Background. In current practice, surgeons frequently deal with elderly patients who have severe medical comorbidities.Methods. We present our series of 18 consecutive patients with severe general comorbidities that received infrahyoid flap reconstruction. The results were compared with those of 16 consecutive patients in good general medical state receiving free radial forearm flap reconstruction during the same study period. We also describe an original method for tongue base reconstruction using the infrahyoid flap.Results. No total flap necrosis was experienced; successful separation between oral cavity/oropharyngeal contents and neck spaces was obtained in all patients with a low rate of general complications. No significant differences were found with regard to verbal intelligibility and diet scores between groups.Conclusions. Infrahyoid flap in high-risk cases represents a valid alternative to free radial forearm flap. We introduced a novel technical innovation for tongue base reconstruction using the infrahyoid flap with very encouraging results.

Background. The main concern in the treatment of laryngeal carcinomas is tumor control with preservation of laryngeal functions. We believe that salvage supracricoid partial laryngectomy (SPL) should be carefully considered in selected cases of radiotherapy failure, because it can offer the possibility of achieving adequate tumor control with preservation of laryngeal functions.Methods. A series of 31 patients who underwent an SPL as salvage procedure after radiotherapy failure was reviewed.Results. Locoregional control rate was 75%, with 60% 5-year overall survival; no patients were lost to follow-up, and a death-from-disease rate of 19.35% was recorded. Restoration of laryngeal functions was achieved in 89.29% of the patients. No statistically significant differences were found in locoregional control regarding anterior commissure involvement, elective neck dissection versus wait-and-see policy, pathologic positive neck disease, and restage I-II versus restage III-IV.Conclusion. The oncologic and functional results indicate the consistency of salvage SPL, proposing this type of operation as a serious alternative to total laryngectomy in carefully selected cases. Keywords: partial laryngectomy; salvage surgery; larynx carcinoma; radiation failure; neck dissectionThe main concern in the treatment of laryngeal carcinomas is tumor control with preservation of whole laryngeal functions.Early laryngeal cancer can be effectively treated either by larynx preserving surgery or with external beam radiation therapy; results in terms of tumor control and preservation of function for both modalities are satisfactory with reported rates of recurrence or persistence of tumor varying from 10% to 35%.

Summary The goal of this study was to identify host and tumour factors associated with postoperative pneumonia (PP) in a selected population of laryngeal cancer patients, treated by partial laryngectomy in 20 years at our Institution and to assess its potential prognostic impact. Clinical records of 416 consecutive patients were retrospectively reviewed. Tobacco consumption, body mass index (BMI), previous pulmonary disease, age, sex, preoperative blood gas analysis values, tumour stage and type of surgery were tested as potential risk factors for PP. Finally, the prognostic impact of these variables, including PP, in terms of disease-free and actuarial survival by Kaplan-Meier and Cox analyses were evaluated. PP developed in 73 patients (16.8%). We identified two groups of patients: 26 patients experienced an early PP within the first 7-9 days after surgery, whilst 44 experienced an ab ingestis PP following attempts of oral food intake restoration, three patients died for PP related sepsis. At multivariate Cox analysis, age older than 60 years and BMI greater than 30 were statistically associated with early PP; whereas male gender and laryngectomy with neck dissection were statistically related to a higher risk of ab ingestis PP. Interestingly, the occurrence of early PP was a negative independent prognostic factor for 5-years disease-free and actuarial survival (p = 0.049 and p = 0.001, respectively). The occurrence of early-onset pneumonia in laryngeal cancer patients selected for conservative laryngectomies is predictable and associated with poor clinical outcome.

Recently, studies were conducted to evaluate the impact of T regulatory (T regs) cells in the pathophysiology of atopic dermatitis (AD). The aim of this study was to investigate whether natural T regs are present in AD skin lesions. We performed skin biopsies in 12 adult patients affected by moderate-to-severe AD and 4 healthy volunteers. The specimens were stained immunohistochemically with anti-human CD25 and forkhead/winged helix transcription factor (FoxP3). Double immunostaining for CD25 and FoxP3 was performed also. CD25+ cells strongly infiltrated the perivascular and papillar dermis of all lesional specimens, and FoxP3+ cells were distributed in the perivascular and interstitial AD dermis, and some cells also infiltrated the dermoepidermal junction and the basal and suprabasal epidermal layers. All healthy skin specimens showed weak CD25 and FoxP3 stainings. Double immunostaining showed that CD25+ FoxP3+ cells were distributed in the perivascular, interstitial, and periadnexal dermis, and healthy skin specimens featured few CD25+ FoxP3+ cells scattered throughout the dermis. The past and present data show that an impaired function of natural T regs may not play a primary role in the pathophysiology of AD lesions.

Genetic susceptibility may play a central role for MM development in patients with HNC.