Mordechai Sela

Cytokines levels, Severity of acute mucositis and the need of PEG tube installation during chemo-radiation for head and neck cancer - a prospective pilot study

BackgroundThe purpose of this pilot study was to detect a correlation between serum cytokine levels and severity of mucositis, necessitating installation of a percutaneous endoscopic gastrostomy tube (PEG) in head and neck (H&N) cancer patients receiving combined chemo-radiation therapy.Patients and MethodsFifteen patients with H&N epithelial cancer were recruited to this study. All patients received radiotherapy to the H&N region, with doses ranging from 50-70 Gy. Chemotherapy with cisplatin, carboplatin, 5-fluorouracil and taxanes was given to high-risk patients, using standard chemotherapy protocols. Patients were evaluated for mucositis according to WHO common toxicity criteria, and blood samples were drawn for inflammatory (IL-1, IL-6, IL-8, TNF-α) and anti-inflammatory (IL-10) cytokine levels before and during treatment.ResultsA positive correlation was found between IL-6 serum levels and severity of mucositis and dysphagia; specifically, high IL-6 levels at week 2 were correlated with a need for PEG tube installation. A seemingly contradictory correlation was found between low IL-8 serum levels and a need for a PEG tube.ConclusionThese preliminary results, indicating a correlation between IL-6 and IL-8 serum levels and severity of mucositis and a need for a PEG tube installation, justify a large scale study.

Modified stock-eye ocular prosthesis

A technique for the use of modified prefabricated eyes was described. When properly used, many of the limitations attributed to prefabricated eyes can be overcome. This technique allows the proper positioning of the iris while simultaneously recording an impression of the ocular defect tissue bed. This technique permits the finished ocular prosthesis to generate an equal distribution of pressure throughout the defect, while increasing its movement due to excellent adaptation to the walls of the socket. Although a custom-eye technique may still be necessary for some, most patients can be treated with the modified prefabricated-eye technique with excellent results.

Prosthetic treatment of earlobe keloids

An ear clip prosthesis has been developed for maintaining pressure on earlobe keloids before and after surgical removal. The prosthesis includes an ear clip to which heat-polymerized acrylic resin is attached, which covers the keloid area.

Prefabricated pressure earring for earlobe keloids

This article describes the fabrication of a pressure earring for the treatment of earlobe keloids that is prefabricated prior to surgery. Since impression making is avoided, the earring can be used immediately after suture removal. It can be easily modified to fit the patient’s earlobe and cover only the area which needs to be placed under pressure. The incorporated screws allow easy pressure adjustment, eliminating side effects of excessive pressure, including tenderness 6 and tissue necrosis. 1 The device is easy to fabricate, requires the use of basic instruments, and complies with the guidelines set forth by Chalian et al. 13 Patients are instructed to wear the earring continuously for 6 months. Screws are tightened until slight blenching is evident, indicating occlusion of small blood vessels causing tissue hypoxia. The technique is limited in use for the earlobe only, which is flexible enough to be pressed between 2 flat rigid surfaces, while maintaining uniform pressure. Treatment of keloids of the cartilaginous auricle requires the use of custom-made devices. PROCEDURE 1. Press together two 3-mm-thick plates of clear polymethyl methacrylate (Perspex; Ramplast, Inc, Netanya, Israel). 2. Using an electric saw, cut through the plates to form 2 identical crescent-shaped pieces, measuring 4 cm x 2 cm (sizes of 3.7 cm x 1.7 cm and 4.3 cm x 2.3 cm are also recommended to accommodate earlobes of smaller and larger sizes). 3. Use a 3-mm tapping bur (M3 tapping bur; Volkel GmbH, Remscheid, Germany) and place 2 holes, approximately 5 mm from the apices, through both plates. 4. Insert two 3-mm nylon screws

Pressure Earring as an Adjunct to Surgical Removal of Earlobe Keloids

Keloid formation is a known complication of earlobe piercing, causing discomfort and disfigurement (Figure 1). Surgical excision of the lesion as a sole treatment modality results in a high recurrence rate of 45% to 100%. A variety of concomitant treatments are used to improve the success rate, such as steroid injections, localized irradiation, cryosurgery, topical application of immune response modifiers, and long-term pressure application using pressure earrings, magnets, or bandages.

A mouth splint for severe burns of the head and neck

An individual mouth splint device that applies continuous or intermittent pressure to stretch commissures and fibrotic muscles in patients treated for microstomia resulting from facial and neck burns is presented. After an individual lip tray is prepared, the method uses the impression and cast of the region of the lips to construct a pink acrylic resin splint. By using the device, split horizontally and activated with a Hyrx screw, an opening of 14 mm can be obtained within 2 weeks. The device is recommended as being easily constructed, inexpensive, almost painlessly inserted, and progressively activated.

Maxillofacial prosthetics and iontophoresis in management of burned ears

An acrylic resin stent that can be of help for successful iontophoresis of the burned ear has been described. The stent can be prepared in a short time, is simple to construct, and easy to manage.

Evaluating cosmetic results in maxillofacial prosthetics.

Fifty-two patients with maxillofacial prosthetic restorations answered questionnaires to measure their feelings of well being. Their overall scores averaged 38.6%. Subsequently, three independent observers reported their evaluation for each patient, yielding a combined improvement score of 35.1%. The apparently low figures reflect the strict criteria used. Men patients showed a greater response than women patients both in subjective questionnaire scores and objective evaluation rating. Greater improvement was reported in younger patients, yet the objective evaluators found better success in the older age group. The original etiology of the maxillofacial defect, i.e., traumatic injury, congenital malformation, or surgical tumor excision was the most important factor in the evaluation. Questionnaire scores were similar in all categories. However, the objective evaluation, especially that of the sculptor, who judged color slides alone, was significantly higher in the injury group than in cancer patients. Apparently, the inner desperation of many cancer patients is apparent in their facial appearance even after complete prosthetic rehabilitation. Such patients deserve greater psychologic attention during their treatment. Prosthodontists should realize their tendency to be hypercritical of their own treatment results. Their constant striving for improvement in their treatment results leads them to belittle their achievements and to underestimate their success. Public opinion, as represented by the artists, is significantly more enthusiastic about maxillofacial prosthetic achievements.

Hospital personnel with penicillin-resistantStreptococcus viridans

Abstract Penicillin is the drug of choice for the prevention of bacterial endocarditis (BE) resulting from dental treatment. The susceptibility of Streptococcus viridans to this antimicrobial agent was studied. A representative sample of hospital personnel (N = 76) was compared to a control group of seventy-six subjects who were not associated with the hospital. Twenty-four of the hospital personnel worked in wards that consume 0.13 to 1.64 (mean ± SD = 0.88 ± 0.64) gm penicillin per day per position (low consumption group = LCG) and fifty-two worked in wards that consume 2.27 to 3.67 (mean ± SD = 3.04 ± 0.55) gm penicillin per day per position (high consumption group = HCG). Antibiograms of oral isolates showed that, while 48.08% of the subjects from the HCG revealed penicillin-resistant S. viridans only 8.33% of the subjects from the LCG and 7.89% of the control group presented such results. The data presented suggest that there are subjects who may unknowingly carry penicillin-resistant S. viridans as part of their oral flora. It is therefore recommended that the preferable antibiotic used for the prevention of BE should be determined by an antibiogram.

Major salivary glands in branchial arch syndromes

In five patients with branchial arch syndromes the presence of the salivary glands was demonstrated. Clinical, sialographic, and scintigraphic examinations revealed morphologic defects and diminished function of the parotid glands. Hyperfunction of the submandibular glands was assumed in the three patients in whom scintigraphic studies were performed. The findings may be of diagnostic value in patients in whom the clinical signs of the syndrome have remained occult.