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Background: Transoral thyroid surgery represented by the da Vinci system is attracted attention and performed by several institutions. However, the current available da Vinci system still has some limitations to be improved for transoral thyroid surgery including high cost of equipment and expendables, larger diameter scope and instruments and no tactile sensation. It triggered us interest in more easily available robotic scope holder. Soloassist II (AktorMed GmbH, Barbing, Germany) is an active endoscope holder system which is controlled by a joystick. It has total six joints: three joints which are controlled by computer, one is controlled by manual and two act as a gimbal joint following the movement of the main body. Materials and Methods: We tried transoral endoscopic thyroidectomy using Soloassist II (AktorMed GmbH, Barbing, Germany) in December 2017 in our hospital. Results: We successfully performed four thyroid lobectomies in four patients with Soloassist II. We refined and described surgical procedures in each step using video clips. It provided an excellent vibration‑free stable surgical view which enabled fatigue‑free work, without shaking or tilting the horizon. The surgeon could perform transoral endoscopic thyroid surgery with only one assistant surgeon. Docking and preparation time for Soloassist was within 10 min in all four patients. The setup and dismantling could be performed parallel to the usual workflow. No complication was reported by any patient. Conclusions: The robotic scope holder (Soloassist II) seems to be safe and feasible equipment for performing transoral endoscopic thyroid surgery. Several possible advantages could be expected with this robotic scope holder. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer.Methods: The present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy.Results: Five-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS.Conclusion: Margin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery. [ABSTRACT FROM AUTHOR]

This article proposes a design of chipless RFID tag with dipole array structure that is fully printable using conductive ink. The proposed tags encode data based on spectral signature modulations. The reading range is considerably increased (2 m) while maintaining low transmission power (1 mW). Several prototype chipless RFID tags were fabricated and measured in the SHF and UHF bands. The proposed dipole array structure enhances the antenna gain of the passive tags and contributes to overcoming the low conductivity of conductive ink. In order to verify the utility of our proposal, the tags are manufactured on paper, using conductive ink, for the purpose of economic mass production. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the role of PNI in HPSCC. Methods: The medical records of 105 patients who underwent surgery-based treatment for HPSCC were reviewed. Clinicopathologic parameters including disease-specific survival were correlated with PNI. Results: PNI was identified in 27 of the 105 (25.7%) cases of HPSCC. Correlation analysis demonstrated that PNI in HPSCC was significantly correlated with pN classification (10.3% in N0/N1 vs 34.8% in N2/N3, p=0.006). Patients with PNI had decreased 5-year disease-specific survival with borderline significance (p=0.065). In a sub-set of 31 patients who did not receive post-operative radiotherapy, PNI was determined to be a significant prognostic predictor (p=0.033). In multivariate analysis, extracapsular invasion was the only independent prognostic factor for disease-specific survival (p=0.001). Conclusion: Perineural invasion (PNI) should be considered an independent predictor for cervical lymph node involvement. PNI status in primary hypopharyngeal squamous cell carcinoma (HPSCC) specimens should be considered in decisions concerning adjuvant radiotherapy. [ABSTRACT FROM AUTHOR]

Esophagogastroduodenoscopy (EGD) is considered a relatively safe procedure. However, the procedure and the materials used in EGD with conscious sedation can cause stress to the patient. Adverse events during EGD have been reported, represented by cardiopulmonary complications. To date, five cases have reported worldwide to be associated with gastrointestinal endoscopy. Stress cardiomyopathy (SCMP) is a reversible cardiomyopathy that typically occurs in postmenopausal women due to stress and may resolve within a few weeks. SCMP resembles acute myocardial infarction but differs in terms of treatment and prognosis. Here, we describe two cases of SCMP with shock during EGD with conscious sedation. [ABSTRACT FROM AUTHOR]

Background/Aims: The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist. Methods: We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist. Results: No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies. Conclusions: Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows. [ABSTRACT FROM AUTHOR]

Background: Cellular function and diversity are orchestrated by complex interactions of fundamental biomolecules including DNA, RNA and proteins. Technological advances in genomics, epigenomics, transcriptomics and proteomics have enabled massively parallel and unbiased measurements. Such high-throughput technologies have been extensively used to carry out broad, unbiased studies, particularly in the context of human diseases. Nevertheless, a unified analysis of the genome, epigenome, transcriptome and proteome of a single human cell type to obtain a coherent view of the complex interplay between various biomolecules has not yet been undertaken. Here, we report the first multi-omic analysis of human primary naïve CD4+ T cells isolated from a single individual. Results: Integrating multi-omics datasets allowed us to investigate genome-wide methylation and its effect on mRNA/protein expression patterns, extent of RNA editing under normal physiological conditions and allele specific expression in naïve CD4+ T cells. In addition, we carried out a multi-omic comparative analysis of naïve with primary resting memory CD4+ T cells to identify molecular changes underlying T cell differentiation. This analysis provided mechanistic insights into how several molecules involved in T cell receptor signaling are regulated at the DNA, RNA and protein levels. Phosphoproteomics revealed downstream signaling events that regulate these two cellular states. Availability of multi-omics data from an identical genetic background also allowed us to employ novel proteogenomics approaches to identify individual-specific variants and putative novel protein coding regions in the human genome. Conclusions: We utilized multiple high-throughput technologies to derive a comprehensive profile of two primary human cell types, naïve CD4+ T cells and memory CD4+ T cells, from a single donor. Through vertical as well as horizontal integration of whole genome sequencing, methylation arrays, RNA-Seq, miRNA-Seq, proteomics, and phosphoproteomics, we derived an integrated and comparative map of these two closely related immune cells and identified potential molecular effectors of immune cell differentiation following antigen encounter. [ABSTRACT FROM AUTHOR]

Here, we report the synthesis of high quality monolayer graphene on the pre-treated copper (Cu) foil by chemical vapor deposition method. The pre-treatment process, which consists of pre-annealing in a hydrogen ambient, followed by diluted nitric acid etching of Cu foil, helps in removing impurities. These impurities include native copper oxide and rolling lines that act as a nucleation center for multilayer graphene. Raman mapping of our graphene grown on pre-treated Cu foil primarily consisted of ~98% a monolayer graphene with as compared to 75% for the graphene grown on untreated Cu foil. A high hydrogen flow rate during the pre-annealing process resulted in an increased I2D/IG ratio of graphene up to 3.55. Uniform monolayer graphene was obtained with a I2D/IG ratio and sheet resistance varying from 1.84 - 3.39 and 1110 - 1290 Ω/□, respectively. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is the fourth leading cause of cancer-related death in the world. The etiology of pancreatic cancer is heterogeneous with a wide range of alterations that have already been reported at the level of the genome, transcriptome, and proteome. The past decade has witnessed a large number of experimental studies using high-throughput technology platforms to identify genes whose expression at the transcript or protein levels is altered in pancreatic cancer. Based on expression studies, a number of molecules have also been proposed as potential biomarkers for diagnosis and prognosis of this deadly cancer. Currently, there are no repositories which provide an integrative view of multiple Omics data sets from published research on pancreatic cancer. Here, we describe the development of a web-based resource, Pancreatic Cancer Database (http://www.pancreaticcancerdatabase.org), as a unified platform for pancreatic cancer research. PCD contains manually curated information pertaining to quantitative alterations in miRNA, mRNA, and proteins obtained from small-scale as well as high-throughput studies of pancreatic cancer tissues and cell lines. We believe that PCD will serve as an integrative platform for scientific community involved in pancreatic cancer research. [ABSTRACT FROM AUTHOR]

The availability of human genome sequencehas transformed biomedical researchover thepast decade.However, anequivalentmapfor the human proteome with direct measurements of proteins and peptides does not exist yet. Herewepresent a draft map of the human proteome using high-resolution Fourier-transform mass spectrometry. In-depth proteomic profiling of 30 histologically normal human samples, including 17 adult tissues, 7 fetal tissues and 6 purified primary haematopoietic cells, resulted in identification of proteins encoded by 17,294 genes accounting for approximately 84% of the total annotated protein-coding genes in humans. A unique and comprehensive strategy for proteogenomic analysis enabled us to discover a number of novel protein-coding regions, which includes translated pseudogenes, non-coding RNAs and upstream open reading frames. This large human proteome catalogue (available as an interactive web-based resource at http://www.humanproteomemap.org) will complement available human genome and transcriptomedata to accelerate biomedical research in health and disease. [ABSTRACT FROM AUTHOR]

A graphene-based, multiband absorber operating in terahertz (THz) frequency range was demonstrated. Graphene film was transferred onto the top of a flexible polymer substrate backed with a gold reflector. The graphene acts as a resistive film that partially attenuates and reflects THz waves. The destructive interference between THz waves reflected from graphene and backside reflector gives rise to perfect absorbance at multiple frequencies. To enhance the absorbance on/off ratio (AR), the conductivity of graphene was varied using a chemical doping method. The resulting p-doped, graphene-based THz absorber exhibited absorbance at maxima and AR higher than 0.95 and 25 dB, respectively. [ABSTRACT FROM AUTHOR]

Purpose We wanted to evaluate the role of postoperative chemoradiotherapy (CRT) for patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Materials and Methods From March 1993 to July 2008, 101 patients with advanced SCCHN and who had undergone macroscopically complete resection were enrolled. Survival and the cumulative incidence of local or regional relapse, metastasis, and acute toxicity were analyzed. Results There was a marginally significant difference of disease-free survival at five years in favor of the CRT arm (51.3% vs. 41.8%, respectively; p=0.10). However, there was no significant difference in overall survival between the two treatment arms (p=0.20). The rate of locoregional failure only for the radiotherapy arm was significantly higher than that for the CRT arm (23.2% vs. 4.4%, respectively; p=0.01). The incidence of grade 3 or 4 hematologic toxicity was significantly higher in the CRT arm than that in the radiotherapy arm (37.7% vs. 1.7%, respectively; p=0.01). In CRT arm, early mortality group within 1 year had low performance status and old age over sixty compared with those of the others. Conclusion After curative-intent surgery, adjuvant CRT is more effective in locoregional tumor control than radiotherapy alone for patients with advanced SCCHN. However, compared with radiotherapy alone, this combined modality treatment had no survival benefit, and was significantly associated with increased toxicity. Thus, patients with low performance status and old age must be cautious in selection of toxic trimodality treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine whether invasion of the pharyngeal constrictor muscle in early squamous cell carcinoma of the tonsil is correlated with lymph node metastasis. Design: Retrospective analysis of medical records and pathology specimens. Setting: Tertiary care referral center. Patients: Forty-eight patients who were diagnosed as having T2 squamous cell carcinoma of the tonsil and who underwent surgery. They were divided into 2 groups: an invasive group with invasion of the pharyngeal constrictor muscle and a noninvasive group without invasion of the pharyngeal constrictor muscle. Main Outcome Measures: Comparison of regional metastasis, 5-year locoregional recurrence, and 5-year disease- specific survival between the 2 groups. Results: Invasion of the pharyngeal constrictor muscle was found in 36 patients (75%) with T2 squamous cell carcinoma of the tonsil. The rate of lymph node metastasis, the mean (SD) number of positive nodes, and the mean (SD) lymph node density were 81%, 5.47 (9.27), and 0.15 (0.22) in the invasive group, respectively, and 50%, 1.33 (1.72), and 0.04 (0.04) in the noninvasive group, respectively (P=.04, P=.02, and P=.01, respectively). Five-year locoregional recurrence was significantly correlated with invasion of the pharyngeal constrictor muscle (P=.05) and with multiple lymph node metastasis (⩾5 nodes) (P=.04) in the univariate analyses. No factor was correlated with 5-year locoregional recurrence in the multivariate analysis. Five-year diseasespecific survival was significantly correlated with multiple lymph node metastasis (⩾5 nodes) in the univariate analyses (P=.009). Five-year disease-specific survival was not significantly correlated with any clinicopathological factor in the multivariate analysis. Conclusion: Higher risk for multiple lymph node metastasis and 5-year locoregional recurrence seems to be predicted in patients with extratonsillar invasion of the pharyngeal constrictor muscle, even in early squamous cell carcinoma of the tonsil. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is known to cause of oropharyngeal squamous cell carcinoma (SqCC). HPV positive SqCCs overexpress p16 and are associated with better survival. Several markers of cell cycles and apoptosis have been reported as a prognostic value. We examined the prognostic value of HPV status, p16, cyclin D1, and Bcl-2 in patients with tonsillar SqCC. Methods: Tissue microarrays were constructed in 56 cases of tonsillar SqCC for which we performed an immunohistochemistry and an in situ hybridization (ISH) of the HPV. Results: Of the 56 cases, 31 (55.3%) were positive for p16 and 20 (35.7%) were positive for HPV ISH. The expressions of p16, cyclin D1, and Bcl-2 were not correlated with the clinicopathologic variables including smoking status, differentiation and pT- and pN-stages. The HPV ISH positive group showed a better overall survival than the HPV negative group (p=0.04), and the p16 positive group showed a better disease free survival (DFS) than the negative group (p=0.016). Cox regression analysis showed that only p16 positivity was an independent prognostic factor for DFS (p=0.03; hazard ratio, 10.1). Conclusions: Our results indicate that both p16 expression and HPV status are useful indicators for risk stratification in patients with tonsillar SqCC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate functional and oncologic results in patients who underwent unilateral arytenoidectomy during supracricoid partial laryngectomy. Design: Retrospective analysis of medical records. Setting: Tertiary care referral center. Patients: One hundred sixteen patients who had received supracricoid partial laryngectomy. Main Outcome Measures: Functional and oncologic results in patients who received supracricoid partial laryngectomy with the extended procedure of unilateral arytenoidectomy. Results: There was a significantly higher rate of aspiration pneumonia (P=.002) and a longer delay of decannulation (P=.03) in the extended group. No significant differences were noted between the 2 groups in the scores for "normalcy of diet" (P=.68), "eating in public" (P=.65), or "understandability of speech" (P<.99) on the Performance Status Scale for Head and Neck Cancer Patients at the last follow-up visit. Five-year overall recurrence was 24.5% in the extended group. Five-year overall survival was 66.6%, and 5-year disease-specific survival was 72.1% in the extended group. Conclusions: Resection of the arytenoids may interrupt physiologic airway protection in the early postoperative period, necessitating special caution to prevent aspiration pneumonia. However, extended supracricoid partial laryngectomy including arytenoidectomy allows for reasonable oncologic safety and avoidance of functional handicaps and social maladjustment. [ABSTRACT FROM AUTHOR]

We evaluated immunohistochemically the expression profiles of metastasis-associated protein (MTA) 1 and their associations with lymph node metastasis in tonsil cancer. Immunohistochemical analysis of 43 tonsillar neoplasm tissues was performed using antibodies raised to MTA1. Depth of tumor invasion, lymph node metastasis, and clinical outcomes were assessed. Clinical N0 patients were divided into two groups: N0a, negative for MTA1; N0b, positive for MTA1. Occult node metastasis was reevaluated according to the revised clinical N staging system taking account of MTA1 expression. The expression rate of MTA1 was 41.9%. There was a significant correlation between the expression of MTA1 and lymph node metastasis ( P = 0.034*). MTA1 had a sensitivity of 53.3% and a specificity of 84.6% for identification of cervical metastases. When cN0b patients were considered to be N+, the recalculated rate of occult metastasis fell from 50% to 7.6% (the false-positive rate remained unchanged). MTA1 was found to be a useful molecular marker to predict lymphatic metastasis in tonsil cancer. [ABSTRACT FROM AUTHOR]

The task of the present study was to investigate the relationship between parameters and factors predictive of voice quality and to suggest treatment guidelines for patients suffering from vocal polyps. In total, 158 patients diagnosed with vocal polyps and who received voice therapy were enrolled. Clinicomorphological factors such as size, location, color, and type of the polyp were evaluated. Perceptive and acoustic voice evaluation was conducted and the relationship of these voice parameters with clinicomorphological factors was analyzed. Additionally, factors favorable for voice therapy were investigated. GRBAS scale grade was closely related to acoustic parameters, such as jitter and shimmer. Univariate analysis showed the size of the polyp, the color of the vocal fold, a history of voice abuse, associated muscle tension dysphonia (MTD), and opposing reactive scar affected voice quality. In multivariate analysis, only the size of the polyp was associated with voice quality. The patients in whom the voice quality improved with voice therapy initially had smaller polyps and whitish-colored vocal folds. Results of the present study indicate that although the most influential factor on voice quality in vocal polyp patients was the size, several other factors should be considered in evaluating and treating vocal polyps. The size of the polyp and the color of the vocal fold are indicative of success or failure in voice therapy. [ABSTRACT FROM AUTHOR]

Postoperative volume changes in reconstructed flaps are known to influence the functional restoration of resected areas of the upper aerodigestive tract. The purposes of this study were to estimate the volume decreases in flaps and investigate clinical factors affecting the volume decrease. The medical records of 19 patients who underwent ablation and flap reconstruction surgeries for head and neck cancers were reviewed. The volume of the reconstructed flap was measured at 3, 12, and 24 months postoperatively using CT or MR imaging and the 3D-DOCTOR software. The relationships between volume changes and perioperative clinical parameters were examined. The primary tumor locations were the nasal cavity and paranasal sinus, oropharynx, oral cavity, and hypopharynx in 8, 6, 4, and 1 case, respectively. Twelve patients underwent anterolateral thigh flap (ALTF) reconstruction, and seven patients underwent pectoralis major myocutaneous flap (PMMCF) reconstruction. Twelve (63.2%) patients received postoperative radiation. The estimated volume decreases at 12 and 24 months postoperatively for ALTF were 20.9 and 24.8%, respectively, while those for PMMCF were 7.3 and 10.8%, respectively. Among clinical factors, only the type of flap affected the volume change. When determining the volume of reconstructed flaps, the type of flap must be considered. It was recommended to make free and regional flaps at least 20 and 10% larger, respectively than the actual defect. [ABSTRACT FROM AUTHOR]

A very efficient, reproducible approach has been developed to fabricate a multiwall carbon nanotube (MWCNT)-supported, high Pt loading electrocatalyst. In this strategy, MWCNT was first functionalized with an anionic surfactant, sodium dodecylsulfate (SDS), to enhance the hydrophilicity of the MWCNTs for high Pt loading. The SDS-modified MWCNTs were further used to support high loading of Pt nanoparticles (NPs) through a urea-assisted homogeneous deposition (HD) strategy, followed by reduction using ethylene glycol (EG) as the precursor of a reducing agent. Through the input of SDS on the MWCNTs, Pt complex species can be readily anchored on the outer surface of the MWCNTs, while in situpH adjustment of the solution with urea and reduction by EG enable the Pt NPs to disperse very uniformly on the SDS–MWCNT support with small particles size. Due to its unique structural characteristics, such as high electronic conductivity, the one-dimensional nanotube structure favouring fast electron transfer and more uniform Pt NP dispersion on the support with smaller particle size, the SDS-MWCNT-supported Pt (60 wt%) catalyst considerably outperformed a commercially available Johnson Matthey catalyst with the same Pt loading supported on Vulcan carbon black, when they were each employed as a cathode catalyst in proton exchange membrane fuel cells. [ABSTRACT FROM AUTHOR]

The microcapillary liquid chromatography (µLC)/tandem mass spectrometry (MS/MS) system has become a prevailing analytical platform in proteomics. Typical proteomic studies aimed at proteome-wide identification of peptides and proteins rely heavily on producing an accurate and reproducible solvent-composition gradient throughout microcapillary separation columns to improve LC separation. With the recent advent of targeted proteomic approaches utilizing the LC retention time as a physicochemical parameter for peptides, high reproducibility of LC separation additionally becomes an important factor. In this study, column temperature elevation is utilized to improve reproducibility and separation efficiency of the µLC-MS/MS system. The simple incorporation of a semi-rigid gas line heater allowed precise control of the temperature of microcapillary columns longer than 70 cm, up to 60 °C. Tryptic enolase peptides were used as a standard sample to evaluate the effect of the controlled temperature elevation on the peptide separation efficiency and reproducibility. In addition to the increased reproducibility in peptide elution time due to the controlled column temperature, the temperature elevation resulted in a decrease in the column operation pressure, which, in turn, allowed a higher solvent flow-rate to be employed using the same LC pumps, leading to further improvements in the performance of µLC systems. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine functional and surgical outcomes after fasciocutaneous free flap reconstruction of the hypopharynx. A retrospective review of the records of 48 consecutive patients that underwent hypopharyngectomy and reconstruction using fasciocutaneous free flaps between 1996 and 2009 was performed. Flap donor sites included the radial forearm ( n = 42), anterolateral thigh ( n = 5), and lateral thigh ( n = 1). There was no perioperative mortality, and the free flap survival rate was 95.8%. Five (10.4%) patients developed a postoperative pharyngocutaneous fistula. In three (6.3%) patients a stricture developed during the postoperative period. Forty-four (92%) patients were decannulated and maintained their voice. Forty-four (92%) patients were able to take oral nutrition, although 4 (8%) needed additional PEG-tube feeding. Five-year overall and disease-specific survival rates were 56 and 61%, respectively. Functional reconstruction of extensive laryngohypopharyngeal defects can be achieved using fasciocutaneous free flaps with favorable functional and surgical results. [ABSTRACT FROM AUTHOR]

Objective: To evaluate microvascular reconstruction of a vertical hemipharyngolaryngectomy (VHPL) defect for hypopharyngeal squamous cell carcinoma. Design: Retrospective analysis of medical records. Setting: Tertiary care referral center. Patients: Thirty-two patients who underwent a VHPL. Main Outcome Measures: Assess the surgical technique and safety of VHPL and review the functional parameters of swallowing and decannulation. Results: The classification was composed of 3 types of VHPL according to the extent of resection: limited VHPL (type I), resection at the lateral border of the conus elasticus to preserve both vocal cords (n=10); total VHPL (type II), removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage with preservation of 1 vocal cord (n=12); and extended VHPL (type III), inclusion of a supraglottic laryngectomy (type IIIa) (n=6) or partial cricoid cartilage resection (type IIIb) (n=4). A radial forearm free flap that included the palmaris longus tendon was used for reconstruction in 31 patients, and an anterolateral thigh flap was used in 1 patient. There was no perioperative mortality, and there was 100% free flap survival. Oral realimentation and tracheotomy weaning were achieved a mean of 33 and 32 days postoperatively, respectively. In 25 patients observed for longer than 6 months, the recurrence rate was 28% (7 of 25), and 5-year disease-specific survival was 64%. Conclusion: Microvascular reconstruction of VHPL offers a wider resection with promising functional results for hypopharyngeal carcinoma. [ABSTRACT FROM AUTHOR]

The objectives of this study are to elucidate the oncologic validity of the supracricoid laryngectomy (SCL) for locally advanced endolaryngeal cancers and as a salvage procedure, and to determine its safety in maintaining laryngeal physiology. The medical records of 114 patients that underwent SCL were reviewed. We examined whether the extended procedures, salvage procedure, adjuvant treatment, and type of reconstruction were associated with patient survival and the mean time of decannulation and nasogastric tube removal. Postoperative complications were investigated. There was no significant difference in survival according to the extent of the resection of the primary tumors and the presence or absence of previous treatment. However, the survival of patients that received radiation or concurrent chemoradiation after SCL was significantly lower than that of patients without any adjuvant treatment. Decannulation and nasogastric tube removal was possible for all except for two patients, and the mean time required was 18.4 and 26.1 days, respectively. The interval to starting oral feeding was significantly increased in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery compared to their counterparts. Pulmonary complications, particularly aspiration pneumonia, were the most common postoperative complications. The results of this study suggest that SCL was feasible for locally advanced laryngeal cancers and as a salvage procedure. Active and effective postoperative swallowing rehabilitation, particularly in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery, is needed to prevent aspiration pneumonia. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate relationships between free flap compromise and perioperative risk factors. A retrospective review was conducted for 237 patients who underwent 247 microvascular free flap reconstructions after head and neck ablative surgery. Twenty-one (8.5%) cases of free flap compromise due to a vascular obstruction were identified, and 11 flaps were lost (4.5%); an overall success rate of 95.5%. A significant correlation was found between diabetes mellitus and free flap compromise ( p = 0.048). Preoperative irradiation was also found to influence free flap compromise, but with borderline significance ( p = 0.052). However, multivariate analysis revealed a significant association between free flap compromise and diabetes mellitus [odds ratio = 4.9 (95% CI 1.1–22.8, p = 0.041)]. The presence of diabetes mellitus may require more attention to improve patient management and free flap outcomes. [ABSTRACT FROM AUTHOR]

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare malignancy derived from antigen-presenting cells, with 55 cases reported thus far. A standard treatment modality is still being debated. This report describes a 56-year-old female who presented with right tonsillar enlargement and right submandibular swelling for 6 months. Treatment with empiric antibiotics did not result in improvement of her symptoms. Fine needle aspiration of the tonsil revealed no malignant cells. Tonsillectomy was eventually performed due to persistent symptoms. Based on microscopic findings, immunohistochemical stains, and review of the literature, the present case was finally diagnosed as IDCS of the tonsil with cervical lymph node involvement. The patient received four cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, and a clinically complete response was achieved followed by adjuvant radiation. [ABSTRACT FROM AUTHOR]