Retrospective study on the effectiveness and indications of different types of flaps used for reconstruction of head and neck

Defects following head and neck surgery can be closed by direct closure when the defect is small, and where local conditions dictate that there is enough lax tissue. Flowever, for larger defects or in situations when direct suture is not applicable, surgical defects may be filled by free grafts, local flaps, pedicled flaps which may be either axial or musculocutaneous, or by using free tissue transfer. This study was conducted in attempt to clarify the success rate of different types of flaps in common use for head and neck reconstruction, the effectiveness of different flaps in terms of functional and esthetic results and which flap is the best for certain defects in head and neck region. In this retrospective study, among the patients with head and neck cancer treated in The Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University, in the period from Jan.2004 to Dec.2009, patients whom post ablative defects needed to be reconstructed by flaps were only included. Patients whom defects were repaired either without flaps or by other means of reconstruction [e.g. gastric pull up] were excluded. The flaps among this study were compaired in terms of flap survival and functional outcomes [speech intelligibility, early starting of oral intake and cosmetic appearance]. This study was conducted upon 38 patients, they were 9 [23.68%] females and 29 [76.31%] males with a mean of age of 61 years [range 36- 84 years]. According to the site of the defect needed to be reconstructed after ablation of the primary lesion, patients were divided into three groups: 1-Patients with defects in the oral cavity and oropharynx which resulted from resection of malignant tumors involving or extending into oral cavity and oropharynx [26 patients] [Gl]. 2-Patients with defects in the hypopharynx which resulted from resection of cancer involving the hypopharynx [8 patients] [G2]. 3- Patients with post maxillectomy defects following resection of sinonasal cancer [4 patients] [G3]. In this study all defects resulted from resection of primary lesions were reconstructed immediately after ablation. As regarding patients with oral and oropharyngeal defects [n-26], the most common flap that was used in reconstruction was the pectoralis major myocutaneous flap [PMMF], that was used in ten patients followed by the radial forearm fasciocutaneous free flap that was used in seven patients, transverse rectus abdominas myocuianeous [TRAM] flap that was used in four patients, the fibula osseocutaneous free flap that was used in three patients and lastly the scapula free flap which was used in two patients. For hypopharyngeal defects [n=8], reconstruction was done in all patients with the free jejunal flap except in a single patient that was performed with the pectoralis major myocutaneous flap. In patients with craniosinonasal defects [n4], the TRAM flap was used in four patients to seal the oro-riasal communication and-the fascia lata for reconstruction of the anterior skull base defects. Overall evaluation of different types of flaps for reconstruction of head and neck defects revealed that radial forearm free flap and PMMF is the best two choices in terms of flap survival and functional outcome for reconstruction of oral cavity defects, free jejunal flap gave fair results for reconstruction of the hypopharynx and finally the TRAM flap isn't the best choice for reconstruction of the maxillary defects. Radial forearm free flap and pectoralis major myocutaneous flap [PMMF] are the best choice for reconstruction of oral cavity defects

Immunohistochemical localization of epidermal growth factor receptors in the liver of normal and streptozotocin-induced diabetic rats

Background: Diabetes mellitus is a metabolic disease characterized by hyperglycemia, which affects different tissues including the liver. Epidermal growth factor receptor [EGFR] family is one of the tyrosine kinase receptor families that regulate liver pathophysiology

Aim of the work: This study aimed to demonstrate the histological and EGFR immunohistochemical changes that occur in the liver of streptozotocin [STZ]-induced diabetic rat

Materials and methods: Twenty male albino rats divided into two groups, group I [control] and group II [diabetic], were used. Diabetes was induced in the animals in group II by a single intraperitoneal injection of STZ [40 mg/kg]. Five rats from each group were sacrificed 2 and 4 weeks after the STZ injection. Blood samples were collected for detection of serum glucose and insulin levels. Paraffin sections of the liver were prepared and stained with H and E, periodic acid Schiff, Masson's trichrome stains, and immunohistochemical stain using anti-EGFR antibody

Results: Diabetes mellitus was associated with marked congestion of central veins, blood sinusoids, and hepatic veins. Hepatocytes showed degenerative and fatty changes, especially in the periportal regions. Four weeks after induction of diabetes, signs of hepatic regeneration such as large binucleated hepatocytes were observed in the pericentral regions. Control livers showed strong positive EGFR immunoreactivity in hepatocytes, mainly in the periportal and pericentral regions, and in the bile duct epithelium. A marked decrease in EGFR immunoreactivity was observed in the livers of diabetic rats

Conclusion: Diabetes mellitus is associated with marked hepatic congestion, degenerative and fatty changes in the hepatocytes, and decreased hepatic EGFR immunoreactivity

Synthesis and antineoplastic activity of certain triazene and triazeno-acridine combilexin derivatives

Four series of bifunctional ligands have been synthesized as DNA-binding combilexins. These novel agents contain a triazeno-benzene sulfonamide linker moiety that is attached to an intercalating acridine or acridone chromophore by a functionalized amide or ester residue. In order to obtain these combilexins three series of the anticipated antitumor triazeno-benzene sulfonamide were synthesized. The synthesis and bioscreening of the new antineoplastic compounds are depending on the structural correlation with several reported antineoplastic acridines. 2-Chlorobenzoic acid was reacted with anthranilic acid to give N-[2-carboxyphenyl] anthranilic acid which upon cyclodehydration with sulfuric acid afforded 9-oxo-9, 10-dihydroacridine-4-carboxylic acid, [acridone-4-carboxylic acid] 8. This latter intermediate has been converted to 9-chloroacridine carbonyl chloride 9 using thionyl chloride. Selective substitution of 9 with derivatives of 4-[piperazine-l-yldiazenyl] benzenesulfonamides 4a-e or derivatives of 4-[2-hydroxyethyl] piperazine-l-yl]diazenyi] benzenesulfonamides 5a-e to yield their 9-chloroacridine-4-carboxamides 10a-e and 9-chloroacridine-4-carboxylic acid esters 13a-e respectively. Those intermediates have been reacted either with different sulfonamides to give derivatives of 4-[4-[4-[4 sulfamoylphenyldiazenyl] piperazine-l-carbonyl]-9-ylamino] benz-enesulfonamides 11a-h and derivatives of 2-[[4-[4-sulfamoyl-phenyl]diazenyl]piperazine-l-yl]ethyl 9-[4-sulfamoylphenyl-amino]-9,10-dihydroacridine-4-carboxylates 14a-i respectively or subjected to mild acid hydrolysis to yield derivatives of 4-[4-[[9-oxo-9,1 Q-dihydroacridine-4-carbonyl]piperazine-l-yl]diazenyl]-benzenesulfonamide 12a-e and derivatives of 2-[4-[[4-sulfamoyl-phenyl]diazenyl]piperazine-l-yl]ethyl-9-oxo-9,10-dihydroacridine-4-carboxylate 15a-e respectively. Besides, the synthesis of derivatives of 4-[piperazine-l-yldiazenyl] benzenesulfonamides 4a-e and derivatives of 4-[2-hydroxyethyl]piperazine-1-yl] diazenyl] benzenesulfonamides 5a-e has been achieved via diazotization of various substituted benzene sulfonamides with sodium nitrite and hydrochloric acid followed by various amines coupling to yield the target triazeno-benzene sulfonamides. Fourteen new compounds were selected for screening their antitumor activity against breast cell line in National Cancer Institute. Six of them were found to be active as antitumor agents, while two were found to be mild active

Management of acute urinary retention secoundry to bening prostatic hyperplasia

To analyze patients' status and current practice in the management of acute urinary retention [AUR] secondary to benign prostatic hyperplasia [BPH]. Salmaniya Medical Complex [SMC], Kingdom of Bahrain. Records of 478 patients with AUR were reviewed. The patients were managed by five consultant urologists during period of eight years [1995-2003]. We have documented: in patients and methods. Urethral catheterization was the initial management of choice in 459 [96%] and suprapubic catheters in 19 [4%]. Digital rectal examination [DRE] and abdominal ultrasonography were done in the majority, of patients. Prostate specific antigen [PSA] was done in 229 [48%]; transrectal ultrasonography in 14 [3%] and intravenous pyelography [IVP] in 129 [27%]. Fifty-three patients [11%] were managed successfully with trial without catheter [TWOC], 2-3 days after starting alpha blocker. Four hundred twenty-five patients [89%] underwent endoscopic examination, of these 10 patients had prostatic stenting only, one had open prostatectomy and the remainder had transurethral resection of the prostate [TURP]. This study revealed a reasonable uniformity in the management of AUR secondary to BPH in SMC without or with guidelines, which needs to depend on evidence-based studies