Incidence of lymph node metastases after piecemeal laser-surgical and en bloc cold steel resection of auricular VX2 carcinoma. A comparative study.

The CO2 laser surgery has become a widely used clinical treatment in otorhinolaryngology. In advanced neoplastic disease of the head and neck it is often difficult and even impossible to expose well the whole tumor through the surgical laryngoscope. In such cases the tumor is usually divided with the CO2 laser in several parts, which are excised separately. This approach seems opposed to the basic principles of oncologic surgery, where the tumor should not be touched in order to avoid local recurrences or metastatic spread. The proponents of the piecemeal resections refer back to few morphological and clinical studies, which show no evidence of increased incidence of metastases after the piecemeal resection. On this background the aim of the present study was to compare the piecemeal laser surgical complete (R0) resection with cold steel complete (R0) en bloc resection of tumors in an animal model. For both surgical approaches the incidence of local recurrences, regional and distant metastases had to be compared. After randomization to the both study arms in 143 male New Zealand White rabbits a VX2 squamous cell carcinoma was induced on the auricle. On day 8 a complete resection of the tumour was performed: for the first group - with cold steel resection en bloc; for the second group the cancer was transected by the CO2 laser following which it was removed in two pieces - piecemeal laser-surgical resection. On the 42nd postoperative day all animals were sacrificed and subjected to evaluation of the tumoral spread. Compared on the incidence of LN metastases the two therapeutic groups showed significant differences. Twenty-five percent of the animals with en bloc cold steel had metastases to regional lymph nodes, whereas forty-seven percent of the laser piecemeal group had metastatic nodal involvement. The incidence of distant metastases was similar for both study groups - 12.3% for the en block resection group and 7.7% for the piecemeal laser resection group. In this experimental setting the piecemeal laser surgical resection achieved better local results, but lead to more metastases (mainly lymphatic ones), than the cold steal en bloc resection. However, it is unlikely that tumor cells disseminated from the resection line itself caused this difference, as the vessels here were occluded by the laser. Mechanisms, which could explain the observed difference include dissemination through the walls of the intratumoral or peritumoral lymphatics. Piecemeal laser resection may decompress intratumoral pressure and release intra and peritumoral lymphatics, causing a flood of tumor emboli. Changes in the permeability and the lymph/blood flow caused by the local laser heat could have similar effect. Additionally mechanical trauma to the tumor mass itself or explosion-like tumor cell spread into the lymphatic network due to the applied laser energy could also precipitate metastases

Physiological-based cord clamping versus immediate cord clamping for infants born with a congenital diaphragmatic hernia (PinC):study protocol for a multicentre, randomised controlled trial

Introduction Pulmonary hypertension is a majordeterminant of postnatal survival in infants with acongenital diaphragmatic hernia (CDH). The current careduring the perinatal stabilisation period in these infantsmight contribute to the development of pulmonaryhypertension after birth—in particular umbilical cordclamping before lung aeration. An ovine model ofdiaphragmatic hernia demonstrated that cord clampingafter lung aeration, called physiological-based cordclamping (PBCC), avoided the initial high pressures in thelung vasculature while maintaining adequate blood flow,thereby avoiding vascular remodelling and aggravationof pulmonary hypertension. We aim to investigate if theimplementation of PBCC in the perinatal stabilisation periodof infants born with a CDH could reduce the incidence ofpulmonary hypertension in the first 24 hours after birth.Methods and analysis We will perform a multicentre,randomised controlled trial in infants with an isolatedleft-sided CDH, born at ≥35.0 weeks. Before birth, infantswill be randomised to either PBCC or immediate cordclamping, stratified by treatment centre and severity ofpulmonary hypoplasia on antenatal ultrasound. PBCCwill be performed using a purpose- built resuscitationtrolley. Cord clamping will be performed when the infantis considered respiratory stable, defined as a heartrate >100 bpm, preductal oxygen saturation >85%,while using a fraction of inspired oxygen of <0.5. Theprimary outcome is pulmonary hypertension diagnosedin the first 24 hours after birth, based on clinical andechocardiographic parameters. Secondary outcomesinclude neonatal as well as maternal outcomes.Ethics and dissemination Central ethical approvalwas obtained from the Medical Ethical Committee ofthe Erasmus MC, Rotterdam, The Netherlands (METC2019-0414). Local ethical approval will be obtained bysubmitting the protocol to the regulatory bodies and localinstitutional review boards

Optical Detection of Preneoplastic Lesions of the Central Airways

Current routine diagnosis of premalignant lesions of the central airways is hampered due to a limited sensitivity (white light bronchoscopy) and resolution (computer tomography (CT), positron emission tomography (PET)) of currently used techniques. To improve the detection of these subtle mucosal abnormalities, novel optical imaging bronchoscopic techniques have been developed over the past decade. In this review we highlight the technological developments in the field of endoscopic imaging, and describe their advantages and disadvantages in clinical use

PULMONARY ARTERY REMODELING IN SEVERE EQUINE ASTHMA

Recurrent episodes of airway obstruction, hypoxemia and pulmonary hypertension (PH) are present during exacerbations of severe equine asthma (SEA). Pulmonary hypoxic vasoconstriction is known to contribute to the development of PH, which may lead to cor pulmonale. However, as PH is only partially reversible by oxygen administration, other etiological factors are likely to be involved. In human chronic obstructive pulmonary disease, pulmonary artery (PA) remodeling contributes to the development of PH. Furthermore, allergic airway inflammation results in remodeling of pulmonary vasculature in mouse models, suggesting that similar findings may be present in asthma. We therefore postulated that PA remodeling is present in SEA and contributes to PH. The project aimed to investigate 1) the presence of PA remodeling in severe equine asthma and its distribution throughout the lungs, 2) the involvement of vascular smooth muscle (VSM) alterations, and 3) their reversibility following long-term antigen avoidance strategies or inhaled corticosteroids administration. Using histomorphometry and tissue bank (ERTB) lung samples, the PA wall was measured on sections stained with hematoxylin-eosin saffron, collected post-mortem from different lung regions of 12 asthmatic horses and 6 age-matched controls. Pulmonary vascular smooth muscle (VSM) mass was also measured on sections stained for \u3b1-smooth muscle actin collected with in vivo thoracoscopy or post-mortem peripheral lung biopsy from 5 controls, 6 asthmatic horses in remission, and 11 asthmatic horses while exacerbation and after 1 year of antigen avoidance alone (5 horses) or treatments with fluticasone (6 horses). Data were compared using one tailed unpaired t tests with Welch correction or paired t tests (p<0.05). Increased PA wall surface was detected in apical (p=0.002) and caudodorsal (p=0.03) lung regions of asthmatic horses in both exacerbation and remission, when compared to controls. The VSM mass was similarly increased (p=0.03) when compared to controls. A tendency for a normalization of the VSM mass was observed after treatment with antigen avoidance (p=0.05), but not with fluticasone (p=0.27). Remodeling of the PA develops in SEA and is associated with an increase in VSM. The resulting narrowing of the lumen of the PA could enhance hypoxic vasoconstriction, contributing to PH during exacerbation of SEA. VSM mass normalization is better achieved by antigen avoidance than by corticosteroids