The lateral island trapezius myocutaneous flap for circumferential reconstruction of hypopharynx and cervical esophagus.

The lateral island trapezius was utilized for reconstruction of hypopharyngeal and cervical esophagus defects in high-risk patients, avoiding entry into the celomic cavities as an approach to decrease morbidity and mortality. Seven male patients were treated at the State University of New York between 1988 and 1991 and underwent reconstruction with the lateral island trapezius flap. There was no mortality, 2 patients developed pharyngocutaneous fistulas; 1 patient operated after radiation treatment failure remained with positive margins at resection but his fistula never healed, and another patient underwent a minor revision with successful closure of the fistula. All patients regained swallowing and none required dilatations. The preferred methods of reconstruction for the reasonable risk patient are gastric pull-up and free jejunal transfer; both of which require entry into cavities. The lateral island is a reliable alternate method of reconstruction for high-risk patients in whom intracavitary surgery may lead to unacceptably high morbidity and mortality. When the vascular anatomy is not favorable, rerouting of the vessels may be required utilizing microvascular reconstruction. The donor site defect is closed primarily or skin grafted, and subsequent functional limitations are minimal and well tolerated.

Intraoperative endoscopic ultrasonography in Zollinger-Ellison syndrome.

In a 46-year-old man with Zollinger-Ellison syndrome, multiple imaging studies were negative for a primary gastrinoma. Preoperative endoscopic ultrasonography (EUS) revealed a 3.3-cm mass which appeared to be in the pancreatic head. During surgery, a celiac lymph node of the size of the mass seen by EUS was found, but the pancreatic head also felt firm and was suspicious for a mass. After resection of the celiac node, intraoperative EUS revealed no mass in the pancreatic head. Based upon intraoperative EUS findings, the pancreatic head was not resected. Histologic evidence of gastrinoma was found in the celiac lymph node and a 4 to 5 mm nodule in the duodenal wall. Postoperatively serum gastrin levels returned to normal.

Analysis of reconstruction for anterior mandibular defects using AO plates.

The functional and cosmetic outcome of 11 patients who had anterior arch mandibulectomy for stage II-IV oral cavity carcinoma and were reconstructed with AO stainless-steel or titanium plates was retrospectively analyzed. Although the complication rate was high, plate removal was uncommon. Patients were afforded good function and cosmesis. Severity of postoperative infection corresponded to a low preoperative absolute lymphocyte count, which suggests that increased preoperative diet supplementation may decrease the incidence of early infections. Improved mandibular function and esthetics may allow future patients to be offered early reconstruction routinely.

The effects of the bioflavonoid quercetin on squamous cell carcinoma of head and neck origin.

Quercetin exhibits antitumor activity. We investigated the effect of quercetin on the in vitro and in vivo growth of two squamous cell carcinoma cell lines and a normal human lung fibroblast-like cell line. The in vivo effect was evaluated using implantable cell growth chambers implanted subcutaneously in immunocompetent rats. Quercetin was injected intraperitoneally, and multiple dosages were tested. Cells were counted on days 1, 3, 5, and 7, and growth curves were constructed. Quercetin caused inhibition of growth in both squamous cell carcinoma lines. Effect on the fibroblast-like human lung cells was noted only at the maximum concentration. Significant growth inhibition of squamous cell carcinoma was observed in implantable cell growth chambers retrieved 3 days after quercetin treatment. Quercetin appears to possess a cytotoxic effect on squamous cell carcinoma of head and neck origin both in vivo and in vitro. The inhibitory effect on malignant cells appears to be selective and dose-dependent.

Chemosensitivity of squamous cell carcinoma grown in implantable chambers.

This study was motivated by the need to develop new methods to predict tumor response to chemotherapeutic agents. Using implantable cell-growth chambers, squamous carcinoma cells from head and neck tumors were xenografted into the peritoneal cavity of immunocompetent rats. Animals were divided into control and treatment groups. The treatment groups received intravenous cisplatin (CDDP) or 5-fluorouracil (5-FU) v normal saline solution for the control. Animals from each group were randomly selected and killed on days 3, 5, and 7 postimplantation. The chambers were retrieved, the media aspirated, and cells counted. Exponential growth curves were derived for the control and treatment groups. Statistically significant growth inhibition was observed for both treatment arms, compared with controls. This method of chemosensitivity testing proved to be inexpensive and reliable, and demonstrated tumor cell killing by 5-FU and CDDP.

Hepatectomy prolongs survival of mice with induced liver metastases.

Resection of hepatic metastases from colorectal cancer has been shown to prolong survival in some patients. Whether this results from a reduction of tumor burden or is an indirect effect mediated by hepatectomy is questionable. Male C57BL/6Ros 8-week-old mice underwent ileocolic vein injection of a suspension of 0.3 mL of 2 x 10(5) viable liver-derived murine (MCA-38) colonic adenocarcinoma cells. This model produces hepatic metastases in all lobes of the liver. At 7, 14, or 21 days after tumor injection, mice were randomized to receive either 42% resection of the liver or laparotomy alone. Survival in the animals with hepatectomy was significantly prolonged when the hepatectomy was performed 14 or 21 days after tumor injection.

Effects of radiotherapy on mandibular reconstruction plates.

The radiation dose in the vicinity of metal mandibular implants was measured using lithium fluoride (TLD-100) thermoluminescent dosimeters. Dosimeters were positioned in contact with Vitallium and stainless steel (AO) reconstruction plates. Simple transmission was measured with a solid state detector removed from the implant at a depth of 2.5 cm in a polystyrene phantom. The measurements were made for a 6 mV photon beam from a linear accelerator. At points in front of, but in contact with the metal implants, the dose was greater by 23 percent for Vitallium and 17 percent for stainless steel than that with no implant. At contact behind the implant, the dose was reduced considerably: 14 percent for Vitallium and 13 percent for stainless steel. At remote points behind the implant, the dose was reduced due to attenuation.