Early Modification in Drainage of Interleukin-1ß and Tumor Necrosis Factor-α Best Predicts Surgical-Site Infection After Cervical Neck Dissection for Oral Cancer.

PURPOSE: Surgical-site infection (SSI) after cervical neck dissection (CND) for head and neck squamous cell carcinoma (HNSCC) increases morbidity and delays adjuvant treatment. This study assessed changes in cytokines levels in postsurgical drainage fluid after CND and examined their predictive value for the early diagnosis of SSI. PATIENTS AND METHODS: An observational prospective pilot study was conducted in 39 consecutively recruited patients with HNSCC undergoing CND who were treated at the authors' service within the past 2 years. Patients met the following inclusion criteria: no previous chemotherapy or radiotherapy, closed-suction drainage, 30-day follow-up, prophylactic treatment with amoxicillin plus clavulanic acid and dexamethasone, no chronic inflammatory disease, and no previous neck surgery. Drainage samples were collected at postoperative days +1 and +3. Sample size was estimated based on SSI incidence after HNSCC surgery (∼15%; α risk, 0.05; ß risk, 0.2; 2-sided test). Interleukin (IL)-1ß, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) levels were measured. Patients were followed to detect SSI. Sensitivity, specificity, and prognostic values were calculated for each cytokine at days +1 and +3 to diagnose SSI. RESULTS: SSI was diagnosed in 6 of 39 patients. Bilateral CND, tracheostomy, surgery duration longer than 7 hours, HNSCC stage T3 or T4, and reconstruction with pedicled flaps versus microvascular flaps for advanced-stage tumors were considered risk factors for SSI. All cytokines except IL-10 showed statistical differences between patients with SSI and those without SSI. The best receiver operating characteristic curves yielded cutoff values at day +1 (TNF-α >14.5 pg/mL; sensitivity, 100%; specificity, 87.88%) and day +3 (IL-1ß >115 pg/mL; sensitivity, 83.33%; specificity, 78.79%). Also, IL-2 levels higher than 6.5 pg/mL at day +1 (sensitivity, 83.33%; specificity, 69.7%) and day +3 (sensitivity, 100%; specificity, 69.7%) and IL-6 levels higher than 3,300 pg/mL at day +3 (sensitivity, 100%; specificity, 60.61%) yielded adequate diagnostic profitability. CONCLUSION: The results of this study suggest that the assessment of cytokine levels in drainage fluid soon after CND could provide a novel method for the early detection of SSI.

Infección fúngica invasiva mixta por Rhizomucor pusillus y Aspergillus niger en un paciente inmunocompetente / Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient

Antecedentes. Las mucormicosis son infecciones poco frecuentes en pacientes inmunocompetentes, y se han descrito muy pocos casos de mucormicosis asociadas a aspergilosis en pacientes no hematológicos. Caso clínico. Un varón de 17 años, inmunocompetente y sin factores de riesgo previamente conocidos, ingresó en el hospital tras presentar crisis convulsivas 11 días después de sufrir un accidente de moto. Presentó un curso clínico tórpido por infección fúngica invasiva mixta, con afectación pulmonar por Aspergillus niger y mucormicosis diseminada por Rhizomucor pusillus (diagnóstico histopatológico y microbiológico en varios lugares no contiguos). Fue tratado con anfotericina B liposomal durante 7 semanas (dosis total acumulada > 10 g) y precisó múltiples reintervenciones quirúrgicas. El paciente sobrevivió y fue dado de alta de UCI tras 5 meses de evolución y múltiples complicaciones. Conclusiones. El tratamiento con anfotericina B liposomal y el manejo quirúrgico agresivo consiguió la erradicación de la infección fúngica invasiva mixta, pero alertamos de la necesidad de mantener un mayor grado de sospecha clínica y de realizar técnicas de diagnóstico precoz de infecciones fúngicas invasivas en pacientes no inmunodeprimidos para evitar la diseminación de la enfermedad y el mal pronóstico asociado (AU)

Background. Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. Case report. A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose > 10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. Conclusions. Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it (AU)

[Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient]. / Infección fúngica invasiva mixta por Rhizomucor pusillus y Aspergillus niger en un paciente inmunocompetente.

BACKGROUND: Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. CASE REPORT: A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. CONCLUSIONS: Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it.

Verrucous carcinoma of the oral mucosa: An epidemiological and follow-up study of patients treated with surgery in 5 last years

INTRODUCTION: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. MATERIAL AND METHODS: This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. RESULTS: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. CONCLUSIONS: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients (AU)

Verrucous carcinoma of the oral mucosa: an epidemiological and follow-up study of patients treated with surgery in 5 last years.

INTRODUCTION: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. MATERIAL AND METHODS: This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. RESULTS: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. CONCLUSIONS: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients.