Tracheoinnominate fistula: successful management with endovascular stenting.

Tracheoinnominate fistula is a rare complication of tracheostomy that is associated with high rates of morbidity and mortality. Recently, endovascular stents have been described as a viable treatment option for the management of this condition. We report a case of tracheoinnominate fistula in a 40-year-old man that was successfully managed with endovascular stent placement. Our evaluation included bronchoscopy, arteriography, and computed tomographic angiography. Intraoperative localization of the fistula required selective catheterization of the innominate artery.

Curcumin inhibits skin squamous cell carcinoma tumor growth in vivo.

OBJECTIVE: Squamous cell carcinoma (SCCa) has increased from 4% to 10% over 4 decades, stimulating interest in developing novel agents that slow sun-damaged skin progression. This is the first study evaluating the naturally occurring bioactive food compound curcumin on skin cancer xenografts. Low bioavailability of curcumin has slowed its transition to clinical trials. It is hypothesized that curcumin has growth-inhibitory effects through the TOR pathway and chemopreventive potential in skin SCCa where local application could bypass bioavailability problems. STUDY DESIGN: A randomized experimental animal and laboratory study. SETTING: Louisiana State University Health Sciences Center, Shreveport, Louisiana. SUBJECTS AND METHODS: SCID mice were pretreated with 0, 5, or 15 mg of curcumin (n = 8 per group), 3 days prior to injecting 106 SRB12-p9 skin SCCa cells in each flank, and were gavaged daily thereafter. Tumor volumes were measured and tumors were harvested on day 24 when mice were sacrificed. Immunohistochemical analysis of pS6 expression (n = 3 per group) and tumor volumes in the 3 groups were compared using 1-way analysis of variance and pairwise comparisons were determined with the Tukey t test if overall comparisons were significant. RESULTS: Tumor volume increased 2.3 times faster in control mice compared with the group receiving 15 mg of curcumin (P = .0003). A significant difference in average tumor volumes was seen (P = .0012), especially with treatment of 15 mg of curcumin compared with control P = .0003). Curcumin inhibited S6 phosphorylation (P = .0027), suggest-ing inhibition of the MTOR pathway. CONCLUSION: Curcumin appears to inhibit skin SCCa growth and blocks tumor progression by inhibiting pS6 even when gavage is used to deliver curcumin, indicating even more significant effects in future experiments with local application.

Skull base osteomyelitis and bisphosphonate use in multiple myeloma: report of two cases and literature review.

OBJECTIVES: Although osteoradionecrosis of the mandible is a well known entity, skull base osteomyelitis involving the temporal bone unrelated to otitis externa in patients with multiple myeloma using bisphosphonates has not been reported. We described a new entity of skull base erosion resulting from osteonecrosis, presenting with malignant features in patients using bisphosphonates for multiple myeloma. METHODS: Two patients with multiple myeloma and prior zolendronic acid use were referred to our cancer center for management of maxillary and temporal bone masses with skull base erosion. Both patients were in remission and not immunocompromised. Clinical symptoms included pain, cranial nerve deficits, and vertigo. An oroantral fistula developed in the maxillary patient. In both cases, repeat CT and MRI revealed an eroding mass consistent with malignancy. After repeated biopsies, however, no malignancy was seen, and pathology revealed chronic inflammation with bacterial colonization. RESULTS: Imaging with technetium and gallium revealed osteomyelitis of the skull base in the temporal bone patient and actinomyces in the maxillary patient. Prolonged intravenous antibiotics resulted insignificant improvement in symptoms and imaging after eight weeks of treatment. CONCLUSION: Bisphosphonate-associated osteomyelitis and necrosis of the mandible has been described in recent literature as a diagnostic and management dilemma. However, skull base osteomyelitis from the temporal bone has not been reported, and few cases from the maxilla have been reported. Early recognition and differentiation from similarly presenting malignant disease may prevent intracranial complications resulting from delayed treatment.

Macrophage adhesion on gelatin-based interpenetrating networks grafted with PEGylated RGD.

Human blood-derived macrophage adhesion on interpenetrating networks (IPNs) composed of PEGylated RGD-modified gelatin and poly(ethylene glycol) diacrylate was studied. The interaction between biomaterial immobilized with biofunctional peptides such as RGD and macrophages is central in the design of tissue-engineering scaffolds. PEGylated RGD-modified gelatin was synthesized via several steps involving PEG derivations and characterized by high-performance liquid chromatography, mass spectroscopy, gel permeation chromatography, and the trinitrobenzenesulfonic acid method. IPNs containing modified or unmodified gelatin were cultured with human macrophages and monitored at 2, 24, 96, and 168 h. At each time point, IPNs containing gelatin modified with PEGylated RGD showed a comparable adherent macrophage density as tissue culture polystyrene and a significantly higher cell density than other IPN formulations containing unmodified gelatin or gelatin modified with PEGylated triglycine. Although surface-immobilized RGD can serve to mediate the adhesion of different cell types on the biomaterial surface, the interaction of RGD with immune/inflammatory cells such as macrophages should also be considered when assessing the potential host response of tissue-engineering scaffolds.