Pattern of invasion of oral squamous cell carcinoma and its relation to the presence of nodal metastases - a review.

Squamous cell carcinomas of the oral cavity represent the largest group of malignancies in this area. Currently, there are many prognostic histopathological factors, according to which the maxillofacial surgeon in collaboration with the oncologist is able to determine the prognosis and subsequently also set an appropriate therapy. Nowadays, the squamous cell carcinoma invasion pattern in the area of the "invasive tumor front" seems to be a very important prognostic factor. The invasion pattern is connected to metastatic potential (and to the presence of subclinical microscopic metastases) and may well be the answer to why even early-stage tumors do not respond to standard therapy. That is to say, based on varying invasion pattern, oral cavity squamous cell carcinomas with identical TNM manifest varying clinical behavior and growth tendencies and a varying metastatic potential.

Early inflammation precedes cardiac fibrosis and heart failure in desmoglein 2 murine model of arrhythmogenic cardiomyopathy.

The study of a desmoglein 2 murine model of arrhythmogenic cardiomyopathy revealed cardiac inflammation as a key early event leading to fibrosis. Arrhythmogenic cardiomyopathy (AC) is an inherited heart muscle disorder leading to ventricular arrhythmias and heart failure due to abnormalities in the cardiac desmosome. We examined how loss of desmoglein 2 (Dsg2) in the young murine heart leads to development of AC. Apoptosis was an early cellular phenotype, and RNA sequencing analysis revealed early activation of inflammatory-associated pathways in Dsg2-null (Dsg2-/-) hearts at postnatal day 14 (2 weeks) that were absent in the fibrotic heart of adult mice (10 weeks). This included upregulation of iRhom2/ADAM17 and its associated pro-inflammatory cytokines and receptors such as TNFα, IL6R and IL-6. Furthermore, genes linked to specific macrophage populations were also upregulated. This suggests cardiomyocyte stress triggers an early immune response to clear apoptotic cells allowing tissue remodelling later on in the fibrotic heart. Our analysis at the early disease stage suggests cardiac inflammation is an important response and may be one of the mechanisms responsible for AC disease progression.

Three-Stage Paramedian Forehead Flap Reconstruction of the Nose Using the Combination of Composite Septal Pivot Flap with The Turbinate Flap and L-Septal Cartilaginous Graft - a Case Report.

Nasal basal cell carcinomas are the most common malignant tumors of the facial skin, which predilectively affect areas exposed to sunlight, including the nasal area. After their radical removal, there is a variable complex defect of the affected area (defect of all 3 layers of the nose) or even a composite defect (it also occupies the adjacent soft tissues around the nose), which are usually used to reconstruct this area. A 73-year-old female patient with recurrent infiltrative basal cell carcinoma of the left nasal ala underwent four re-excisions before histologically verified free margins without the presence of the tumor. The result was a composite defect that occupied the top of the dome of the right nostril, the entire left half of the soft nose, including the base of the wing, part of the upper lip, and a defect of the adjacent face area of 9 × 5cm. In the first phase, the left cheek and upper lip were reconstructed by advancement French plasty and coverage of the two residual skin defects with full-thickness skin graft. One month later, during the second phase of reconstruction, the flap was re-elevated, shifted and rotated, and a three-stage nasal reconstruction was started using a composite septal pivotal flap and left turbinate flap for inner lining reconstruction, and the nasal skeleton was reconstructed with a cartilaginous L-graft from the 6th rib, septal and conchal cartilages. The skin cover of the nose was reconstructed with the left paramedian forehead flap, which was thinned during the second stage with the simultaneous widening of the bottom of the left nostril by the transposition flap, during the third stage the flap pedicle was removed. In the reconstruction of a complex defect of the nose and its surroundings, it is first necessary to create a stable platform on which the reconstruction of the nose itself will be performed. To achieve an excellent functional and aesthetic result of nose reconstruction, it is appropriate to use a three-stage forehead flap. In this paper, we describe a unique method of nasal reconstruction - a combination of a septal pivotal flap with a turbinate flap to reconstruct the inner lining in conjunction with an L-graft to ensure a stable nasal skeleton and forehead flap to reconstruct the skin cover.

Anterior open bite - diagnostics and therapy.

An anterior open bite (AOB) is an occlusal disorder that causes the patient both an aesthetic and functional handicap. The lower third of the face is disproportionately larger. Patients are unable to properly occlude with the anterior part of dental arch and occlusion only happens in the premolar and/or molar regions. An anterior open bite may be the result of anatomical anomalies. Long term stability as well as an immediate outcome of the surgery depends on the choice of a suitable treatment strategy. In this article, we review options of AOB treatment, from classical orthodontic treatment to current combined orthodontic and surgical approach with a benefit of an anchor system.

HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW.

Medicinal leeches (Hirudo medicinalis, Hirudo verbana) have been used in the field of medicine to treat various diseases for thousands of years. Popularity of their use changed over time and in Europe, it peaked at the beginning of the 19th century. In modern medicine, application of leeches on flaps with venous congestion was first used and described by Deganc and Zdravic in 1960. A certain renaissance of leech use is currently taking place, especially in the field of reconstructive surgery. In general, use of leeches is indicated during critical post-operative period, in which the microcirculation and veins are incapable of sufficient drainage of venous blood, which can lead to stagnation of circulation in tissues at all levels, clinically manifested as a change in color and turgor of the flap. If this venostasis is not recognized in time and treated adequately, tissue necrosis can develop. Medicinal leeches can be used in venous drainage disorders after a replantation of fingers, auricles, lips and parts of the nose. In head and neck reconstructive surgery, there are many studies that confirm the success rate of hirudotherapy in hematoma evacuation or in dealing with complications after scalp replantation and transfers of free and pedicled flaps. Leech application therapy can also be indicated as a part of non-surgical methods that improve conditions of the venous system.

INDICATION AND IMPORTANCE OF RECONSTRUCTIVE SURGERIES OF FACIAL SKELETON IN MAXILLOFACIAL SURGERY: REVIEW.

Malignant head and neck tumors belong among common diseases and their incidence constantly rises. In the Czech Republic, the proportional representation of orofacial tumors ranges around 2% of the total number of malignancies. Rational treatment of these tumors is complex and long. In the course of therapeutic planning, you have to consider the age of the patient and the stage of the disease including the presence of distant metastases. Removal of the tumor with a sufficient safety margin and an eventual treatment of the relevant lymphatic system according to the type of the tumor is an important prerequisite for the success of the surgical therapy. Reconstructive procedures in maxillofacial oncosurgery presume good interdisciplinary cooperation and a high professional preparedness of the surgical and nursing team. Selection of the right patient is also very important with regard to the risks of both local and systemic postoperative complications. Use of the free flap techniques is currently the gold standard, but it is also necessary to master pedicled flap techniques, whose advantages lie in simpler technique and often better aesthetic results. At the same time, we have to realize that even traditional, classical reconstructive procedures using prosthetic replacements can still represent the ideal solution in many cases.

Pedicled pectoralis major flap in head and neck reconstruction - technique and overview.

The pedicled pectoralis major flap was the original workhorse flap for head and neck reconstruction. Over time, it became the secondary choice for oropharyngeal reconstruction with the implementation of free-soft tissue transfers. Nowadays, a polymorbid patient is primarily indicated for pedicled pectoralis major flap reconstruction, other indications include combinations of pedicled pectoralis major flap with free microvascular flap, salvage reconstruction due to complications, salvage reconstruction due to free flap failure and salvage reconstruction due to recurrent or extended primary disease. Pedicled pectoralis major flap can be successfully used for specific oropharyngeal defects, even primary resections, especially for less cooperative patients and patients after extensive neck dissection. Improving the flap harvesting techniques can reduce undesired complications in specific cases of oropharyngeal reconstruction. Flap morbidity in these cases remains comparable to morbidity of patients who had undergone free flap reconstruction. Pedicled pectoralis major flap remains valid reconstruction tool that should be included in the armamentarium of each surgeon dealing with reconstruction of the head and neck.

Pedicled pectoralis major flap in head and neck reconstruction - our experience.

INTRODUCTION: The pedicled pectoralis major flaps are still harvested and mainly indicated for reconstruction in the polymorbid patient. Other indications are combinations of pedicled pectoralis major flaps with free microvascular flap, salvage reconstruction following complications, free flap failure and recurrent or extended primary disease. MATERIALS AND METHODS: We describe the pedicled pectoralis major flap in 18 patients operated on at the Department of Oral and Maxillofacial Surgery, Olomouc from 1st January 2014 to 1st December 2016. RESULTS: Fifteen oropharyngeal defect reconstructions were performed using pedicled pectoralis major flap (including 1 submandibular defect of the neck). Indications were primary resection in polymorbid patients in 10 cases and recurrent diseases after previous neck dissection and radiotherapy in 5 cases. Pedicled pectoralis major flap was used for secondary reconstruction in 3 cases. Complications occurred in 50 % of patients, 28 % were major and 22 % minor. Major complications included a total flap failure (defect was successfully treated with free tissue transfer of latissimus dorsi myocutaneous flap) in 1 case, plate exposure in 2 cases, large dehiscence and large hemorrhage 1 case each. Minor complications included only small dehiscences (22 %). One was associated with fluidothorax after rib harvesting (6%). There were no cases of neck contracture or supraclavicular bulge. CONCLUSION: Even today, usage the pedicled pectoralis major flap in head and neck reconstruction surgery cannot be considered as an obsolete reconstructive procedure that has been completely replaced by a free microvascular flap. Innovations of flap harvesting techniques and high rate of flap survival are the main reasons why pedicled pectoralis major flap can still be primarily indicated for high-risk patients, non-cooperative patients and also for patients with extensive neck dissection. The pedicled pectoralis major flap has been the first choice in salvage surgery, in cases of a complication or free flap failure or a recurrence of a primary disease.

[HPV in etiology of orofaryngeal cancer according to sexual activity]. / HPV v etiologii orofaryngeálního karcinomu a jeho vztah k sexuální aktivite

OBJECTIVE: The objective of this study is to confirm or exclude the presence of the HPV in oral cavity according to sexual activity. DESIGN: Prospective not blinded study. SETTING: Clinic of Oral and Maxillofacial Surgery, Clinic of Obsterics and Gynecology, Department of Microbiology, Medical Faculty Palacky University and University Hospital Olomouc. METHODS: The patients were examined during the screenig for cervix carcioma at the Clinic of Obsterics and Gynecology. After filling the Consent Form and the questionnaire for possible exposure to potentional risk the swabs from cervix and mouth were sampled. The samples have been processed at the Department of Microbiology by the Real Time PCR. RESULTS: The results have not confirmed the relation between sexual practices and infection of oral cavity by the HPV. CONCLUSION: Our results correspond with certain authors. There is unclear correlation between total number of sexual partners and infection of mouth with the HPV. Nevertheless the HPV related tumors have been proven - especially in the oropharynx- but the way how the infection enters the mouth remains still unclear, according to us.

[Scintigraphically "hot" thyroid nodules mainly go hand in hand with a normal TSH]. / Szintigraphisch mehranreichernde Schilddrüsenknoten gehen überwiegend mit normwertigem TSH einher.

AIM: In recent years, various professional societies published guidelines for diagnostic evaluation of thyroid nodules, in which the indication for scintigraphy is restricted to patients with subnormal TSH values. It is seen controversial whether such recommendations should be transferred to Germany, partly because of lower iodine intake in this country and the consequent higher percentage of autonomous thyroid nodules, which are not accompanied by a measurable dysfunction. Since reliable data to this topic are scarce, we analyzed multicentrically the spectrum of scintigraphically "hot" and "warm" nodules under the current epidemiological conditions. PATIENTS, METHODS: In 10 German nuclear medicine out-patient institutions we evaluated the diagnostic data from a total of 514 patients, in whom unequivocally hyperfunctional nodules (focal increased uptake in comparison to perinodular tissue with a sonographically nodular correlative ≥1 cm) could be detected by (99m)Tc-pertechnetate scintigraphy. To minimize selection bias, the surveys were not carried out in hospitals.The recorded parameters included the thyroid hormone levels, the global (99m)Tc-uptake (TcTU), the size of each nodule and the total autonomous nodular volume (V(aut)). RESULTS: Only 20% of the patients with "hot" nodules had subnormal TSH levels (<0.1 to 0.33 mU / l), the remaining patients had TSH levels from 0.34 to 3.5 mU /l (in one third of the patients TSH levels even exceeded 1.0 mU/l). Moreover, we found no relevant correlation between TSH and TcTU or V(aut). CONCLUSIONS: In Germany, in at far the largest proportion of patients with autonomous thyroid nodules objectified by means of scintigraphy, TSH levels are within the normal range. Since such nodules with maximum safety can be classified as benign, a corresponding scintigraphic finding has a high priority for the patient. These current data support that it is not reasonable to restrict scintigraphy to patients with subnormal TSH values in this country.

A comparison of tissue reactions to Ketac-Fil and amalgam.

The objective of this study was to compare the bone tissue reactions of Ketac-Fil to the most commonly used retrograde filling material, amalgam, in a rat model. Forty-eight Harlan rats were divided into three groups: amalgam, Ketac-Fil, and controls. Following anesthesia, the right lower incisor was extracted from each animal. A 3-mm long x 1-mm diameter polyethylene tube filled with amalgam or Ketac-Fil was implanted in the extraction site. The animals were killed at 14, 42, and 90 days; and the mandibles were dissected en block and processed histologically. The inflammatory reaction was assessed by the number of plasma cells, lymphocytes, polymorphonuclear neutrophils, giant cells, and osteoclasts within 100 microns of the implant. Bone formation was determined as either present or absent in the same area. There was no statistically significant bone apposition within 100 microns of the Ketac material, and there was a statistically significant increase in inflammation in the amalgam group. This study indicates that both Ketac-Fil and amalgam are relatively biocompatible, and provides support for clinical usage tests of Ketac-Fil as a retrograde filling material.

The role of [18F]fluoride positron emission tomography in the early detection of aseptic loosening of total knee arthroplasty.

Total knee arthroplasty is successful in the treatment of degenerative, arthritic or injured joints. But the most important long term complication seems to be aseptic loosening. An inflammatory process at the bone/cement or bone/prosthesis interface leads to a severe osteolysis. Although early diagnosis is very important the standard techniques often fail. [(18)F]Fluoride ion positron emission tomography (F-PET) is an appropriate tracer paired with a modern method for the evaluation of increased bone metabolism at the bone/prosthesis interface. In this preliminary study we describe for the first time the value of F-PET in the early diagnosis of aseptic loosening. We studied 14 painful knee arthoplasties. In 6 cases the definite diagnosis was determined by surgical procedure, for 8 cases a long clinical follow-up of the least 6 months after the onset of symptoms led to the diagnosis. The F-PET scans were obtained by with an ECAT EXACT HR+ scanner with and without attenuation correction in the two-and three-dimensional mode. An intermediate or high uptake along the bone/prosthesis or bone/cement interface including either the tibial stem or the half of the femoral component was suspected to be aseptic loose. The result were compared with plain radiographs. We found a sensitivity of 100%, a specificity of 56% and an accuracy of 71%. No false negative results were detected, in 4 patients one component as false positive. The sensitivity, specificity and accuracy for the plain radiograph of the same patients were 43%, 86% and 64%, respectively. In conclusion PET seems to be a promising new method in the early diagnosis of painful TKA because of its excellent spatial solution. In combination with the bone seeking tracer [(18) F]fluoride, PET allows the detection of aseptic loosening and the differentiation to the simple synovitis. Our preliminary results suggest that F-PET could be a useful tool although we examined a small group of patients.

Chemical properties of two antigens controlled by the major histocompatibility complex of the chicken.

The chemistry of antigens controlled by the major histocompatibility complex of the chicken has been investigated. Peripheral blood leukocytes of five chicken strains were radioactively labeled by incorporation of tritiated amino acids, enzymatic iodination, or mild periodate oxidation followed by reduction with tritiated sodium borohydride. Membrane-bound antigens were solubilized with Nonidet P-40 and purified by a two-step immunoprecipitation procedure. The resulting immunoprecipitates were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing or nonreducing conditions. The chicken major histocompatibility antigens (B antigens) are composed of polypeptide chains with molecular weights (in the reduced form) of 40,000 to 43,000 and 11,000 to 12,000, as deduced from their mobilities in internally calibrated gels. The larger chains, when isolated from different chicken strains, can have slightly different mobilities in such gels; thus the mobilities of the large polypeptides from strains WA and WB correspond to molecular weights of 40,000 and 43,000, respectively. Gels run under nonreducing conditions give similar results; in particular no dimers or oligomers of the larger chains are detectable, thus ruling out an immunoglobulin-like structure for the B antigens. The large chains are labeled by the periodate oxidation-reduction procedure, suggesting that they are glycoproteins (probably containing sialic acid), while the small polypeptides cannot be labeled by this method. An additional protein or proteins of apparent molecular weight about 30,000 could be precipitated from 3H-amino-acid-labeled leukocyte lysates by one particular anti-B serum. This protein(s), named B-L, differs from the B major histocompatibility antigens in that it is not associated with the small chain of molecular weight 11,000 to 12,000 and does not occur on erythrocytes. Thus, at least two protein chains are coded for (or have their synthesis controlled by) genes in the chicken major histocompatibility complex.

A model of bursal colonization.

In the chicken, and perhaps in all birds, the development of the cells which form antibodies, the B-cells, differs substantially from that in mammals. In birds, committed B-cells colonize a specialized organ, the bursa of Fabricius, which consists of some 10(4) follicles. Diversification, i.e., the development of the antibody repertoire, takes place in bursal follicles by a process termed "gene conversion." The avian bursa is easily accessible experimentally, and in the chicken, it has been the subject of extensive research. As an aid to experimentation in this field, we present here a formal mathematical model of bursal development. Formulae are derived which allow one to estimate the number and sizes of B-cell clones in bursal follicles, and hence the size of the overall antibody repertoire. Particular attention is paid to the problem of estimating experimental errors.

Presence of T 145 on cytolytic T cell lines and their lectin-resistant mutants.

Murine cytolytic T cell lines have been analyzed for the expression of two surface glycoproteins called T145 and T130. T145, known to be expressed by activated cytolytic T cells, is also expressed by such lines, but T130, which has been described by a universal T cell marker, is not. Our results suggest a structural relationship between T145 and T130. Vicia villosa lectin, which binds selectively to T145 of activated T cells and which is cytotoxic for cytolytic T cell lines, has been used to select lectin-resistant mutants from these lines. Five independent lectin-resistant mutants have been obtained. All of them are cytolytically active, bind up to 100-fold less lectin than the parental lines, but still express T145 or a closely related glycoprotein.

Effects of interferons on immune response to a synthetic peptide malaria sporozoite vaccine in non-immune adults.

A Plasmodium falciparum sporozoite vaccine, composed of a synthetic dodecapeptide (NANP)3 coupled to tetanus toxoid (TT), was injected, at weeks 0 and 8, into non-immune volunteers in two randomized double-blind placebo-controlled trials. In the first trial, 37 volunteers received the vaccine simultaneously with placebo (group 1), 0.5 x 10(6-) (group 2), or 1.5 x 10(6) U (group 3) of recombinant human interferon-alpha (= IFN-alpha). In the second trial, 35 other volunteers received the vaccine with placebo (group 4), 0.25 x 10(6) (group 5), or 1.0 x 10(6) IU (group 6) of interferon-gamma (= IFN-gamma). Immunizations were well tolerated and resulted in seroconversion rates (greater than or equal to 4-fold increase of antibody titre in immunofluorescence or enzyme-linked immunosorbent assays) of 67-100% of volunteers. IFN-alpha significantly enhanced the IgG antibody titres in ELISA to malaria peptide.

[Principles of PET/CT and clinical application]. / Grundlagen und klinischer Nutzen von PET-CT.

Medicine today imposes high demands on diagnosing disease. Techniques should be preferably noninvasive, identify the disease at an early stage, and be quick and accurate. Frequently, these demands can only be met by employing various diagnostic modalities. Consequently, the integration of two imaging modalities, such as the combination of PET and CT, increases the quality of coregistration and facilitates a timely diagnosis. However, complex imaging procedures require a judicious choice of the areas of application. If, for example, both PET and CT are indicated then a combined PET/CT exam results in improved diagnosis, whereby the actual benefit will depend upon the clinical problem. Typically we expect an advantage of 10% with PET/CT compared to separate examinations with CT and PET. In addition, PET/CT allows for new indications and applications, which cannot be performed satisfactorily with independent examinations and retrospective image alignment. One example is the application of PET/CT in radiation therapy planning.

Major surface antigen p190 of Plasmodium falciparum: detection of common epitopes present in a variety of plasmodia isolates.

Plasmodium falciparum merozoites are covered with polymorphic proteins that are processed from a 190 kd (p190) precursor protein. These are candidates for an antimalarial vaccine. We cloned and expressed a number of DNA fragments, comprising almost the entire p190 gene of the K1 isolate, in Escherichia coli. Pooled human endemic-area sera and rabbit antibodies raised against p190 protein isolated from K1 parasites react with only a limited number of the recombinant proteins. From these studies we could select two antigenic polypeptides containing conserved amino acid stretches of the otherwise highly polymorphic protein. Rabbits and mice injected with the purified recombinant proteins produce antibodies reacting differentially with various isolates of P. falciparum. We obtained antibodies detecting all isolates tested and a monoclonal antibody specific for isolates containing a K1 type allele of the p190 gene.

Combined PET/CT with iodine-124 in diagnosis of spread metastatic thyroid carcinoma: a case report.

Iodine-124 positron emission tomography (PET) is a useful 3D imaging technique for diagnosis and management of thyroid diseases. The difficulty in interpretation of the PET scans with highly selective tracers, such as iodine-124, is the lack of identifiable anatomical structures, so an accurate anatomical localization of foci presenting abnormal uptake is problematic. Consequently, a combined PET/CT scanner can resolve these difficulties by co-registering PET and CT data in a single session allowing a correlation of functional and morphologic imaging. A case is presented where iodine-124 produced by a clinical cyclotron and FDG were used to acquire images with a combined PET/CT scanner for clinical staging. On the basis of the PET/CT exams the treatment of the patient was modified.