326 oral Cancer in the oropharynx: can we prioritize treatment modalities based on costs of primary treatment, anticipated locoregional relapse rates and grade III/IV complications?

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

Download Full-text

Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review

Journal of Clinical Medicine ◽

10.3390/jcm10153307 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3307

Author(s):

Aleksandra Zgryźniak ◽

Joanna Przeździecka-Dołyk ◽

Marek Szaliński ◽

Anna Turno-Kręcicka

Keyword(s):

Ocular Hypertension ◽

Laser Energy ◽

Open Angle Glaucoma ◽

Biological Effects ◽

Primary Treatment ◽

Treatment Modalities ◽

Complication Rates ◽

Open Angle ◽

Selective Laser Trabeculoplasty ◽

Laser Trabeculoplasty

Selective laser trabeculoplasty (SLT) is a glaucoma treatment that reduces intraocular pressure (IOP). Its mechanism is based on the biological effects of the selective application of laser energy to pigmented trabecular meshwork (TM) cells, resulting in increased outflow facility. Herein, we review current publications on SLT and summarize its efficacy and safety for different indications in open-angle glaucoma (OAG) and ocular hypertension (OHT) treatment. SLT effectively reduces IOP when used as a primary treatment. In patients whose IOP is medically controlled, SLT helps to reduce medication use, and when maximally tolerated topical therapy is ineffective, SLT facilitates the realization of the target IOP. SLT is a repeatable procedure for which the vast majority of complications are mild and self-limiting. With effective IOP reduction, low complication rates and the potential to repeat the procedure, SLT offers the possibility of delaying the introduction of medical therapy and other more invasive treatment modalities while simultaneously avoiding the accompanying complications. With this knowledge, we suggest that SLT be considered as an essential primary treatment option in OAG and OHT, switching to other treatment modalities only when laser procedures are insufficient for achieving the required target IOP.

Download Full-text

Evaluation of outcome in open and stapler haemorrhoidectomy in grade III/IV haemorrhoids

International Surgery Journal ◽

10.18203/2349-2902.isj20204125 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3294

Author(s):

Manju Singh ◽

Amit Agarwal ◽

Kush Pandey

Keyword(s):

Postoperative Bleeding ◽

Treatment Modalities ◽

Stapled Haemorrhoidopexy ◽

College Hospital ◽

Duration Of Surgery ◽

Operative Complications ◽

Hospital Stays ◽

Grade Iii ◽

Post Operative Complications

Background: Haemorrhoids are one of most common benign anorectal malformation worldwide. There are various surgical treatment modalities for 3rd and 4th degree haemorrhoids. Open haemorrhoidectomy was the most widely practiced and is considered the current gold standard. In search of a newer surgical technique, stapler has been introduced for haemorrhoidectomy and has revolutionised operative procedures over the last decade world-wide due to its ease and simplicity and lesser post-operative complications. The following study was done to evaluate the outcome of open versus stapled haemorrhoidectomy in terms of post-operative pain, postoperative bleeding, duration of surgery, duration of hospital stays in a medical college hospital at Raipur, Chhattisgarh.Methods: This was a prospective follow-up study, in patients undergoing surgery for grade III/IV haemorrhoids conducted in the Department of Surgery, Dr BRAM Hospital, Raipur, from August 2017 to July 2018. Fourteen patients underwent stapled haemorrhoidopexy and eighteen underwent open haemorrhoidectomy. All patients were reviewed immediately after surgery, at discharge and at 1, 3 and 10 weeks post-operatively. The two groups were compared for post-operative outcomes and complications.Results: The majority of patients in the study were males and had grade 4 haemorrhoids. Stapled haemorrhoidopexy group had shorter duration of surgery, less postoperative pain, shorter duration of hospital stays as compared with open haemorrhoidectomy group. There were no major post-operative complications in the follow up period of 10 weeks in the stapled group.Conclusions: Stapled haemorrhoidopexy is a safer alternative to open haemorrhoidectomy with many short-term benefits.

Download Full-text

13-gene DNA Methylation Analysis from Oral Brushing: A Promising Non Invasive Tool in the Follow-up of Oral Cancer Patients

Journal of Clinical Medicine ◽

10.3390/jcm8122107 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2107 ◽

Cited By ~ 4

Author(s):

Davide B. Gissi ◽

Achille Tarsitano ◽

Andrea Gabusi ◽

Roberto Rossi ◽

Giuseppe Attardo ◽

...

Keyword(s):

Dna Methylation ◽

Oral Cancer ◽

Cancer Treatment ◽

Sample Collection ◽

Methylation Analysis ◽

Non Invasive ◽

Locoregional Relapse ◽

Positive Score ◽

Dna Methylation Analysis

Background: This study aimed to evaluate the prognostic value of a non-invasive sampling procedure based on 13-gene DNA methylation analysis in the follow-up of patients previously treated for oral squamous cell carcinoma (OSCC). Methods: The study population included 49 consecutive patients treated for OSCC. Oral brushing sample collection was performed at two different times: before any cancer treatment in the tumor mass and during patient follow-up almost 6 months after OSCC treatment, within the regenerative area after OSCC resection. Each sample was considered positive or negative in relation to a predefined cut-off value. Results: Before any cancer treatment, 47/49 specimens exceeded the score and were considered as positive. Six months after OSCC resection, 16/49 specimens also had positive scores in the samples collected from the regenerative area. During the follow-up period, 7/49 patients developed locoregional relapse: 6/7 patients had a positive score in the regenerative area after OSCC resection. The presence of a positive score after oral cancer treatment was the most powerful variable related to the appearance of locoregional relapse. Conclusion: 13-gene DNA methylation analysis by oral brushing may have a clinical application as a prognostic non-invasive tool in the follow-up of patients surgically treated for OSCC.

Download Full-text

Postherpetic Nneuralgia: Review of Treatment Modalities

Pain Research and Management ◽

10.1155/2000/370945 ◽

2000 ◽

Vol 5 (1) ◽

pp. 69-74 ◽

Cited By ~ 1

Author(s):

Philip SL Chan ◽

Alexander J Clark

Keyword(s):

Postherpetic Neuralgia ◽

Tricyclic Antidepressants ◽

Opioid Analgesics ◽

Primary Treatment ◽

Treatment Modalities ◽

Nerve Blocks ◽

Varicella Zoster ◽

Primary Treatment Modality ◽

Topical Medications ◽

Physical Modalities

BACKGROUND: Varicella zoster virus (VZV) is the etiological agent for both varicella (chickenpox) and herpes zoster (HZ) (shingles). HZ results from the reactivation of VZV acquired during childhood. Postherpetic neuralgia (PHN) is the most common complication of HZ infection in immunocompetent patients. There is no universally accepted definition of PHN. While the mechanisms producing pain associated with PHN are not fully understood, peripheral and central processes are thought to be important.METHODS: The literature on the pathophysiology and the treatment of postherpetic neuralgia was reviewed for the past 30 years by using Index Medicus.CONCLUSIONS: Many modalities to treat PHN are available; none of them are very effective. The most commonly used modalities are tricyclic antidepressants, anticonvulsants, opioid analgesics, topical medications, physical modalities such as acupuncture and transcutaneous nerve stimulation, and nerve blocks. The tricyclic antidepressants have the most evidence supporting their role in treating PHN, although only half of the patients with PHN benefit. Recent studies support the use of opioid analgesics in PHN. There is a growing body of evidence in support of the use of gabapentin for PHN. Physical modalities and topical medications are probably most useful as adjuncts to centrally acting agents, not as a primary treatment modality. Injections (nerve blocks) are effective in relieving PHN anecdotally, although there are no controlled clinical trials showing efficacy.

Download Full-text

Targeting AKT/mTOR in Oral Cancer: Mechanisms and Advances in Clinical Trials

International Journal of Molecular Sciences ◽

10.3390/ijms21093285 ◽

2020 ◽

Vol 21 (9) ◽

pp. 3285 ◽

Cited By ~ 5

Author(s):

Choudhary Harsha ◽

Kishore Banik ◽

Hui Li Ang ◽

Sosmitha Girisa ◽

Rajesh Vikkurthi ◽

...

Keyword(s):

Oral Cancer ◽

Epithelial To Mesenchymal Transition ◽

Mammalian Target Of Rapamycin ◽

Mtor Inhibitors ◽

Mtor Pathway ◽

Mtor Signaling ◽

Therapeutic Interventions ◽

Treatment Modalities ◽

Disease Heterogeneity ◽

Mesenchymal Transition

Oral cancer (OC) is a devastating disease that takes the lives of lots of people globally every year. The current spectrum of treatment modalities does not meet the needs of the patients. The disease heterogeneity demands personalized medicine or targeted therapies. Therefore, there is an urgent need to identify potential targets for the treatment of OC. Abundant evidence has suggested that the components of the protein kinase B (AKT)/ mammalian target of rapamycin (mTOR) pathway are intrinsic factors for carcinogenesis. The AKT protein is central to the proliferation and survival of normal and cancer cells, and its downstream protein, mTOR, also plays an indispensable role in the cellular processes. The wide involvement of the AKT/mTOR pathway has been noted in oral squamous cell carcinoma (OSCC). This axis significantly regulates the various hallmarks of cancer, like proliferation, survival, angiogenesis, invasion, metastasis, autophagy, and epithelial-to-mesenchymal transition (EMT). Activated AKT/mTOR signaling is also associated with circadian signaling, chemoresistance and radio-resistance in OC cells. Several miRNAs, circRNAs and lncRNAs also modulate this pathway. The association of this axis with the process of tumorigenesis has culminated in the identification of its specific inhibitors for the prevention and treatment of OC. In this review, we discussed the significance of AKT/mTOR signaling in OC and its potential as a therapeutic target for the management of OC. This article also provided an update on several AKT/mTOR inhibitors that emerged as promising candidates for therapeutic interventions against OC/head and neck cancer (HNC) in clinical studies.

Download Full-text

Submandibular Gland Invasion by Oral Cavity Cancers: A Systematic Review

Otolaryngology ◽

10.1177/0194599819838475 ◽

2019 ◽

Vol 161 (2) ◽

pp. 227-234 ◽

Cited By ~ 1

Author(s):

Yusuf Dundar ◽

Quinton Mandle ◽

Syed N. Raza ◽

Ho-Sheng Lin ◽

John Cramer ◽

...

Keyword(s):

Systematic Review ◽

Oral Cavity ◽

Lymph Nodes ◽

Submandibular Gland ◽

Primary Treatment ◽

Treatment Modalities ◽

Adjuvant Radiation ◽

Primary Tumors ◽

Tumor Involvement ◽

Oral Cavity Cancers

ObjectiveThe submandibular gland (SMG) is typically included in level I neck dissection specimens despite limited data demonstrating SMG invasion. The main objective of this article is to determine the rate and pathways of SMG invasion by squamous cell carcinoma of the oral cavity and oropharynx.Data SourcesA systematic review of relevant studies was performed, evaluating articles identified via the PubMed, Cochrane, and Medline databases.Review MethodsDescriptive features of primary tumors, primary treatment modalities, the rate and pathway of SMG invasion, and survival outcomes, if present, were reported following the PRISMA guidelines.ResultsThe initial literature search yielded 273 articles, of which 17 met inclusion criteria. A total of 2306 patients with 2792 SMG resections were analyzed. Fifty-eight resections (2.0%) were revealed to have tumor involvement. Among patients with SMG tumor involvement, the most common invasion pathway was direct SMG invasion by primary tumor (43 of 58, 74.1%). The second-most common mode of SMG invasion was from involved adjacent lymph nodes (10 of 58, 17.2%). Only 3 SMG resections out of 2792 (0.1%) had isolated metastatic parenchyma without evidence of direct tumor invasion or invasion by involved lymph nodes.ConclusionGiven this rarity of SMG involvement, preservation of SMG might be feasible in selected patient population. However, additional studies need to examine the functionality of preserved SMGs among patients who receive postoperative adjuvant radiation therapy.

Download Full-text