Priya Shah

Management of deep-seated malformations with photodynamic therapy: a new guiding imaging modality

Photodynamic therapy is an emerging technology and results from the interactions between a photosensitiser, oxygen and light. The delivery of light may either be by surface illumination or by interstitial application. We describe the first clinical application of ultrasound-guided interstitial photodynamic therapy (US-iPDT). A total of 23 treatments with meta-tetra-hydroxyphenyl chlorine (mTHPC) and ultrasound-guided interstitial photodynamic therapy were performed on 21 patients with various conditions at the Head & Neck Centre, University College London Hospital. The needles could be clearly identified during insertion in all 23 treatments, and it was possible to guide parallel needle insertions using ultrasound. Although the resolution of ultrasound is not as high as that of other imaging modalities [i.e. computed tomography (CT) and magnetic resonance imaging (MRI)] it was satisfactory in identifying the centre and the peripheries of the pathological lesions. Ultrasound is very easy to perform, non-invasive, relatively inexpensive, quick, convenient, non-ionising, suited to the imaging of soft tissues and does not cause any discomfort. Ultrasound can be used to guide ‘real-time’ photodynamic therapy in deep-seated tumours and other malformations and can augment the information from other imaging modalities without affecting the patient’s treatment outcome.

Cervical Lymphadenitis Due to Mycobacterium Malmoense

Nontuberculous mycobacteria are isolated from soil, dust, water, milk, eggs, vegetables, and domestic animals. They may be transmitted to humans through inhalation of particles from the air. 1-4 Nontuberculous mycobacteria were first described as pathogens of the head and neck in 1956. 5,6 Mycobacterium malmoense (MM) is a rare infection 7 and was first described in 1977 by Schroder and Juhlin. 8 This atypical mycobacterium has been isolated in increasing numbers from clinical samples next to Mycobacterium tuberculosis and the Mycobacterium avium complex. 9 Cervical lymphadenitis and lymphadenopathy are common in children and may be caused by local or systemic infection (Table 1). The most common presentation of nontuberculous mycobacterial (NTM) infection in children is cervicofacial adenitis. 10 In 2006 Thavagnanam et al 11 conducted a review of pediatric data over the last 14 years from mycobacterial laboratories in Northern Ireland. They found an upward trend in the number of cases of cervical lymphadenitis attributable to NTM infections. MM is primarily a pulmonary pathogen. 12 The main extrapulmonary disease type of MM infection is pediatric cervical lymphadenitis. 13 Most of the literature supports the view that the treatment of choice for cervical lymphadenitis due to NTM infection is surgical excision. 14 However, the complications of surgery are also well documented, and some authors advocate medical therapy, with antimicrobials, as an alternative or as an adjunct. 1 We report 2 cases of 2.5-year-old immunocompetent female patients with unilateral cervical lymphadenitis due to infection with MM. The clinical features and management are described.

Fluorescence spectroscopy in the detection of oral dysplasia

Modalities All tissues fluoresce due to the presence of fluorescent chromophores (fluorophores) within them. The commonly fluorophores are NADH, collagen, elastin and cofactors such as flavins (FAD, FMN). FS can detect these substances and provide characteristic spectra that reflect biochemical changes within the tissues. There are three main ways to obtain fluorescence, autofluorescence (induced by UV light) Laser-induced and enhanced/dye which can be by either topical or systemic application of 5-aminolaevulinic acid (5-ALA). Dysplastic and malignant tissues, as well as having different spectral characteristics, tend to have increased red fluorescence and decreased green fluorescence. Therefore, significant increase in the red/green fluorescence ratio is an accurate predictor of dysplasia and malignancy.

The effect of smoking, drinking and smoking cessation on morbidity and mortality in oral cancer: a controlled study

Materials and methods A controlled cohort involved 67 patients who were diagnosed with oral squamous cell carcinoma. The smoking and drinking habits of this groups was recorded, in addition cessation of smoking after diagnosis was assessed; these were compared to TNM, depth of invasion, pattern of invasion, dysplasia at margin, vascular and nerve invasion, recurrence, 3 and 5 years survival and cause of death.

cTNM vs. pTNM: are we as good as we think?

Background Accurate clinical staging of oral squamous cell cancer can be quite difficult to achieve especially if nodal involvement is identified. Radiologically-assisted clinical staging is more accurate and informs the clinician of locoregional and distant metastasis. Locoregional metastasis is radiologically assessed by MRI of the head and neck region and 2D-US of the neck followed by FNAC of any identified neck lump when indicated. Distant metastasis is usually assessed by either a PA-CXR or a CT chest.

Pathological tissue processing time vs. morbidity and mortality

Methods We have retrospectively analysed information acquired from 168 patients treated following recurrent squamous cell cancer. Pathological tissue processing time was identified at 4 intervals (first diagnostic biopsy, first surgical resection, second diagnostic biopsy for recurrence and second surgical resection). This was compared to primary sites, recurrence sites, TNM staging and survival over 3 and 5 years.