Photodynamic Therapy for Eye, Ear, Laryngeal Area, and Nasal and Oral Cavity Diseases: A Review

Photodynamic therapy (PDT) has emerged as a promising modality for the treatment of various diseases. This non-invasive approach utilizes photosensitizing agents and light to selectively target and destroy abnormal cells, providing a valuable alternative to traditional treatments. Research studies have explored the application of PDT in different areas of the head. Research is focusing on a growing number of new developments and treatments for cancer. One of these methods is PDT. Photodynamic therapy is now a revolutionary, progressive method of cancer therapy. A very important feature of PDT is that cells cannot become immune to singlet oxygen. With this therapy, patients can avoid lengthy and costly surgeries. PDT therapy is referred to as a safe and highly selective therapy. These studies collectively highlight the potential of PDT as a valuable therapeutic option in treating the head area. As research in this field progresses, PDT may become increasingly integrated into the clinical management of these conditions, offering a balance between effectiveness and minimal invasiveness.

Postprandial splenic stiffness changes on magnetic resonance elastography in a young healthy population

Magnetic resonance elastography (MRE) is an accurate noninvasive diagnostic tool for assessing the stiffness of parenchymal organs, including the spleen. However, this measurement may be biased due to postprandial changes in splenic stiffness. The aim of the current study was to evaluate postprandial changes in spleen stiffness assessed by MRE in a large sample of healthy volunteers. This was a prospective institutional research ethics board-approved study. Healthy volunteers with no history of liver disease were recruited for an MRE test and blood draw from December 2018 to July 2019. Each participant underwent spleen MRE after at least 4 h of fasting and again 30 min after a 1000 kcal meal. Also, 14 randomly selected volunteers underwent additional MRE examinations at 1.5 and 2.5 h after food intake. The MRE data were acquired at 60 Hz using a 1.5-T MRI scanner. The spleen stiffness was assessed using a weighted mean of stiffness values from regions of interest manually drawn on three to five spleen slices. Spearman's rank correlation, Wilcoxon signed-rank, Friedman, and Mann-Whitney tests were used for statistical analysis. A total of 100 volunteers met the inclusion criteria and were eventually enrolled in this study (age 23 ± 2 years; 65 women). The mean spleen stiffness for the whole group increased by 7.9% (p < 0.001) from the mean ± SD value of 5.09 ± 0.63 (95% CI: 4.96-5.21) kPa in the fasting state to 5.47 ± 0.66 (95% CI 5.34-5.60) kPa 30 min after the meal and then gradually decreased. However, even 2 h 30 min after the meal, the spleen stiffness was higher than in the fasting state. This difference was statistically significant at p less than 0.001. It was concluded that meal intake results in a statistically significant elevation of spleen stiffness that persists for 2.5 h. This finding supports the recommendation for routine fasting for more than 2.5 h prior to assessing MRE-based spleen stiffness.

PDT-Induced Activation Enhanced by Hormone Response to Treatment

Photodynamic therapy (PDT) is a medical treatment with the use of a photosensitizing agent (PS), which, when activated by light, results in selective tissue damage with a cytotoxic effect on tumor cells. PDT leads to the induction of an acute-phase response, which results in the involvement of adrenal glucocorticoid (GC) hormones. PDT, by activating the hormonal response, affects the treatment of cancer. GC release is observed due to adrenal activity, which is driven by changes in the hypothalamic pituitary-adrenal axis triggered by stress signals emanating from the PDT treated tumor. The hormones released in this process in the context of the PDT-induced acute-phase response perform many important functions during anticancer therapy. They lead, among other things, to the systemic mobilization of neutrophils and the production of acute-phase reagents, and also control the production of immunoregulatory proteins and proteins that modulate inflammation. GCs can radically affect the activity of various inflammatory and immune cells, including the apoptosis of cancer cells. A better understanding of the modulation of GC activity could improve the outcomes of cancer patients treated with PDT.

Evaluation of Spleen Stiffness in Young Healthy Volunteers Using Magnetic Resonance Elastography

PURPOSE

Magnetic resonance elastography (MRE) has been established as the most accurate noninvasive technique for diagnosing liver fibrosis. Recent publications have suggested that the measurement of splenic stiffness is useful in setting where portal hypertension may be present. The goal of the current study was to compile normative data for MRE-assessed stiffness measurements of the spleen in young adults.

MATERIALS AND METHODS

A total of 100 healthy young Caucasian volunteers (65 females and 35 males) in the age range of 20 to 32 years were enrolled in this study. The participants reported no history of chronic spleen and liver disease, normal alcohol consumption, and a normal diet. The MRE data were acquired by using a 1.5 T whole-body scanner and a 2D GRE pulse sequence with 60 Hz excitation. Spleen stiffness was calculated as a weighted mean of stiffness values in the regions of interest manually drawn by the radiologist on three to five spleen slices.

RESULTS

Mean spleen stiffness was 5.09 ± 0.65 kPa for the whole group. Male volunteers had slightly higher splenic stiffness compared to females: 5.28 ± 0.78 vs. 4.98 ± 0.51 kPa, however, this difference was not statistically significant (p = 0.12). Spleen stiffness did not correlate with spleen fat content and liver stiffness but a statistically significant correlation with spleen volume was found.

CONCLUSIONS

The findings of this study provide normative values for 2D MRE-based measurement of spleen stiffness in young adults, a basis for assessing the value of this biomarker in young patients with portal system pathologies.

The Use of Photodynamic Therapy for Head, Neck, and Brain Diseases

Head-neck cancers as a group have the 7th highest rate of incidence worldwide. The most often diagnosed disease of the head and neck is squamous cell carcinoma (90% of cases). Another specific group of tumors is brain tumors. These can be divided into primary tumors and secondary tumors associated with metastasis. Research shows that treating head and neck cancers continues to be problematic and challenging, and researchers are actively seeking new treatments that would improve survival rates and reduce side effects. Irradiation of tumor tissue with the optimal wavelength of light in photodynamic therapy (PDT) generates predominantly singlet oxygen in tissue-based photosensitizers (PSs) or reactive oxygen radicals in the case of vascular PSs leading to cellular apoptosis and necrosis. A very important feature of PDT is that cells cannot become immune to the effects of singlet oxygen or reactive oxygen radicals. However, photosensitizer (PS) transport is influenced by the specific structures of cancer tumors and the concentration of PS decreases in cells far from the vessel lumen. Therefore, PSs may not reach tumor interiors, which decreases therapy effectiveness. The use of drug carriers and 3rd generation PSs that contain biocompatible functional groups makes it possible to control transport. This review of the current literature on PDT was conducted through databases such as PubMed and Scopus. The types of publications considered included clinical studies and most of the articles included were published in English. Based on the publications collected, we conclude that researchers have demonstrated the potential of PDT as a therapeutic platform for head, neck, and brain diseases.

Rose Bengal and Future Directions in Larynx Tumor Photodynamic Therapy†

Photodynamic Therapy (PDT) seems to be a promising method in the treatment of larynx tumor tissues. The aim of the present analysis was the study of photosensitizer penetration of larynx tissue associated with the application of PDT in vitro. This study is based on the use of photosensitive compounds Rose Bengal (RB) that selectively accumulate in larynx tissue. The selection of the study group of patients who will undergo surgery in accordance with medical principles was of key importance for the project. Histopathological examination of samples subjected to PDT revealed numerous changes in the morphology of the cancer cells and surrounding tissues. After PDT treatment, the number of tumor cells decreased compared with the cells number before PDT and the arrangement was relatively loose. After PDT with RB the nuclei morphology was incomplete and fragmented. The effects of the applied PDT of larynx in vitro were assessed under an optical microscope. The future directions in larynx tumor PDT with the use of upconversion nanoparticles (UPCNP) is also discussed.

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with laparoscopic surgical mode

OBJECTIVES

Obesity has been suggested to have a negative influence on procedural outcomes of endometrial cancer laparoscopic treatment. Obesity and other possible risk factors of laparoscopic endometrial cancer treatment has not been precisely described in the literature. The aim of the study is to determine the factors that have the greatest influence on the course of laparoscopic surgery for endometrial cancer, with particular emphasis on the influence of obesity.

MATERIAL AND METHODS

The study included 75 females who were treated for endometrial cancer by laparoscopic surgery. Preoperative body-mass index (BMI), waist circumference(WC), waist to hip ratio(WHR), and selected anatomical indices were measured. The duration of surgery and hospitalization stay, loss of hemoglobin, and procedural-related complications served as parameters of in-hospital outcomes.

RESULTS

Multiple linear regression analysis indicate the body mass as most sensitive parameter of obesity which influence in-hospital outcomes in patients treated with laparoscopic procedure. Procedural-related complications occurred in the group of patients with significantly greater WC and BMI. Multiple linear regression indicates also histological grading (G1-G3), external conjugate, intertrochanteric distance as significant risk factors. The multiple linear regression analysis confirmed also that implementation of sentinel lymph node procedure is related with decreased hemoglobin loss in patients with cancer of endometrium compare to lymphadenectomy without sentinel node biopsy(Est.: 0.488; 95% CI: 0.083-0.892, p = 0.018).

CONCLUSIONS

The most sensitive risk factor of in-hospital outcomes in laparoscopic treatment of endometrial cancer is body mass. The implementation of the sentinel node procedure is associated with reduced surgery time and reduced hemoglobin loss.

The assessment of phonatory and ventilatory functions in patients after microsurgery for Reinke's edema

BACKGROUND

Short and long-term results of microsurgical treatment with the mini-microflap technique in patients with Reinke's edema (RE) were assessed based on the phonatory and ventilatory functions of the larynx.

OBJECTIVES

To assess the short and long-term results of microsurgical treatment with the mini-microflap technique in patients with RE based on the phonatory and ventilatory functions of the larynx.

MATERIAL AND METHODS

Twenty patients diagnosed with advanced stage of RE confirmed with laryngovideostroboscopy (LVS) were enrolled in the study. Phonatory function disturbances were additionally assessed on the basis of Maximum Phonation Time (MPT) measurement, Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-ROOL) questionnaires. Ventilatory function was assessed using spirometry. The aforementioned complex examinations were conducted prior to surgery and 1, 6 and 9 months following the surgery.

RESULTS

Good postsurgical results were obtained in subjective and objective evaluation, which assessed the phonatory function and ventilatory parameters. Post-surgery increase in MPT, VHI and VQROL was noticed in all patients in 3 check points (p < 0.001). The results demonstrate postsurgical improvement for some LVS parameters, including assessment of glottis closure (p < 0.003) observed 6 months after the surgery. An improvement in most of the ventilation parameters was observed also 6 months after surgery (p < 0.001). For the spirometry flow parameter PEF, significant improvement was noted in each check point (p1 < 0.004, p6 < 0.001, p9 < 0.001). The study revealed a correlation between phonatory parameter - MPT and PEF observed 1 month after the procedure (p = 0.026), confirming the interdependence of ventilatory efficiency and phonatory condition of larynx.

CONCLUSIONS

Mini-microflap surgery brings satisfactory clinical effect in patients with advanced stages of RE by optimization of phonatory and ventilatory functions of the larynx.

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with traditional surgical mode

OBJECTIVES

Abdominal obesity is a risk factor for endometrial cancer. The negative impact of individual parameters of obesity on the procedural effects of endometrial cancer surgical treatment has been suggested. The aim of the current study was to estimate the relationship of particular parameters of obesity and in-hospital outcomes in patients treated surgically due to endometrial cancer.

MATERIAL AND METHODS

The study included 70 women treated surgically for endometrial cancer. Pre-operatively, mass, body mass index (BMI), waist circumference, waist-hip ratio and selected anatomical indices were measured. The duration of surgery, hospitalisation, and the loss of haemoglobin served as parameters of in-hospital procedure success. Also, procedural-related complications were estimated.

RESULTS

There were 37 (52.8%) obese females in the current study. They were obese patients presenting more advanced clinical stages of endometrial cancer before operation. The duration of operation (94.9 ± 21.6 min. vs. 76.1 ± 13.5 min., p < 0.0001), hospitalisation (12.4 ± 3.4 days vs. 10 ± 2.3 days, p = 0.0009) and haemoglobin loss (2.5 ± 0.9 g/dL vs. 1.9 ± 0.8 g/dL, p = 0.004) were significantly greater in obese patients. Multivariate analysis, among the independent predictors of the duration of operation, has confirmed the correlation between BMI, waist circumference and weight and the duration of hospitalisation. Waist and hip circumference and BMI coupled with external conjugate dimension and intertrochanteric distance have been linked with haemoglobin loss. The strongest correlation for the duration of operation, hospitalisation and haemoglobin loss was noticed for waist circumference (r = 0.7, r = 0.57 and r = 0.59).

CONCLUSIONS

Waist circumference and BMI are strong predictors of in-hospital outcomes among patients with endometrial cancer treated via traditional surgical operation.

Monitoring photodynamic oxygen consumption by endogenous oxygen contrast MRI

Photodynamic oxygen consumption was measured by changes in spin-lattice relaxation time (T₁) in aqueous solution in a clinical GE scanner at 1.5 T. Similar measurements were attempted in excised laryngeal and thyroid tissues that were infused with Rose Bengal. First, T₁ was measured as a function of dissolved oxygen in argon and in oxygen pre-saturated water samples that were opened to the atmosphere in a series of steps allowing air to diffuse into or out of solution; for both argon and oxygen saturated water solutions, stepwise air re-equilibration resulted in a return to air-saturated water T₁. Secondly, T₁ was measured as a function of time under type II photooxidative conditions in aqueous solution. Under type II photooxidative conditions, a 492 ± 53 ms increase in T₁ was measured following 300 s of visible light illumination of aqueous solutions containing the photosensitizer Rose Bengal (2.5 × 10^-6 M) and the singlet oxygen trap methionine (0.0012 M). The 492 ± 53 ms increase in T₁ corresponded to consumption of all the measurable dissolved oxygen (˜ 0.1 mg O₂ in 15.0 mL of H₂O) during photooxidation of methionine in air saturated water. This rapid oxygen consumption, indicated by an increase in T₁, is due to irreversible trapping of photogenerated singlet oxygen by methionine. Thirdly, an increase in T₁ was observed in Rose Bengal infused normal laryngeal tissue, and in normal and cancerous thyroid tissue samples following 20 min of exposure to visible light. An increase in T₁ was not observed after 40 min of illumination which suggests that the increases in T₁ observed after 20 min were not due to water uptake, but rather to photoconsumption of interstitial dissolved oxygen.

A Review of Selected Factors of Salivary Gland Tumour Formation and Malignant Transformation

Salivary gland tumours represent about 6% of head and neck neoplasms and about 0.5% of all malignancies in humans. Tumour growth and malignant transformation are complex processes involving various actions of molecules. Furthermore, some malignant salivary gland tumours are deemed to be caused by dedifferentiation or malignant transformation of benign tumours. The mechanisms of this transformation depend on a variety of different elements, such as cell cycle regulators, oncogenes, proteins, angiogenesis factors, and adipocytokines. The authors used PubMed, Medline, and Google websites to find and review the most significant papers related to malignant transformation in benign salivary gland tumours.

[Bilateral acinar cell carcinoma of the parotid gland]

Authors have described a case of bilateral acinic cell carcinoma of parotid gland. The patient has been treated successfully by left superficial parotidectomy and right total parotidectomy followed by complementary Co 60 therapy. During 3 years after surgery the patient revealed no recurrence of the disease. Clinical course, histology and pathology have also been presented. The authors have pointed out the difficulties in diagnosing ACC because of the variety of histological pictures and unclear terminology.

[Problems with treatment in patients with tongue and/or floor of the mouth neoplasms]

From 1974 to 1993 in Otolaryngology Department of County Hospital No 1 in Rzeszów, Poland in 98 patients cancers of the oral tongue and/or floor of the mouth have been diagnosed. Pathology examinations revealed squamous cell carcinoma in 98% of the total number of patients. Based on the hospital data and control examinations authors have analyzed retrospectively 42 patients (35 male and 7 female, aged 32-90). Because of the advanced stage of the disease as many as 17 patients have applied only palliative treatment. 13 patients were treated surgically followed by radiotherapy and/or chemotherapy, 9 patients were treated with radiation and 3 patients have radiotherapy and chemotherapy. 3, 5, and 10 years survivals have been estimated.

[Suprahyoid lymphangiectomy in patients treated for lip cancer]

Bilateral suprahyoid lymphangiectomy have been made in 95 patients because of suspicion of submandibular lymph nodes metastases. The patients with lip carcinoma have been previously treated with surgery, surgery and radiotherapy or with radiotherapy followed by surgery. Histological examinations have revealed lymph node metastases in 62 (65.3%) patients, in 31 (32.6%) patients histology has been negative and in 2 (2.2%) patients lymphonodular tuberculosis has been stated. Authors have analyzed 3, 5 and 10 years survivals in 65 patients after suprahyoid lymphangiectomy during lip cancer treatment.

[A model for diagnosis and treatment of thyroid tumors]

From 1992 to 1994 23 patients with tumor or nodular goiter of thyroid gland have been treated in Otolaryngology Department of County Hospital No 1 in Rzeszów, Poland. Histology examination has revealed malignant tumors in 5 (21.7%) cases: papillary carcinoma in 3 cases and follicular carcinoma in 2 cases. Based on own material and references authors present the model of diagnostic course in case of single or multiple nodules of thyroid gland. Physical examination, ultrasonography, thyroid hormone levels, fine-needle biopsy, nuclear scan and intrasurgery pathology examination in case of malignancy suspicion have been taken into consideration. Treatment of thyroid gland tumors requires cooperation otolaryngology, endocrinology, oncology and surgery specialties. In a case of thyroid carcinoma radical surgery must be followed by radiotherapy with using radioactive iodine and/or external radiotherapy.

[Tumor of the neck as the primary sign of thyroid cancer]

From 1974 to 1994 in Otolaryngology Department of County Hospital No 1 in Rezszów, Poland in 35 patients tumor of neck derived from thyroid gland has been revealed. There were 22 females and 13 males, aged 16 to 78 (mean age 48), among the patients. Pathology examination of surgery removed tumors has revealed malignancy in 19/35 (54%) cases, non-neoplastic tumors in 11/35 (32%) cases and non-malignant tumors in 5/35 (14%) cases. Among malignant tumors metastasis of papillare adenocarcinoma was the most frequent pathology (37%). Authors analyze feature of the thyroid gland derived tumors based on their size, consistency, localization, mobility, towards surroundings and the picture during surgery. Because of the presence of thyroid gland malignant tumor metastasis without clinical symptoms, author emphasised the necessity of its consideration in differential diagnosis.