RESUMEN
We study the metal-organic framework (MOF) ZIF-67 with 1H and 13C nuclear magnetic resonance (NMR). In addition to the usual orbital chemical shifts, we observe spinning sideband manifolds in the NMR spectrum due to hyperfine interactions of the paramagnetic cobalt with 1H and 13C. Both orbital and paramagnetic chemical shifts are in good agreement with values calculated from first principles, allowing high-confidence assignment of the observed peaks to specific sites within the MOF. Our measured resonance shifts, line shapes, and spin lattice relaxation rates are also consistent with calculated values. We show that molecules in the pores of the MOF can exhibit high-resolution NMR spectra with fast spin lattice relaxation rates due to dipole-dipole couplings to the Co2+ nodes in the ZIF-67 lattice, showcasing NMR spectroscopy as a powerful tool for identification and characterization of "guests" that may be hosted by the MOF in electrochemical and catalytic applications.
RESUMEN
In this study we compared the aesthetic outcome of (1) Le Fort I (LFI) osteotomy and (2) intraoral quadrangular Le Fort II (IQLFII) osteotomy for surgical correction of skeletal class III dysgnathia involving midfacial deficiency. The aim was to investigate whether laypersons see differences in facial changes that occur due to variations of the osteotomy cuts. The patient collectives consisted of 23 patients in each group. Pre- and postoperative photographs were presented in a random sequence to 40 layperson raters. The rating procedure was conducted with a four-point Likert scale. Assessed characteristics were 'attractiveness' ('Attraktivität'), 'likeability' ('Sympathie'), 'intelligence' ('Intelligenz'), 'aggressiveness' ('Aggressivität') and 'dominance' ('Dominanz'). For preoperative photographs we found a significant difference for 'likeability' with lower ratings for the IQLFII group; all other criteria were rated similarly. For the IQLFII group we found a significantly larger shift from lower to higher ratings for 'attractiveness' and 'likeability' and a significantly larger shift from higher to lower ratings for 'aggressiveness' and 'dominance' than for the LF I group. Our study shows that lay raters detect significant differences between the two surgical groups. Thus, IQLFII osteotomy, when indicated, represents a favourable alternative to conventional LFI osteotomy, if patients desire the expectable change in recognition by their social circle.
Asunto(s)
Labio Leporino , Fisura del Paladar , Cefalometría , Estética Dental , Cara , Humanos , Maxilar/cirugía , Osteotomía Le FortRESUMEN
Direct evidence of successful or failed predation is rare in the fossil record but essential for reconstructing extinct food webs. Here, we report the first evidence of a failed predation attempt by a pterosaur on a soft-bodied coleoid cephalopod. A perfectly preserved, fully grown soft-tissue specimen of the octobrachian coleoid Plesioteuthis subovata is associated with a tooth of the pterosaur Rhamphorhynchus muensteri from the Late Jurassic Solnhofen Archipelago. Examination under ultraviolet light reveals the pterosaur tooth is embedded in the now phosphatised cephalopod soft tissue, which makes a chance association highly improbable. According to its morphology, the tooth likely originates from the anterior to middle region of the upper or lower jaw of a large, osteologically mature individual. We propose the tooth became associated with the coleoid when the pterosaur attacked Plesioteuthis at or near the water surface. Thus, Rhamphorhynchus apparently fed on aquatic animals by grabbing prey whilst flying directly above, or floating upon (less likely), the water surface. It remains unclear whether the Plesioteuthis died from the pterosaur attack or survived for some time with the broken tooth lodged in its mantle. Sinking into oxygen depleted waters explains the exceptional soft tissue preservation.
Asunto(s)
Dinosaurios/fisiología , Conducta Alimentaria/fisiología , Animales , Evolución Biológica , Cefalópodos , Dieta/veterinaria , Fósiles , Conducta Predatoria , Reptiles/fisiologíaRESUMEN
The assessment of muscular interactions between biceps, triceps, and brachioradialis can be used as an approach for the detection of spasticity in the upper limbs. A crucial prerequisite for the aforementioned validation of muscular interactions is the calculation of time frequencies due to the non-stationary characteristics of electromyographic (EMG) signals and thus the estimation of coherences. Adding biomechanical parameters increases the validity of the assessment process and simplifies the comparison of EMG data as a result of categorization. In this numerical-experimental study, a method will be introduced by using the smoothed pseudo Wigner-Ville distribution and a categorization algorithm to estimate and categorize coherences between biceps, triceps, and brachioradialis during dynamic contractions. The categorization will be performed according to the type of contraction, external load, joint angle, and angular velocity and will be used to assess 10 healthy subjects and 6 patients with spasticity. Generally, the introduced method shows the velocity dependence of coherence during spasticity in extension movements as well as much stronger muscular co-activation between triceps, biceps, and brachioradialis in spastic patients in comparison to healthy subjects. Furthermore, the influence of variables e.g. as joint angle, angular velocities, and type of contraction on the coherence is quantified.
Asunto(s)
Electromiografía/métodos , Espasticidad Muscular/diagnóstico por imagen , Músculo Esquelético/fisiología , Adulto , Anciano , Algoritmos , Brazo/fisiología , Brazo/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular/fisiología , Músculo Esquelético/fisiopatología , Procesamiento de Señales Asistido por ComputadorRESUMEN
Cleft Lip and Palate (CLP) - a common facial malformation in newborns - is typically corrected by surgical intervention to allow for normal speech development, psychosocial adjustment, and facial attractiveness. The long term treatment outcome can be evaluated after a number of years, possibly in adulthood. We investigated the aesthetics of the nasolabial region by subjective ratings. To compare various surgical approaches we recruited 12 raters to evaluate 429 patients. Expert and lay raters judged photographs from patients, who have completed treatment with one of three different surgical strategies performed in our institution over 50 years. Facial photographs were cropped, presented to the raters in a randomized sequence, and judged by the raters on a 5 point Likert scale. The subjective ratings between the raters revealed a fair to substantial inter-rater reliability. The average ratings of the surgical outcome improved continuously over the investigated 5 decades. Despite possible differences between raters and rater groups this overall result was consistently seen in the gender groups (male/female), or expertise related groups (expert/lay). Our analysis revealed that patients with bilateral CLP scored worse than patients with unilateral CLP when treated in the fifties; more recently treated patients of both groups scored similarly.
Asunto(s)
Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Estética , Cara/fisiopatología , Labio Leporino/epidemiología , Labio Leporino/cirugía , Fisura del Paladar/epidemiología , Fisura del Paladar/cirugía , Cara/cirugía , Femenino , Humanos , Masculino , Nariz/fisiopatología , Nariz/cirugía , Hueso Paladar/fisiopatología , Hueso Paladar/cirugía , Adulto JovenAsunto(s)
Cromosomas Humanos Par 16/genética , Leucemia Mieloide Aguda/genética , Animales , Línea Celular Tumoral , Inversión Cromosómica/genética , Subunidad alfa 2 del Factor de Unión al Sitio Principal/genética , Factores de Unión al Sitio Principal/genética , Proteínas de Unión al ADN/genética , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Factores de Transcripción/genéticaRESUMEN
BACKGROUND: Multidrug-resistant organisms (MDROs) are not only a problem in the hospital but also in the community setting. The MRE-Net Rhine-Main was founded in order to decrease the rate of development and spread of MDROs in the region and to counter the stigmatisation of people with MDROs. The network attempts to achieve these goals by offering telephone support, information flyers, internet services, information events and training for health-care practitioners from hospitals (HOSP), residential and nursing homes (RNH), outpatient care services (OCS), emergency services (ES), medical practices (MP) and rehabilitation centers (RC). A first interim evaluation examined the expectations each institution had associated with its participation and how well these objectives were fulfilled. Furthermore the utilisation and acceptance of the services offered by the network were investigated. METHOD: The participating institutions (n=143) received a standardised questionnaire adapted to the type of institution by mail including questions focusing on the above-mentioned issues. RESULTS: 96 questionnaires could be evaluated (response 67.1%). More than 90% of the participants expected to participate in trainings, receive improved information, to gain more confidence in handling patients and to improve hygiene measures - with great differences between HOSP, RNH and OCS. These expectations were largely satisfied. 65.5% of the institutions participated at least once in a training, particularly RNH, OCS, whereby the usefulness of the trainings was rated high by these institutions. 14.4% of the institutions had made use of the telephone service, the gain of information was rated as high by HOSP, RNH and OCS. 81% knew of and used the flyers, but almost half of the institutions did not know the homepage of the network. CONCLUSIONS: Overall the expectations of the network participants were met well to very well and the benefit derived from the trainings and the print and online media was rated as high. Therefore the network will continue and further intensify its work.
Asunto(s)
Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/prevención & control , Redes Comunitarias/estadística & datos numéricos , Farmacorresistencia Bacteriana Múltiple , Promoción de la Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Femenino , Alemania/epidemiología , Líneas Directas/estadística & datos numéricos , Humanos , Incidencia , Masculino , Educación del Paciente como Asunto/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Revisión de Utilización de RecursosRESUMEN
BACKGROUND: Osteosynthesis failure rates of 11.3% with 1 miniplate, 6.7% with 2 miniplates, and 4.4% with a single Medartis condyle plate were reported in previous studies of our clinic. Current science is still focused on the osteosynthesis material. Besides clinical parameters, conventional radiographs are still the first choice to detect osteosynthesis failures. This study scrutinized several factors assessable in postoperative orthopantomographs which might elevate the risk of osteosynthesis failure. STUDY DESIGN: A total of 136 patients (22 with osteosynthesis failure, 114 without) with 151 mandibular condyle fractures were included in this study. Eight parameters were assessed in postoperative orthopantomographs. RESULTS: The best predictor of osteosynthesis failure was a simplified concept of ramus height. In cases of reduced or normal ramus height, the odds of osteosynthesis failure was significantly (P = .000001) reduced to a 10th. Isolated fractures were significantly more error prone (P = .0009). CONCLUSIONS: Postoperative orthopantomographs depict factors which increase the risk of osteosynthesis failure.
Asunto(s)
Fijación Interna de Fracturas/métodos , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/cirugía , Radiografía Panorámica , Cuidados Posteriores , Fenómenos Biomecánicos , Placas Óseas , Cefalometría/métodos , Estudios de Cohortes , Endoscopía , Estudios de Seguimiento , Predicción , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/diagnóstico por imagen , Radiografía Panorámica/métodos , Estudios Retrospectivos , Rotación , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
UNLABELLED: A survey was conducted to assess interest in an osteoporosis website. Two thirds of respondents indicated they would read about osteoporosis on a website, and half reported they might use the website more interactively. Women were receptive to the concept of web-based education and management of osteoporosis care. INTRODUCTION: As Americans increasingly use the Internet as a source for health information, healthcare providers continue to develop disease management and education websites. Providence Health & Services conducted a survey among female patients eligible for osteoporosis screening to assess interest in a physician-prescribed osteoporosis website. METHODS: In 2006, a self-administered survey designed to assess osteoporosis status, Internet use, and the likelihood of using an osteoporosis website for information and disease management was sent to 3,000 active female patients between the ages of 50 and 85 in the Portland, Oregon metropolitan area. RESULTS: Among 778 respondents, 80% reported having access to the Internet, and 70% indicated they were likely to use the Internet for health-related information gathering. While 65% of respondents indicated they would be likely to read about osteoporosis on a dedicated website, only about half reported they might use the website for more interactive disease management activities such as scheduling appointments, receiving test results, or consulting with their physician. Both Internet access and interest in the osteoporosis website declined significantly with age. CONCLUSIONS: These data suggest that middle-aged women are moderately receptive to the concept of web-based care for certain components of osteoporosis management and education.
Asunto(s)
Actitud hacia los Computadores , Internet/estadística & datos numéricos , Osteoporosis Posmenopáusica/terapia , Educación del Paciente como Asunto/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Computadores/estadística & datos numéricos , Métodos Epidemiológicos , Femenino , Humanos , Persona de Mediana Edad , Oregon , Osteoporosis Posmenopáusica/diagnóstico , Factores SocioeconómicosRESUMEN
AIM: Clinical assessment does not provide objective and quantitative evaluation of the shoulder function. Based on instrumental gait analysis a system for three-dimensional motion analysis of the upper extremities has been developed. The aim of this study is to evaluate the results of instrumental upper extremity motion analysis with respect to dependence on sex and side dominance. METHOD: 16 healthy subjects (8 male, 8 female, mean age 26 years) were included. Three-dimensional motion analysis was carried out with a video-based system and passive markers. All subjects performed two movement tasks representing activities of daily living (task A: reaching the neck, task B: removing a parking token). All joint angles of the upper extremity were recorded and graphically displayed. Additionally, a calculation of quantitative parameters was performed. RESULTS: Contrary to expectations the task "reaching the neck" was not combined with external shoulder rotation. Females performed most of the tasks quicker and with higher reproduction accuracy. Movement reproduction accuracy was rarely dependent on dominance. CONCLUSION: Three-dimensional upper extremity motion analysis of activities of daily living allows a precise and quantitative evaluation of movement patterns. The differences with respect to sex and side in a healthy group have to be respected in studies dealing with comparative shoulder function.
Asunto(s)
Lateralidad Funcional/fisiología , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Movimiento/fisiología , Examen Físico/métodos , Extremidad Superior/fisiología , Adulto , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Factores Sexuales , Extremidad Superior/anatomía & histologíaRESUMEN
BACKGROUND AND OBJECTIVE: Approximately six million Germans have been diagnosed with diabetes mellitus. A continuously increasing number of people with diabetes is expected within the next few years. Genetic disposition, age and especially lifestyle play an important role in the development of the disease. Diabetes normally develops during a long preclinical phase. During this preclinical phase an impaired glucose tolerance can easily be detected. Since an impaired glucose tolerance is often reversible the onset of diabetes can be prevented effectively by a change of lifestyle during this phase. The Bavarian Red Cross Blood Transfusion Service therefore determined the diabetes risk among its blood donors during two one-week study periods. PATIENTS AND METHODS: The diabetes risk of the participating donors was assessed by using the FindRisk diabetes test published by the German Diabetes Foundation and the HbA1c test. RESULTS: Approximately 12 percent of the participants (8187 persons aged 18-68 years) showed a moderate, high or even very high risk of developing diabetes within the next 10 years. The probability of developing the disease ranged from 17% (moderate risk) to 50% (very high risk). This corresponds to 3% of persons with unknown diabetes among the total population. An elevated HbA1c was found in approximately 5% of the donors in the first study week and in approximately 19% in the second study week. The analysis of the questionnaire and the HbA1c results indicated that elevated HbA1c values correlate with known diabetes risk factors. Persons with a body mass index greater than 25, an increased score in the FindRisk questionnaire and aged over 50 years more frequently showed an elevated HbA1c value. CONCLUSIONS: The combination of a diabetes risk questionnaire and HbA1c testing could be used successfully for diabetes screening in an identified risk group.
Asunto(s)
Donantes de Sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Hemoglobina Glucada/análisis , Adolescente , Adulto , Anciano , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etiología , Femenino , Alemania/epidemiología , Humanos , Estilo de Vida , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Medición de Riesgo/métodos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
In order to limit the consequences of infantile cerebral palsy (ICP), physiotherapy should start as early as possible. This requires that infants at risk are detected at the earliest age possible. Today, diagnosis is based on visual observation by physicians and as such is influenced by subjective impressions. Objective methods, quantifying the pathological deviation from normal spontaneous motor activity would be preferable as they, for example, allow an inter- and intra-individual comparison of movement. In this paper we have developed a methodology that allows the 3-dimensional acquisition of unconstrained movement in newborn babies, using a motion analysis system. From the recorded movement data we have extracted 53 quantitative parameters that describe the differences between healthy and affected participants. Considered individually, each of these parameters does not permit a conclusive statement to be made as to whether or not the patient is at risk. Cluster analysis based on Euclidian distances therefore has been used to find an optimal combination of eight parameters. The optimal combination has been subsequently applied to organize the participants' movement into preferably homogeneous classes labelled "healthy" or "at risk". Classification was performed utilising quadratic discriminant analysis. The methodology presented allows a reliable discrimination between healthy and affected participants. Overall detection rate reached 73%. This value is expected to rise with increasing patient and norm collective database size.
Asunto(s)
Parálisis Cerebral/fisiopatología , Recien Nacido Prematuro , Actividad Motora/fisiología , Movimiento/fisiología , Parálisis Cerebral/diagnóstico , Análisis por Conglomerados , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Trastornos del Movimiento , Periodicidad , Medición de RiesgoRESUMEN
The development of fatigue at the muscle fibre level can be assessed in terms of a decrease in conduction velocity (CV). The present study aimed to investigate if work-related muscular disorders in occupations characterised by static loads of long duration affect fatigue resistance in the painful muscle. A group of eight secretaries suffering from bilateral chronic muscle pain in the shoulder/neck region was compared to a group of healthy subjects. The upper trapezius muscle was studied under isometric contractions, holding the arm in the horizontal plane up to the endurance point. Changes in CV estimated at the motor unit level were investigated using a non-invasive high spatial resolution electromyographic (EMG) approach. In addition, the number of motor unit potentials per second (PPS), and the root mean square (RMS) of bipolar signals were assessed, and the results reported as the mean and standard error for each value. Subjects with work-related disorders showed less pronounced changes in CV with respect to healthy subjects. No differences between subjects with and without work-related disorders were encountered for the PPS and RMS. The present findings on CV indicate an increased fatigue-related recruitment of MUs in the painful muscle with respect to a healthy muscle. The fact that this recruitment is not reflected in the PPS and RMS estimates might be due to a fatigue-induced decrease in the firing rate and/or the de-recruitment of fatigued MUs. Furthermore, methodological limitations of the adopted method in the estimation of 'global' parameters such as the PPS and RMS have to be considered.
Asunto(s)
Electromiografía/instrumentación , Fatiga Muscular , Músculo Esquelético/fisiología , Enfermedades Musculares/fisiopatología , Músculos del Cuello/fisiología , Enfermedades Profesionales/fisiopatología , Adulto , Estudios de Casos y Controles , Electromiografía/métodos , Femenino , Humanos , Persona de Mediana Edad , Contracción Muscular , Resistencia FísicaRESUMEN
The aim of the present study was to investigate the extent to which work-related muscular disorders of the upper trapezius affect the activity of other pain-free muscles, in particular in the biceps brachii. Two groups of female subjects (age >43 years) participated in the study: seven affected subjects with self-reported disorders in the shoulder/neck region (cases) and nine healthy subjects (control group). Multi-channel electromyography (EMG) and force were recorded during maximum voluntary contractions (MVC) and during 6 min sustained contractions (at 30% MVC) of the upper trapezius and biceps brachii on the dominant side. From the EMG signals, the root mean square (RMS), median frequency (MDF) and single motor unit (MU) conduction velocity (CV) were estimated. From the force signal, the coefficient of variation was calculated. All data are presented as mean values and standard deviation. Differences between the cases and controls were found in the MVC force of the upper trapezius, which was lower in cases [253 (70) N] than in controls [357 (75) N], while the coefficient of variation of force during the sustained contraction was increased [cases 5.5 (2.2); controls 4.1 (1.9)]. The RMS (normalized to the RMS at MVC) during the 6 min sustained contractions was significantly lower in the cases than in the controls for both the upper trapezius and the biceps brachii. A tendency towards a smaller increase in the RMS with fatigue was only found in the trapezius muscle [slope: cases 6.5 (14.1) %/min, controls 10.2 (12.9) %/min]. No differences were found between the two subject groups with respect to the MDF and single MU CV in both muscles. While the lower RMS for the trapezius muscles of the cases may reflect changes at the local level, as well as in motor control, the lower biceps activity indicates a change in the central control strategies of the primarily unaffected muscle. Indications for a changed fatigability of the muscle were only found in the trapezius.
Asunto(s)
Contracción Muscular/fisiología , Fatiga Muscular , Músculo Esquelético/fisiología , Enfermedades Musculares/fisiopatología , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Proyectos Piloto , Análisis de RegresiónRESUMEN
Changes in muscle fibre length and surface electrode position with respect to the muscle fibres affect the amplitude and frequency characteristics of surface electromyography (SEMG) in different ways. Knowledge of changes in muscle fibre length would help towards a better interpretation of the signals. The possibility of estimating the length through SEMG during voluntary contractions was checked in this study. The fibres' semi-length was estimated from the product of the conduction velocity and conduction time during which the wave of excitation propagated from the end-plate region to the ends of the fibres. Short (10 s), moderate (30% of maximum voluntary contraction) isometric contractions were performed by 10 subjects at different elbow joint angles (80-140 degrees in steps of 20 degrees ). Monopolar signals were detected non-invasively, using a two-dimensional electrode array. High spatial resolution EMG and a decomposition technique were utilised to extract single motor unit activities for triggered averaging and to estimate conduction velocity. A significant increase with joint angle was found in conduction time and estimated fibre semi-length. Changes in conduction velocity with joint angle were found to be not significant. The methodology described allows the relative changes in fibres' semi-length to be estimated from SEMG data.
Asunto(s)
Potenciales de Acción/fisiología , Articulación del Codo/anatomía & histología , Neuronas Motoras/fisiología , Fibras Musculares Esqueléticas/fisiología , Adulto , Articulación del Codo/fisiología , Electromiografía/métodos , Femenino , Humanos , Contracción Isométrica/fisiología , Masculino , Modelos Biológicos , Modelos Neurológicos , Placa Motora/fisiología , Fibras Musculares Esqueléticas/ultraestructura , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Conducción Nerviosa/fisiología , Rango del Movimiento Articular/fisiología , Procesamiento de Señales Asistido por Computador , Factores de TiempoRESUMEN
The purpose of this study was to assess the prognostic value of histological response to preoperative radiochemotherapy in an established multimodal therapy concept for advanced oral and oropharyngeal cancer. Two hundred and twenty-two patients who underwent preoperative radiochemotherapy (RCT: 50 Gy, mitomycin C and fluorouracil) and radical surgery were retrospectively evaluated. Resected tumours of all patients were histologically analysed and response to RCT was classified in histopathological grades of regression (RG). In a multivariate statistical analysis, RG was compared with established factors regarding their predictive value for overall and disease-specific survival. The 5-year overall survival probability in the different groups of histopathological regression grades were: RG1 (no vital tumour): 73.4%, RG2 (minimal tumour remnants encompassing less than 5%): 72.1%, RG3 (5-50% vital tumour cells): 41.9%, RG4 (more than 50% vital tumour): 37.9%. For disease-specific survival probability no significant differences were found between both groups of "responders" (RG1 and RG2) nor between "non-responders" (RG3 and RG4), whereas responders and non-responders differed significantly from each other (log-rank test; p < 0.001). T-classification, N-classification and disease stage, histological grading, tumour site, age, and sex had less prognostic value than RG in a Cox regression model. In the neoadjuvant multimodal therapy concept, histological response to preoperative RCT is a crucial prognostic factor even when surgical R0-resection is accomplished. Thus, non-responders have to be regarded as high-risk patients for recurrence and may benefit from further therapy.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Neoplasias de la Boca/patología , Neoplasias de la Boca/terapia , Terapia Neoadyuvante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/cirugía , Análisis Multivariante , Estadificación de Neoplasias , Neoplasia Residual/patología , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/cirugía , Neoplasias Orofaríngeas/terapia , Pronóstico , Modelos de Riesgos Proporcionales , Dosis de Radiación , Radioterapia Adyuvante , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
To analyse survival and locoregional control in patients with advanced oral and oropharyngeal squamous cell carcinoma (SCC) after multimodal therapy with preoperative radiochemotherapy (RCT) and radical surgery. We included in this analysis 222 patients who underwent multimodal therapy between 1990 and 2000. Eligible were patients with UICC disease stages II-IV (T2: 33.3%; T3: 12.6%; T4: 54.1%; N0: 45.9%; N1: 17.6%; N2: 33.3%; N3: 3.2%; stage II: 21.1%; stage III: 14.9%; stage IV: 64%). Patients received preoperative radiochemotherapy consisting of Mitomycin C (15-20 mg/m2, day 1) plus 5-Fluorouracil (750 mg/m2/24 h-infusion, days 1-5) and concomitant radiotherapy for a total dose of 50 Gy. Radical locoregional en bloc-resection according to the pretherapeutic tumour extension was carried out in all patients. After a median surveillance period of 72.3 months (24-152 months), 131 patients (59%) were alive, and 91 (41%) patients died; 12 (5%) of them died postoperatively, 46 (21%) due to tumour recurrence, and 33 (15%) deaths were not directly related to the primary tumour. Overall survival probability was 76% after 2 years, and 62% after 5 years. Two- and 5-year local control probability were 88 and 81%, respectively. Regarding the high percentage of stage IV disease in the reported patients, the multimodal concept is an effective therapy offering excellent survival and local control probability.