Syntheses, crystal structures and Hirshfeld surface analyses of N-aryl-sulfonyl derivatives of cytisine.

By aryl-sulfonyl-ation of cytisine in the presence of tri-ethyl-amine, three new compounds have been obtained in good yields: (7R,9R)-N-[(4-ethyl-phen-yl)sulfon-yl]cytisine, C19H22N2O3S (I) {systematic name: (1R,5R)-3-[(4-ethyl-phen-yl)sulfon-yl]-1,2,3,4,5,6-hexa-hydro-8H-1,5-methano-pyrido[1,2-a][1,5]diazo-cin-8-one}, (7R,9R)-N-[(4-chloro-phen-yl)sulfon-yl]cytisine, C17H17ClN2O3S (II) {systematic name: (1R,5R)-3-[(4-chloro-phen-yl)sulfon-yl]-1,2,3,4,5,6-hexa-hydro-8H-1,5-methano-pyrido[1,2-a][1,5]diazo-cin-8-one} and (7R,9R)-N-[(3-nitro-phen-yl)sulfon-yl]cytisine, C17H17N3O5S (III) {systematic name: (1R,5R)-3-[(3-nitro-phen-yl)sulfon-yl]-1,2,3,4,5,6-hexa-hydro-8H-1,5-methano-pyrido[1,2-a][1,5]diazo-cin-8-one}. The crystal structures of the compounds were determined on the basis of single-crystal X-ray diffraction data. The crystal structures of (I)-(III) are distinguished by the arrangement of two fragments of the mol-ecule around the sulfonyl site. For all structures, weak C-H⋯O hydrogen bonds are developed. Hirshfeld surface analysis shows that H⋯H (for I and II) and H⋯O/O⋯H (for III) inter-actions make the most important contribution to the crystal packing.

URINARY MALONDIALDEHYDE AS A PREDICTIVE AND DIAGNOSTIC MARKER FOR NEONATAL ACUTE KIDNEY INJURY.

Newborns are especially prone to oxidative stress (OS). Many free radical-mediated diseases have been described in newborns including bronchopulmonary dysplasia, respiratory distress syndrome, encephalopathy, and kidney injury. Objective of this work was to determine predictive and diagnostic value of urinary malondialdehyde (UMDA) as a marker for acute kidney injury (AKI) in critically sick full-term newborns. 67 critically sick full-term neonates were enrolled in the study including 31 newborns with AKI (group I) and 36 newborns without AKI (group II). The control group included 40 healthy full-term neonates (group III). The level of UMDA was measured by means of the test based on the reaction of MDA to thiobarbituric acid. The mean and 95% confidence interval (CI) for UMDA was 12.7 (11.5; 13.9) µmol/l in group I, 10.2 (9.61; 10.8) µmol/l in group II, 9.01 (8.16; 9.93) µmol/l in group III (pI-II<0.05; pI-III<0.05; pII-III<0.05). ROC curve analysis showed that UMDA had AUC 0.80 (95% CI 0.68; 0.93, p=0.0014) for AKI. The optimum UMDA cut-point was 12.0µmol/l. For AKI sensitivity and specificity of UMDA were determined to be 68.2% (95% CI 45.1; 86.1%) and 85.7% (95% CI 69.7; 95.1%) respectively, with positive predictive value of 75.0% (95% CI 55.9; 87.6%), and negative predictive value of 81.1% (95% CI 69.7; 88.9%), positive likelihood ratio of 4.77 (95% CI 2.02; 11.3), and negative likelihood ratio of 0.37 (95% CI 0.20; 0.69). This data support studies to evaluate UMDA as an immediate biomarker for AKI in critically sick newborns. However, a larger study should be conducted to assess the diagnostic accuracy of other serum and urinary markers for OS and renal dysfunction, which would enable us to formulate a mathematical model for the prognosis and diagnosis of AKI in newborns.

Ablation of advanced tongue cancer and mobile tongue reconstruction by using a sensitive anterolateral thigh and vastus lateralis muscle free flap.

BACKGROUND: Successful tongue reconstruction after total glossectomy for advanced tongue or base of tongue cancer should restore swallowing, speech function, and cosmesis. METHODS: The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer. RESULTS: Good functional outcomes, measured by independent feeding, speech and swallowing, were achieved. CONCLUSIONS: The anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with an adequate volume, producing acceptable swallowing function and cosmesis. The reconstruction with free flaps is a feasible method of restoring the functional outcomes in speech and deglutition among patients who undergo total glossectomy with laryngeal preservation.

Surgical management in a rare case of basaloid squamous cell carcinoma of the maxilla.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive version of squamous cell carcinoma (SCC) that preferentially occurs in the upper aerodigestive tract. Since the first description by Wain SL et al., in 1986, only 21 cases with BSCC in the nasal cavity or in the paranasal cavity have been reported in the English literature. We present a case of BSCC arising in a paranasal sinus, a 51-year-old male patient with four months history of right cheek swelling and unilateral nasal obstruction, who underwent an operation and postoperative radiotherapy. Clinical, pathological and surgical findings in this case are presented along with a brief discussion of literature.

Perineural invasion in head and neck cancers - a review.

RATIONALE: perineural invasion is an under-recognized way of metastatic spread via tumoral invasion of the nerves. It is encountered in malignancies located in the head and neck but also in cancers involving the pancreas, colon and rectum, prostate, biliary tract and stomach. For some tumors, it may be the only way of metastatic spread. It represents a marker for poor outcome, with increased risk for locoregional recurrence and reduced survival rates. The molecular mechanisms behind this process are not yet fully understood; research is done to identify new therapeutic targets in order to achieve disease control. OBJECTIVE: to make a rigorous analysis of this phenomenon and to highlight the best therapeutic approach. METHOD AND RESULTS: a review of the current literature in order to harmonize the international protocols to our local pathology. DISCUSSIONS: the surgical intervention is decisive to defeat the malignant process but must be associated with modern therapeutic methods, such as the image-guided radiation therapy and immunotherapy.

Orbital exenteration - a salvage procedure?

Orbital exenteration is a procedure performed usually for malignancies. The subsequent reconstructive efforts are directed towards rapid and stable healing but allowing detection of recurrent disease, obliteration of any communication between the orbit and surrounding cavities and above all a good quality of life. The surgical options must be tailored to each patient; we have to achieve first disease control and to compensate a 3D defect as best as we can. In the following, we present a series of three patients with aggressive tumors of the midface, admitted in our clinic in the last four years. For each case, orbital exenteration was performed in order to achieve tumor clearance. The results were good excepting one case (a relapse at three years interval) with a squamous cell carcinoma and perineural invasion.