Analysis of immediate vascular reconstruction for lower-limb salvage in patients with lower-limb bone and soft-tissue sarcoma.

BACKGROUND: Limb amputation has historically been the first choice of treatment for patients with bone or soft-tissue sarcomas involving major blood vessels. However, recent advances in surgical technique have allowed limb-salvage surgery. We reviewed our experiences with limb-salvage surgery and immediate vascular reconstruction following en bloc resection of bone or soft-tissue sarcomas of the lower extremity. MATERIALS AND METHOD: We reviewed 23 patients (15 male and eight female; mean age, 43.6 years) who underwent limb-salvage surgery and immediate vascular reconstruction. Details of surgical factors and postoperative complications were evaluated. RESULTS: Reconstructed vessels remained patent in 21 cases. The rate of limb oedema was higher in patients who underwent only arterial reconstruction after arteriovenous resection. Twenty patients could walk well without crutches a few months after reconstructive surgery. All patients avoided amputation. Two patients died of disseminated disease within 3 years after surgery. CONCLUSION: The high rate of limb oedema suggests that venous reconstruction is necessary after arteriovenous resection. Vascular reconstruction and musculocutaneous flap techniques are useful in limb-salvage surgery and are indicated for patients who have achieved good disease control. Evidence Rating Scale for Therapeutic Studies: Level III.

Analysis of operative mortality and post-operative lethal complications after head and neck reconstruction with free tissue transfer.

OBJECTIVE: Operative mortality is the most important index for assessing operative results, which has rarely been examined in reconstructive surgery. The aims of this study were to establish a representative index of operative mortality after head and neck reconstruction and to consider measures to improve operative results. METHODS: We reviewed cases of head and neck reconstruction by means of free tissue transfer performed from July 1992 through December 2005 at the National Cancer Center Hospital East, Chiba, Japan. The subjects were 1249 patients with a mean age of 62 years. Operative mortality was evaluated on the basis of the 30-day post-operative mortality rate and the in-hospital mortality rate. Statistical analysis was performed with the Cochran-Armitage test. RESULTS: The 30-day post-operative mortality rate was 0.88% (11 of 1249 patients), and the in-hospital mortality rate was 1.84% (23 of 1249 patients). The 30-day post-operative mortality was significantly correlated with age (P = 0.002), but the in-hospital mortality was not (P = 0.148). Among patients older than 80 years, the 30-day post-operative mortality rate was 8.57%. The most common cause of 30-day post-operative death was cerebral infarction. Of the 23 in-hospital deaths, 13 were due to cancer recurrence. CONCLUSIONS: These results indicate that head and neck reconstruction with free flaps is reliable. However, the high 30-day post-operative mortality rate among patients 80 years or older should be considered when deciding whether to operate. To decrease the operative mortality rate, careful perioperative management is needed to prevent complications and shorten the hospital stay.

Window resection of the trachea and secondary reconstruction for invasion by differentiated thyroid carcinoma.

OBJECTIVE: In cases of differentiated thyroid carcinoma, the presence or absence of invasion into the circumferential organs is an important prognostic factor. Surgical procedures include circular resection of the trachea with end-to-end anastomosis and window resection with secondary closure. We have used window resection with secondary closure since 1993, and herein retrospectively analyze the treatment outcomes for this surgical procedure in order to determine the indications for procedure selection. METHODS: Subjects comprised 41 cases of invasion by differentiated thyroid carcinoma into the trachea, for which surgery was performed at the Department of Head and Neck Surgery of the National Cancer Center Hospital East from 1993 to 2007. The mean age was 65.7±7.9 years, and the median length of the observation period was 43 months. There were 17 cases (41.4%) cases of secondary relapse. RESULTS: The 5-year and 10-year overall survival rates for this surgical procedure were 78.9% and 74.5%, respectively, while the 5-year and 10-year local control rates were 92.4% and 73.4%, respectively. The pathological resection stump was positive in 27 cases (65.8%), but no significant differences in treatment outcome were observed between the stump-positive group and the stump-negative group. There were 26 cases in which closure of the tracheal fistula was performed by the time of observation. When the tracheal defect had a diameter equivalent to 7 rings of the trachea or less and a circumference half that of the tracheal cartilage or smaller, including partial cricoid cartilage, it was possible to perform closure with only a local flap. For larger defects, reconstruction was performed using hard tissues or materials, such as hydroxyapatite, titanium mesh, and costal cartilage. There were 2 cases that required re-window because of dyspnea after closure. CONCLUSION: The treatment outcomes for this surgical procedure for invasive cases of differentiated thyroid carcinoma into the trachea resulted in a low rate of local recurrence and similar survival rates as described in other reports. Even for cases of resection exceeding half the circumference of the trachea, closure of the tracheal fistula can be performed using hard tissues or materials; however, in such cases, we believe that closure should be attempted progressively in a two-stage reconstruction.

The role of pulmonary resection in tumors metastatic from head and neck carcinomas.

OBJECTIVE: The purpose of this study was to determine the role of surgical treatment and to identify factors affecting the survival of patients undergoing pulmonary resection for tumors metastatic from head and neck carcinomas. METHODS: Thirty-three patients who had undergone resection of pulmonary tumors metastatic from head and neck carcinomas, other than thyroid cancers and sarcomas of the head and neck, were reviewed. RESULTS: The operative morbidity rate was only 6%, no patients died within 30 days after resection and complete resection was achieved in 94% of patients. The overall 1- and 3-year survival rates were 76% and 43%, respectively, and the median survival time was 21 months. The factors found on univariate analysis to significantly affect survival were a disease-free interval of < or =2 years, tongue carcinoma and squamous cell carcinoma. The factor found, on multivariate analysis, to most strongly affect survival was tongue carcinoma. The most frequent pattern of initial recurrence after pulmonary resection was distant metastasis (64%). CONCLUSIONS: The safety and effectiveness of surgical treatment for pulmonary tumors metastatic from head and neck carcinomas in adaptive criteria for resection are well demonstrated. The poor survival after surgical resection of pulmonary tumors metastatic from cancers of the tongue should be noted.

Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for periorbital skin hyperpigmentation in Asians.

BACKGROUND: Periorbital skin hyperpigmentation, so-called dark circles, is of major concern for many people. However, only a few reports refer to the morbidity and treatment, and as far as the authors know, there are no reports of the condition in Asians. METHODS: A total of 18 Japanese patients underwent combined therapy using Q-switched ruby laser to eliminate dermal pigmentation following topical bleaching treatment with tretinoin aqueous gel and hydroquinone ointment performed initially (6 weeks) to reduce epidermal melanin. Both steps were repeated two to four times until physical clearance of the pigmentation was confirmed and patient satisfaction was achieved. Skin biopsy was performed at baseline in each patient and at the end of treatment in three patients, all with informed consent. Clinical and histologic appearances of periorbital hyperpigmentation were evaluated and rated as excellent, good, fair, poor, or default. RESULTS: Seven of 18 patients (38.9 percent) showed excellent clearing after treatment and eight (44.4 percent) were rated good. Only one (5.6 percent) was rated fair and none was rated poor. Postinflammatory hyperpigmentation was observed in only two patients (11.1 percent). Histologic examination showed obvious epidermal hyperpigmentation in 10 specimens. Dermal pigmentation was observed in all specimens but was not considered to be melanocytosis. Remarkable reduction of dermal pigmentation was observed in the biopsy specimens of three patients after treatment. CONCLUSION: The new treatment protocol combining Q-switched ruby laser and topical bleaching treatment using tretinoin and hydroquinone is considered effective for improvement of periorbital skin hyperpigmentation, with a low incidence of postinflammatory hyperpigmentation.

Development of polysilane-supported palladium/alumina hybrid catalysts and their application to hydrogenation.

Novel immobilized Pd catalysts, polysilane-supported palladium/alumina hybrid catalysts, have been developed. The catalysts showed high catalytic activity for hydrogenation, and could be used in an organic solvent or under solvent-free conditions.

Synthesis and Diels-Alder reactions of 1,2-dimethylene[2.n]metacyclophanes.

The Diels-Alder reaction of 1,2-dimethylene[2.n]MCPs (MCP = metacyclophane) with suitable dienophiles followed by aromatization and photoinduced or FeCl(3)-induced transannular cyclization afforded phenanthrene-anellated polycyclic aromatic hydrocarbons, which were found to adopt helical chirality in the solid state.