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1.
Front Psychol ; 14: 1271422, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38343893

RESUMEN

The use of the Experience Sampling Method (ESM), which involves repeated assessments in people's daily lives, has increased in popularity in psychology and associated disciplines in recent years. A rather challenging aspect of ESM is its technical implementation. In this paper, after briefly introducing the history of ESM and the main reasons for its current popularity, we outline the ESM-Quest experience sampling app which is currently being developed at the University of Vienna. ESM-Quest runs on different operating systems, specifically on mobile devices such as smartphones and tablets running either iOS or Android. An internet connection is not necessary during the assessment. Compared to most other ESM apps, ESM-Quest allows event-based random sampling, which is very helpful when assessments need to be collected within specific situations. Currently, ESM-Quest is being utilized at the University of Vienna and will be made available for research groups worldwide upon request. We introduce the technical aspects of ESM-Quest and provide examples of analyses on ESM data collected through this app, such as examining fluctuations in constructs within individuals. Finally, we outline potential next steps in ESM research.

2.
BMC Health Serv Res ; 22(1): 959, 2022 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-35902845

RESUMEN

BACKGROUND: Reablement is a multi-professional and internationally established home-based health care service for mainly older people with the aim to reduce the need for long-term care and to promote self-determination. However, it is unknown which factors would facilitate the implementation of reablement in health care services. Therefore, the aim of this work was to identify relevant factors for the implementation process and to elucidate their importance based on the perspectives of experts. METHODS: Within an exploratory sequential mixed-methods design, a literature search followed by framework analysis was carried out using the five domains of the Consolidated Framework of Implementation Research (CFIR) to collect potentially relevant factors for implementation of reablement. A survey was then drawn up encompassing the factors identified. Within the survey international reablement - experts were asked to rate the relevance of these factors . RESULTS: The literature search identified 58 publications that served as sources for the framework analysis, where 40 potentially relevant factors were clustered into the five CFIR domains. These 40 factors were rated by experts in an online-survey. Based on the analysis of survey-data, 35 factors were considered as relevant for implementation of reablement services. The CFIR-domain characteristics of individuals, including teamwork and communication skills, was seen as most relevant. CONCLUSIONS: The implementation of reablement services is complex and requires the consideration of numerous factors, especially regarding the CFIR-domain characteristics of individuals. From the perspective of the survey´s participants one important factor of a successful implementation was the engagement of the persons involved. It requires team members with a strong, shared vision. Communication skills are highly important to promote teamwork and intensive training is needed to establish these skills. Further research on the implementation of reablement services is essential to realize its full potential.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Vida Independiente , Actividades Cotidianas , Anciano , Humanos
3.
PLoS One ; 16(3): e0249082, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33784325

RESUMEN

Wildlife-related accidents, especially deer-vehicle accidents, pose a serious problem for road safety and animal protection in many countries. Knowledge of spatial and temporal patterns of deer-vehicle accidents is inevitable for accident analysis and mitigation efforts with temporal deer-vehicle accident data being much more difficult to obtain in sufficient data quality. We described the temporal patterns of roe deer (Capreolus capreolus) roadkills occurring in the period 2002-2006 in southeastern Austria. Using a comprehensive dataset, consisting of 11.771 data points, we examined the influence of different time units (i.e. season, month, day of week, day of year), illumination categories (coarse and fine temporal resolution) and lunar phases on deer-vehicle accidents by performing linear and generalized additive models. Thereby, we identified peak accident periods within the analyzed time units. Highest frequencies of deer-vehicle accidents occurred in November, May and October, on Fridays, and during nights. Relationships between lunar phases and roe deer-vehicle accidents were analysed, providing evidence for high frequencies of deer-vehicle accidents during full moon phases. We suggest that deer-vehicle accidents are dependent both on human activity in traffic and wildlife activity, which is in turn affected by phenology, intra- and interspecific competition, climatic and astronomical events. Our results highlight, that short-term mitigation measures (e.g. traffic controls and speed limits) can be highly effective to reduce deer-vehicle accidents, but should be flexibly adapted to specific temporal periods.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciervos , Luna , Estaciones del Año , Animales , Factores de Tiempo
4.
Head Neck ; 41(9): 3144-3158, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31179614

RESUMEN

BACKGROUND: Oncological and functional outcome of transoral laser microsurgery (TLM) for primary treatment of oropharyngeal cancer was examined using a multimodal treatment concept. METHODS: A total of 368 patients with oropharyngeal squamous cell carcinoma (pT1-4, pN0-2, M0) underwent TLM +/- neck dissection (85%), +/- (chemo)radiotherapy (57%). The majority of patients had advanced stage III and IVa disease (79%). RESULTS: Five-year Kaplan-Meier estimates for local control were 83.5% for pT1, 74.1% for pT2, 77.3% for pT3, and 76.0% for pT4a tumors. Five-year estimates of overall, disease-specific, and recurrence-free survival for stage I were 76.0%, 92.8%, and 69.1%; for stage II 71.1%, 85.7%, and 49.6%; for stage III 61.7%, 72.5%, and 58.8%; and for stage IVa 57.3%, 73.7%, and 63.9%, respectively. Postoperative (chemo)radiotherapy improved the outcome for advanced disease. p16-positive tumors had superior survival estimates. Overall, 93.5% maintained regular oral nutrition without feeding tube dependency. CONCLUSION: Primary TLM in multimodal concepts of treatment offers good oncologic outcome even for advanced-stage oropharyngeal cancer.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Terapia por Láser , Microcirugia/métodos , Neoplasias Orofaríngeas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales , Neoplasias Orofaríngeas/mortalidad , Cuidados Posoperatorios , Complicaciones Posoperatorias , Estudios Retrospectivos
5.
Multibody Syst Dyn ; 43(2): 175-191, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29780274

RESUMEN

The adjoint method shows an efficient way to incorporate inverse dynamics to engineering multibody applications, as, e.g., parameter identification. In case of the identification of parameters in oscillating multibody systems, a combination of Fourier analysis and the adjoint method is an obvious and promising approach. The present paper shows the adjoint method including adjoint Fourier coefficients for the parameter identification of the amplitude response of oscillations. Two examples show the potential and efficiency of the proposed method in multibody dynamics.

6.
Multibody Syst Dyn ; 42(4): 397-410, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29563851

RESUMEN

The adjoint method is an elegant approach for the computation of the gradient of a cost function to identify a set of parameters. An additional set of differential equations has to be solved to compute the adjoint variables, which are further used for the gradient computation. However, the accuracy of the numerical solution of the adjoint differential equation has a great impact on the gradient. Hence, an alternative approach is the discrete adjoint method, where the adjoint differential equations are replaced by algebraic equations. Therefore, a finite difference scheme is constructed for the adjoint system directly from the numerical time integration method. The method provides the exact gradient of the discretized cost function subjected to the discretized equations of motion.

7.
Multibody Syst Dyn ; 40(1): 43-54, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28473738

RESUMEN

We present a method for optimizing inputs of multibody systems for a subsequently performed parameter identification. Herein, optimality with respect to identifiability is attained by maximizing the information content in measurements described by the Fisher information matrix. For solving the resulting optimization problem, the adjoint system of the sensitivity differential equation system is employed. The proposed approach combines these two well-established methods and can be applied to multibody systems in a systematic, automated manner. Furthermore, additional optimization goals can be added and used to find inputs satisfying, for example, end conditions or state constraints.

8.
Head Neck ; 39(8): 1631-1638, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28474378

RESUMEN

BACKGROUND: The oncologic and functional outcome of transoral laser microsurgery (TLM) for primary treatment of hypopharyngeal cancer was examined in a multimodal treatment concept. METHODS: Two hundred eleven patients with squamous cell carcinoma (SCC) of the hypopharynx (pT1-4a, pN0-2, M0) were treated by TLM +/- neck dissection (88%) +/- (chemo)radiotherapy ([C]RT; 51%). The majority of cases were advanced stages III and IVa (85%). RESULTS: The 5-year Kaplan-Meier estimates for local control after TLM were pT category-related 88.1%, 74.8%, 77.3%, and 61.8% for pT1-4a tumors. The 5-year estimates of overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) for early stages I and II were 68.2%, 96.7%, and 74.6%, respectively; for stage III they were 65.9%, 83.8%, and 56.4%, respectively; and the rates for stage IVa were 44.5%, 60.7%, and 50.3%, respectively. Overall, 95.7% of the patients maintained regular oral nutrition without feeding tube dependency. CONCLUSION: Primary TLM in multimodal concepts of treatment (+/- neck dissection, +/- [C]RT) offers favorable oncologic results as compared with other therapeutic regimes.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Hipofaríngeas/cirugía , Terapia por Láser/métodos , Microcirugia , Disección del Cuello , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/terapia , Quimioradioterapia Adyuvante , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Hipofaríngeas/terapia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
9.
Eur Arch Otorhinolaryngol ; 274(4): 1997-2004, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28028607

RESUMEN

For the treatment of T1b glottic carcinoma, different treatment options, such as transoral laser microsurgery, open surgical techniques, and primary radiotherapy, are under discussion. In this context, the aim of the present study was to describe oncologic results and complication rates of transoral laser microsurgery in treatment of T1b glottic carcinoma. This is a retrospective unicenter chart review of patients treated at an academic tertiary referral center between 1986 and 2006. Fifty-one previously untreated T1b cases were exclusively treated by transoral laser microsurgery and included into this study, 47 were male, and 4 were female. The main outcome measures included local control rate and complications, overall, disease specific, and recurrence-free survival. The median follow-up period was 98 months. The 5-year local control rate was 90.2%; larynx preservation rate was 92.2%. No intra- or postoperative complications, such as wound infections, postoperative bleeding, hematoma, edema, and fistula development, were observed. A single patient required revision surgery due to synechia. Five-year survival rates were: overall 84.7%, disease specific 97.7%, and recurrence free 72.4%. Our data support the conclusion that transoral laser microsurgery is a considerable treatment option in T1b glottic carcinoma. The oncologic outcome was at least comparable to other treatment options, while the perioperative morbidity and complication rate were lower.


Asunto(s)
Carcinoma de Células Escamosas , Glotis , Neoplasias Laríngeas , Terapia por Láser , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias , Anciano , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Femenino , Alemania , Glotis/patología , Glotis/cirugía , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Terapia por Láser/efectos adversos , Terapia por Láser/métodos , Masculino , Microcirugia/efectos adversos , Microcirugia/métodos , Persona de Mediana Edad , Boca/cirugía , Estadificación de Neoplasias , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Estudios Retrospectivos
10.
Eur Arch Otorhinolaryngol ; 273(6): 1533-41, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25864181

RESUMEN

This study analyzed the efficacy of transoral laser microsurgery and postoperative (chemo) radiotherapy (CRT) for head and neck squamous cell carcinoma. Between 1987 and 2007, 318 patients with pN2 neck disease were included. Seventy-three patients received laser resection and neck dissection alone, 154 postoperative radiotherapy, and 91 postoperative (C)RT. Mean follow-up was 58.2 ± 51.2 months, and locoregional control was significantly better after postoperative (C)RT (surgery alone: 42 %, radiotherapy: 57 %, CRT: 59 %; p < 0.01). Postoperative (C)RT did not have a significant impact on disease-specific survival (DSS) (surgery alone: 55 %, radiotherapy alone: 60 %, CRT: 64 %; p = 0.36). Fifty-seven patients (17.92 %) developed distant metastases, and 39 patients (12.26 %) presented with secondary malignancies, with no significant differences found between the treatment groups. Postoperative (C)RT significantly improved locoregional control, but had no significant effect on DSS because of high rates of secondary malignancies and distant metastases. Reduced radicality in combination with an effective screening might improve prognosis and quality of life of these patients.


Asunto(s)
Carcinoma de Células Escamosas/terapia , Quimioradioterapia/métodos , Neoplasias de Cabeza y Cuello/terapia , Terapia por Láser/métodos , Microcirugia/métodos , Disección del Cuello/métodos , Recurrencia Local de Neoplasia/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Pronóstico , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento
11.
Nonlinear Dyn ; 81(1-2): 343-352, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26224993

RESUMEN

Many models of three-dimensional rigid body dynamics employ Euler parameters as rotational coordinates. Since the four Euler parameters are not independent, one has to consider the quaternion constraint in the equations of motion. This is usually done by the Lagrange multiplier technique. In the present paper, various forms of the rotational equations of motion will be derived, and it will be shown that they can be transformed into each other. Special attention is hereby given to the value of the Lagrange multiplier and the complexity of terms representing the inertia forces. Particular attention is also paid to the rotational generalized external force vector, which is not unique when using Euler parameters as rotational coordinates.

12.
Head Neck ; 37(2): 156-61, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24519973

RESUMEN

BACKGROUND: The purpose of this study was to evaluate oncologic outcomes of transoral laser microsurgery (TLM) in patients with cancer of the oropharyngeal and/or hypopharyngeal posterior wall. METHODS: Between August 1986 and December 2006, 25 patients (oropharyngeal n = 12; hypopharyngeal n = 13) were treated by primary CO2 laser microsurgery. Treatment was exclusively TLM with or without selective neck dissection in 12 cases (48%); TLM with adjuvant (chemo)radiotherapy was performed in 13 cases (52%). RESULTS: Data were analyzed by using the Kaplan-Meier method. The median follow-up was 41.6 months. The 5-year overall, recurrence-free, and disease-specific survival rates for stages I/II were 36,5%, 60,0%, and 87,5% and for stages III/IVa 41,2%, 36,4%, and 56,3%, respectively. CONCLUSION: With respect to local control and survival, results are comparable to conventional surgery.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Hipofaríngeas/cirugía , Terapia por Láser/métodos , Microcirugia/métodos , Neoplasias Orofaríngeas/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/patología , Láseres de Gas , Masculino , Persona de Mediana Edad , Disección del Cuello , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Complicaciones Posoperatorias , Terapia Recuperativa
13.
Head Neck ; 37(6): 889-95, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24623709

RESUMEN

BACKGROUND: Various therapeutic options exist for treatment of T1a glottic squamous cell cancer (SCC). Radiotherapy (RT) has been favored over surgical excision. This has been challenged by transoral laser microsurgery (TLM) showing low morbidity and good functional results. METHODS: A retrospective chart review was carried out. Patients with untreated T1a glottic SCC were included in the study. Endpoints were locoregional control, overall survival, disease-specific survival, and absolute rate of larynx preservation. RESULTS: Four hundred four patients were included in this study. Five-year Kaplan-Meier estimates were: local control 86.8%, overall survival 87.8%, disease-specific survival 98.0%, recurrence-free survival 76.1%, and larynx preservation 97.3%. The complication rate was 1%; the majority of patients had either normal or mildly dysphonic voices. CONCLUSION: Low complication rates, excellent functional outcome, and high rates of organ preservation favor TLM. In agreement with the literature, TLM should be the treatment of choice for patients presenting with T1a glottic SCC.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Glotis/patología , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Recurrencia Local de Neoplasia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidad , Estudios de Cohortes , Bases de Datos Factuales , Supervivencia sin Enfermedad , Femenino , Glotis/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Terapia por Láser/mortalidad , Masculino , Microcirugia/métodos , Microcirugia/mortalidad , Persona de Mediana Edad , Boca , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/mortalidad , Invasividad Neoplásica/patología , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Tratamientos Conservadores del Órgano/métodos , Pronóstico , Estudios Retrospectivos , Terapia Recuperativa/métodos , Carcinoma de Células Escamosas de Cabeza y Cuello , Análisis de Supervivencia , Resultado del Tratamiento
14.
Accid Anal Prev ; 66: 168-81, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24549035

RESUMEN

The increasing number of deer-vehicle-accidents (DVAs) and the resulting economic costs have promoted numerous studies on behavioural and environmental factors which may contribute to the quantity, spatiotemporal distribution and characteristics of DVAs. Contrary to the spatial pattern of DVAs, data of their temporal pattern is scarce and difficult to obtain because of insufficient accuracy in available datasets, missing standardization in data aquisition, legal terms and low reporting rates to authorities. Literature of deer-traffic collisions on roads and railways is reviewed to examine current understanding of DVA temporal trends. Seasonal, diurnal and lunar peak accident periods are identified for deer, although seasonal pattern are not consistent among and within species or regions and data on effects of lunar cycles on DVAs is almost non-existent. Cluster analysis of seasonal DVA data shows nine distinct clusters of different seasonal DVA pattern for cervid species within the reviewed literature. Studies analyzing the relationship between time-related traffic predictors and DVAs yield mixed results. Despite the seasonal dissimilarity, diurnal DVA pattern are comparatively constant in deer, resulting in pronounced DVA peaks during the hours of dusk and dawn frequently described as bimodal crepuscular pattern. Behavioural aspects in activity seem to have the highest impact in DVAs temporal trends. Differences and variations are related to habitat-, climatic- and traffic characteristics as well as effects of predation, hunting and disturbance. Knowledge of detailed temporal DVA pattern is essential for prevention management as well as for the application and evaluation of mitigation measures.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Luna , Estaciones del Año , Análisis Espacio-Temporal , Animales , Análisis por Conglomerados , Ciervos , Factores de Tiempo
15.
Head Neck ; 36(6): 859-66, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23720321

RESUMEN

BACKGROUND: The purpose of this study was to evaluate oncological and functional results of transoral laser microsurgery (TLM) in patients with T2 and T3 glottic laryngeal squamous cell carcinoma (SCC). METHODS: A retrospective chart analysis was carried out. Cases were classified into categories pT2a, pT2b, and pT3. Treatment was exclusively TLM ± selective neck dissection and adjuvant (chemo)radiotherapy. RESULTS: Three hundred ninety-one patients were treated by TLM; 142 cases were category pT2a, 127 were pT2b, and 122 were pT3. Median follow-up was 71 months. Five-year overall, recurrence-free, and disease specific survival rates were 72.2%, 76.4%, and 93.2% for pT2a tumors, 64.9%, 57.3%, and 83.9% for pT2b tumors, and 58.6%, 57.8%, and 84.1% for pT3 tumors, respectively. Larynx preservation was achieved in 93% (pT2a) and 83% (pT2b and pT3). CONCLUSION: Results are comparable to open partial or total laryngectomy and superior to primary (chemo)radiotherapy. TLM results in a lower morbidity and superior function compared to standard treatment.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía , Terapia por Láser , Cirugía Endoscópica por Orificios Naturales , Recurrencia Local de Neoplasia/cirugía , Tratamientos Conservadores del Órgano/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia Adyuvante/métodos , Femenino , Estudios de Seguimiento , Glotis/fisiopatología , Glotis/cirugía , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Laringectomía/métodos , Terapia por Láser/métodos , Masculino , Sistemas de Registros Médicos Computarizados , Microcirugia/métodos , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/métodos , Disección del Cuello , Invasividad Neoplásica , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , Recuperación de la Función , Estudios Retrospectivos , Terapia Recuperativa/métodos , Resultado del Tratamiento
16.
Head Neck ; 36(6): 787-94, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23616283

RESUMEN

BACKGROUND: The purpose of this study was to investigate oncological and functional results of enoral laser microsurgery in treatment for cancer of the oral cavity. METHODS: A retrospective chart analysis was carried out. Two hundred thirty-two patients with cancer of the oral cavity were treated by enoral laser microsurgery ± selective neck dissection ± postoperative (chemo)radiotherapy. RESULTS: Seventy-three percent of the patients (n = 170) received a unilateral or bilateral selective or modified radical neck dissection, 32% (n = 75) received adjuvant (chemo)radiotherapy. The median follow-up period was 71.89 months. The 5-year overall survival (OS) was 54.6%, recurrence-free survival (RFS) was 60.2%, and disease-specific survival (DSS) was 70.3%. Nasogastric feeding tubes were needed in 96 patients, only 2 patients required a temporary gastrostomy tube. CONCLUSION: Enoral laser microsurgery is an efficient therapeutic option in the treatment of oral cavity cancer. Oncological and functional results are comparable to any other treatment regimen, whereas morbidity and complications tend to be lower.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Terapia por Láser , Microcirugia , Neoplasias de la Boca/cirugía , Recurrencia Local de Neoplasia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia Adyuvante/métodos , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Terapia por Láser/métodos , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Neoplasias de la Boca/terapia , Disección del Cuello/métodos , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Terapia Recuperativa/métodos , Resultado del Tratamiento
17.
Head Neck ; 36(5): 652-9, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-23596018

RESUMEN

BACKGROUND: The purpose of this study was to assess the feasibility of transoral laser microsurgery (TLM) in treatment of pT3 laryngeal cancer. METHODS: We conducted a retrospective case series study of 226 patients with pT3 glottic (n = 122; 54%) or supraglottic laryngeal carcinoma (n = 104; 46%). All patients were treated by TLM in combination with neck dissection (63%) and with postoperative radiotherapy (18%). Our main outcome measures were local control, organ preservation, functional outcome, overall survival, recurrence-free survival, and disease-specific survival. RESULTS: Median follow-up period was 57.8 months. The 5-year organ-preservation and local control rates for all patients were 87% and 71.4%, respectively. The 5-year overall, recurrence-free, and disease-specific survival were 64.4%, 63.0%, and 83.3%, respectively. CONCLUSION: Results are comparable to partial or total laryngectomy, while being superior to primary chemo(radio)therapy. TLM results in low morbidity, rapid recovery, and good function and can be a valid option for organ-preserving surgery of pT3 glottic and supraglottic cancer.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Quimioradioterapia/métodos , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Recurrencia Local de Neoplasia/patología , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Glotis/patología , Glotis/cirugía , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Laringectomía/métodos , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/mortalidad , Disección del Cuello/métodos , Invasividad Neoplásica/patología , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Tratamientos Conservadores del Órgano , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento
18.
Eur Arch Otorhinolaryngol ; 270(10): 2719-27, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23408021

RESUMEN

The main objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of T4a laryngeal cancer and to report the oncological and functional outcomes. This is a retrospective case-series study, held in a single-institute, academic tertiary referral center. Seventy-nine patients with previously untreated T4a glottic (n = 31, 39 %) or supraglottic laryngeal carcinoma (n = 48, 61 %) were included in this study. Five patients (6 %) were treated exclusively by TLM, 16 (20 %) had TLM and unilateral neck dissection, 27 (35 %) had TLM and bilateral neck dissection. Adjuvant (chemo)radiotherapy was additionally administered in 26 (33 %) cases following TLM and neck dissection, and in 5 (6 %) cases after TLM without neck dissection. The main outcome measures included organ preservation, local control, functional outcome, overall, recurrence-free, and disease-specific survival. The median follow-up period was 49 months, 5 year organ preservation rate and local control rate were 80.0 and 67.2 %, 5 year overall, recurrence-free and disease-specific survival were 55.8, 61.9 and 71.8 %. The 5 year overall survival rates were 62.5 % in pN0 cases and 57.2 % in cases with pN-positive neck disease. With respect to survival, these results are comparable to total laryngectomy, while being superior to primary (chemo)radiotherapy. TLM results in a low morbidity, rapid recovery and good function and can be a valid option for organ preserving surgery of pT4a glottic and supraglottic cancer.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Glotis/cirugía , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Microcirugia/métodos , Recurrencia Local de Neoplasia/prevención & control , Tratamientos Conservadores del Órgano/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia Adyuvante , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Laringoscopía/métodos , Masculino , Persona de Mediana Edad , Disección del Cuello/métodos , Estadificación de Neoplasias , Estudios Retrospectivos , Resultado del Tratamiento
19.
Eur Arch Otorhinolaryngol ; 270(8): 2299-306, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23274878

RESUMEN

The objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of squamous cell cancer of the tonsil and to report the oncological and functional outcomes, using retrospective chart review in the setting of single-institute, academic tertiary referral center. Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13% presented with stage I and II (UICC/AJCC 2002) tumors and 87% with stages III and IVa. The median follow-up was 63 months. All patients were treated by TLM with (or without) neck dissection (95%) and with (66%) postoperative radiotherapy. Overall survival, recurrence-free survival, disease-free survival, local control and loco-regional control were analyzed as end points. Rate of tracheotomies, postoperative complications and swallowing function were also analyzed. 5-year Kaplan-Meier local and loco-regional control was 78% for pT1 and pT2 and 75 % for pT3 and pT4a tumors. 5-year Kaplan-Meier disease-free survival, recurrence-free survival, and overall survival and was 74, 64 and 59% for stage I and II, 68, 60 and 56 % for stage III and IVa, respectively. Our data supports the conclusion, that TLM should be considered as a therapeutic option for the treatment of cancer of the tonsil. The oncological and functional results are comparable to any other treatment regimen, while the morbidity and complications tend to be lower.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Terapia por Láser/métodos , Microcirugia/métodos , Tonsila Palatina/cirugía , Neoplasias Faríngeas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tonsila Palatina/patología , Neoplasias Faríngeas/mortalidad , Neoplasias Faríngeas/patología , Estudios Retrospectivos , Resultado del Tratamiento
20.
Eur Arch Otorhinolaryngol ; 270(8): 2315-26, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23306348

RESUMEN

The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan-Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85% for pT1/pT2, 82% for pT3, and 76% for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92%, for stages III and IVa 59, 65, and 81%, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Microcirugia/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/radioterapia , Masculino , Persona de Mediana Edad , Disección del Cuello , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Tasa de Supervivencia , Resultado del Tratamiento
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