies showed that narrow band imaging (NBI) increases the diagnostic potential of conventional white light imaging (WLI) by... more
Visualization by endoscopy is essential in the diagnosis of upper aerodigestive tract lesions. Recent studies showed that narrow band imaging (NBI) increases the diagnostic potential of conventional white light imaging (WLI) by highlighting the superficial vessels. The objective of this study was to evaluate whether the use of NBI would influence inter- and intraobserver agreement while making diagnostic decisions using rigid endoscopy of the upper aerodigestive tract. Retrospective study. One hundred routinely collected pictures of laryngeal, hypopharyngeal, and oropharyngeal lesions were used. Rigid endoscopies and patient data collection were performed according to standard protocol. Twelve observers, grouped in different levels of experience, assessed all lesions twice with a 2 to 4 week interval. Fleiss and Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s kappa (κ) values were calculated to assess inter- and intraobserver agreement. Overall interobserver agreement increased from κ = 0.34 to κ = 0.40 by adding NBI to WLI (WLI and WLI + NBI, respectively). In experienced observers, an improvement from κ = 0.39 to κ = 0.43 was observed; in less-experienced observers an improvement from κ = 0.30 to κ = 0.37 was observed. Overall intraobserver agreement increased from moderate (κ = 0.54) to substantial (κ = 0.63) with addition of NBI. Intraobserver agreement for less-experienced observers improved remarkably when WLI was combined with NBI (κ = 0.51 vs. κ = 0.67). Addition of NBI during rigid endoscopies of the upper aerodigestive tract led to improvement of both inter- and intraobserver agreement. 4 Laryngoscope, 2016.
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There are controversial data on oncological and surgical outcome after major head and neck cancer surgery in the elderly. The aim of this study was to evaluate the outcome of elderly cancer patients after total laryngectomy in combination... more
There are controversial data on oncological and surgical outcome after major head and neck cancer surgery in the elderly. The aim of this study was to evaluate the outcome of elderly cancer patients after total laryngectomy in combination with neck dissection. A total of 58 patients separated into two age groups (28 < 65 vs. 30 ≥ 65 years) with hypopharyngeal and laryngeal cancer who underwent total laryngectomy and neck dissection were enrolled. Comorbidities of both age groups using the Charlson comorbidity index, hospitalization days as well as surgical complications evaluated by the Clavien-Dindo classification were examined. Overall and disease-free survivals of all patients were analyzed. The average follow-up was 2.9 years. Surgical complication rate was significantly increased in elderly (p = 0.04). However, complications could be treated without surgical intervention in most cases without significant extension of hospitalization. Locoregional and distant control did not ...
Research Interests: Germany, Humans, Female, Male, Squamous Cell Carcinoma, and 14 moreFollow-up studies, Incidence, Clinical Sciences, Aged, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Adult, Time Factors, Survival Rate, Retrospective Studies, Laryngectomy, Postoperative Complications, Disease Free Survival, and Neck dissection
Research Interests: Biological Sciences, Serotonin, Dopamine, Sensorineural Hearing Loss, Animals, and 12 moreMale, Auditory System, Serotonin Receptors, Guinea Pig, Auditory Nerve, Serotonin antagonists, Gamma-Aminobutyric Acid, Neurochemical, GABAA receptor, Serotonin receptor, Medical and Health Sciences, and Guinea pigs
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While small cell neuroendocrine carcinomas (SCNCs) most often arise in the lung, extrapulmonary SCNCs arise in a variety of locations-including the head and neck region. In particular, laryngeal SCNCs-while rare tumors-are nevertheless... more
While small cell neuroendocrine carcinomas (SCNCs) most often arise in the lung, extrapulmonary SCNCs arise in a variety of locations-including the head and neck region. In particular, laryngeal SCNCs-while rare tumors-are nevertheless recognized as distinct lesions. The rarity of laryngeal SCNC gives rise to two distinct difficulties: first (particularly with small biopsy specimens), laryngeal SCNC can be difficult to diagnose by routine light microscopy; second, limited experience with these tumors can make the crafting of a treatment plan for individual patients difficult. As regards the first problem, pathologic diagnosis is greatly enhanced by the application of immunohistochemistry. The second problem-crafting a successful treatment strategy-presents a much larger difficulty. It is tempting to extrapolate from experience with the (more common) pulmonary SCNC in search of a strategy applicable to laryngeal SCNC; such an extrapolation, however, may not be uniformly successful. I...
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This article summarises recommendations reached following systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa (EB). The guidelines... more
This article summarises recommendations reached following systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa (EB). The guidelines are intended to help inform decision-making by clinicians dealing with this complex complication of a devastating disease. This article is protected by copyright. All rights reserved.
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The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Health care... more
The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program "In Tune without Cords" (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and postintervention T1) on TLPs' uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed. HCPs of 6 out of 9 centers (67 % uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73 % uptake rate). Thirty-eight of these 55 TLPs used ITwC and...
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(18)F-fluoroazomycinarabinoside ((18)F-FAZA) is a promising hypoxia radiopharmaceutical agent with outstanding biokinetic parameters. We aimed to determine the accuracy of (18)F-FAZA-PET/CT scan in detecting hypoxic regions within the... more
(18)F-fluoroazomycinarabinoside ((18)F-FAZA) is a promising hypoxia radiopharmaceutical agent with outstanding biokinetic parameters. We aimed to determine the accuracy of (18)F-FAZA-PET/CT scan in detecting hypoxic regions within the tumor using immunohistochemical markers in a pilot study. Eleven patients with primary or recurrent laryngeal squamous cell carcinoma were indicated for total laryngectomy (TLE). Patients underwent (18)F-FAZA-PET/CT scan before TLE. Hypoxic regions inside the laryngeal tumor were determined. After TLE, regions with high uptake on (18)F-FAZA-PET scan were selected for immunohistochemical examination for exogenous (pimonidazole) and endogenous (HIF1α, CA-IX and GLUT-1) hypoxia markers. To assess the accuracy of (18)F-FAZA-PET scanning, radiopharmacon accumulation was related with immunohistochemical expression of hypoxia markers. Inter- and intratumoral heterogeneity of tumor hypoxia was observed on (18)F-FAZA-PET scan. Nine of the eleven tumors were hypoxic with (18)F-FAZA-PET. Hypoxia could also be detected with pimonidazole, HIF1α, CA-IX and GLUT-1 expression in some tumors. No clear association was observed between (18)F-FAZA uptake and hypoxia markers. This pilot study could not prove the accuracy of (18)F-FAZA-PET in determining hypoxic subvolumes in laryngeal cancer. Further study is required to investigate the benefit of (18)F-FAZA-PET imaging in radiotherapy planning.
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Research Interests: Pregnancy, Humans, Female, Clinical Sciences, Newborn Infant, and 9 morePublic health systems and services research, Circulation, Aneurysm, Respiratory Sounds, Recurrent laryngeal nerve, Pregnancy complications, Vocal cord paralysis, Cardiovascular medicine and haematology, and Remission Spontaneous
Laryngomalacia is the most common cause of dyspnea and stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In the... more
Laryngomalacia is the most common cause of dyspnea and stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In the past, different classification systems have been introduced. Until now no classification system is widely accepted and applied. Our goal is to provide a simple and complete classification system based on systematic literature search and our experiences. Retrospective cohort study with literature review. All patients with laryngomalacia under the age of 5 at time of diagnosis were included. Photo and video documentation was used to confirm diagnosis and characteristics of dynamic airway change. Outcome was compared with available classification systems in literature. Eighty-five patients were included. In contrast to other classification systems, only three typical different dynamic changes have been identified in our series. Two existing classificati...
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To evaluate the effects of a reduced nil per os (NPO) period after total laryngectomy (TLE) on general and wound related post-operative complications, swallowing function and duration of hospital stay. In a retrospective case-control... more
To evaluate the effects of a reduced nil per os (NPO) period after total laryngectomy (TLE) on general and wound related post-operative complications, swallowing function and duration of hospital stay. In a retrospective case-control study in 71 patients after TLE with primary closure (i e. without reconstruction with tissue transfer), complications and hospitalization in 36 patients who started oral feeding on day 3-5 (early feeding) were compared with 30 patients who started oral feeding on day 7-10 (late feeding). Incidence of complications, swallowing function and duration of hospitalization. There were no significant differences between the early and late feeding group in the occurrence of pharyngocutaneous fistulae, neopharyngeal stenosis or wound complications in general. Swallowing function was comparable for both groups. Mean overall hospitalization was 2 days shorter in the early feeding group (mean: 17,4 days) as compared to the late feeding group (mean: 19,4 days) (P <...
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Careful selection of patients eligible for extensive head and neck cancer surgery is extremely important. A reliable predictor for postoperative outcomes in the vulnerable elderly population is not yet available. The concept of frailty... more
Careful selection of patients eligible for extensive head and neck cancer surgery is extremely important. A reliable predictor for postoperative outcomes in the vulnerable elderly population is not yet available. The concept of frailty describes a clinical state of increased vulnerability and can be assessed by using frailty tests, like the Groningen Frailty Indicator (GFI). In the current study the influence of GFI-measured frailty on clinical outcome was investigated in elderly patients surgically treated for head and neck cancer. Retrospective, explorative cohort study. Tertiary referral center. 90 patients of 65 years and older receiving surgical treatment for head and neck cancer with different primary sites. The influence of frailty (GFI) on postoperative complications (Clavien-Dindo classification), subjective postoperative experience of both patient and surgeon and survival were analyzed. 36 patients were considered as frail (40%). Postoperative complications could not be pr...
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To define the optimal time point for the integration of hypoxia (18)F-FAZA-PET/CT information into radiotherapy treatment planning to benefit from hypoxia modification or dose escalation treatment. Therefore, we performed a prospective... more
To define the optimal time point for the integration of hypoxia (18)F-FAZA-PET/CT information into radiotherapy treatment planning to benefit from hypoxia modification or dose escalation treatment. Therefore, we performed a prospective cohort study, using serial hypoxic imaging ((18)F-FAZA-PET/CT) prior to and at several time-points during (chemo)radiotherapy (CHRT) in six head and neck squamous cell (HNSCC) and six non-small cell lung cancer (NSCLC) patients. The spatio-temporal dynamics of tumor hypoxia and fractional hypoxic volumes (FHV) were evaluated using a voxel-by-voxel analysis based on a (18)F-FAZA-T/B ratio of 1.4 at four time points in HNSCC patients, at baseline (FAZA-BL), at week one (FAZA-W1), two (FAZA-W2), and four (FAZA-W4) during CHRT and at three time points in NSCLC patients (baseline; W2, W4). Ten out of twelve patients showed a substantial pre-treatment tumor hypoxia representing a FHV⩾1.4 assessed by (18)F-FAZA-PET/CT. The median FHV was 38% (FAZA-BL), 15% (...
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Objectives: We describe our experience with the Groningen Dilatation Tracheoscope (Karl Storz GmbH & Co, Tuttlingen, Germany) in treating benign subglottic and tracheal stenosis. Methods: We performed a retrospective survey from a medical... more
Objectives: We describe our experience with the Groningen Dilatation Tracheoscope (Karl Storz GmbH & Co, Tuttlingen, Germany) in treating benign subglottic and tracheal stenosis. Methods: We performed a retrospective survey from a medical record analysis of 26 patients with different origins of benign, grade II (Myer-Cotton) subglottic or tracheal stenosis. All patients underwent dilatation tracheoscopy for a total of 64 times (average, 2.46 operations per patient). Five patients had to undergo subsequent operations. Patient data (sex, age at intervention, underlying and other systemic diseases) and operation data (course, intraoperative and postoperative adverse events) were recorded. Analysis of the measured preoperative and postoperative peak flow values was performed. Results: The average predilatation and postdilatation peak flow values were 225 L/min and 331 L/min, respectively Eighty percent of the patients (21 of 26) were successfully treated with 1 or more dilatation trache...
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Surgical treatment of head and neck cancer often results in complex defects requiring reconstruction with microvascular free tissue transfer. However, in elderly patients, curative treatment with radical surgery and free flap... more
Surgical treatment of head and neck cancer often results in complex defects requiring reconstruction with microvascular free tissue transfer. However, in elderly patients, curative treatment with radical surgery and free flap reconstruction is often withheld. The objective of this study is to assess the outcomes of free flap surgery in elderly patients, using a standard surgical complication classification system. A retrospective review was conducted of patients who underwent primary free flap reconstruction following major surgery for head and neck cancer between 1995 and 2010. Complications were assessed using the Clavien Dindo classification system, and grades III-V were classified as major complications. Comorbidity was classified according to the adult comorbidity evaluation index 27. A comparison was done between patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;70 and ≥70 years. Two hundred-two patients were included in this study. Multivariate analysis showed that only disease stage was a significant predictor of recipient site complications, and comorbidity was the only significant predictor of medical complications. Age was not a predictor of complications. There were no significant differences in disease specific or overall survival between young and elderly patients. Optimal patient selection for free flap surgery is essential. This requires thorough pre-operative assessment, including analysis of comorbidity in both young and elderly patients. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; biological age, and not chronological age, should be individually determined to assess feasibility of major surgery. Patients should not be denied surgery based on age alone.
Research Interests: Survival Analysis, Treatment Outcome, Risk assessment, Comorbidity, Humans, and 15 moreFemale, Male, Netherlands, Clinical Sciences, Aged, Retrospective Studies, Prognosis, Geriatric Assessment, Risk Assessment, Postoperative Complications, Patient selection, Neoplasm staging, free tissue flaps, Head and neck neoplasms, and Reconstructive Surgical Procedures
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The prevalence of sensorineural hearing loss is increasing worldwide, mainly due to ageing, increased noise exposure and cardiovascular risk factors. Several papers dealt with the mechanisms underlying the primary causes of impaired... more
The prevalence of sensorineural hearing loss is increasing worldwide, mainly due to ageing, increased noise exposure and cardiovascular risk factors. Several papers dealt with the mechanisms underlying the primary causes of impaired hearing and eventual deafness, including the damage and loss of auditory hair cells; however, very little is known about the protective mechanisms that exist for hearing. Several recent investigations have implicated dopamine (DA) in a neuroprotective circuit for the cochlea. The lateral olivocochlear (LOC) efferents provide axonal innervation of the inner hair cell afferent synapses and release DA and other substances in response to different stimuli. Under ischemic conditions or during noise exposure, DA has been proven to play a neuroprotective role against glutamate excitotoxicity. This review summarises what is currently known about the modulation of DA release in the cochlea, using primarily in vitro experimental data. Based on recent knowledge, there could be two functional subgroups within the LOC fibres, i.e., the DA- and GABA-containing projections. In this review, we attempt to show the neurochemical interactions between these two subsystems. Other aspects of cochlear neurotransmission are also discussed to provide a complete picture of cochlear dopaminergic function in physiological and pathophysiological cases with particular reference to excitotoxicity.
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Aminoglycoside ototoxicity is a well-documented process via several pathophysiological pathways. The protective role of cochlear dopamine, released from the lateral olivocochlear efferents, was implicated previously in case of ischemia or... more
Aminoglycoside ototoxicity is a well-documented process via several pathophysiological pathways. The protective role of cochlear dopamine, released from the lateral olivocochlear efferents, was implicated previously in case of ischemia or acoustic trauma, as it postsynaptically inhibits the effect of excessively released glutamate from the hair cells. In our in vitro superfusion experiments we showed that neomycin dose- dependently inhibits the dopamine release from isolated guinea pig cochlea, while gentamicin and kanamycin was ineffective on it. After chronic application of neomycin the dopamine outflow did not change significantly, suggesting an adaptive process. In our experiments we have found a possibly new action site of one of the aminoglycoside antibiotics, neomycin.
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Sinonasal malignancies are uncommon neoplasms with several histological subtypes, most commonly treated with surgery and postoperative radiotherapy. The aim of this study was to evaluate complications and survival, focusing on differences... more
Sinonasal malignancies are uncommon neoplasms with several histological subtypes, most commonly treated with surgery and postoperative radiotherapy. The aim of this study was to evaluate complications and survival, focusing on differences between elderly and younger patients undergoing surgery. Historical cohort based on medical records. Tertial referral center. Medical charts of 103 surgically treated patients (71 patients younger than 70 years and 32 patients aged 70 years and older) in a tertiary referral center with sinonasal malignancy were retrospectively analyzed. Comorbidity was scored according to the Adult Comorbidity Evaluation 27 system. Treatment outcomes were analyzed by collecting treatment-related complications scores and survival data. Although comorbidity was more common in elderly patients, no significant differences were recorded in complications. In multivariate analysis, length of surgery was the only predictor for complication. Furthermore, no significant differences were seen in disease-specific survival and recurrence in young and elderly patients. Young patients with malignant epithelial tumors and melanoma had worse overall survival than patients with other histological subtypes. However, in elderly patients, no significant differences were seen in survival between histological subtypes. For complications, survival, and recurrence, no differences were seen between young and elderly patients. Based on this study, surgery can also be safely performed in elderly sinonasal cancer patients after careful preoperative evaluation and patient selection.