Infantile myofibromatosis treated by mandibulectomy and staged reconstruction with submental flap and free fibula flap: a case report.

BACKGROUND: Infantile myofibromatosis is the most common benign fibrous tumor in infants. Three different types have been reported in the literature. The most commonly affected areas are the head, the neck and the trunk. Our patient showed a very high level of mandibular destruction resistant to all mandibular sparing treatment strategies requiring segmental mandibulectomy and complex reconstruction. CASE PRESENTATION: We describe a rare case of multicentric infantile myofibromatosis with mandibular bone destruction. The treatment required a succession of chemotherapy, a subtotal transoral resection and a hemi-mandibulectomy. The mandibular reconstruction was staged with initial bridging titanium plate with a submental flap, followed later by a fibula free flap. CONCLUSION: Mandibular involvement by myofibromatosis is rare, and the extend of bone destruction and reconstruction make this case unique. To our knowledge, this is the only reported case of fibula free flap mandibular reconstruction in a patient with infantile myofibromatosis , as well as one of the youngest reported submental island flaps for any pathology. We describe the clinical presentation and management, including relevant imaging, histopathology, medical and surgical treatment as well as a review of relevant literature.

Incidence of differentiated thyroid cancer by socioeconomic status and urban residence: Canada 1991-2006.

BACKGROUND: The incidence of thyroid cancer is increasing in Canada. The purpose of this study was to investigate the following questions. First, what was the magnitude of increased incidence of thyroid cancer in Canada from 1991-2006? Second, is there an association between socioeconomic status (SES) and thyroid cancer incidence in Canada? Third, does the relationship between SES and the incidence of thyroid cancer vary by rural/urban status? METHODS: Thyroid cancer cases were drawn from the Canadian Cancer Registry. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. We linked cases to income quintiles (InQs) according to patients' postal codes, and categorized place of residence into city, town, or rural. We then performed a negative binomial regression analysis on the incidence of thyroid cancer to identify relationships between these variables. RESULTS: The overall incidence of thyroid cancer in Canada increased by 156% between 1991 and 2006. Incidence was significantly lower among individuals from lower InQs (incidence rate ratio 0.77 for lowest InQ compared to highest). The incidence of thyroid cancer was more than 25% lower in towns or rural areas compared to cities, after controlling for SES and demographic factors. Lastly, when we allowed the relationship between thyroid cancer incidence and geography of residence to vary by SES, we found that the difference in incidence between highest and lowest InQs was significantly larger in cities than in towns and was insignificant in rural areas. CONCLUSIONS: Our study confirmed a dramatic increase in thyroid cancer incidence in Canada. Thyroid cancer incidence was significantly higher in higher InQs and in cities. These data support the theory that increased access to imaging is largely responsible for this increased incidence.

Cascade polycyclization: exploration of a convergent route to access various tricyclic and tetracyclic products related to sterols.

The expedient synthesis of tricyclic and tetracyclic compounds via a cascade polycyclization methodology is described. Nazarov substrates (II) containing two Michael acceptors and a cyclohexenone ester (I) underwent cycloaddition followed by intramolecular 1,4-addition to furnish, in a highly stereoselective manner, tricyclic and tetracyclic products (III). Such compounds are interesting intermediates for the synthesis of polycyclic natural and unnatural products.