The determination of the levels of circulating galectin-1 and -3 in HNSCC patients could be used to monitor tumor progression and/or responses to therapy.

To evaluate galectin-1, -3 and -7 serum levels as diagnostic and/or prognostic markers for head and neck squamous cell carcinomas (HNSCCs). ELISA was employed to test sera from 102 patients with HNSCCs and from 38 healthy control volunteers for galectin-1, -3 and -7 serum levels. Serum galectin levels were assayed by ELISA and the levels of galectin expression in HNSCCs were determined by means of immunohistochemistry. HNSCCs display significant immunohistochemical amounts of galectin-7, but this galectin cannot be detected in the blood of HNSCC patients. Galectin-3 levels differ significantly (p=0.03) in healthy volunteers and HNSCC patients. Using a threshold value of 4.3 ng/ml, galectin-3 serum level enabled a significant level of discrimination (p=0.03) to be established between the cancer patients and the healthy volunteers, with 90% level of specificity and 36% level of sensitivity. The discrimination was even better when using a threshold value of 13.5 ng/ml for galectin-1 (p=0.001), with 100% level of specificity and 22% level of sensitivity. A subgroup of stage IV HNSCC patients displayed significantly reduced levels of circulating galectin-1 (p=0.003) and galectin-3 (p=0.001) after treatment as opposed to before. Galectin-3 concentrations in sera from the patients with a metastatic disease were significantly (p=0.01) higher than in sera from the patients with localized tumors. The determination of circulating levels of galectin-1 and -3 could be used to monitor the progression of their disease or their response to therapy.

Congenital transsphenoidal meningocele: case report and review of the literature.

Intrasphenoidal meningoencephalocele is a rare clinical entity. Its origin can be congenital, traumatic, tumoral, or spontaneous. Presenting as cerebrospinal fluid fistula with rhinorrhea, the diagnosis and treatment of this uncommon disease is a real challenge for the otorhinolaryngologist. We report a case of sphenoidal meningocele treated using an endoscopic procedure and review the literature regarding its congenital origin.

Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap.

OBJECTIVE: The purpose of the study was to evaluate the effectiveness of a U-shaped pectoralis major myocutaneous flap (PMMF) to reconstruct a large circumferential defect involving the oro- and hypopharynx. STUDY DESIGN AND SETTING: Retrospective case series. RESULTS: Twelve patients with advanced oro- and hypopharyngeal cancer (stage IV) underwent surgery resulting in a circumferential defect of pharyngoesophageal segment (PES). Those defects were reconstructed using a U-shaped PMMF. Four pharyngocutaneous fistulas were observed postoperatively and healed spontaneously within 3 to 7 weeks. Eight patients were able to resume a regular diet. A voice prosthesis was functional in 5 patients. CONCLUSION: This preliminary study shows that this technique is a simple and effective method with acceptable morbidity rate and satisfactory functional results. We demonstrate that this procedure allows the reconstruction of large defects involving the oro- and hypopharynx in irradiated patients. This technique could be an interesting alternative for surgical teams suffering from the absence of a microsurgical team. EBM RATING: C-4.

Primary tracheal schwannoma: one case report and a literature review.

We report a case of primary tracheal schwannoma causing symptoms of airway obstruction in a 51-year-old woman. There was no history of pulmonary disease. The patient had been coughing and suffering from progressive dyspnea for over 1 year. Medical treatment with bronchodilatators had no effect. Computerized tomography and bronchoscopy demonstrated a polypoid mass located inside the trachea's cervical segment, obstructing 50% of the lumen. A biopsy was not attempted because of the tumor's vascularity to avoid bleeding. Tracheal resection with primary anastomosis was performed. The diagnosis was confirmed with histological analysis. It revealed a benign neurogenic tumor of Schwann's cell origin. Schwannoma of the trachea is extremely rare. Only 23 cases have been reported previously. Most of them occur in adults (19/23, 82.6%) and are located in the lower trachea. They usually have a long natural history, causing symptoms only after they have attained a large size. The treatment of choice is surgical removal.

Use of tubed gastro-omental free flap for hypopharynx and cervical esophagus reconstruction after total laryngo-pharyngectomy.

In case of total laryngo-pharyngectomy (TLP), replacement of the pharyngoesophageal segment is more often done with jejunal flap; however, in some cases, this flap doesn't represent the best surgical technique of reconstruction. The tubed gastro-omental free flap (TGO) offers an alternative procedure in selective cases. The objective of the study was to assess the TGO as a method of pharyngoesophageal reconstruction. Our study was based on a literature review and a retrospective study of six consecutive cases of TGO reconstruction after TLP. Six patients aged from 52 to 70 years underwent TGO reconstruction after TLP. Five patients had previously received systemic chemotherapy and external irradiation at curative doses, and three had undergone previous surgery. No abdominal complication occurred. Partial necrosis of the gastric flap occurred in one case. Except for this case, the feeding tube could be removed after 15 days. One patient was successfully treated with pneumatic esophageal dilatation for stricture 2 months after surgery. Four patients died of loco-regional tumor evolution or distant metastatic disease. For both of the patients who survived (mean follow-up, 40 months), a normal diet and an esophageal voice were obtained. The TGO offers a safe method of reconstructing the pharyngoesophageal segment in a surgical field compromised of previous multimodal therapy.