Risk Factors of Free Flap Complications in Reconstruction for Head and Neck Cancer

Background: Although head and neck reconstruction using free flaps has become a common procedure, flap complications remain a concern. This study aimed to analyze the risk factors of free flap complications and to identify the causes of these complications. Methods: We studied 97 patients with head and neck cancer with intraoral defects who underwent reconstruction using free flaps at Tottori University Hospital between 2011 and 2020. We used a retrospective cohort study design to investigate whether flap complications, including flap necrosis (total and partial) and flap dehiscence, were related to various factors, including the underlying disease condition, treatment status, and surgical factors. Results: Of the 97 patients analyzed, total flap necrosis was observed in one patient (1.0%). The incidence rate of flap complications, including flap necrosis and flap dehiscence, was 29.9%. When the time taken to perform one vascular anastomosis, including preparation of the recipient vessel and flap vessel, exceeded 30 min, the incidence rates of flap necrosis (total and partial) (odds ratio, 8.30; 95% confidence interval, 1.91-36.00; P = 0.005) and flap dehiscence (odds ratio, 3.46; 95% confidence interval, 1.05-11.36; P = 0.041) increased significantly. Conclusion: The time taken to perform one vessel anastomosis was the factor that contributed the most to the incidence of flap complications. Reconstructive surgeons should reduce the incidence of flap complications by keeping the known risk factors of the surgery in mind and by aiming to complete a vascular anastomosis time, including the time taken for the preparation of vessels, of ≤ 30 min per vessel during surgery

Solitary Fibrous Tumor of the Thigh: A Patient Report

We report a rare case of solitary fibrous tumor (SFT) within the thigh muscle. A 37-year-old woman noticed a painless mass in her left thigh, which had gradually enlarged. Computed tomography (CT) showed an intramuscular tumor and enhanced CT showed strong enhancement within the lesion. Magnetic resonance imaging revealed that the tumor measured 13.1 × 7.3 × 2.3 cm and was located within the sartorius muscle, with a clearly defined margin. Malignancy was suspected and the tumor was surgically resected. The tumor was characterized by a well-circumscribed lesion, and was composed of bland or short spindle cells, which were patternless, with scattered thick collagen bundles, and variably gaping thin- or hyalin-walled blood vessels. Immunohistochemically, the tumor cells were positive for vimentin, CD34, CD99 and focally, bcl-2. The tumor was subsequently diagnosed as an extrapleural SFT, which is classified into an intermediated (rarely metastasizing) category. Extrapleural SFT should be considered in the evaluation of soft tissue tumors in the extremities, although it may be rare

A novel COL4A1 variant associated with recurrent epistaxis and glioblastoma

COL4A1-related disorders are characterized by a higher incidence of cerebral hemorrhage than other hereditary cerebral small vessel diseases. Accumulating data have shown broad phenotypic variations, and extracerebral hemorrhages have been linked to these disorders. Moreover, the coexistence of neural tumors has been described. Here, we report a Japanese family with a novel COL4A1 variant, including a patient with recurrent epistaxis and glioblastoma

A Case of Malignant Gastrointestinal Stromal Tumor of the Transverse Colon: Evaluation of Proliferation Activity

Here, we report a colonic gastrointestinal stromal tumor (GIST) in a middle-aged man above 40. A histologically similar second tumor was detected 2 years after initial surgery. The primary GIST, measuring 5.5 ? 6.0 cm, consisted of spindle tumor cells with a higher number of mitoses and Ki67 labeling index (about 20%) than those of the second tumor, implying a de novo GIST. These markers might be useful in evaluating malignant potential, as well as to differentiate between a de novo and a recurrent tumor in the colonic GIST

地域中核病院から病理解剖を依頼したALS

An 82-year-old man, who developed dysphagia several months ago, presented Tokushima University Hospital and was diagnosed of ALS in December 2019. The patient got gradually worse and became bedridden in May 2020. He was admitted into Tokushima University Hospital suffering an aspiration pneumonia in June 2020. The pneumonia rapidly improved with a treatment ; however, the patient failed to be treated at home against his wish and was transferred to Kaminaka Hospital. We accepted his wish for refusing mechanical ventilation or tube feeding. Later, we requested autopsy consent from the patient. He did not refuse our proposal ; therefore, we presearched transporters capable to deceased bodies and contacted the division of pathology in Tokushima University. 60 days later, the patient died due to a suddenly developed putamen hemorrhage. After getting the family's consent, as previously arranged, we transferred the deceased body to Tokushima University and accomplished an autopsy. Although the number of autopsies is declining, we suggest that hospital collaboration may help perform autopsies

A novel biomarker TERTmRNA is applicable for early detection of hepatoma

<p>Abstract</p> <p>Backgrounds</p> <p>We previously reported a highly sensitive method for serum human telomerase reverse transcriptase (hTERT) mRNA for hepatocellular carcinoma (HCC). α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) are good markers for HCC. In this study, we verified the significance of hTERTmRNA in a large scale multi-centered trial, collating quantified values with clinical course.</p> <p>Methods</p> <p>In 638 subjects including 303 patients with HCC, 89 with chronic hepatitis (CH), 45 with liver cirrhosis (LC) and 201 healthy individuals, we quantified serum hTERTmRNA using the real-time RT-PCR. We examined its sensitivity and specificity in HCC diagnosis, clinical significance, ROC curve analysis in comparison with other tumor markers, and its correlations with the clinical parameters using Pearson relative test and multivariate analyses. Furthermore, we performed a prospective and comparative study to observe the change of biomarkers, including hTERTmRNA in HCC patients receiving anti-cancer therapies.</p> <p>Results</p> <p>hTERTmRNA was demonstrated to be independently correlated with clinical parameters; tumor size and tumor differentiation (P < 0.001, each). The sensitivity/specificity of hTERTmRNA in HCC diagnosis showed 90.2%/85.4% for hTERT. hTERTmRNA proved to be superior to AFP, AFP-L3, and DCP in the diagnosis and underwent an indisputable change in response to therapy. The detection rate of small HCC by hTERTmRNA was superior to the other markers.</p> <p>Conclusions</p> <p>hTERTmRNA is superior to conventional tumor markers in the diagnosis and recurrence of HCC at an early stage.</p

Estimations of relative biological effectiveness of secondary fragments in carbon ion irradiation using CR‐39 plastic detector and microdosimetric kinetic model

PurposeTo estimate relative biological effectiveness (RBE) ascribed to secondary fragments in a lateral distribution of carbon ion irradiation. The RBE was estimated with the microdosimetric kinetic (MK) model and measured linear energy transfer (LET) obtained with CR‐39 plastic detectors.MethodsA water phantom was irradiated by a 12C pencil beam with energy of 380 MeV/u at the Gunma University Heavy Ion Medical Center (GHMC), and CR‐39 detectors were exposed to secondary fragments. Because CR‐39 was insensitive to low LET, we conducted Monte Carlo simulations with Geant4 to calculate low LET particles. The spectra of low LET particles were combined with experimental spectra to calculate RBE. To estimate accuracy of RBE, we calculated RBE by changing yield of low LET particles by ±10% and ±40%.ResultsAt a small angle, maximum RBE by secondary fragments was 1.3 for 10% survival fractions. RBE values of fragments gradually decreased as the angle became larger. The shape of the LET spectra in the simulation reproduced the experimental spectra, but there was a discrepancy between the simulation and experiment for the relative yield of fragments. When the yield of low LET particles was changed by ±40%, the change of RBE was smaller than 10%.ConclusionsRBE of 1.3 was expected for secondary fragments emitted at a small angle. Though, we observed a discrepancy in the relative yield of secondary fragments between simulation and experiment, precision of RBE was not so sensitive to the yield of low LET particles