Deltopectoral flap in the era of microsurgery

OBJECTIVES: In 1965, Bakamjian described the deltopectoral (DP) flap as a reconstructive option in head and neck surgery. It served as the premier flap for reconstructing complex head and neck defects until the late 1970s. Today, the DP flap is often overlooked; although its role has diminished, its use is still warranted in certain select clinical situations. METHODS: A retrospective patient chart review of 25 DP flap procedures performed at the University of Iowa Hospitals and Clinics and Iowa City Veterans Administration Hospital between January 1, 1991, and June 1, 2002, was undertaken. The data collected included patient demographics and assessment of DP flap survival and its ability to accomplish established preoperative reconstructive goals. RESULTS: The DP flap was used for the following situations: vascularized skin coverage of the neck, carotid arteries, and face (16 cases), including simultaneous coverage of other reconstructive flaps in 6 cases; controlled orocutaneous fistula development (3 cases) or fistula closure (5 cases); and pharyngoesophageal reconstruction (4 cases). In 3 cases the flap was used for more than one of the preoperative goals described above (n = 25). Minor flap-related complications that required local wound treatment developed in 5 cases (20.0%), but the flaps were successfully salvaged and no subsequent reconstructive procedure was required. In an additional 5 cases (20.0%), the flap failed in some measure to accomplish its preoperative goal, necessitating further surgical reconstruction. Sixteen patients (64%) had undergone previous or simultaneous reconstructive procedures that limited other available reconstructive options. CONCLUSIONS: The technical simplicity of the DP flap, coupled with its predictable vascular supply, has allowed it to maintain a niche role in contemporary reconstructive surgery. The DP flap provides an excellent method of reconstruction in select cases in which vascularized skin coverage of the neck is needed. The DP flap also provides a valuable salvage option in situations in which other reconstructive techniques are not possible.published_or_final_versio

Long non-coding RNA deregulation in tongue squamous cell carcinoma

Background. The deregulated tumorigenic long non-coding RNA (lncRNA) has been reported in several malignancies. However, there is still no comprehensive study on tongue squamous cell carcinoma (SCC). Methods. Functional reannotation for the human lncRNA was carried out by ncFANs. Real-time quantitative PCR was used to validate the identified lncRNAs. Results. Using the functional annotation algorithm from ncFANs, 8 differentially expressed lncRNAs were identified. Lnc-PPP2R4-5, lnc-SPRR2D-1, lnc-MAN1A2-1, lnc-FAM46A-1, lnc-MBL2-4:1, and lnc-MBL2-4:3 were upregulated in the microdissected tongue SCC tissues. In comparison, lnc-AL355149.1-1 and lnc-STXBP5-1 showed significant downregulation. High level of lnc-MBL2-4:3 was significantly associated with the node positive tongue SCC patients. Further, patients with advanced T-stage demonstrated a further reduction of lnc-AL355149.1-1 in the tumor tissues. Treatment of tongue SCC cells with 5-fluorouracil and paclitaxel can reserve the expression patterns observed in the tongue SCC tissues. Further, changes of lnc-MBL2-4:3 and lnc-AL355149.1-1 expression levels were noticed in the cisplatin-resistant tongue SCC cells. Conclusions. Our results demonstrated that functional reannotation allows us to identify novel lncRNAs using the existing gene expression array dataset. The association of lncRNA with the T-stage and nodal status of tongue SCC patients suggested that lncRNA deregulation was involved in the pathogenesis of tongue SCC.published_or_final_versio

Transcriptional regulation of E-cadherin by Zinc Finger E-Box Binding Homeobox (ZEB) in solid tumors

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Differential expression of long noncoding RNA in primary and recurrent nasopharyngeal carcinoma

Background. Recent studies suggested that non-protein-coding genes are implicated in the tumorigenic process of nasopharyngeal carcinoma (NPC). In the present study, we aimed to identify the differentially expressed long noncoding RNA (lncRNA) using data available in the public domain. Methods. Microarray data set GSE12452 was reannotated with ncFANs. Real-time quantitative PCR was used to quantify and validate the identified lncRNAs in NPC. Results. In primary NPC, upregulation of lnc-C22orf32-1, lnc-AL355149.1-1, and lnc-ZNF674-1 was observed. High levels of lnc-C22orf32-1 and lnc-AL355149.1-1 were significantly associated with the male patients. In addition, increased expression of lnc-C22orf32-1 and lnc-ZNF674-1 was associated with advanced tumor stages. Recurrent NPC displayed a distinctive lncRNA expression pattern. lnc-BCL2L11-3 was significantly increased in the recurrent NPC tissues. In addition, significant reduction of lnc-AL355149.1-1 and lnc-ZNF674-1 was observed in the recurrent NPC tissues. Conclusions. Our results demonstrated that it is feasible to identify the differentially expressed lncRNA in the microarray dataset by functional reannotation. The association of lncRNA with gender and tumor size implicated that lncRNA possibly plays a part in the pathogenesis of primary NPC. Further, the distinctive lncRNA identified in the recurrent NPC may reveal a distinctive development mechanism underlying tumor recurrence. © 2014 Wei Gao et al.published_or_final_versio

Role of surgery in the treatment of radiation-induced sarcomas of the head and neck

Introduction: Radiation-induced sarcoma (RIS) is a well-known complication of radiotherapy. It is an aggressive tumour and the prognosis is often poor, despite radical treatment. We aim to investigate the role of surgery in the treatment of patients with RIS of the head and neck region. Method: We conducted a retrospective review of records of patients whom were treated for radiation-induced sarcoma at Queen Mary Hospital, Hong Kong, between the period 1999 to 2010. Data collected included patient age, gender, latency period for the development of RIS, site of RIS, symptoms, treatment given, pathology and survival. Results: Nineteen patients were included, (M=11, F=8). Eighteen received radiotherapy for treatment of primary nasopharyngeal carcinoma. One received radiotherapy for carcinoma of the parotid. The medial latency period for the development of sarcoma was 11.1 years (range 5.3-25.1). The most common site for development of RIS was the neck (n=8), followed by the oropharynx/oral cavity (n=4), nasopharynx (n=3) nasal cavity (n=2), maxilla (n=1) and mandible (n=1). The most common histology was undifferentiated sarcoma (n=6). Nine patients underwent surgical resection of the RIS with curative intent, three and six patients achieved R0 and R1 resection respectively. Chemotherapy was used in eleven instances after surgery. Radiotherapy was used in seven instances, three through brachytherapy, four through external beam irradiation. Overall medial survival from diagnosis of RIS was 1.74 years (95% CI 0.60-2.87), which improves to 2.47 years (95% CI 0.97-3.97) when only calculating those whom surgery was performed. Conclusions: Patients suffering from radiation-induced sarcomas have a poor prognosis, in keeping with existing literature. Treatment is mainly by surgery aiming at resection with a curative intent. If curative resection is impossible, surgery may still have a role in palliating the patients’ symptoms such as bleeding, fungation, or painpublished_or_final_versio

The role of elective neck dissection during surgical salvage for recurrent nasopharyngeal carcinoma

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Review of salivary gland neoplasms

Salivary gland tumours most often present as painless enlarging masses.Most are located in the parotid glands andmost are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but most cases will require surgical excision as ameans of coming to a definitive diagnosis. Benign tumours and early low-grademalignancies can be adequately treated with surgery alone, while more advanced and high-grade tumours with regional lymph node metastasis will require postoperative radiotherapy. The role of chemotherapy remains largely palliative. This paper highlights some of the more important aspects in the management of salivary gland tumours.published_or_final_versio

Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients

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The role of tumor suppressing microRNA let-7 in undifferentiated nasopharyngeal carcinoma

Conference Theme: Accelerating Science: Concept to ClinicPoster Session 37: Late-Breaking Poster Presentations - Epigenetics: abstract no. LB-385This journal suppl. entitled: Proceedings: AACR 103rd Annual Meeting ... 2012AIMS:This study aimed at evaluating the potential anti-proliferative effects of the microRNA let-7 family in nasopharyngeal carcinoma (NPC) cells. In addition, the association between let-7 suppression and DNA hypermethylation is examined. MATERIALS AND METHODS:Levels of mature let-7 family members (-a, -b, -d, -e, -g, and -i) in normal nasopharyngeal cells (NP69 and NP460) and nasopharyngeal carcinoma cells (HK1 and HONE1) were measured by real-time quantitative PCR. Cell-proliferation assay and c-Myc immunohistochemical staining were performed on NPC cells transfected with let-7 precursor molecules. In addition, expression changes in let-7 family members in response to demethylating agents (5-azacytidine and zebularine) were also examined. RESULTS:In comparison with the normal nasopharyngeal cells, let-7 (-a, -b, -d, -e, -g, and -i) levels were reduced in nasopharyngeal carcinoma cells. Ectopic expression of the let-7 family in nasopharyngeal carcinoma cells resulted in inhibition of cell proliferation through downregulation of c-Myc expression. Demethylation treatment of nasopharyngeal carcinoma cells caused activation of let-7 expression in poorly differentiated nasopharyngeal carcinoma cells only. CONCLUSION:Our results suggested that miRNA let-7 might play a role in the proliferation of NPC. DNA methylation is a potential regulatory pathway, which is affected when let-7 is suppressed in NPC cells. However, the extent of DNA hypermethylation/hypomethylation in regulating let-7 expression requires further elucidation.postprin