| 1. |
- Ahlberg, Alexander, et al.
(författare)
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Early self-care rehabilitation of head and neck cancer patients
- 2011
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 131:5, s. 552-61
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSIONS: No positive effects of early preventive rehabilitation could be identified. The results do not contradict the proposition that rehabilitation based on self-care can be effective but it is important to establish evidence-based training programs and identify proper instruments for selection of patients and evaluation of intervention. OBJECTIVES: Patients with head and neck cancer suffer from functional impairments due to intense treatment. In this study, we investigated the effectiveness of an experimental early preventive rehabilitation using hard, objective end points in a nonselective, longitudinal, prospective cohort study. METHODS: In all, 190 patients were included in the program and received instructions for training before the start of treatment with the aim of reducing swallowing problems and reducing mouth opening and stiffness in the neck. A control group of 184 patients was recruited. RESULTS: There was no difference in weight loss and 2-year survival between the two groups. No positive effects concerning functional impairments were found in patient-reported outcome measures.
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| 2. |
- Ahlberg, Alexander, et al.
(författare)
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ESOPHAGEAL STRICTURE AFTER RADIOTHERAPY IN PATIENTS WITH HEAD AND NECK CANCER : EXPERIENCE OF A SINGLE INSTITUTION OVER 2 TREATMENT PERIODS
- 2010
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Ingår i: Head and Neck. - : Wiley. - 1043-3074 .- 1097-0347. ; 32:4, s. 452-461
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Tidskriftsartikel (refereegranskat)abstract
- Background. Risk factors for development of a stricture of the upper esophagus after radiotherapy for head and neck cancer are poorly defined. Methods. This was a retrospective case-control study of patients diagnosed and treated for esophageal stricture after radiotherapy for head and neck cancer. Results. The incidence of esophageal stricture after external beam radiation therapy (EBRT) was 3.3%. Seventy patients with stricture and 66 patients without stricture were identified. A multivariate analysis showed that there was increased risk of stricture in receiving enteral feeding during EBRT or in receiving a mean dose of >45 By to the upper esophagus. Conclusions. Enteral feeding during EBRT is strongly associated with the development of stricture of the esophagus, as is a mean dose of >45 Gy to the upper esophagus. Treatment of the stricture with Savary-Gilliard bougienage or through scope balloon dilatation is safe and successful but often has to be repeated.
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| 3. |
- Ahlberg, Alexander, et al.
(författare)
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Morbidity of supraomohyoidal and modified radical neck dissection combined with radiotherapy for head and neck cancer : a prospective longitudinal study
- 2012
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Ingår i: Head and Neck. - : Wiley. - 1043-3074 .- 1097-0347. ; 34:1, s. 66-72
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of this study was to show the investigated impact of supraomohyoidal neck dissection and modified radical neck dissection, both combined with radiotherapy, on cervical range of motion (CROM), mouth opening, swallowing, lymphedema, and shoulder function.METHODS: One hundred eight patients who had neck dissections and 98 patients who had non-neck dissections were evaluated in a prospective, nonselective, longitudinal cohort study by a physiotherapist and a speech-language pathologist (SLP) before the start of radiotherapy and up to 12 months after treatment.RESULTS: The incidence of shoulder disability after neck dissection was 18%. Supraomohyoidal neck dissection had no significant effect on the evaluated parameters at any time point. Modified radical neck dissection significantly reduced CROM and mouth opening 2 months after treatment, but after 12 months only cervical rotation was still significantly reduced.CONCLUSION: In patients treated with external beam radiation (EBRT), modified radical neck dissection induced additional morbidity regarding CROM but not regarding mouth opening, swallowing, and lymphedema 1 year after treatment. Both modified radical neck dissection and supraomohyoidal neck dissection induced shoulder disability.
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| 4. |
- Ahlberg, Alexander
(författare)
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Patients with head and neck cancer : aspects on treatment, complications and rehabilitation
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Head and neck cancer is reported to be the fifth most common cancer globally and around 1,200 new patients are diagnosed in Sweden every year. Historically, survival rates have been rather constant but have started to improve over the last few decades as a result of new and more aggressive oncological treatments. For this reason, there is a need to re-evaluate surgical treatment—both its necessity and its morbidity in comparison to the oncological treatments available. There is also a risk of higher incidence of side effects from newer oncological regimens, which still needs to be evaluated. In this thesis, different populations of head and neck cancer patients from our institution have been analysed concerning aspects of treatment, sequelae, and rehabilitation. The material is highly applicable to everyday clinical situations. In paper I, patients diagnosed between1998 and 2002 with metastases in the neck that were treated with full-dose external beam radiotherapy (EBRT) were evaluated concerning histopathology and clinical outcome, with a view to evaluating the necessity of a planned neck dissection after EBRT. One hundred and fifty-six patients were included. Overall survival was 62% and disease-specific survival was 76%. There was a clinically complete response to radiotherapy in the neck in 63 patients (40%). Of these, 15 had viable tumor cells in the neck specimen. In patients who did not achieve a clinically complete response, 40% (37/93) had viable tumor cells in the neck specimen. Disease-specific survival in patients with viable tumor cells in the neck after EBRT was 48% (25/52), and it was 90% (93/104) in patients without viable tumor cells. Paper II describes a retrospective case-control study of patients diagnosed and treated for stricture of the upper oesophagus after EBRT for head and neck cancer between 1992 and 2005. The aim of the study was to identify possible risk factors for stricture formation. Clinical parameters were collected from the medical files. The EBRT dose delivered to the upper oesophagus was calculated using the dose-planning system data. Seventy patients with stricture and 66 patients without were identified. The incidence of upper esophageal stricture at the institution during the study period was 3.3%. A multivariate analysis showed an increased risk of stricture in patients who received enteral feeding during EBRT or with a mean dose of > 45 Gy delivered to the upper oesophagus. Treatment of the stricture with Savary-Gilliard bougienage or through-thescope balloon dilatation was found to be safe and successful, but often had to be repeated. In paper III, the morbidity of supraomohyoidal neck dissection (SOND) or modified radical neck dissection (MRND) combined with EBRT was evaluated regarding cervical range of movement, lymphoedema, mouth opening, swallowing, and shoulder disability. The patient material was collected from the study population in paper IV. Ninety-eight patients who received only EBRT were identified, 25 patients were treated with both SOND and EBRT, and 83 were treated with MRND and EBRT. The overall incidence of shoulder disability after both types of neck dissection was 18%. SOND had no other significant negative effects on the parameters under evaluation at any time 5 point, while with MRND there was significantly reduced CROM and mouth opening two months after treatment. After 12 months, only cervical rotation was still significantly reduced. In paper IV, the aim of the study was to evaluate the effect of an early preventive rehabilitation programme on functional losses and quality of life. The programme started at diagnosis before the start of treatment and was based on self-care after receiving instructions from a speech language pathologist and a physiotherapist. The patients were instructed to use the training programme during and after the treatment period. One hundred and ninety patients were included in the early experimental rehabilitation programme. A control group of 184 patients who did not receive early rehabilitation was constructed. It was shown that the programme could be implemented without delaying the start of oncological treatment, but no positive effects concerning survival, weight loss, functional loss, working ability, or quality of life were observed. The need for a neck dissection after EBRT cannot be determined by clinical examination as a high percentage of patients with clinical complete response showed viable tumor cells in the neck specimen. When performing a neck dissection, a SOND should be considered in suitable patients as morbidity of SOND is low except for shoulder disability. An EBRT dose delivered to the upper 5 cm of the oesophagus should be kept below 45 Gy to lower the risk of oesophageal stricture, and patients should be instructed to continue to swallow even if they receive enteral nutrition during treatment. Finally, even though no positive effects of early rehabilitation could be shown, the results do not contradict the idea that rehabilitation based on self-care can be effective. Efforts should be made to identify rehabilitation that can reduce functional losses and improve quality of life. Future rehabilitation programmes should also concentrate on identification of proper instruments for selection of patients and for evaluation of intervention in head and neck cancer patients.
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| 5. |
- Alevronta, Eleftheria, et al.
(författare)
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Dose-response relations for stricture in the proximal oesophagus from head and neck radiotherapy
- 2010
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 97:1, s. 54-59
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Determination of the dose-response relations for oesophageal stricture after radiotherapy of the head and neck. Material and methods: In this study 33 patients who developed oesophageal stricture and 39 patients as controls are included. The patients received radiation therapy for head and neck cancer at Karolinska University Hospital, Stockholm, Sweden. For each patient the 3D dose distribution delivered to the upper 5 cm of the oesophagus was analysed. The analysis was conducted for two periods, 1992-2000 and 2001-2005, due to the different irradiation techniques used. The fitting has been done using the relative seriality model. Results: For the treatment period 1992-2005, the mean doses were 49.8 and 33.4 Gy, respectively, for the cases and the controls. For the period 1992-2000, the mean doses for the cases and the controls were 49.9 and 45.9 Gy and for the period 2001-2005 were 49.8 and 21.4 Gy. For the period 2001-2005 the best estimates of the dose-response parameters are D-50 = 61.5 Gy (52.9-84.9 Gy), gamma = 1.4 (0.8-2.6) and s = 0.1 (0.01-0.3). Conclusions: Radiation-induced strictures were found to have a dose response relation and volume dependence (low relative seriality) for the treatment period 2001-2005. However, no dose response relation was found for the complete material.
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| 6. |
- Astradsson, Thorsteinn, et al.
(författare)
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Trismus in patients with head and neck cancer and 5-year overall survival
- 2018
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 138:12, s. 1123-1127
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Tidskriftsartikel (refereegranskat)abstract
- Background: Trismus is a common complication of radiotherapy for head and neck cancer but its impact on survival is unknown.Aims/Objectives: This prospective study evaluates the incidence of trismus in patients with head and neck cancer receiving radiotherapy and the impact of trismus on 5-year overall survival.Material and methods: Two hundred forty-four patients with head and neck cancer were included. All patients received instructions on jaw exercises and were evaluated before initiation of radiotherapy and at 2, 6, and 12 months after termination of radiotherapy.Results: One year after treatment 25% had a reduced maximum interincisal opening (MIO) of 13 mm or more as compared to the pretreatment MIO. Trismus was most prevalent in patients with oral and oropharyngeal cancer. A trend towards worse 5-year overall survival was seen among patients with trismus.Conclusions: The trismus rate was approximately 30% at 12 months. Jaw exercises should primarily be offered to patients with oral and oropharyngeal cancer who are most likely to benefit. Further studies are required to investigate the effect of trismus on survival.Significance: This study identifies patients likely to benefit from jaw exercises and provides basis for further research on trismus and survival.
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| 7. |
- Björling, Alexander, 1983, et al.
(författare)
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Kinetics of surface modification induced by submonolayer electrochemical oxygen adsorption on Pt(1 1 1)
- 2010
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Ingår i: Electrochemistry Communications. - : Elsevier BV. - 1388-2481. ; 12:3, s. 359-361
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Tidskriftsartikel (refereegranskat)abstract
- Electrochemical oxygen adsorption/desorption below monolayer level leads to a disordering of platinum single-crystal surfaces vicinal to the (1 1 1) plane. The kinetics can be described by means of a consecutive reaction from (1 1 1)-terrace sites to (1 1 0)-defect sites, in which (1 0 0)-defects act as intermediates. The first oxidation of the electrode reflects independent contributions from terrace and step sites, the latter being structure sensitive. Oxygen adsorption charges amount to a mean value of one electron per step site.
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| 8. |
- Buervenich, Silvia, et al.
(författare)
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A rare truncating mutation in ADH1C (G78Stop) shows significant association with Parkinson disease in a large international sample.
- 2005
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Ingår i: Archives of neurology. - : American Medical Association (AMA). - 0003-9942. ; 62:1, s. 74-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Alcohol dehydrogenases (ADHs) may be involved in the pathogenesis of neurodegenerative disorders because of their multiple roles in detoxification pathways and retinoic acid synthesis. In a previous study, significant association of an ADH class IV allele with Parkinson disease (PD) was found in a Swedish sample. PATIENTS: The previously associated single-nucleotide polymorphism plus 12 further polymorphisms in the ADH cluster on human chromosome 4q23 were screened for association in an extension of the original sample that now included 123 Swedish PD patients and 127 geographically matched control subjects. A rare nonsense single-nucleotide polymorphism in ADH1C (G78stop, rs283413) was identified in 3 of these patients but in no controls. To obtain sufficient power to detect a possible association of this rare variant with disease, we screened a large international sample of 1076 PD patients of European ancestry and 940 matched controls. RESULTS: The previously identified association with an ADH class IV allele remained significant (P<.02) in the extended Swedish study. Furthermore, in the international collaboration, the G78stop mutation in ADH1C was found in 22 (2.0%) of the PD patients but only in 6 controls (0.6%). This association was statistically significant (chi(2)(1) = 7.5; 2-sided P = .007; odds ratio, 3.25 [95% confidence interval, 1.31-8.05]). In addition, the G78stop mutation was identified in 4 (10.0%) of 40 Caucasian index cases with PD with mainly hereditary forms of the disorder. CONCLUSION: Findings presented herein provide further evidence for mutations in genes encoding ADHs as genetic risk factors for PD.
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| 9. |
- Grün, Nathalie, et al.
(författare)
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Human papillomavirus prevalence in mouthwashes of patients undergoing tonsillectomy shows dominance of HPV69, without the corresponding finding in the tonsils.
- 2017
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Ingår i: Infectious diseases (London, England). - : Informa UK Limited. - 2374-4243 .- 2374-4235. ; 49:8, s. 588-593
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The role of human papillomavirus (HPV) in tonsillar squamous cell carcinomas (TSCC) is of interest, since a considerable proportion of TSCC in Sweden and other Western countries is HPV positive. Nevertheless, the natural history of HPV in normal tonsils, and the progression from localized infection to pre-malignant lesion to cancer are poorly understood. The aim of this study was to investigate whether HPV types found in mouthwash samples correlated to those in tonsillar tissue from the same individuals undergoing tonsillectomy.METHODS: Mouthwash samples from 232 patients, aged 3-56 years, undergoing tonsillectomy, the majority with chronic tonsillitis, were collected at the time of surgery and analysed for the presence of 27 HPV types by a bead based multiplex assay.RESULTS: An HPV prevalence of 10.3% (24/232) was observed in mouthwash samples, with HPV 69 being the dominant type (10/24). Ten patients were positive for high risk HPV (HPV 16, 33, 35, 45, 56, 59). None of the tonsils resected from patients with HPV-positive mouthwash samples were positive for HPV.CONCLUSIONS: Despite an oral HPV prevalence of 10.3% in mouthwash samples from tonsillectomized patients, with dominance of HPV 69, none of the corresponding tonsillar samples exhibited the presence of HPV.
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| 10. |
- Jirkovský, Jakub S, 1980, et al.
(författare)
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Reduction of Oxygen on Dispersed Nanocrystalline CoS2
- 2012
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Ingår i: Journal of Physical Chemistry C. - : American Chemical Society (ACS). - 1932-7447 .- 1932-7455. ; 116:46, s. 24436-24444
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Tidskriftsartikel (refereegranskat)abstract
- The electrocatalytic properties of nanocrystalline CoS2 have been investigated for the oxygen reduction reaction (ORR) in 0.1 M HClO4. CoS2 with pyrite structure was prepared by hydrothermal synthesis and attached to a glassy carbon electrode from solution with a mixture of carbon and Nafion. The prepared CoS2 electrode layers showed high activity toward the ORR and very good stability under oxygen reducing conditions. Selectivity of the ORR toward H2O2 was determined by rotating (ring) disk electrode measurements, and relatively high selectivity was obtained with up to 80% H2O2 formation around 0.4 V (vs Ag/AgCl), but this dropped to zero for potentials below 0.0 V. The amount of H2O2 produced between 0.6 and 0.0 V was dependent on the quality of the CoS2 dispersion within the electrode layer, and decreasing CoS2 particle size resulted in significant improvement in the ORR electrocatalytic activity, both by increasing the turnover frequency and through decreasing the selectivity toward H2O2 production.
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