Faculty Bibliography

OBJECTIVES: To evaluate the awareness of oral cancer, its risk factors and to estimate the prevalence of risk factors in a high-risk semi-urban population in India. METHODS: A questionnaire-based survey was carried out by house-to-house interview on a single day by 120 health volunteers. The data were analyzed using SPSS 11.0 software for links between prevalence of risk factors and oral cancer awareness, as well as other confounding variables. RESULTS: A total of 1885 persons participated in the survey. Of the surveyed population, 86% had heard about oral cancer and 32% knew someone with oral cancer. Sixty-two percent of the subjects correctly identified the causes; this included 77% of the subjects who identifying smoking, 64% alcohol and 79% pan chewing as a cause of oral cancer. More than 42% believed that poor oral health could lead to oral cancer and 53% thought that oral cancer is an incurable disease. Forty percent of males and 14% females had one or more high-risk habits. It was observed that the awareness was proportional to the education level (p<0.001) and inversely proportional to the prevalence of risk factor habits (p<0.001). Eighty-two percent of the smokers, 75% of the tobacco chewers and 66% of those who consumed alcohol were aware that their habits could lead to oral cancer. CONCLUSIONS: Overall, the awareness of oral cancer in this high-risk population was satisfactory, though certain gaps exist, pointing to a need for targeted health education and risk factor cessation counseling.

OBJECTIVE:To assess the utility of the pectoralis major muscle flap (PMMF) in patients undergoing salvage total laryngectomy. DESIGN/METHODS:Retrospective cohort analysis. SETTING/METHODS:Tertiary care cancer center. PATIENTS/METHODS:The study included 461 patients who underwent laryngectomy. Eighty of them underwent salvage surgery with primary pharyngeal closure. INTERVENTIONS/METHODS:Of the 80 patients, 69 (86%) underwent primary pharyngeal closure alone and 11 (14%) underwent a PMMF, which was used to buttress the pharyngeal suture line. MAIN OUTCOME MEASURE/METHODS:Two hundred thirty-six variables were recorded for each patient. Complications related to pharyngeal closure were measured. RESULTS:Sixty-four percent of the patients who underwent PMMF also underwent chemoradiation therapy as the initial definitive treatment compared with 25% in the non-PMMF group (P = .03). On multivariate analysis, chemoradiation therapy was the only independent predictor of pharyngocutaneous fistula formation (relative risk, 1.82; P = .02). Nevertheless, the pharyngocutaneous fistula rate was similar in the PMMF (27%) and the non-PMMF (24%) groups. Furthermore, similar durations of tube feeding, days to oral feeding, and hospitalization period were recorded in both groups. CONCLUSION/CONCLUSIONS:The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.

OBJECTIVE: JAK2V617F occurs in approximately 93% of patients with polycythemia vera and approximately 50% of patients with either primary myelofibrosis or essential thrombocythemia. Chromosomal abnormalities are detected in 50% of patients with primary myelofibrosis, 29% with polycythemia vera, and 8% to 10% with essential thrombocythemia. The relationship between the presence of such chromosomal abnormalities and the JAK2V617 allele burden, and the role that each of these genetic events play in the origins and progression of the myeloproliferative neoplasms (MPNs), remain unclear. MATERIALS AND METHODS: Individual hematopoietic colonies were assayed in vitro from the CD34(+) cells of six JAK2V617F-positive MPN patients with marker chromosomal abnormalities. Colonies were simultaneously analyzed for JAK2 genotype and chromosomal abnormalities. RESULTS: Among the 248 colonies assayed from cultures containing 500 CD34(+) cells, chromosomal abnormalities were detected in 5% of colonies with wild-type JAK2, 32% of JAK2V617F heterozygous colonies and 56% of JAK2V617F homozygous colonies. Overall, 92% of chromosomally abnormal colonies were also JAK2V617F homozygous. Although 54 colonies contained wild-type JAK2 exclusively, 4 of these colonies were characterized by chromosomal abnormalities. CONCLUSION: This study indicates that MPN hematopoietic progenitor cells do not necessarily always acquire genetic events in the same sequence. (Chromosomally abnormal progenitor cells are closely associated with JAK2V617F homozygosity; p=0.0001.). Chromosomal abnormalities such as +8, +9 can occasionally precede acquisition of JAK2V617F. These findings support the existence of earlier genetic events that precede JAK2V617F or cytogenetic abnormalities in MPN hematopoietic progenitor cells

The tongue is the most commonly involved structure in cancer of the oral cavity. For locally advanced tumours, adequate resection necessitates near total or total glossectomy. Such patients pose a unique surgical challenge because of the potential for severe speech and swallowing disruption and life-threatening aspiration. These patients also undergo radiotherapy, leading to xerostomia with associated poor quality of life. Present day techniques use dynamic muscles or musculocutaneous flaps for reconstruction of such defects which, although providing adequate glossopalatal contact and tongue movements, are still far from achieving normal tongue appearance and have no intrinsic secretory capability. We have tried to circumvent this problem by using two different free flaps simultaneously, the gracilis muscle to work as functional motor unit for providing tongue movements and elevation together with free stomach, turned inside-out, as an added source of secretion for dry mouth and attached omentum for providing adequate bulk. This technique has been used in two patients over the last 18 months with satisfactory functional and aesthetic results.

Apoptosis is frequently regulated by different protein kinases including protein kinase C family enzymes. Both inhibitory and stimulatory effects were demonstrated for several of the different PKC isoforms. Here we show that the novel PKC isoform, PKCeta, confers protection against apoptosis induced by the DNA damaging agents, UVC irradiation and the anti-cancer drug--Camptothecin, of the breast epithelial adenocarcinoma MCF-7 cells. The induced expression of PKCeta in MCF-7 cells, under the control of the tetracycline-responsive promoter, resulted in increased cell survival and inhibition of cleavage of the apoptotic marker PARP-1. Activation of caspase-7 and 9 and the release of cytochrome c were also inhibited by the inducible expression of PKCeta. Furthermore, JNK activity, required for apoptosis in MCF-7, as indicated by the inhibition of both caspase-7 cleavage and cytochrome c release from the mitochondria in the presence of the JNK inhibitor SP600125, was also suppressed by PKCeta expression. Hence, in contrast to most PKC isoforms enhancing JNK activation, our studies show that PKCeta is an anti-apoptotic protein, acting as a negative regulator of JNK activity. Thus, PKCeta could represent a target for intervention aimed to reduce resistance to anti-cancer treatments.

The objectives of this study are to describe central nervous system modulation associated with voice improvement following Type I thyroplasty in a patient with glottic insufficiency secondary to unilateral vocal fold paralysis. Serial functional magnetic resonance imaging scans were performed before as well as one and six months after thyroplasty. Paradigms consisting of four voice production tasks and a motor control task were completed. Volumes of activation within regions activated during each task were measured. Acoustic and aerodynamic measures were also obtained. A widespread network of neural activations was shown for all tasks. Differences in volumes of activation 1-month postsurgery positively correlated with acoustic and aerodynamic improvements. Sixth months following medialization, lesser volumes of activation were observed in all regions. Prior to this session, however, the patient's mediastinal disease progressed, leading to a significant deterioration in voice. Functional differences between patient brain maps yield new information about the central nervous system's ability to reorganize sensorimotor representations associated with voice improvement following Type I thyroplasty in a patient with glottic insufficiency secondary to unilateral vocal fold paralysis (UVFP)

OBJECTIVE: Determine long-term loss of mandible height with use of stress-shielding reconstruction plates for free fibula flap mandible reconstruction. DESIGN: Retrospective single-blinded medical record review. SUBJECTS: Seventy patients who had fibula free flap mandible reconstructions performed for 10 years. Patients who underwent radiotherapy were excluded. METHODS: Review of 70 fibula free flap mandible reconstructions performed for the last 10 years in a city hospital revealed 7 patients (10%) who had resections for benign odontogenic diseases. All had a three-dimensional cast model made, on which the reconstruction plate was bent to the desired shape preoperatively. Free fibula height on panoramic x-ray images taken preoperatively and at 2 and 12 months postoperatively. RESULTS: Seven (10%) patients met criteria for the study. Bone height was maintained at 2 months postoperatively, but at 12 months, there was a statistically significant loss of fibular bone height averaging 20% in the anterior, body, and ramus areas (P < 0.05). Despite this, all patients were considered eligible for dental rehabilitation, and 4 of 7 patients have had osseointegrated implants placed. CONCLUSIONS: As opposed to miniplates, increased resorption may have been due to the stress-shielding phenomenon unique to a reconstruction plates. However, this did not seem to affect the ability to place osseointegrated implants.

Modified orbitozygomatic craniotomy (MOZC) is an anterior lateral skull base approach characterized by simplicity and wide exposure. The approach was first introduced in 2003 and there are few clinical reports. This report details treatment of patients with large (>4 cm) sphenoid wing meningiomas via a MOZC approach, and to the authors' knowledge, the first published in English. Total resection was achieved in all 5 patients in this study. One patient experienced a postoperative epidural hematoma that was successfully treated. All patients returned to daily activity without neurological sequellae. The advantages of MOZC are sparing of the zygomatic arch and removal of the orbital rim; hence, the surgeon can plan a capacious operative field without excessive brain retraction and resect the tumor before opening the dura. The MOZC approach is a clinically feasible, low morbidity, surgical option for paraclinoid lesions, such as large sphenoid wing meningiomas.