Partial pharyngolaryngectomy with infrahyoid flap: Our experience

Aim: We evaluated a cohort of advanced hypopharyngeal squamous cell carcinoma, treated with conservative surgery, reconstruction with infrahyoid flap and radio-chemotherapy. Methods: We used partial pharyngo-laryngectomy and radio-chemotherapy to treat fifty-seven patients with stage III–IV hypopharyngeal SCC from November 1994 to December 2011. Clinical examination and speech therapy evaluation were used for estimation of laryngeal function. Results: All patients received a partial pharyngo-laryngectomy. All patients underwent neck dissection; 56 patients received bilateral neck dissection. Reconstruction was achieved by infra-hyoid flap. Five-year overall and disease-specific survival rates were 54.4% and 61.4%, respectively. Successful laryngeal function preservation with complete five-year remission was achieved in 44% of the patients. Conclusion: Selected even if advanced carcinomas of the hypopharynx maybe treated with partial pharyngo-laryngectomy with reconstruction with pedicled flap. Both oncological and functional results showed a good outcome

Reconstruction microchirurgicale et prise en charge globale des patients porteurs de cancer ORL : l’importance d’une approche qualité et d’un circuit protocolisé [Microsurgical reconstruction and full management of patients with head and neck cancer: Importance of a quality approach and a circuit protocolisation]

Main of study: Management and surgical reconstruction of head and neck cancers remain a challenge. From the first consultation to surgery and radiotherapy, it is necessary to save time to ensure optimum treatment and better survival rates. Objectif: To establish a kind of quality approach to the management of patients with head and neck cancers. 54 patients who had microsurgical reconstruction after head and neck cancer were included in this study between 1997 and 2006. Results : Multiple data were considered: body mass index (BMI), ASA stage, age, existence of a pre-or postoperative radiotherapy, the surgeon's experience and the number of veins drainage. The success rate is superior when more than one draining vein is sutured to the flap for patients with a BMI > 20. Radiotherapy does not seem to affect the survival of the flap. Conclusion: According to current literature, the survival rate of these patients is better when the overall time care is less than 100 days. That period is possible with a perfect organization of the medical and paramedical team. Therefore, we propose to include these patients in a circuit protocolisation care, which saves time, to better inform patients and improve survival rates. Buts: la prise en charge et la reconstruction chirurgicale des cancers ORL restent un challenge. De la première consultation à la chirurgie et la radiothérapie, il est nécessaire de gagner du temps afin d’assurer une traitement optimum et un meilleur taux de survie. Objectif : établir une sorte d’approche qualité de la prise en charge des patients porteurs de cancers ORL. 54 patients qui ont bénéficié d’une reconstruction microchirurgicale suite à un cancer ORL ont été inclus dans cette étude entre 1997 et 2006. Résultats : plusieurs données ont été étudiées : l’index de masse corporelle (IMC), le stade ASA, l’âge, l’existence d’une radiothérapie pré ou post opératoire, l’expérience du chirurgien ainsi que le nombre de veines de drainage. Le taux de succès se révèle supérieur lorsque plus d’une veine de drainage est suturée au lambeau, pour des patients ayant un IMC > 20. La radiothérapie ne semble pas avoir de répercussion sur la survie du lambeau. Conclusion : conformément à la littérature actuelle, le taux de survie de ces patients est meilleur lorsque le temps global de prise en charge est inférieur à 100 jours. Ce délai court n’est possible qu’avec une parfaite organisation de l’équipe médicale et paramédicale. De ce fait, nous proposons d’inclure ces patients dans un circuit de prise en charge protocolisé, ce qui permet de gagner du temps, de mieux informer le patient et d’améliorer le taux de survie

Separation and characterization of nonphosphorylated and serine-phosphorylated urokinase. Catalytic properties and sensitivity to plasminogen activator inhibitor type 1.

Urokinase synthesized by human A431 epidermoid carcinoma cells is phosphorylated on serine (Mastronicola, M. R., Stoppelli, M. P., Migliaccio, A., Auricchio, F., and Blasi, F. (1990) FEBS Lett. 266, 109-114). To test the possibility that phosphorylation may have specific effects on urokinase function, the phosphorylated and nonphosphorylated forms of urokinase were separated by Fe(3+)-Sepharose chromatography. Both forms exhibit indistinguishable Km and kcat for plasminogen activation. On the other hand, their sensitivity toward the specific plasminogen activator inhibitor type 1 is different as assessed by measuring both the stability of the covalent complex and the residual enzymatic activity. Phosphorylated urokinase was 50% inhibited at a concentration of plasminogen activator inhibitor type 1 4-fold higher than nonphosphorylated urokinase (0.7 versus 0.15 nM). Furthermore about 10% of phosphorylated urokinase was resistant to plasminogen activator inhibitor type 1 at a concentration as high as 20 nM. Thus, phosphorylation affects urokinase sensitivity to plasminogen activator inhibitor type 1, therefore resulting in a net, although indirect, increase of urokinase activity. These results suggest the existence of a novel cellular regulatory mechanism of extracellular proteolysis