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.

BACKGROUND: The 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 METHODS: Fifteen 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-alpha) and anti-inflammatory (IL-10) cytokine levels before and during treatment. RESULTS: A 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. CONCLUSION: These 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.

Reconstruction of pectus excavatum with silicone implants.

The pectus excavatum deformity is characterised by a deep depression usually involving the lower one-half to two-thirds of the sternum. The indications for surgery are often aesthetic. Extensive procedures, requiring fracturing and remodelling of the chest wall skeleton are associated with high morbidity and high rate of complications. In this article we describe our renewed experience with reconstruction of mild and moderate pectus excavatum deformities with custom made prefabricated silicone implants. The fabrication of the implant and the surgical technique are described in detail. An excellent aesthetic correction of the deformity was achieved in all of the patients in our series, with high patient satisfaction rate. We conclude that with careful patient selection, artistic implant fabrication and meticulous surgical technique, this approach achieves excellent aesthetic correction with minimal morbidity and a low complication rate and therefore should maintain its place in the armamentarium of surgical techniques for reconstruction of pectus deformities.

CO2-laser treatment of ulcerative lesions.

This article reports the successful use in our clinic of CO(2)-laser to reduce severe pain in the treatment of oral aphthosis. The patients, presenting stress-related, chemoradiotherapy-induced, and immuno-related oral aphthosis, reported immediate pain relief and rapid recovery. Treatment technique and laser parameters are described.

The use of lasers in dentistry: principles of operation and clinical applications.

This article describes the principles of laser operation and the clinical application of laser technology in the different fields of dentistry. It discusses the use of the Er:YAG laser in restorative dentistry, pediatric dentistry, and periodontics, as well as the introduction of a new side-firing spiral tip for efficient cleaning of the root canal system by means of lateral laser irradiation. Although the Er:YAG laser is used mostly on enamel and dentin, the gingival depigmentation procedure using this laser also is described. Clinical applications of the CO2 and diode lasers on soft tissues, particularly in the fields of oral and maxillofacial surgery and perodontics, are explained. Because teeth whitening for esthetic reasons has gained increasing popularity in dentistry, the application of diode lasers for this purpose is discussed. All the dental laser procedures described in this article are conducted at the Hebrew University-Hadassah School of Dental Medicine and are further investigated in various clinical research projects.