Objective: Treatment advances have evolved to prolong the duration of life in lateral skull base ... more Objective: Treatment advances have evolved to prolong the duration of life in lateral skull base tumor patients, but focus is now being placed more on quality of life. The aim of this study was to help elucidate the quality of life in participants following treatment for lateral skull base tumors. Method: A total of 21 participants agreed to take part in the study. Each completed a semistructured interview, focusing on quality of life following radiotherapy or surgical treatment for different lateral skull base tumor diagnoses. Interviews were recorded and transcribed verbatim, with a thematic analysis of the transcripts undertaken. Results: Four overriding themes were identified and labeled: 1) perceptions of quality of life and coping strategies; 2) impact of specific symptoms on daily life activities; 3) initial recovery period posttreatment; 4) information surrounding treatment and administration. The majority of participants reported an indifferent or positive impact of treatment on quality of life, with various coping mechanisms such as adjustment, thinking positively, and selective attention used to deal with stressors. Many participants described frustration and concern at the lack of information surrounding management; however, others were aware of the risks of excessive information and tentative of receiving more. Conclusion: Adjustment following treatment could possibly support the phenomena of cognitive adaptation or response shift. The positive role of social support and lack of information has highlighted the need for more support in this cohort of patients, but crucially within a patient-centered holisitc framework. Implications for a tailored quality of life tool are discussed.
Liquid sclerotherapy, laser and surgery have been used in the treatment of head and neck vascular... more Liquid sclerotherapy, laser and surgery have been used in the treatment of head and neck vascular anomalies with variable success for many years. A multidisciplinary team consisting of plastic surgery, maxillofacial surgery and interventional radiology currently treats such lesions by converting liquid sclerosant into foam. Foam sclerotherapy is currently used successfully to treat varicosities of the lower limbs and in this study, we present four cases in which 3% sodium tetradecyl sulfate has been used to treat low-flow vascular malformations in the head and neck.
International Journal of Oral and Maxillofacial Surgery, 2011
In the modern implantology, bone grafting has become a frequent procedure to reconstruct alveolar... more In the modern implantology, bone grafting has become a frequent procedure to reconstruct alveolar bone resorption and defects in edentulous areas. The aim of this prospective clinical study was to evaluate the viability of a new bone graft technique using autogenous bone block, kept in place by the strength of soft tissue and periosteum, to increase width in the partial edentulous maxilla, to allow the installation of dental implants. Bone graft procedures were realized in 29 patients, using onlay bone block with subperiosteal tunneling technique in 41 atrophic edentulous areas. Clinical biometry using digital calipers and photographs data were taken. The main analyzed aspect was the bone augmentation aiming implant placement. The follow up period ranged from 5 to 9 months when implants were installed. Aspects concerning soft tissue healing, technical facility comparing to conventional techniques and the behavior of bone blocks grafted with no fixation devices were observed. The one-way analyses of variance (ANOVA), following by Tukey's test, demonstrated a significant difference (p < 0.05) for the initial average measurements (2.95 mm + −0.79) and final average measurements (6.64 mm + −0.99), with resorption rate of 6.21% after the bone repair period. The success rate for this technique was 97.5% (1 failure out of 41 grafted areas). The results of this study demonstrated that the subperiosteal tunneling technique promoted good bone graft healing, with less resorption rate when comparing to conventional techniques, using a much more simple technique, with less surgical time, morbidity and minor costs.
IW, Heyndrickx GR. Pretreatment of adult bone marrow mesenchymal stem cells with cardiomyogenic g... more IW, Heyndrickx GR. Pretreatment of adult bone marrow mesenchymal stem cells with cardiomyogenic growth factors and repair of the chronically infarcted myocardium. The in vivo cardiac differentiation and functional effects of unmodified adult bone marrow mesenchymal stem cells (MSCs) after myocardial infarction (MI) is controversial. We postulated that ex vivo pretreatment of autologous MSCs using cardiomyogenic growth factors will lead to cardiomyogenic specification and will result in superior biological and functional effects on cardiac regeneration of chronically infarcted myocardium. We used a chronic dog MI model generated by ligation of the coronary artery (n ϭ 30). Autologous dog bone marrow MSCs were isolated, culture expanded, and specified into a cardiac lineage by adding growth factors, including basic FGF, IGF-1, and bone morphogenetic protein-2. Dogs underwent cell injection Ͼ8 wk after the infarction and were randomized into two groups. Group A dogs (n ϭ 20) received MSCs specified with growth factors (147 Ϯ 96 ϫ 10 6 ), and group B (n ϭ 10) received unmodified MSCs (168 Ϯ 24 ϫ 10 6 ). After the growth factor treatment, MSCs stained positive for the early muscle and cardiac markers desmin, antimyocyte enhancer factor-2, and Nkx2-5. In group A dogs, prespecified MSCs colocalized with troponin I and cardiac myosin. At 12 wk, group A dogs showed a significantly larger increase in regional wall thickening of the infarcted territory (from 22 Ϯ 8 to 32 Ϯ 6% in group A; P Ͻ 0.05 vs. baseline and group B, and from 19 Ϯ 7 to 21 Ϯ 7% in group B, respectively) and a decrease in the wall motion score index (from 1.60 Ϯ 0.05 to 1.35 Ϯ 0.03 in group A; P Ͻ 0.05 vs. baseline and group B, and from 1.58 Ϯ 0.07 vs. 1.56 Ϯ 0.08 in group B, respectively). The biological ex vivo cardiomyogenic specification of adult MSCs before their transplantation is feasible and appears to improve their in vivo cardiac differentiation as well as the functional recovery in a dog model of the chronically infarcted myocardium. cardiac repair; myogenesis; chronic myocardial infarction; heart failure SEVERAL CELL TYPES HAVE BEEN utilized in the regeneration of damaged heart tissue (2, 4, 9, 11, 13, 16 -18, 23-25). After transplantation to the damaged heart, skeletal myoblasts dif-Address for reprint requests and other correspondence: J. Bartunek,
Oral epithelial dysplasia grading is currently recognised as the most useful prognostic indicator... more Oral epithelial dysplasia grading is currently recognised as the most useful prognostic indicator for predicting conversion of potentially malignant disorders of the oral cavity to squamous cell carcinoma. It is also used as a basis for deciding management options. However, the diagnosis of oral epithelial dysplasia is subjective and thus unreliable. Surgery is currently recommended for removal of high-risk lesions; however, the evidence for its success is lacking, and in some cases, there have been reports of increased recurrence of malignancy following surgical excision. Molecular and genetic markers have been identified and show promising results in identifying which potential malignant disorders are at risk of malignant transformation. The current evidence available for prognosis of potential malignant disorders and its treatment is based on observational and retrospective data. No randomised control trials have been conducted to date to assess the efficacy of surgery in oral epithelial dysplasia. Until good quality evidence is available from well-designed randomised control trials, experts still recommend the surgical removal of potential malignant disorders which are regarded as high risk.
The first two cases of fructose-1,6-diphosphatase (FDPase) deficiency from the Middle East have b... more The first two cases of fructose-1,6-diphosphatase (FDPase) deficiency from the Middle East have been diagnosed on leukocytes using a spectrophotometric assay and a new radiochemical technique. The control mean for FDPase measured by the spectrophotometric assay was 178.2 nm mg-1 h-1 (n = 12), 66.8 nm mg-1 h-1 for obligate heterozygotes (n = 4) and non-detectable in the two patients. By the radiochemical assay the values were controls, 103.3; heterozygotes, 20.6; patients, 0.46 and 3.5 nm mg-1 h-1. Using both methods it was possible to identify two certain FDPase heterozygotes and three non-carriers in the family of one of the probands. The radiochemical method was found to be more effective in differentiating heterozygotes from controls than the spectrophotometric method. However, either technique may be conveniently used for the diagnosis of FDPase deficiency in leukocytes.
The exposure rates due to external gamma radiation were measured in 11 Iraqi governerates. Measur... more The exposure rates due to external gamma radiation were measured in 11 Iraqi governerates. Measurements were performed with an Environmental Monitoring System (RSS-111) in open air 1 m above the ground. The average absorbed dose rate in each governerate was as follows (number x 10(-2) microGy h-1): Babylon (6.0), Kerbala (5.3), Al-Najaf (5.4), Al-Kadysia (6.5), Wasit (6.5), Diala (6.5), Al-Anbar (6.5), Al-Muthana (6.6), Maisan (6.8), Thee-Kar (6.6), and Al-Basrah (6.5). The collective doses to the population living in these governerates were 499, 187, 239, 269, 262, 458, 384, 153, 250, 450, and 419 person-Sv, respectively.
Heart failure is a cause of pulmonary vasoconstriction and remodelling, leading to pulmonary hype... more Heart failure is a cause of pulmonary vasoconstriction and remodelling, leading to pulmonary hypertension (PH) and decreased survival. The pathobiology of PH in heart failure remains incompletely understood. We investigated pulmonary vascular function and signalling molecules in early stage PH secondary to experimental heart failure. Eight beagle dogs with overpacing-induced heart failure underwent haemodynamic assessment and postmortem pulmonary arterial reactivity, morphometry and quantification of genes encoding for factors involved in vascular reactivity and remodelling: endothelin-1 (ET-1), ETA and ETB receptors, vascular endothelial growth factor (VEGF), VEGF receptors 1 and 2 (VEGFR1 and VEGFR2), endothelial nitric oxide synthase, angiopoietin-1, bone morphogenetic protein receptors (BMPR1A and BMPR2), serotonin transporter (5-HTT) and the 5-HT(2B) receptor. Overpacing was associated with a decrease in cardiac output and an increase in pulmonary vascular pressures. However, there were no changes in pulmonary vascular resistance or in arteriolar medial thickness. There were increased expressions of genes encoding for ET-1, ETB, VEGF and VEGFR2, while expression of the other genes analysed remained unchanged. In vitro, pulmonary arteries showed decreased relaxation and increased reactivity, while systemic mammary arteries were unaffected. Early PH in heart failure is characterized by altered vasoreactivity and increased ET-1/ETB and VEGF/VEGFR2 signalling.
British Journal of Oral and Maxillofacial Surgery, 2009
We report the case of a 73-year-old woman who developed multiple self-healing squamous cell carci... more We report the case of a 73-year-old woman who developed multiple self-healing squamous cell carcinomas over a 6-year period. Some were excised and others resolved spontaneously.
British Journal of Oral and Maxillofacial Surgery, 2010
invasive with few complications. USCB, unlike FNAC, does not provide immediate results but does p... more invasive with few complications. USCB, unlike FNAC, does not provide immediate results but does permit grading and typing of carcinomas and improved diagnosis of lymphoid proliferation. This potentially reduces the number of patients requiring surgical intervention. The accuracy of FNAC decreases without experienced on-site cytologists. Therefore, USCB is increasingly the mainstay of tissue sampling and also due to its lower false negative rate and improved diagnostic yield is likely to increase in head and neck cancers. We present a series of cases with histological confirmation demonstrating the improved diagnostic yield of combining the 3 diagnostic methods. Conclusion: Triple assessment of palpable parotid lesions is recommended with correlation of clinical, sonographic, and histological findings. FNAC and USCB are both efficient to confirm diagnosis, although USCB does have potential advantages. 25 TGF-b in scarless wound healing -myth or reality: a literature review A. Ujam, I. Al-Hadad, R. Grose. Barts and The London NHS Trust Hospitals, UK Aims: Scar formation following trauma can have devastating consequences causing physiological and psychosocial concerns.
Objective: Treatment advances have evolved to prolong the duration of life in lateral skull base ... more Objective: Treatment advances have evolved to prolong the duration of life in lateral skull base tumor patients, but focus is now being placed more on quality of life. The aim of this study was to help elucidate the quality of life in participants following treatment for lateral skull base tumors. Method: A total of 21 participants agreed to take part in the study. Each completed a semistructured interview, focusing on quality of life following radiotherapy or surgical treatment for different lateral skull base tumor diagnoses. Interviews were recorded and transcribed verbatim, with a thematic analysis of the transcripts undertaken. Results: Four overriding themes were identified and labeled: 1) perceptions of quality of life and coping strategies; 2) impact of specific symptoms on daily life activities; 3) initial recovery period posttreatment; 4) information surrounding treatment and administration. The majority of participants reported an indifferent or positive impact of treatment on quality of life, with various coping mechanisms such as adjustment, thinking positively, and selective attention used to deal with stressors. Many participants described frustration and concern at the lack of information surrounding management; however, others were aware of the risks of excessive information and tentative of receiving more. Conclusion: Adjustment following treatment could possibly support the phenomena of cognitive adaptation or response shift. The positive role of social support and lack of information has highlighted the need for more support in this cohort of patients, but crucially within a patient-centered holisitc framework. Implications for a tailored quality of life tool are discussed.
Liquid sclerotherapy, laser and surgery have been used in the treatment of head and neck vascular... more Liquid sclerotherapy, laser and surgery have been used in the treatment of head and neck vascular anomalies with variable success for many years. A multidisciplinary team consisting of plastic surgery, maxillofacial surgery and interventional radiology currently treats such lesions by converting liquid sclerosant into foam. Foam sclerotherapy is currently used successfully to treat varicosities of the lower limbs and in this study, we present four cases in which 3% sodium tetradecyl sulfate has been used to treat low-flow vascular malformations in the head and neck.
International Journal of Oral and Maxillofacial Surgery, 2011
In the modern implantology, bone grafting has become a frequent procedure to reconstruct alveolar... more In the modern implantology, bone grafting has become a frequent procedure to reconstruct alveolar bone resorption and defects in edentulous areas. The aim of this prospective clinical study was to evaluate the viability of a new bone graft technique using autogenous bone block, kept in place by the strength of soft tissue and periosteum, to increase width in the partial edentulous maxilla, to allow the installation of dental implants. Bone graft procedures were realized in 29 patients, using onlay bone block with subperiosteal tunneling technique in 41 atrophic edentulous areas. Clinical biometry using digital calipers and photographs data were taken. The main analyzed aspect was the bone augmentation aiming implant placement. The follow up period ranged from 5 to 9 months when implants were installed. Aspects concerning soft tissue healing, technical facility comparing to conventional techniques and the behavior of bone blocks grafted with no fixation devices were observed. The one-way analyses of variance (ANOVA), following by Tukey's test, demonstrated a significant difference (p < 0.05) for the initial average measurements (2.95 mm + −0.79) and final average measurements (6.64 mm + −0.99), with resorption rate of 6.21% after the bone repair period. The success rate for this technique was 97.5% (1 failure out of 41 grafted areas). The results of this study demonstrated that the subperiosteal tunneling technique promoted good bone graft healing, with less resorption rate when comparing to conventional techniques, using a much more simple technique, with less surgical time, morbidity and minor costs.
IW, Heyndrickx GR. Pretreatment of adult bone marrow mesenchymal stem cells with cardiomyogenic g... more IW, Heyndrickx GR. Pretreatment of adult bone marrow mesenchymal stem cells with cardiomyogenic growth factors and repair of the chronically infarcted myocardium. The in vivo cardiac differentiation and functional effects of unmodified adult bone marrow mesenchymal stem cells (MSCs) after myocardial infarction (MI) is controversial. We postulated that ex vivo pretreatment of autologous MSCs using cardiomyogenic growth factors will lead to cardiomyogenic specification and will result in superior biological and functional effects on cardiac regeneration of chronically infarcted myocardium. We used a chronic dog MI model generated by ligation of the coronary artery (n ϭ 30). Autologous dog bone marrow MSCs were isolated, culture expanded, and specified into a cardiac lineage by adding growth factors, including basic FGF, IGF-1, and bone morphogenetic protein-2. Dogs underwent cell injection Ͼ8 wk after the infarction and were randomized into two groups. Group A dogs (n ϭ 20) received MSCs specified with growth factors (147 Ϯ 96 ϫ 10 6 ), and group B (n ϭ 10) received unmodified MSCs (168 Ϯ 24 ϫ 10 6 ). After the growth factor treatment, MSCs stained positive for the early muscle and cardiac markers desmin, antimyocyte enhancer factor-2, and Nkx2-5. In group A dogs, prespecified MSCs colocalized with troponin I and cardiac myosin. At 12 wk, group A dogs showed a significantly larger increase in regional wall thickening of the infarcted territory (from 22 Ϯ 8 to 32 Ϯ 6% in group A; P Ͻ 0.05 vs. baseline and group B, and from 19 Ϯ 7 to 21 Ϯ 7% in group B, respectively) and a decrease in the wall motion score index (from 1.60 Ϯ 0.05 to 1.35 Ϯ 0.03 in group A; P Ͻ 0.05 vs. baseline and group B, and from 1.58 Ϯ 0.07 vs. 1.56 Ϯ 0.08 in group B, respectively). The biological ex vivo cardiomyogenic specification of adult MSCs before their transplantation is feasible and appears to improve their in vivo cardiac differentiation as well as the functional recovery in a dog model of the chronically infarcted myocardium. cardiac repair; myogenesis; chronic myocardial infarction; heart failure SEVERAL CELL TYPES HAVE BEEN utilized in the regeneration of damaged heart tissue (2, 4, 9, 11, 13, 16 -18, 23-25). After transplantation to the damaged heart, skeletal myoblasts dif-Address for reprint requests and other correspondence: J. Bartunek,
Oral epithelial dysplasia grading is currently recognised as the most useful prognostic indicator... more Oral epithelial dysplasia grading is currently recognised as the most useful prognostic indicator for predicting conversion of potentially malignant disorders of the oral cavity to squamous cell carcinoma. It is also used as a basis for deciding management options. However, the diagnosis of oral epithelial dysplasia is subjective and thus unreliable. Surgery is currently recommended for removal of high-risk lesions; however, the evidence for its success is lacking, and in some cases, there have been reports of increased recurrence of malignancy following surgical excision. Molecular and genetic markers have been identified and show promising results in identifying which potential malignant disorders are at risk of malignant transformation. The current evidence available for prognosis of potential malignant disorders and its treatment is based on observational and retrospective data. No randomised control trials have been conducted to date to assess the efficacy of surgery in oral epithelial dysplasia. Until good quality evidence is available from well-designed randomised control trials, experts still recommend the surgical removal of potential malignant disorders which are regarded as high risk.
The first two cases of fructose-1,6-diphosphatase (FDPase) deficiency from the Middle East have b... more The first two cases of fructose-1,6-diphosphatase (FDPase) deficiency from the Middle East have been diagnosed on leukocytes using a spectrophotometric assay and a new radiochemical technique. The control mean for FDPase measured by the spectrophotometric assay was 178.2 nm mg-1 h-1 (n = 12), 66.8 nm mg-1 h-1 for obligate heterozygotes (n = 4) and non-detectable in the two patients. By the radiochemical assay the values were controls, 103.3; heterozygotes, 20.6; patients, 0.46 and 3.5 nm mg-1 h-1. Using both methods it was possible to identify two certain FDPase heterozygotes and three non-carriers in the family of one of the probands. The radiochemical method was found to be more effective in differentiating heterozygotes from controls than the spectrophotometric method. However, either technique may be conveniently used for the diagnosis of FDPase deficiency in leukocytes.
The exposure rates due to external gamma radiation were measured in 11 Iraqi governerates. Measur... more The exposure rates due to external gamma radiation were measured in 11 Iraqi governerates. Measurements were performed with an Environmental Monitoring System (RSS-111) in open air 1 m above the ground. The average absorbed dose rate in each governerate was as follows (number x 10(-2) microGy h-1): Babylon (6.0), Kerbala (5.3), Al-Najaf (5.4), Al-Kadysia (6.5), Wasit (6.5), Diala (6.5), Al-Anbar (6.5), Al-Muthana (6.6), Maisan (6.8), Thee-Kar (6.6), and Al-Basrah (6.5). The collective doses to the population living in these governerates were 499, 187, 239, 269, 262, 458, 384, 153, 250, 450, and 419 person-Sv, respectively.
Heart failure is a cause of pulmonary vasoconstriction and remodelling, leading to pulmonary hype... more Heart failure is a cause of pulmonary vasoconstriction and remodelling, leading to pulmonary hypertension (PH) and decreased survival. The pathobiology of PH in heart failure remains incompletely understood. We investigated pulmonary vascular function and signalling molecules in early stage PH secondary to experimental heart failure. Eight beagle dogs with overpacing-induced heart failure underwent haemodynamic assessment and postmortem pulmonary arterial reactivity, morphometry and quantification of genes encoding for factors involved in vascular reactivity and remodelling: endothelin-1 (ET-1), ETA and ETB receptors, vascular endothelial growth factor (VEGF), VEGF receptors 1 and 2 (VEGFR1 and VEGFR2), endothelial nitric oxide synthase, angiopoietin-1, bone morphogenetic protein receptors (BMPR1A and BMPR2), serotonin transporter (5-HTT) and the 5-HT(2B) receptor. Overpacing was associated with a decrease in cardiac output and an increase in pulmonary vascular pressures. However, there were no changes in pulmonary vascular resistance or in arteriolar medial thickness. There were increased expressions of genes encoding for ET-1, ETB, VEGF and VEGFR2, while expression of the other genes analysed remained unchanged. In vitro, pulmonary arteries showed decreased relaxation and increased reactivity, while systemic mammary arteries were unaffected. Early PH in heart failure is characterized by altered vasoreactivity and increased ET-1/ETB and VEGF/VEGFR2 signalling.
British Journal of Oral and Maxillofacial Surgery, 2009
We report the case of a 73-year-old woman who developed multiple self-healing squamous cell carci... more We report the case of a 73-year-old woman who developed multiple self-healing squamous cell carcinomas over a 6-year period. Some were excised and others resolved spontaneously.
British Journal of Oral and Maxillofacial Surgery, 2010
invasive with few complications. USCB, unlike FNAC, does not provide immediate results but does p... more invasive with few complications. USCB, unlike FNAC, does not provide immediate results but does permit grading and typing of carcinomas and improved diagnosis of lymphoid proliferation. This potentially reduces the number of patients requiring surgical intervention. The accuracy of FNAC decreases without experienced on-site cytologists. Therefore, USCB is increasingly the mainstay of tissue sampling and also due to its lower false negative rate and improved diagnostic yield is likely to increase in head and neck cancers. We present a series of cases with histological confirmation demonstrating the improved diagnostic yield of combining the 3 diagnostic methods. Conclusion: Triple assessment of palpable parotid lesions is recommended with correlation of clinical, sonographic, and histological findings. FNAC and USCB are both efficient to confirm diagnosis, although USCB does have potential advantages. 25 TGF-b in scarless wound healing -myth or reality: a literature review A. Ujam, I. Al-Hadad, R. Grose. Barts and The London NHS Trust Hospitals, UK Aims: Scar formation following trauma can have devastating consequences causing physiological and psychosocial concerns.
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