Cancer Subclones Derived from the Patient's Head and Neck Squamous Cell Carcinoma Tumor Stem Cells for the Screening of Personalized Antitumor Immunotherapy and Chemotherapy.

Studying on subclonal evolution of cancer stem cells can help illustrate how the immune system recognizes tumor cells, leading to subclonal treatment by immune-based therapies. Here, we discuss that cancer subclones derived from the patient's head and neck squamous cell carcinoma tumor stem cells can be used for the screening of personalized antitumor immunotherapy and chemotherapy, to maximize benefits and to minimize the adversary effects, toward personalized or precision medicine. We propose a "wait-and-watch" scheme for monitoring a lifetime cancer stem cell subclonal development evolved with local environments to cancer.

The macroscopic and microscopic effects of radiofrequency injury in the porcine tongue: a pilot study.

OBJECTIVE: Current treatment protocols for obstructive sleep apnea/hypopnea syndrome with radiofrequency ablation of the base of the tongue are empiric. Injecting local anesthetics and saline into the treatment site is believed to shorten treatment duration and improve results. Our objective is to compare lesions at different energy levels, both macroscopically and histologically, and to determine if electrolyte solution injection results in a larger lesion. STUDY DESIGN: A prospective, experimental animal study. SETTING: University-affiliated institution. SUBJECTS AND METHODS: Five pigs each received four treatments on the right and four on the left side of the tongue. Three of four treatments were applied sequentially by increasing length of exposure (15, 30, or 60 seconds), and the fourth was conducted over 15 seconds after injecting 1 cc of a 1:1 local anesthetic-saline solution into the treatment site. The animals were recovered for three days and then sacrificed. Macroscopic measurements for each lesion were analyzed, and histological comparison was performed. RESULTS: The average volume of the lesions was 57.36, 65.18, and 60.50 mm(3) for treatment durations of 60, 30, and 15 seconds, respectively, and there was no significant difference. Lesion volume at sites where anesthetic-saline was injected had a mean volume of 36.72 mm(3). Paired comparison against the three treatment durations revealed significantly smaller lesion volume size (P = 0.0041, 0.0007, 0.0047, respectively). CONCLUSION: The lesions created with radiofrequency energy were consistent and predictable. The volumes of the lesions did not differ significantly with regard to different energy levels. The lesion was significantly smaller after injection of anesthetic-saline at the treatment site.

Nonmelanoma skin cancer of the head and neck II: surgical treatment and reconstruction.

Surgical treatment of non-melanoma skin cancers (NMSC) is most often straight forward and can be performed as an office-based procedure by non-surgically trained professionals. However, the cases that present to an Otolaryngology practice typically will involve difficult-to-treat lesions around the face and lesions that necessitate an in depth knowledge of how to balance the need for adequate surgical margins with the reconstructive contraints imposed by aesthetic subunits of the face. This article discusses modern concepts of surgical margins for NMSC, including the Moh's micrographic surgical technique, and then reviews the most common reconstructive strategies for difficult-to-treat areas on the face. The goal of this paper is to help the general Otolaryngollogists to understand the basic principles of surgical resection and reconstruction of NMSC lesions on the face.

Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior.

Non-Melanoma skin cancer (NMSC) is the most commonly encountered malignancy in almost every area of practice, but the cases that present to an Otolaryngology practice will be advanced in nature. The major subtypes of NMSC include basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, merkel cell carcinoma, and adnexal malignancies. In this review, we present the epidemiology, histology, clinical presentation and management of these major subtypes. Further, we present background on multimodality treatment for NMSC lesions that have become metastatic from their primary site and an introduction to the behavior and treatment of NMSC lesions in patients who have received organ transplants. Understanding the clinical behavior of advanced NMSC is essential knowledge for a general Otolaryngologist.

Keloid banding using suture ligature: a novel technique and review of literature.

INTRODUCTION: Successful wound healing represents the coordinated response of cellular, cytokine, and growth factor mechanisms involved in tissue recovery. Disruptions in transforming growth factor-beta signaling, senescence/apoptosis, keratinocyte-fibroblast interactions, and other regulatory cascades can lead to the production of hypertrophic scar or keloid tissue formation. Current clinical investigations support surgical excision, meticulous closure, postoperative steroid injections, and postprocedural pressure dressings in the treatment of keloid tissue formation. Unfortunately, a universal approach in keloid therapy has yet to be identified. Here we offer a novel banding technique using suture ligature for the removal of these tissues. METHODS: Using a suture ligature, keloid tissues were banded along their base for a 5-week period. Tissue evaluation and additional suture banding was performed on a weekly basis until complete mummification and spontaneous removal of ligated tissues. No additional pressure dressings were placed after tissue removal as treated sites had essentially undergone pressure therapy from the banding treatment. RESULTS: Keloid tissues from multiple sites of the head and neck were effectively removed without complication using the suture banding technique. During a follow-up period of 12 months, no evidence of keloid tissue recurrence was observed. CONCLUSION: Keloid tissue formation remains a formidable challenge for the patient and physician alike. The application of a simple tissue banding technique holds promise in the direct and preventative treatment of keloid tissue formation whereas the end results merit further clinical and laboratory investigation.

Long-term hearing loss in gerbils with bacterial meningitis treated with superoxide dismutase.

HYPOTHESIS: The treatment of superoxide dismutase (SOD) in gerbils with bacterial meningitis will not only prevent cochlear fibrosis and neo-ossification but also reduce hearing loss. BACKGROUND: SOD an O2-scavenger, has been shown to prevent cochlear fibrosis and neo-ossification in gerbils infected with bacterial meningitis when injected intrathecally. The objective of this study is to investigate the effects of SOD on long-term hearing loss in gerbils infected with bacterial meningitis and to assess the relationship between hearing results and the amount of fibrosis. The effectiveness of middle ear infusion of SOD will also be examined. METHODS: Meningitis was induced in 3 groups of 10 gerbils with injection of Streptococcus pneumoniae into the cisterna magna. Group 1 received intrathecal SOD, group 2 received a middle ear infusion of SOD, and group 3, the control group, received no SOD. Histologic data and auditory brainstem responses were obtained from each gerbil. RESULTS: In the intrathecal SOD group, the average deterioration in pure tone thresholds between the preoperative baseline and 15 weeks after induction of meningitis at 4, 8, 16, and 32 kHz was significantly less than that of the middle ear SOD and the control group (p = 0.001). There was no significant difference between the middle ear SOD and the control group. There was no fibrosis in the intrathecal SOD group, 15% of the gerbils developed an average of 11% fibrosis in the middle ear SOD group, and 20% of the gerbils developed an average of 15% in the control group. CONCLUSION: Intrathecal infusion of SOD not only prevented cochlear fibrosis and neo-ossification after bacterial meningitis but also decreased subsequent hearing loss.

The effects of superoxide dismutase in gerbils with bacterial meningitis.

BACKGROUND: Inflammatory products, such as oxygen radicals generated during the course of bacterial meningitis, can damage nerve endings, hair cells, and/or supporting cells in the cochlea. Superoxide dismutase (SOD), an O2-scavenger, has been shown to play an important role in the protection against radical toxicity in various animal experiments. OBJECTIVE: To study the antioxidant effects of SOD on the inflammatory response of gerbils with bacterial meningitis. STUDY DESIGN: Meningitis was induced in three groups of 10 gerbils by intrathecal (IT) injection of Streptococcus pneumoniae into the cisterna magna. Group 1 received IT SOD, group 2 received intramuscular (IM) SOD, and group 3, the control group, received IM normal saline. Histologic data and auditory brainstem responses (ABR) were obtained from each gerbil. RESULTS: Fibrosis and/or neo-ossification were near absent in the IT SOD group and significantly less fibrosis occurred in the IM group (IT vs. IM: P = 0.010; IT vs. control group: P = 0.001). The amount of surviving spiral ganglion cells correlated inversely with the extent of fibrosis (r = -0.753, P < 0.00001). CONCLUSIONS: IT injection of SOD significantly reduced cochlear fibrosis and neo-ossification, reduced the spiral ganglion cell loss, and decreased damage of the cochlear components following bacterial meningitis.