Ateriovenous subclavia-shunt for head and neck reconstruction

Reconstruction of the facial hard- and soft tissues is of special concern for the rehabilitation of patients especially after ablative tumor surgery has been performed. Impaired soft and hard tissue conditions as a sequelae of extensive surgical resection and/or radiotherapy may impede common reconstruction methodes. Even free flaps may not be used without interposition of a vein graft as recipient vessels are not available as a consequence of radical neck dissection

Targeting cholesterol-rich microdomains to circumvent tamoxifen-resistant breast cancer

Adjuvant treatment with tamoxifen substantially improves survival of women with estrogen-receptor positive (ER+) tumors. Tamoxifen resistance (TAMR) limits clinical benefit. RRR alpha tocopherol ether-linked acetic acid analogue (alpha-TEA) is a small bioactive lipid with potent anticancer activity. We evaluated the ability of alpha-TEA in the presence of tamoxifen to circumvent TAMR in human breast cancer cell lines. Methods: Two genotypically matched sets of TAM-sensitive (TAMS) and TAM-resistant (TAMR) human breast cancer cell lines were assessed for signal-transduction events with Western blotting, apoptosis induction with Annexin V-FITC/PI assays, and characterization of cholesterol-rich microdomains with fluorescence staining. Critical involvement of selected mediators was determined by using RNA interference and chemical inhibitors. Results: Growth-factor receptors (total and phosphorylated forms of HER-1 and HER-2), their downstream prosurvival mediators pAkt, pmTOR, and pERK1/2, phosphorylated form of estrogen receptor-alpha (pER-alpha at Ser-167 and Ser-118, and cholesterol-rich lipid microdomains were highly amplified in TAMR cell lines and enhanced by treatment with TAM. alpha-TEA disrupted cholesterol-rich microdomains, acted cooperatively with TAM to reduce prosurvival mediators, and induced DR5-mediated mitochondria-dependent apoptosis via an endoplasmic reticulum stress-triggered pro-death pJNK/CHOP/DR5 amplification loop. Furthermore, methyl-beta-cyclodextrin (M beta CD), a chemical disruptor of cholesterol rich microdomains, acted cooperatively with TAM to reduce prosurvival mediators and to induce apoptosis. Conclusions: Data for the first time document that targeting cholesterol-rich lipid microdomains is a potential strategy to circumvent TAMR, and the combination of alpha-TEA + TAM can circumvent TAMR by suppression of prosurvival signaling via disruption of cholesterol-rich lipid microdomains and activation of apoptotic pathways via induction of endoplasmic reticulum stress.Clayton Foundation for ResearchCenter for Molecular and Cellular Toxicology at the University of TexasNIEHS/NIH T32 ES07247Nutritional Science

Vessel geometry and microvascular hand-sewn end-to-end anastomoses using Alexis Carrell’s technique: is the intuition of the Nobel Prize still valuable?

Background We review here our substantial experience in using Alexis Carrel’s technique with a geometrical optimization for microsurgical end-to-end anastomoses. Methods The technique used for microsurgical end-to-end anastomoses is described. We performed a retrospective analysis of head and neck free flaps where we used the described microsurgical anastomoses technique at Bufalini Hospital in Cesena, Italy. Patients’ demographic data, intraoperative findings, and postoperative progress, including complications, were accurately re- corded. We also recorded the cases where vessel size discrepancy was observed intraoperatively, either arterial or venous. Results The described technique has been used in 300 consecutive flaps in the last 18 years, with an average of 16 free flaps per year. No significant problems were encountered using this simple technique. Comprehensive flap survival was 98%. We had 5 free flap failures, and in all cases, the main problem was not related to the microvascular anastomoses. Vessel size discrepancy was recorded in 25% of the total. Conclusions Alexis Carrel’s technique for microvascular end-to-end anastomoses is still a very efficient end safe technique. Our geometrical optimization of it is a useful trick to keep in mind for the microvascular surgeon, especially in hospitals with a small volume of microsurgical procedures per year