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Hohenberger R, Endres P, Salzmann I, Plinkert PK, Wallner F, Baumann I, Alt J, Riedel F, Lippert BM, Bulut OC. Quality of Life and Screening on Body Dysmorphic Disorder, Depression, Anxiety in Septorhinoplasty. Laryngoscope 2024; 134:2187-2193. [PMID: 38050954 DOI: 10.1002/lary.31212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/10/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Septorhinoplasty (SRPL) can improve quality of life (QoL) in functional and aesthetical aspects of the nose. A key factor compromising postoperative satisfaction is symptoms of body dysmorphic disorder (BDD), defined by excessive concerns and distress over slight or imagined physical defects. Although a high prevalence of BDD in SRPL patients is evident, the effect of positive screening on BDD and other psychiatric disorders is understudied. It was hypothesized that patients screening positive for BDD, depression or anxiety do not show increased postoperative QoL. METHODS A multicenter, prospective study including 259 patients. For psychiatric evaluation, the BDD concern questionnaire-aesthetic version and the Hospital Anxiety and Depression Scale were used; for disease-specific QoL the Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory (FROI-17). RESULTS In preoperative evaluation, 32.5% had a positive screening for BDD, 42.2% for increased anxiety, and 32.9% for depression. Mean QoL improved in the whole cohort (FROI total score: 54.4 ± 21.8 to 32.8 ± 23.7 and ROE: 32.3 ± 15.6 to 69.8 ± 23.1, both p < 0.001). Patients screening positive for BDD, depression or anxiety did show an increased postoperative QoL, but to a significantly lower degree and with lower pre- and postoperative QoL levels. CONCLUSIONS SRPL patients show a high prevalence of BDD symptoms, elevated anxiety, and depression. These subgroups show lower QoL levels and an impaired QoL increase after surgery. Rhinoplasty surgeons must be aware of the disorders and their symptoms, discuss potential concerns with the patients, and potentially refer them to a specialist. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2187-2193, 2024.
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Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Endres
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Irina Salzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Wallner
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Janes Alt
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
| | | | - Burkard M Lippert
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
| | - Olcay Cem Bulut
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
- HNO-Zentrum Rhein-Neckar, Mannheim, Germany
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Bulut OC, Lippert BM, Riedel F, Plath M, Hohenberger R. Quality of Life Improvement in Concurrent Septorhinoplasty and Endoscopic Sinus Surgery. Laryngoscope 2024; 134:1239-1245. [PMID: 37706653 DOI: 10.1002/lary.31054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Septorhinoplasty (SRPL) and functional endoscopic sinus surgery (FESS) are two frequently performed surgeries to improve quality of life (QoL) in patients with nasal symptoms. It has been demonstrated as a safe combination regarding complication rates, but patient satisfaction in concurrent surgery has not been adequately studied yet. METHODS Patients undergoing sole FESS due to chronic rhinosinusitis (n = 57), sole SRPL (n = 148), and concurrent surgery (n = 62) were prospectively evaluated for their disease-specific QoL before and one year after surgery. Each procedure was performed by the same surgeon (OCB). For SRPL, the patient-reported outcome measures Rhinoplasty Outcomes Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory (FROI-17) were utilized, and for chronic rhinosinusitis, the Sino-Nasal Outcome Test-22 (SNOT22). RESULTS All three groups showed significant improvement in the postoperative QoL measurements (all p < 0.01). The postoperative improvements were slightly smaller in the concurrent surgery group compared with the single surgery groups measured with ROE (combined: +55.2 ± 9.3, single: +58.8 ± 9.8, p = 0.02), FROI total score (combined: +47.6 ± 5.2, single: +49 ± 5.4; p = 0.08) and SNOT22 (combined: +33.1 ± 6.7, single +34.5 ± 7, p = 0.26). CONCLUSIONS SRPL, FESS, and combined surgery improve disease-specific QoL. When applicable, surgeons may offer the benefits of a combined procedure without compromising the QoL gain. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1239-1245, 2024.
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Affiliation(s)
- Olcay Cem Bulut
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
- HNO-Zentrum Rhein-Neckar, Mannheim, Germany
| | - Burkard M Lippert
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
| | | | - Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Hohenberger R, Baumann I, Riedel F, Plinkert PK, Bulut OC. Impact of Psychiatric Symptoms on Nasal Perception in Septorhinoplasty Patients. Facial Plast Surg 2024. [PMID: 38196074 DOI: 10.1055/a-2240-8943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Psychological assessment plays a crucial role in the preoperative phase of septorhinoplasty (SRPL), exerting potential influence on both pre- and postoperative aspects of quality of life (QoL). In this prospective study, SRPL patients were systematically screened using two validated questionnaires for body dysmorphic disorder (BDD) and one each for anxiety, depression, and somatic symptom disorder (SSD). Nasal perception was evaluated utilizing two disease-specific, self-report instruments: The Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory-17 (FROI-17). A total of 95 patients were enrolled. Positive screening rates were 40.4 and 28.3% for BDD, 37.3% for elevated anxiety, 16.4% for depression, and 22.4% for SSD. Mean scores on the ROE and FROI indicated lower QoL in all positive screening groups. Statistically significant differences were observed for anxiety (FROI total score: 47.1 ± 14.6 to 37.8 ± 16.2; p = 0.021) and BDD (ROE: 43.7 ± 15.7 to 32.5 ± 15.5; p = 0.003 and FROI total score: 47.4 ± 15.3 to 37.8 ± 17.1; p = 0.014). The Hospital Anxiety and Depression Scale exhibited a significant correlation with the preoperative FROI score (r = 0.34, p = 0.005). Patients with positive screenings for depression, anxiety, BDD, and SSD demonstrated compromised QoL during preoperative assessments compared with their negative counterparts, reflecting diminished nasal perception in both esthetic and functional dimensions. Surgeons must be cognizant of these psychological aspects during preoperative evaluations.
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Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Hohenberger P, Menge F, Hohenberger R, Kasper B, Marx A, Haller F, Baumgarten C, Wardelmann E, Jakob J. Trauma and sporadic desmoid tumor development: An approach toward real incidence and aspects of causality. Cancer 2024; 130:51-59. [PMID: 37751183 DOI: 10.1002/cncr.35040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES The development of desmoid tumors (DT) is associated with trauma, which is an aspect with medicolegal relevance. The objective of this study was to analyze the proportion and type of trauma (surgical, blunt/fracture, implants), its lag time, and mutations of the CTNNB1 gene in patients with sporadic DT. METHODS We analyzed a prospectively kept database of 381 females and 171 males, median age at disease onset 37.7 years (females) and 39.3 years (males) with a histologically confirmed DT. Patients with germline mutation of the APC gene were excluded. Details of the history particularly of traumatic injuries to the site of DT were provided by 501 patients. RESULTS In 164 patients (32.7%), a trauma anteceding DT could be verified with a median lag time of 22.9 months (SD, 7.7 months; range, 9-44 months). A prior surgical procedure was relevant in 98 patients, a blunt trauma in 35 patients, a punctuated trauma (injections, trocar) in 18 patients, and site of an implant in 10 patients. In 220 patients, no trauma was reported (43.9%), and 58 females (11.6%) had a postpregnancy DT in the rectus abdominis muscle. In 42 patients (8.4%), data were inconclusive. The distribution of mutations in the CTNNB1 gene (codon 41 vs. 45) was similar in patients with and without a history of trauma before DT development. CONCLUSIONS A significant subgroup of patients suffers from a trauma-associated DT, predominantly at a prior surgical site including implants to breast or groin, accounting for 77.9% of the cases, whereas blunt trauma was responsible in 22.1%. We found no data to support that trauma-associated DT have different molecular features in the CTNNB1 gene.
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Affiliation(s)
- Peter Hohenberger
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Franka Menge
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Ralph Hohenberger
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Alexander Marx
- Institute of Pathology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Haller
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | | | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Jens Jakob
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Sauter C, Kolb V, Bosch N, Hornberger C, Plinkert PK, Hohenberger R. Recurrent laryngeal lymphangiomatosis in a patient with Proteus syndrome: A case report. Clin Case Rep 2023; 11:e8073. [PMID: 37854262 PMCID: PMC10580701 DOI: 10.1002/ccr3.8073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
Proteus syndrome is a rare genetic disease characterized by an asymmetrical growth of individual parts of the body and has only been described in single cases. This patient presented with recurrent manifestations of a laryngeal and hypopharyngeal lymphangioma, which were treated with laser surgery, systemic therapy, and sclerotherapy. The reported data depict the diagnosis and treatment in the department of otorhinolaryngology, head and neck surgery of the university hospital Heidelberg from 2019 until May 2023. The recurrent endoscopy of the upper airway was performed using a flexible HD-endoscope and the Visera Elite video tower from Olympus, Hamburg. The 29-year old female patient initially presented in February 2019 with stridor and exertional dyspnea due to a lymphatic malformation of the left larynx and hypopharynx. In April 2019 there was no improvement by sclerotherapy with Picibanil, so that systemic therapy with the PIK3CA inhibitor alpelisib was initiated (03-07/2020) and discontinued due to a high side effect profile. In the course of 2021-2023, three microlaryngoscopies with laser surgical resection and renewed sclerotherapy of the lymphangioma with Picibanil were carried out due to fluctuating findings. After these interventions a stable disease could be established until May 2023. Laser surgical therapy is currently described as the therapy of choice in lymphangiomas in the head and neck region and also showed the highest effectiveness in our patient. In case of airway obstruction in particular, it can bring rapid symptom relief. Alternatively, and with a lower surgical risk, local improvements have been reported by sclerotherapy, which was less effective in the presented case. Rare syndromic diseases require multidisciplinary collaboration. In the case of laryngeal lymphangiomatosis, other treatment options should be considered in addition to surgical excision, especially in the case of recurrence.
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Affiliation(s)
- Christina Sauter
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Veronika Kolb
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Nikolaus Bosch
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Cornelia Hornberger
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Peter Karl Plinkert
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of HeidelbergHeidelbergGermany
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Anschuetz L, Hohenberger R, Kaecker C, Elicin O, Giger R, Caversaccio M. Sinonasal malignancies: histopathological entities, regional involvement and long-term outcome. J Otolaryngol Head Neck Surg 2023; 52:36. [PMID: 37118840 PMCID: PMC10148547 DOI: 10.1186/s40463-023-00627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 02/23/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND To assess a large patient cohort with sinonasal malignancies focusing on regional involvement, recurrence and oncological outcome. METHODS Patients (n = 144) with malignant tumors of the nasal cavity and paranasal sinuses were treated at our tertiary referral center between 2008 and 2019. A chart review on patient and tumor characteristics, treatment and long-term outcome was performed. RESULTS Most frequent histological types were squamous cell carcinoma (SCC) (n = 74), adenocarcinoma (n = 24) and mucosal melanoma (n = 18). Primary therapy was surgery in 66% of patients (n = 95) of which 65.8% (n = 66) received adjuvant radiotherapy. Twenty patients (13.8%) were initially staged as cN + and in seven cases, pN + status was histopathologically confirmed. Fifty-six of 130 patients (43.1%) had a relapse after curative intended therapy, including nine loco-regional (6.9%) and seven isolated regional recurrences (5.4%). Twelve of these 16 patients with (loco-)regional recurrence had SCC. Adenoid cystic carcinoma (87.5%) and SCC (65.3%) showed the best long-term overall survival. CONCLUSIONS Regional involvement and regional recurrence are scarce. Because of rarity and heterogeneity, evidence on therapeutic management is sparse resulting in the lack of clinical guidelines.
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Christoph Kaecker
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
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Bulut OC, Oladokun D, Lippert BM, Hohenberger R. Can Sex Improve Nasal Function?-An Exploration of the Link Between Sex and Nasal Function. Ear Nose Throat J 2023; 102:40-45. [PMID: 33393816 DOI: 10.1177/0145561320981441] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This study was conducted to examine the impact of sexual activity on nasal breathing and compare such effect to that of a nasal decongestant. METHODS We evaluated nasal breathing at 5 different times: (1) before sexual activity (baseline), (2) immediately after sexual activity, (3) 30 minutes, (4) 1 hour (5), and 3 hours after sexual climax. Same measurements were taken on the second day following application of nasal decongestant spray. For evaluation of nasal breathing, we used a visual analogue scale (VAS). Additionally, we used a portable rhinometric device to measure resistance and nasal flow. RESULTS Nasal breathing improved significantly after sexual intercourse with climax to the same degree as after application of nasal decongestant for up to 60 minutes, as measured subjectively with the VAS (sex -3.6, P < .001; spray -3.2, P < .001). This was confirmed in the objective rhinometric data as mean nasal flow (mL/s) increased while resistance decreased immediately (flow sex +214, P < .001; flow spray +235, P < .001), 30 (flow sex +249, P < .001; flow spray +287, P < .001), and 60 minutes (flow sex +180, P < .001; flow spray +287, P < .001) post-intervention. Nasal breathing was back to the baseline level after 3 hours following sexual intercourse, while it continued to be improved for longer after application of nasal decongestant. Only participants having nasal obstruction (Nasal Obstruction Symptom Evaluation score >30) showed nasal function improvement after sex. CONCLUSIONS Sexual intercourse with climax can improve nasal breathing to the same degree as application of nasal decongestant for up to 60 minutes in patients having nasal obstruction.
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Affiliation(s)
- Olcay Cem Bulut
- Department of Otorhinolaryngology, SLK Kliniken Am Gesundbrunnen, Heilbronn, Germany.,Department of Otorhinolaryngology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany
| | - Dare Oladokun
- Department of Otolaryngology, York District Hospital, York, UK
| | - Burkard M Lippert
- Department of Otorhinolaryngology, SLK Kliniken Am Gesundbrunnen, Heilbronn, Germany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany
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Plath M, Cavaliere C, Seide S, Hohenberger R, Plinkert PK, Baumann I, Zaoui K. Does a closed reduction improve aesthetical and functional outcome after nasal fracture? Eur Arch Otorhinolaryngol 2022; 280:2299-2308. [PMID: 36434436 DOI: 10.1007/s00405-022-07754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSES How closed reduction (CR) to repair a nasal fracture affects the patient's quality of life (QoL) has not been investigated. Here, we assessed QoL before and after CR using disease-specific questionnaires and compared the QoL scores of patients with nasal fractures with normative scores from a reference cohort. METHODS This was a prospective study of 96 patients with nasal fractures undergoing CR. Patients were interviewed about aesthetic, functional, and QoL issues before and after surgery using the Functional Rhinoplasty Outcome Inventory (FROI-17) and the Rhinoplasty Outcome Evaluation (ROE). Photographs of the nasal area were taken before and after surgery and reviewed. Data were compared with those from a reference cohort (n = 1000). RESULTS Most fractures were type I (80.6%) and most were caused by sport-related accidents (36.5%). The ROE scores increased from 67.3 preoperatively to 73.4 postoperatively (p = 0.001). The FROI-17 also improved, indicating the overall effect of the nose on QoL (p = 0.002). Compared with the reference cohort, patients felt more affected by nasal symptoms before surgery (- 9.37, p = 0.02) than by more general aspects. ROE scores returned to normative values after surgery (p < 0.001). The postoperative cohort had lower scores for the FROI-17 item overall effects of the nose on QoL than the reference cohort did, although the nasal symptom score remained higher in patients than in reference controls. CONCLUSIONS This study showed that CR can improve the aesthetical but not the functional outcome of the nose.
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Hohenberger R, Beckmann S, Kaecker C, Elicin O, Giger R, Caversaccio M, Anschuetz L. Morbidity and Oncological Outcome After Curative Treatment in Sinonasal Squamous Cell Carcinoma. Ear Nose Throat J 2022:1455613221117787. [PMID: 35938196 DOI: 10.1177/01455613221117787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Sinonasal squamous cell carcinomas are rare and aggressive tumors. Curative therapy includes surgery and radiotherapy, with high risk for local morbidity and impaired quality of life. The objective of this study was to analyze a large cohort of patients with sinonasal squamous cell carcinoma on treatment morbidity and oncological outcome. METHODS Patients with sinonasal squamous cell carcinoma (n = 75) treated at a tertiary referral center between 2008 and 2019 were identified. In patients with curative treatment intent (n = 70), a chart review and analysis on patient and tumor characteristics, morbidity, and oncological outcome was performed. RESULTS Mean follow-up was 59 months. Primary curative therapy was surgery alone (n = 18), surgery with radiation (n = 25), and primary (chemo)radiation (n = 27). Forty-two (60%) patients suffered from treatment-related morbidity; most frequent symptoms were dry nasal mucosa (20%), nasal obstruction (14.3%), and vision impairment or loss (11.5%). Patients with early disease had less morbidity (51.4 vs 71.1%; P = 0.09), a lower recurrence rate (27% vs. 48.5%; P = 0.08), and better overall survival (92.5% vs. 71.1%; P = 0.01). CONCLUSION Treatment-related morbidity is common after curative treatment of sinonasal squamous cell carcinomas. Early disease is beneficial in terms of occurrence and severity as multimodal treatment and recurrence can more likely be avoided.
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Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sven Beckmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Kaecker
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Hohenberger R, Baumann I, Krisam R, Wallner F, Plinkert PK, Lippert BM, Bulut OC. Validating the Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery in a German rhinoplasty population. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34670729 DOI: 10.1016/j.bjps.2021.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/19/2021] [Accepted: 09/19/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany
| | - Frank Wallner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Burkard M Lippert
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Am Gesundbrunnen 20-26, Heilbronn 74078, Germany
| | - Olcay Cem Bulut
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Am Gesundbrunnen 20-26, Heilbronn 74078, Germany
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Reif T, Dyckhoff G, Hohenberger R, Kolbe CC, Gruell H, Klein F, Latz E, Stolp B, Fackler OT. Contact-dependent inhibition of HIV-1 replication in ex vivo human tonsil cultures by polymorphonuclear neutrophils. Cell Rep Med 2021; 2:100317. [PMID: 34195682 PMCID: PMC8233696 DOI: 10.1016/j.xcrm.2021.100317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 12/01/2022]
Abstract
Polymorphonuclear neutrophils (PMNs), the most abundant white blood cells, are recruited rapidly to sites of infection to exert potent anti-microbial activity. Information regarding their role in infection with human immunodeficiency virus (HIV) is limited. Here we report that addition of PMNs to HIV-infected cultures of human tonsil tissue or peripheral blood mononuclear cells causes immediate and long-lasting suppression of HIV-1 spread and virus-induced depletion of CD4 T cells. This inhibition of HIV-1 spread strictly requires PMN contact with infected cells and is not mediated by soluble factors. 2-Photon (2PM) imaging visualized contacts of PMNs with HIV-1-infected CD4 T cells in tonsil tissue that do not result in lysis or uptake of infected cells. The anti-HIV activity of PMNs also does not involve degranulation, formation of neutrophil extracellular traps, or integrin-dependent cell communication. These results reveal that PMNs efficiently blunt HIV-1 replication in primary target cells and tissue by an unconventional mechanism. PMNs blunt HIV-1 spread and CD4 T cell depletion in HIV-infected human tonsils Suppression of HIV-1 replication by PMNs requires cell-cell contacts PMNs do not affect HIV via effector functions such as NETosis or degranulation PMNs exert unconventional antiviral activity
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Affiliation(s)
- Tatjana Reif
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Carl-Christian Kolbe
- Institute of Innate Immunity, Department of Innate Immunity and Metaflammation, University Hospital Bonn, 53127 Bonn, Germany
| | - Henning Gruell
- Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50931 Cologne, Germany
| | - Florian Klein
- Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50931 Cologne, Germany
| | - Eicke Latz
- Institute of Innate Immunity, Department of Innate Immunity and Metaflammation, University Hospital Bonn, 53127 Bonn, Germany
| | - Bettina Stolp
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Oliver T Fackler
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,German Center for Infection Research (DZIF), Partner Site Heidelberg, 69120 Heidelberg, Germany
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Hohenberger R, Bremer I, Brinster R, Plinkert PK, Federspil PA. Is antibiotic prophylaxis expendable in parotid gland surgery? A retrospective analysis of surgical site infection rates. Clin Otolaryngol 2021; 46:948-953. [PMID: 33724686 DOI: 10.1111/coa.13753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 12/17/2020] [Accepted: 02/28/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the rate of surgical site infection (SSI) and associated risk factors after parotid gland surgery including the impact of antibiotic prophylaxis. DESIGN Retrospective single-centre clinical study. SETTING Tertiary referral centre for head and neck surgery. PARTICIPANTS Seven hundred and fifty four patients who underwent parotid gland surgery at the University Hospital Heidelberg, Germany, between 2007 and 2014 were enrolled in this study. Data on patient age, American Society of Anesthesiologists (ASA) classification system, smoking status, diabetes mellitus, operation time, and antibiotic prophylaxis were collected. Additionally, the National Healthcare Safety Network (NHSN) risk index was calculated. Association of these factors with SSI was evaluated in univariate analyses and a multivariate logistic regression model. MAIN OUTCOME MEASURES Rate of SSI. RESULTS Twenty four patients (3.2%) had an SSI according to the NHSN definition. In univariate analyses, only smokers (P = .048) and male patients (P = .01) had a significantly higher rate of SSI. Since the majority of smokers were men (62.3%), the effect of male gender, smoking, together with the NHSN risk index was further investigated as predictors of SSI within a logistic regression model. All three predictors showed a significant effect on SSI. CONCLUSIONS Parotid gland surgery has a low rate of SSI. In our cohort, male gender, smoking and high NHSN risk index scores were significantly associated with SSI, whereas antibiotic prophylaxis had no protective effect.
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Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Isabel Bremer
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Regina Brinster
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philippe A Federspil
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
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13
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Kaw S, Ananth S, Tsopoulidis N, Morath K, Coban BM, Hohenberger R, Bulut OC, Klein F, Stolp B, Fackler OT. HIV-1 infection of CD4 T cells impairs antigen-specific B cell function. EMBO J 2020; 39:e105594. [PMID: 33146906 PMCID: PMC7737609 DOI: 10.15252/embj.2020105594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022] Open
Abstract
Failures to produce neutralizing antibodies upon HIV‐1 infection result in part from B‐cell dysfunction due to unspecific B‐cell activation. How HIV‐1 affects antigen‐specific B‐cell functions remains elusive. Using an adoptive transfer mouse model and ex vivo HIV infection of human tonsil tissue, we found that expression of the HIV‐1 pathogenesis factor NEF in CD4 T cells undermines their helper function and impairs cognate B‐cell functions including mounting of efficient specific IgG responses. NEF interfered with T cell help via a specific protein interaction motif that prevents polarized cytokine secretion at the T‐cell–B‐cell immune synapse. This interference reduced B‐cell activation and proliferation and thus disrupted germinal center formation and affinity maturation. These results identify NEF as a key component for HIV‐mediated dysfunction of antigen‐specific B cells. Therapeutic targeting of the identified molecular surface in NEF will facilitate host control of HIV infection.
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Affiliation(s)
- Sheetal Kaw
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Swetha Ananth
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, Heidelberg, Germany.,German Centre for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany
| | - Nikolaos Tsopoulidis
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Morath
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Bahar M Coban
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, Heidelberg, Germany.,German Centre for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Olcay C Bulut
- German Centre for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, SLK Klinikum Am Gesundbrunnen, Heilbronn, Germany
| | - Florian Klein
- Laboratory of Experimental Immunology, Institute of Virology, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Köln, Köln, Germany
| | - Bettina Stolp
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver T Fackler
- Department of Infectious Diseases, Integrative Virology, University Hospital Heidelberg, Heidelberg, Germany.,German Centre for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany
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14
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Hohenberger R, Baumann I, Plinkert PK, Brinster R, Krisam J, Affolter A, Hein M, Flechsig P, Rathke H, Oladokun D, Lippert BM, Bulut OC. Validating the Xerostomia Inventory in a radiation-induced xerostomia population in German language. Oral Dis 2019; 25:1744-1750. [PMID: 31295368 DOI: 10.1111/odi.13154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Though xerostomia is a frequent oral symptom, there is no validated disease-specific questionnaire in German. The purpose of this study was to translate and validate versions of the Xerostomia Inventory and the Summated Xerostomia Inventory in a German-speaking population. PARTICIPANTS AND METHODS Thirty-nine patients including 18 patients suffering from radiation-induced xerostomia enrolled in this study. Both questionnaires were translated into German language according to international accepted guidelines. For validation, we evaluated reliability, validity, and responsiveness using the COSMIN manual for cross-cultural adaptation. RESULTS Cronbach's α was 0.92 for XI and 0.91 for SXI, showing both high internal consistency. Patients suffering from xerostomia showed significantly higher average scores demonstrating its discriminant validity. Confirmatory factor analysis showed excellent "goodness-of-fit" values for SXI and good to moderate values for XI, confirming the assumed factor structures. The Xerostomia Inventory and its summated version both showed excellent test-retest reliability in the non-xerostomia group (ICC = 0.85 and 0.84). CONCLUSIONS The XI and SXI in their cross-cultural adapted versions are the first validated self-report assessments for xerostomia in German language. They are characterized by practical design and can be easily interpreted by the treating physician.
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Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Regina Brinster
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Annette Affolter
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matti Hein
- Department of Otorhinolaryngology, SLK Kliniken am Gesundbrunnen, Heilbronn, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hendrik Rathke
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Dare Oladokun
- Department of Otolaryngology, Castle Hill Hospital, Cottingham, UK
| | - Burkard M Lippert
- Department of Otorhinolaryngology, SLK Kliniken am Gesundbrunnen, Heilbronn, Germany
| | - Olcay Cem Bulut
- Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany.,Department of Otorhinolaryngology, SLK Kliniken am Gesundbrunnen, Heilbronn, Germany
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15
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Bulut OC, Hohenberger R, Oladokun D, Odenwald K, Plinkert PK, Federspil PA. Long‐term quality of life and sensory impact of great auricular nerve preservation in parotid surgery as measured with the Parotidectomy Outcome Inventory‐8. Clin Otolaryngol 2019; 44:743-748. [DOI: 10.1111/coa.13366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/23/2019] [Accepted: 05/12/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Olcay Cem Bulut
- Department of Otorhinolaryngology University of Heidelberg Heidelberg Germany
- Department of Otorhinolaryngology SLK Kliniken Am Gesundbrunnen Heilbronn Germany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology University of Heidelberg Heidelberg Germany
| | - Dare Oladokun
- Department of Otorhinolaryngology Leeds General Infirmary Leeds UK
| | - Katharina Odenwald
- Department of Otorhinolaryngology University of Heidelberg Heidelberg Germany
| | - Peter K. Plinkert
- Department of Otorhinolaryngology University of Heidelberg Heidelberg Germany
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16
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Haufe S, Hohenberger R, Hein M, Kratochwil C, Rathke H, Plinkert P, Baumann I, Holland-Letz T, Haberkorn U, Flechsig P, Bulut O. Impact of sialendoscopy on improving health related quality of life in patients suffering from radioiodineinduced xerostomia. Nuklearmedizin 2018; 57:160-167. [DOI: 10.3413/nukmed-0964-18-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Summary
Introduction: Xerostomia following radioiodine therapy (RIT) in patients suffering from differentiated thyroid cancer is a common side effect in 2 % to 67 % of patients treated with radioiodine (I-131). In order to evaluate the impact of sialendoscopy on health related quality of life (HRQOL) in patients suffering from therapy induced sialadenitis and xerostomia, we analyzed findings from two dedicated questionnaires (Xerostomy Questionnaire XQ and Xerostomy Inventory XI) in patients before and three months after sialendoscopy. Procedures: In total, 12 patients suffering from differentiated thyroid carcinoma (10 women and 2 men) were evaluated. All patients had experienced conservative management. Patients were offered a sialendoscopy procedure if no major contradictions were present. Patients who denied the procedure formed the control group. Pre- and (three months) postoperative HRQOL was measured with the Patient Reported Outcome Measures (PROM) Xerostomia Questionnaire (XQ) and the Xerostomia Inventory (XI), as well as by a pre- and post-interventional salivary gland scintigram. Patients were graded according to their sialendoscopical findings. Results: Interventional group presented with significant improvements in HRQOL measurements regarding XQ and XI-scores three months postoperatively. Control group showed no significant changes in the XQ or the XI scores. Number of RIT and cumulative activity of I-131 did not correlate with higher disease grade in regards to sialendoscopical findings nor did it correlate with higher XQand XI scores. Pre- and post-interventional salivary gland scintigram stated that parotid glands are more severely damaged than submandibular glands (SMG), but no significant scintigraphically changes could be detected after sialendoscopy. Conclusion: Sialendoscopy in patients suffering from therapy induced sialadenitis and xerostomia seems to be beneficial when evaluating the impact on HRQOL. Functional parameters measured by salivary gland scintigram did not show significant changes in post-interventional scintigrams.
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17
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Houben P, Hohenberger R, Yamanaka K, Büchler MW, Schemmer P. Evaluation of Graft Effluent High Mobility Group Box-1 (HMGB-1) for Prediction of Outcome After Liver Transplantation. Ann Transplant 2018; 23:475-480. [PMID: 30002362 PMCID: PMC6248035 DOI: 10.12659/aot.909165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/28/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pre-transplant assessment of the graft for liver transplantation is crucial. Based on experimental data, this study was designed to assess both nuclear high mobility group box-1 (HMGB-1) protein and arginine-specific proteolytic activity (ASPA) in the graft effluent. MATERIAL AND METHODS In a non-interventional trial, both HMGB-1 and ASPA were measured in the effluent of 30 liver grafts after cold storage before transplantation. Values of HMGB-1 and ASPA levels were compared with established prognostic parameters such as the donor risk index, balance of risk score, and Donor-Model for End-Stage Liver Disease. RESULTS The early allograft dysfunction (EAD) was best predicted by recipient age (p=0.026) and HMGB-1 (p=0.031). HMGB -1 thresholds indicated the likelihood for initial non-function (1608 ng/ml, p=0.004) and EAD (580 ng/ml, p=0.017). The multivariate binary regression analysis showed a 21-fold higher (95% CI: 1.6-284.5, p=0.022) risk for EAD in cases with levels exceeding 580 ng/ml. The ASPA was lower in cases of initial non-function (p=0.028) but did not correlate with the rate of EAD (p=0.4). CONCLUSIONS This study demonstrates the feasibility of HMGB-1 detection in the graft effluent after cold storage. Along with conventional prognostic scores, it may be helpful to predict the early fate of a graft in human liver transplantation.
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18
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Bulut OC, Wallner F, Oladokun D, Plinkert PK, Baumann I, Hohenberger R. Patients Screening Positive for Body Dysmorphic Disorder Show No Significant Health-Related Quality of Life Gain after Functional Septorhinoplasty at a Tertiary Referral Center. Facial Plast Surg 2018; 34:318-324. [PMID: 29702720 DOI: 10.1055/s-0038-1632400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Body dysmorphic disorder (BDD) is a psychiatric disorder defined by an excessive concern about one's physical appearance, especially regarding slight or imagined abnormities of the body. This study was conducted to compare postoperative quality of life (QOL) changes after primary septorhinoplasty among patients screening positive and those screening negative for BDD. Two common instruments for the screening of BDD were used namely the Dysmorphic Concern Questionnaire (DCQ) and the BDD Concern Questionnaire (BDDQ). For the determination of QOL changes, three validated screening instruments were used. The Functional Rhinoplasty Outcome Inventory (FROI-17) and the Rhinoplasty Outcomes Evaluation (ROE) were used as disease-specific instruments and the Short Form 36 Health Survey (SF-36) was used as a general instrument. All patients completed the FROI-17, the ROE, and the SF-36 preoperatively and 60 months postoperatively. The BDD questionnaires were singularly obtained 60 months after surgery. The authors identified 9.8% of our patients with a possible BDD diagnosis. The patients screening positive for BDD showed significantly lower ROE scores postoperatively, compared with those screening negative for BDD. QOL gains detected by the disease-specific instruments (ROE and FROI-17) were only significant in the non-BDD group. No significant QOL gains were detectable with the FROI-17, the ROE, and the SF-36 in the BDD group. In patients screening negative for BDD, QOL, as measured with the SF-36, improved significantly in five categories: physical functioning, role-functioning physical, bodily pain, general health, and social functioning. Patients screening positive for BDD did not improve in any categories of the general SF-36 questionnaire. Instead, their score in the "mental health" category was significantly lower 5 years after their surgery compared with preoperatively. Patients retrospectively screening positive for BDD in our cohort did not improve in QOL postoperatively. Alternative nonsurgical treatments such as cognitive behavioral treatment and/or selective serotonin reuptake inhibitors have been reported to be effective and should be considered as the treatment of choice. Some studies suggest that a smaller subgroup of BDD patients may benefit from functional rhinoplasty. Further research and larger long-term prospective outcome studies are needed to understand the influence of BDD symptoms on postoperative satisfaction and QOL changes after septorhinoplasty.
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Affiliation(s)
- Olcay C Bulut
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Frank Wallner
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Dare Oladokun
- Department of Otorhinolaryngology, Leeds General Infirmary, Leeds, United Kingdom
| | - Peter K Plinkert
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
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19
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Bulut OC, Wallner F, Hohenberger R, Plinkert PK, Baumann I. Quality of life after primary septorhinoplasty in deviated- and non-deviated nose measured with ROE, FROI-17 and SF-36. Rhinology 2017. [PMID: 28025985 DOI: 10.4193/rhin16.243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Quality of life measurements are gaining in importance. The present study was conducted with the aim to compare patient satisfaction after septorhinoplasty according to their preoperative nasal deformity. METHODS The patients completed two disease-specific questionnaires before their surgery: the Functional Rhinoplasty Outcome Inventory (FROI-17), the Rhinoplasty Outcome Evaluation (ROE) and as a general instrument, the Short Form 36 Health Survey (SF-36). The second measurement was taken during an outpatient examination 12 months after their primary septorhinoplasty. Patients were grouped in nasal axis deviation (NAD), nasal hump deformity (NHD) and NAD plus NHD. Additionally the patients with preoperative NAD and NAD+NHD were combined as deviated nose and compared to the non-deviation group. RESULTS One hundred and two patients (51 male and 51 female) underwent primary septorhinoplasty. The ROE- and the FROI-17 overall score including all three subgroups showed significant postoperative improvements. Regarding the SF-36, the postoperative score improved significantly only in two scales (role-functioning physical and mental health). Looking at the the different QoL questionnaires, there were significant postoperative differences in regards to deviated versus non-deviated nose in the FROI-17 overall- and FROI-17 subscores (nasal and general symptoms) and in three scales of the SF-36 (vitality, social functioning, role-functioning emotional), showing a greater postoperative satisfaction in the deviated-nose patient. CONCLUSION Patients with and without nasal deviation showed improved QoL after their surgery, as measured with the ROE, the FROI-17 and the SF-36. The patients with a nasal deviation showed a significantly better outcome, as measured with the FROI-17, in comparison with the non-deviated group.
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Affiliation(s)
- O C Bulut
- Department of Otolaryngology, University of Heidelberg, Germany
| | - F Wallner
- Department of Otolaryngology, University of Heidelberg, Germany
| | - R Hohenberger
- Department of Otolaryngology, University of Heidelberg, Germany
| | - P K Plinkert
- Department of Otolaryngology, University of Heidelberg, Germany
| | - I Baumann
- Department of Otolaryngology, University of Heidelberg, Germany
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20
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Bulut OC, Wallner F, Hohenberger R, Plinkert PK, Baumann I. Quality of life after primary septorhinoplasty in deviated- and non-deviated nose measured with ROE, FROI-17 and SF-36. Rhinology 2017; 55:75-80. [PMID: 28025985 DOI: 10.4193/rhino16.243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Quality of life measurements are gaining in importance. The present study was conducted with the aim to compare patient satisfaction after septorhinoplasty according to their preoperative nasal deformity. METHODS The patients completed two disease-specific questionnaires before their surgery: the Functional Rhinoplasty Outcome Inventory (FROI-17), the Rhinoplasty Outcome Evaluation (ROE) and as a general instrument, the Short Form 36 Health Survey (SF-36). The second measurement was taken during an outpatient examination 12 months after their primary septorhinoplasty. Patients were grouped in nasal axis deviation (NAD), nasal hump deformity (NHD) and NAD plus NHD. Additionally the patients with preoperative NAD and NAD+NHD were combined as deviated nose and compared to the non-deviation group. RESULTS One hundred and two patients (51 male and 51 female) underwent primary septorhinoplasty. The ROE- and the FROI-17 overall score including all three subgroups showed significant postoperative improvements. Regarding the SF-36, the postoperative score improved significantly only in two scales (role-functioning physical and mental health). Looking at the the different QoL questionnaires, there were significant postoperative differences in regards to deviated versus non-deviated nose in the FROI-17 overall- and FROI-17 subscores (nasal and general symptoms) and in three scales of the SF-36 (vitality, social functioning, role-functioning emotional), showing a greater postoperative satisfaction in the deviated-nose patient. CONCLUSION Patients with and without nasal deviation showed improved QoL after their surgery, as measured with the ROE, the FROI-17 and the SF-36. The patients with a nasal deviation showed a significantly better outcome, as measured with the FROI-17, in comparison with the non-deviated group.
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Affiliation(s)
- O C Bulut
- Department of Otolaryngology, University of Heidelberg, Germany
| | - F Wallner
- Department of Otolaryngology, University of Heidelberg, Germany
| | - R Hohenberger
- Department of Otolaryngology, University of Heidelberg, Germany
| | - P K Plinkert
- Department of Otolaryngology, University of Heidelberg, Germany
| | - I Baumann
- Department of Otolaryngology, University of Heidelberg, Germany
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21
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Ronellenfitsch U, Wiedemann B, Menge F, Jakob J, Hohenberger R, Kasper B, Hohenberger P. Desmoid tumor (DT): Clinical and treatment characteristics and quality of life (QoL) in a large cohort from a referral center. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.10566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10566 Background: Due to its low incidence, evidence regarding DT is scarce, and consensus on recommended treatment is difficult to achieve. This study systematically assesses clinical presentation, treatment characteristics and QoL in a large cohort of DT patients (pts). Methods: Demographic and clinical variables were retrieved from a database of 224 pts with histologically confirmed DT presenting to our referral center from 10/04-7/12. For a subset of 46 pts, QoL was assessed with the SF-12 questionnaire. The distribution of variables in the entire pt population and clinically relevant subgroups was calculated and compared with appropriate statistics (t-test, nonparametric tests). Denominators varied due to non-availability of variables for some pts. Results: 153 (68.3%) pts were female. Mean age at first diagnosis was 36.9 (3-73) yrs. Primary tumor site was limb/intraabdominal/rectus abdominis/trunk in 40/43/43/66 (21/22/22/35%) of 192 pts. 65/108 (60%) pts recalled a trauma or medical intervention at the DT site. 38/43 (88%) pts with rectus abdominis DT were female, and 31/38 (82%) had previous pregnancies, median time to DT diagnosis after end of pregnancy was 17 months. Primary therapy was resection/imatinib/tamoxifen/watchful waiting in 136/9/8/7 (83/6/5/4%) pts. Resection was R0/R1/R2 in 47/66/22 (35/49/16%) pts. After R0/R1 resection, DT recurred in 46% and 62% resp. after a median of 356/334 days. Physical/mental SF-12 summary scores were 39.2/40.8, 41.5/45.4, and 48.0/44.5 in pts with limb, intraabdominal, and trunk DT and 38.6/42.6 and 43.3/42.5 in pts with and without recurrence (reference population score 50; all p>0.05 for subgroup comparisons). Five women delivered a healthy child in parallel to clinically existent DT. 56% of our patients are alive with disease, whereas 44% have no evidence of disease. Conclusions: In 83% of DT pts, resection is the first treatment step and is R0 only in one third. 60% of the pts recall trauma/medical intervention at the DT site. Rectus abdominis DT occur after a median of 1.5 yrs after pregnancy. Despite the fact that 56% of our pts live with disease, their QoL is only slightly decreased, with lowest values for physical QoL in pts with recurrence.
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Affiliation(s)
| | - Bea Wiedemann
- University Medical Center Mannheim, Department of Surgery, Mannheim, Germany
| | - Franka Menge
- University Medical Center Mannheim, Department of Surgery, Mannheim, Germany
| | - Jens Jakob
- University Medical Center Mannheim, Department of Surgery, Mannheim, Germany
| | - Ralph Hohenberger
- University Medical Center Mannheim, Department of Surgery, Mannheim, Germany
| | - Bernd Kasper
- University of Heidelberg, Mannheim University Medical Center, ITM - Interdisciplinary Tumor Center Mannheim, Sarcoma Unit, Mannheim, Germany
| | - Peter Hohenberger
- University Medical Center Mannheim, Department of Surgery, Mannheim, Germany
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