Jacek Banaszewski

PRAME expression in head and neck cancer correlates with markers of poor prognosis and might help in selecting candidates for retinoid chemoprevention in pre-malignant lesions

OBJECTIVES PRAME (Preferentially Expressed Antigen in Melanoma) is a tumor-associated antigen recognized by immunocytes, and it induces cytotoxic T cell-mediated responses in melanoma. PRAME expression in tumors interferes with retinoic acid receptor (RAR) signaling thus promoting tumor progression. Here, we study PRAME expression in head and neck squamous cell carcinoma (HNSCC) to determine its potential clinical significance. MATERIALS AND METHODS PRAME expression in HNSCC was evaluated by immunohistochemistry in tissue microarrays of primary tumors (n=53), metastatic lymph nodes (n=8) and normal oral mucosa (n=11). Biopsies of dysplastic oral lesions (n=12) were also examined. PRAME expression levels in tissues were correlated with markers of poor prognosis in HNSCC. PRAME mRNA in HNSCC cell lines and in normal immortalized human keratinocytes (HaCaT cell line) was measured by qRT-PCR, and the protein expression by flow cytometry and western blots. RESULTS PRAME was expressed in HNSCC cell lines and HNSCC lesions. PRAME expression in dysplastic mucosa was variable. No or only weak expression was found in normal cells or tissues. PRAME expression levels significantly correlated with the tumor grade, size, nodal involvement and the clinical status of HNSCC patients. CONCLUSIONS Elevated PRAME expression associates with clinicopathologic markers of poor outcome in HNSCC and might identify potential candidates with pre-cancerous lesions for chemoprevention with retinoids.

Analysis of aromatic DNA adducts in laryngeal biopsies.

Abstract Epidemiological studies have confirmed the correlation between tobacco smoking, environmental pollution and the incidence of cancers of the respiratory tract. The occurrence of laryngeal cancer in Poland is relatively high compared to other European countries. Since 1969 the mortality related to larynx cancer appears to be increasing. Tobacco smoke contains an abundance of such carcinogenic compounds as polycyclic aromatic hydrocarbons (PAH), aromatic amines and N-nitrosoamines, which can react with DNA and form adducts. We analyzed aromatic DNA adducts in laryngeal tissues from patients with primary laryngeal, which was confirmed histopathologically to be squamous cell carcinoma. The group consisted of 33 patients (5 women and 28 men). Total laryngectomy was performed in patients. A detergent-phenol method was used for DNA isolation. Aromatic DNA adducts were analyzed by a 32P-postlabelling technique with butanol extraction and high performance liquid chromatography. The presence of aromatic DNA adducts was demonstrated in all tissues. Large interindividual differences of DNA adduct levels were seen in each tissue studied. There was a higher mean level of DNA adducts in interarytenoid area non-tumors (51.96/108± 91.71 NN) than in non-tumor tissue elswhere (46.91/108± 46.36 NN) and tumor tissue (43.52/108± 45.88 NN). Adduct levels were correlated with age, sex, cigarette smoking and TNM stage.

Supraclavicular artery pedicled flap in reconstruction of pharyngocutaneous fitulas after total laryngectomy.

The aim of the study was to analyze the efficacy of treatment of closure of cutaneopharyngeal fistulas, following total laryngectomy, using a fasciocutaneous flap. In the group of 6 patients treated in years 2013-2014, in 4 (67%) patients the healing process was successful, in one patient complete flap necrosis was noted on the 6th day, in another patient a small cutaneopharyngeal fistula was recognized, which closed secondarily with no intervention. Flaps of this type, having a small risk of local complications at donor site and satisfactory functional and aesthetic results, may be an alternative form of flap to others used in the reconstruction of superficial deficits in the head and neck areas.

The reconstruction of large laryngeal defect with medial condyle femur corticoperiosteal free flap--a case report.

The larynx is a complicated organ with very important functions. Reconstructive operations of the larynx often result in some function reduction caused by scars and stenoses. The aim of this report is to present the results of the one‐stage reconstructive operation after a large excision of the chondrosarcoma of the larynx. The patient was male, aged 48 with the history of the operation of the highly mature cartilaginous sarcoma of the thyroid on the right side with tumor recurrence. The one‐stage reconstructive surgery using medial condyle femur corticoperiosteal free flap which reshaped the cartilage scaffold and restored an inner layer as the mucosa was made. The flap survived without local and systemic complications. Six months follow‐up revealed no local recurrence and good breathing results. There was no restriction of movement of the lower limbs. The patient returned to work previously performed. Results were shown in endoscopic examinations and computer tomography. The medial condyle femur corticoperiosteal free flap may be an option for reconstruction of large laryngeal defect with restoring its shape and inner layers.

Mandibular Reconstruction with Osteo-cutaneous Free Flaps in a Patient afterExtensive Surgery Supported with 3D Printed Models

Introduction and objective: The aim of the study was to evaluate usefulness of 3-D models utilizing generated incremental techniques from thermoplastic materials in mandibular reconstruction with utilization of free osteocutaneous fibular and scapular flaps. Methods: 12 patients were treated due to an advanced oral cavity squamous cell carcinoma (T4b). In four patients with a mandibular defect a physical 3-D model consisting of the reconstructed and unaffected sites was prepared for a reconstruction protocol. The 3-D models were designed based to high resolution CT scans. Results: Assessment of comparative functionality (stability of junction, mobility, mastication ability), and cosmetics was examined in both groups, following an 8- week healing period. Conclusion: Applying 3-D models for mandibular manufacturing using a three dimensional printing technologies allows for obtainment of better functionality of restored mandible in comparison to the traditional method. Utilization of mandibular and fibular model significantly decreases time of the operation and allows for achievement of desired shape and esthetic effect within the 1/3 of the lower face.

Zabiegi rekonstrukcyjne w wielkich guzach gruczołów ślinowych

OBJECTIVE Evaluation the outcome after extensive surgery of salivary glands tumors with simultaneous reconstruction of soft tissue and skin defect. MATERIAL In the period 2007-2011, surgery treatments performed in 295 of major salivary glands. 31 patients underwent surgery due to malignant parotid gland tumors: 19 women (61%) and 12 men (39%). In 8 (26%) presented skin infiltration. 10 (32%) patients had facial palsy between II-IV degree (House Brackmann scale). The radiographic findings in some patients showed infiltration of the deep lobe of parotid gland, external auditory canal, infiltration of mastoid process, skull base and the subtemporal fossa. METHODS Of the 31 patients in 13 (42%) reconstruction techniques with muscle cutaneous trapezius flap were applied in 4 (31%) patients. In group of 7 (54%) patients using a muscle flap based on the sterno-cleido-gland, in 2 (15%) patients defects were covered using the free anterior lateral thigh flap. RESULTS In all patients, healing proceeded normally. In the operated patients, one patient did not receive radical surgery due to the infiltration of the skull base. Length of hospitalization ranged between 7-21 days. In no case was lost flap, also there was no local complications at the donor. CONCLUSIONS The choice of treatment for malignant parotid gland tumors which are usually radioresistant is surgical resection. In patients with extensive tumors with infiltration of neighbouring organs reconstruction with use of distant flaps are recommended. It provides a good oncological and aesthetic result.

Cena uzyskania wolnego płata przedramienia w rekonstrukcjach w obrębie jamy ustnej i gardła – powikłania miejsca donorowego

PURPOSE Evaluation of the donor site efficiency in patients after reconstructive surgery with use of free forearm flap. All patients were treated for oral cavity and larynx cancer. MATERIALS AND METHODS a group of 21 patients (16 men and 5 women) treated in 2007-2011. The retrospective analysis was conducted on the anamnesis, operating protocols, physical examination and a questionnaire, there was completed by patients during a routine ENT follow up examination. The PRWE (Patient Rated Wrist Evaluation) subjective questionnaire was used to estimate the rate of pain severity and wrist mobility. RESULTS In 59% of patients the wrist was healed primary, in 36% of patients by granulation. In all patients the wound was healed satisfactory in follow up examination, but 60% of patients revealed extensive scars formation. 62% of patients showed no local pain at rest, while in 38% of them worsening of symptoms was noticed--average 0.5/10 (median 1.0). Pain was more intense in patients who did basic motor activity of hands approximately 1/10 and lifting weights averaging 2.1/10. Dysfunction of the wrist was at the level of the average value of 4.2/50. CONCLUSIONS Surgical reconstruction with a use of the free forearm flap is associated with the formation of extensive wrist scars. The risk of local complications is low while preserving the qualification protocol, postoperative care and proper surgical management. Reconstructive surgery based on the free forearm flaps gives satisfactory functional results of the donor site. However, it requires surgical experience and practical knowledge of anatomy.

Schemat postępowania i wstępne wyniki leczenia brodawczaków krtani dotkankowym preparatem cidofovir

Summary Introduction Recurrent respiratory papillomatosis (RRP) is a rare disease in children and adults. It is characterized by proliferation of benign squamous cell papillomas within the respiratory-digestive tract, predominantly the larynx. Standard treatment consists of surgical excision of papillomata to maintain airway patency and voice quality. For last several years cidofovir is the most contemporary adjuvant anti-viral treatment for recurrent respiratory papillomatosis and its topical use is widely described. Material and methods Intralesional cidofovir therapy was given to 20 patients treated for laryngeal papillomas in the Department of Otolaryngology in Poznan between I-XII.2009. The character of the lesion differed: from one anatomical site and moderate growth to four or five localizations with heavy extension. The number of cidofovir injections per patient varied from one to six times and the volume of solution ranges from 1–12 ml. The cidofovir injections were combined with laser or mechanical excision of the lesions. In disperse papillomata the injections administered in particular anatomical sites in 4–6 weeks period. In massive lesions injections were repeated in the same anatomical site. Results Complete remission was observed in 3 out of 20 patients. 12 patients show remission in a place of cidofovir injection. In 4 patients during the 4 week observation new foci of papillomatosis occurred. In two patients hepatic toxic side effect were observed. Conclusions Intralesional cidofovir injection has been shown to be an effective an safe therapy for laryngeal papilloma and should be considered in those patients who experienced disease relapse.

Retrospektywna analiza przyczyn niepowodzeń w leczeniu nowotworów jamy ustnej i gardła w Klinice Otolaryngologii i Onkologii Laryngologicznej Uniwersytetu Medycznego w Poznaniu w latach 2000–2005

Summary Aim Retrospective analysis of treatment results in the patients group with oral cancer treated in Department of Otolaryngology and Clinical Oncology K. Marcinkowski University of Medical Sciences in Poznan between the years 2000–2005. The critical view of the cause of the failure. Material The clinical data include: sex, age, stage of the tumor (TNM classification), histological grading, nodes status and 5-years follow up. The parameters were analysed regarding to history of the patients, operative books, outpatients documentation. All parameters were underwent statistical analysis using following tests: Kaplan-Meier, Wilcoxon regarding Gehan and chi2. Data for analysis was classified as „end feature” (death or lack of postoperative control) and „cut feature” (patient still under control). Results Between 2000 and 2005 263 patients were operated due to oral cancer. Only 144 undergo analysis. The rest of 108 patients were calculated as a treatment failure. The middle age was 63 years. There was statistical correlation between tumor stages T (p≤0.00768), pathological N stage (p≤0.07225) and 5 year survival. No correlation was found between age, extracapsular spread of the nodes and histopathological grading G and prognosis. In our group 5-years survival present 32% of the patients. Conclusions The results of 5-years survival in our patients group are still unsatisfactory. The key lies probably on both side. The first the patients visited doctors still too late with significant advancement of the tumor and second we need better education, introduction of new technologies and shorter time for histological diagnosis and waiting list for post operative radiochemioterapy.

Application of Low-Cost 3D Printing for Production of CT-Based Individual Surgery Supplies

The main problem addressed in this paper is the use and evaluation of low-cost additive manufacturing (3D printing) techniques and CT images as tools for manufacture of usable and individualized, anatomically correct models, assisting surgeons in their daily work. The authors formulate own methodology of design and additive manufacturing of medical products on the basis of medical imaging data. A specific case was selected—a surgical lower jaw template for use in the middle of operation. Two Fused Deposition Modeling machines—professional and low-cost—were used to manufacture the same product, which was later evaluated, inspected for accuracy (by 3D scanning) and used during the surgery. By two 3D printing processes comparison it was found that the low cost comes at a price of lower accuracy and increased demand for process supervision. The authors obtained a fully usable medical product used during an actual reconstruction surgery. Partial clinical results are presented—use of 3D printed templates helped reduce surgery time and generally improved the patient recovery process.