Risk factors for multiple malignancies in the head and neck.

OBJECTIVE: To define the prognostic role of multiple epidemiological, clinical, and biological factors for the development of multiple malignancies (MM) in patients with head and neck cancer (HNC). STUDY DESIGN: Historical cohort study. p53 gene status, microsatellite instability (MSI) of the index tumor, and inherited chromosome fragility (CF) were studied. SETTING: Ninety-six consecutive patients affected by primary HNC, between January 1987 and October 1991, who were eligible for curative radiation therapy were followed up. SUBJECTS AND METHODS: p53 gene status, MSI, and CF in 96 curative radiotherapy-treated patients were correlated with the risk for MM. RESULTS: Multiple malignancies occurred in 28.9%. Microsatellite instability (P = 0.05), CF (P < 0.01), and smoking after treatment of the index tumor (P = 0.02) were correlated with an increased risk of MM. CONCLUSION: Genetic susceptibility may play a central role for MM development in patients with HNC.

Infrahyoid flap reconstruction of oral cavity and oropharyngeal defects in elderly patients with severe general comorbidities.

BACKGROUND: In current practice, surgeons frequently deal with elderly patients who have severe medical comorbidities. METHODS: We present our series of 18 consecutive patients with severe general comorbidities that received infrahyoid flap reconstruction. The results were compared with those of 16 consecutive patients in good general medical state receiving free radial forearm flap reconstruction during the same study period. We also describe an original method for tongue base reconstruction using the infrahyoid flap. RESULTS: No total flap necrosis was experienced; successful separation between oral cavity/oropharyngeal contents and neck spaces was obtained in all patients with a low rate of general complications. No significant differences were found with regard to verbal intelligibility and diet scores between groups. CONCLUSIONS: Infrahyoid flap in high-risk cases represents a valid alternative to free radial forearm flap. We introduced a novel technical innovation for tongue base reconstruction using the infrahyoid flap with very encouraging results.

Supracricoid partial laryngectomy as salvage surgery for radiation therapy failure.

BACKGROUND: The main concern in the treatment of laryngeal carcinomas is tumor control with preservation of laryngeal functions. We believe that salvage supracricoid partial laryngectomy (SPL) should be carefully considered in selected cases of radiotherapy failure, because it can offer the possibility of achieving adequate tumor control with preservation of laryngeal functions. METHODS: A series of 31 patients who underwent an SPL as salvage procedure after radiotherapy failure was reviewed. RESULTS: Locoregional control rate was 75%, with 60% 5-year overall survival; no patients were lost to follow-up, and a death-from-disease rate of 19.35% was recorded. Restoration of laryngeal functions was achieved in 89.29% of the patients. No statistically significant differences were found in locoregional control regarding anterior commissure involvement, elective neck dissection versus wait-and-see policy, pathologic positive neck disease, and restage I-II versus restage III-IV. CONCLUSION: The oncologic and functional results indicate the consistency of salvage SPL, proposing this type of operation as a serious alternative to total laryngectomy in carefully selected cases.

FoxP3-expressing T regulatory cells in atopic dermatitis lesions.

Recently, studies were conducted to evaluate the impact of T regulatory (T regs) cells in the pathophysiology of atopic dermatitis (AD). The aim of this study was to investigate whether natural T regs are present in AD skin lesions. We performed skin biopsies in 12 adult patients affected by moderate-to-severe AD and 4 healthy volunteers. The specimens were stained immunohistochemically with anti-human CD25 and forkhead/winged helix transcription factor (FoxP3). Double immunostaining for CD25 and FoxP3 was performed also. CD25+ cells strongly infiltrated the perivascular and papillar dermis of all lesional specimens, and FoxP3+ cells were distributed in the perivascular and interstitial AD dermis, and some cells also infiltrated the dermoepidermal junction and the basal and suprabasal epidermal layers. All healthy skin specimens showed weak CD25 and FoxP3 stainings. Double immunostaining showed that CD25+ FoxP3+ cells were distributed in the perivascular, interstitial, and periadnexal dermis, and healthy skin specimens featured few CD25+ FoxP3+ cells scattered throughout the dermis. The past and present data show that an impaired function of natural T regs may not play a primary role in the pathophysiology of AD lesions.