Simvastatin suppresses breast cancer cell proliferation induced by senescent cells.

Cellular senescence suppresses cancer by preventing the proliferation of damaged cells, but senescent cells can also promote cancer though the pro-inflammatory senescence-associated secretory phenotype (SASP). Simvastatin, an HMG-coA reductase inhibitor, is known to attenuate inflammation and prevent certain cancers. Here, we show that simvastatin decreases the SASP of senescent human fibroblasts by inhibiting protein prenylation, without affecting the senescent growth arrest. The Rho family GTPases Rac1 and Cdc42 were activated in senescent cells, and simvastatin reduced both activities. Further, geranylgeranyl transferase, Rac1 or Cdc42 depletion reduced IL-6 secretion by senescent cells. We also show that simvastatin mitigates the effects of senescent conditioned media on breast cancer cell proliferation and endocrine resistance. Our findings identify a novel activity of simvastatin and mechanism of SASP regulation. They also suggest that senescent cells, which accumulate after radio/chemo therapy, promote endocrine resistance in breast cancer and that simvastatin might suppress this resistance.

When is a neck lump not a neck lump? Initial presentation of a solitary sternocleidomastoid muscle in an adult.

A 70-year-old woman was referred to us for evaluation of a presumed left-sided neck mass. The referral was based on the visual appearance of subtle neck asymmetry. The patient reported no ENT symptoms. Clinical examination and ultrasonography identified no pathology, but computed tomography revealed that the asymmetry was present because the patient's right sternocleidomastoid muscle (SCM) was absent. The SCM on the left side was normal. Congenital absence of an SCM is uncommon, and to the best of our knowledge, an initial presentation in an adult has not been previously reported in the literature.

Indications for tonsillectomy: are we documenting them?

INTRODUCTION: Tonsillectomy is one of the most frequently performed operations in the UK. Documentation of the indications for tonsillectomy is vital, and should fulfil evidence-based guidelines where possible. We present a completed audit, evaluating the documentation of our department's practice in meeting the recommendations made by the Scottish Intercollegiate Guideline Network (SIGN) on indications for tonsillectomy. PATIENTS AND METHODS: A prospective audit of 100 children undergoing tonsillectomy for recurrent tonsillitis at a university hospital during two time periods: October 2007 to January 2008 and March to September 2008. Interventions including the production of posters and rubber stamps were agreed and implemented between the two audit periods. RESULTS: Following the implementation of simple changes, significant improvements were seen in documentation relating to the SIGN guidelines for tonsillectomy. Overall, the number of children meeting all four SIGN criteria for tonsillectomy rose from 12% to 44% (chi(2) = 57.8; P < 0.001). Furthermore, a significant reduction was seen in the number of children below the age of 5 years undergoing tonsillectomy for recurrent tonsillitis (chi(2) = 14.66; P < 0.001). CONCLUSIONS: With increasing scrutiny on tonsillectomy, it is important to ensure that the reasons for performing tonsillectomy are documented clearly and adhere to evidence-based guidance where possible. We have demonstrated that, with only simple and low-cost interventions, significant improvements in the documentation of tonsillectomy indications can be achieved.

Inflammatory pseudotumour of the maxillary sinus presenting as a sino-nasal malignancy.

Inflammatory pseudotumours are a rare group of benign neoplasms of unknown aetiology. They are uncommon in head and neck sites, particularly the paranasal sinuses. Surgical excision, radiotherapy and steroids have all been used as treatment modalities. A report is made of a 27-year-old female who presented with a rapid-onset proptosis that clinically and radiologically mimicked an aggressive sino-nasal malignancy. Histology eventually confirmed an inflammatory pseudotumour of the maxillary sinus. The patient was treated successfully with a combination of surgery and steroid therapy.

Ectopic extra-cranial meningioma presenting as an aural polyp.

Ectopic meningiomas located within the external auditory canal without any intracranial connection are an extremely rare finding. A report is made of a 38-year-old woman presenting with a conductive hearing loss due to an aural polyp, which was subsequently diagnosed as a meningioma. Computer-aided tomography (CT) and magnetic resonance imaging (MRI) showed the tumour to be entirely extracranial. Complete tumour excision was achieved using a modified radical mastoidectomy approach.

Bilateral submandibular duct relocation for drooling: an evaluation of results for the Birmingham Children's Hospital.

Drooling is a problem of the neurologically impaired that often leads to stigmatisation and social isolation. Bilateral submandibular duct relocation (BSMDR) is a surgical procedure that may be used to control troublesome drooling. The aim of this study was to assess the results following surgery and attempt to identify those factors that would mitigate against a successful outcome. A retrospective case note review was performed, and data were collected on 23 neurologically impaired patients who underwent the procedure between 1993 and 2000 at the Birmingham Children's Hospital, UK. An overall improvement in drooling was demonstrated in 20 (87%) cases, with complete cessation of drooling in 13 (57%) cases. The complications included one ranula, three transient submandibular gland swellings and two persistent swellings requiring gland excision. It is difficult to predict which patients will have an unsuccessful outcome following surgery. In our series, three (13%) patients had poor results. We could not determine any special features that could account for this, except that these patients in particular demonstrated the greatest degree of oral-motor dysfunction. BSMDR is a technically straightforward procedure associated with minimal morbidity and a high success rate. It is the procedure of choice at our institution.

Dermoid cyst of the infratemporal fossa.

Dermoid cysts are rare benign tumours, they represent the simplest form of teratoma. Approximately seven per cent affect the head and neck region, within this region they are frequently encountered in the area of the lateral eyebrow, the orbit and the nose. A case of a 17-year-old girl who developed a rapidly growing facial swelling due to an infratemporal fossa dermoid cyst is presented. A review of the literature using Medline has not revealed any previous reports of similar cases. The lesion was completely excised using a lateral approach to the infratemporal fossa.

Updating concepts of first branchial cleft defects: a literature review.

OBJECTIVE: The Sinuses and fistulae of first branchial cleft origin have been widely reported in the literature and their variable relationship to the facial nerve has been described. Most published series however are too small to allow a detailed analysis of the relative frequency of various relationships of these lesions to the facial nerve and therefore enabling the determination of risks to the nerve at surgery. The aim of this study was to perform a comprehensive review of literature in an attempt to identify those patients with a deep tract (lying deep to the main trunk of the facial nerve and/or its branches, and/or between the branches) and to recognize the incidence of the complications of surgical management. METHODS: Available English, French and German literature between 1923 and 2000 was reviewed and variables including patient's age, sex, side and type of anomaly, opening of the lesion and the relationship of the tract are analyzed in relation to the position of the facial nerve. The complications due to their surgical excision are also reported. RESULTS: Of the total number of cases with fistulae and sinuses identified (n=158) fistulous tracts were more likely to lie deep to the facial nerve compared with sinus tracts (P=0.01). Lesions with openings in the external auditory meatus are associated with a tract superficial to the facial nerve (P=0.05). Patients presenting at a younger age were more likely to have a deep tract with consequent increased risk of facial nerve damage. CONCLUSION: Identification of the facial nerve trunk at an early stage of dissection is critical. Extra care and caution should be exercised in younger patients (<6 months), those with fistulous tracts and in patients with a tract opening elsewhere other than the external auditory canal.