Human papillomavirus type 6 subtype a (HPV-6a) was detected in a human invasive tonsiilar carcinoma. Southern blot hybridization analysis showed the presence of additional bands when using non-cutting and single-cut restriction enzymes. Molecular cloning yielded two recombinant clones of 8-0 and 1.4 kb in size. The first represents the complete HPV-6a genome. Sequence analysis of the second clone showed a 0.6 kb DNA sequence corresponding to the L2 region of HPV-6a, whereas the rest belongs to cellular sequences. These data show the presence of a usually low risk HPV type in an invasive carcinoma, at an unusual infection site, with viral DNA integrated into the host genome. These findings add evidence in support of the hypothesis of a relationship between HPV infection and at least some ororespiratory cancers.A strong association exists between human papillomavirus (HPV) and some human cancers. HPV types 16, 18, 31, 33 and 35 and a few others account for more than 90 of cervical carcinomas (zur Hausen, 1989) whereas the genome of HPV type 5 and more rarely also types 8, 17 and 20 are found in almost all malignant lesions of individuals suffering from epidermodysplasia verruciformis, a disease in which 30 to

A retrospective analysis is made of 61 patients with clinical and histological diagnosis of pure sarcomas of the jaw treated between 1950 and 1984. Surgery was the treatment of choice in 41 cases. Biopsy or palliative treatment were undertaken in the remaining patients. Twenty-four cases relapsed before 12 months, and 12 relapsed before 3 years. Twenty-four died before 12 months, nine before 2 years, and three after 2 years. At present there is no evidence of disease in eight patients: three out of 25 fibrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), three out of 15 chondrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), and two out of 15 osteosarcomas (one more than 18 years). The prognosis is gloomy. However, an early diagnosis and radical surgery contribute to an improvement in the course of the disease.

Background: the problems of reconstructive surgery for the midface are variable and can be very complex. The anatomical proximity of the midface to the orbit, base of the skull and maxillary sinuses is a challenge for the surgeon who must perform a curative resection. Objective: The aim of this presentation is to report the survival rate and disease-free interval in T4a and T4b neoplasms of the palate and paranasal sinuses consecutively resected over a 30-year period. Material and methods: Surgery was extended to the orbit in 85.2%, the skull in 8.3%, the neck in 18.7% and the parotid gland in 7.3%. Soft tissue reconstruction was performed using free flaps in 32.5%, muscle flaps in 21.6%, local flaps in 20.2%, musculocutaneous flaps in 14.7% and skin flaps in 11.3%. Results: Local and general complications were reported, and 4/203 patients (2%) died. At 5 years, overall survival was 62.5% and disease-free survival was 53%. Univariate analysis revealed that lack of previous treatment was significantly associated with recurrence and squamous cell carcinoma was a predictor of survival. Conclusions: The indication of exenteration is mandatory in the presence of ophthalmoplegia or involvement of the orbital content. Survival at 5 years is acceptable, considering the advanced stages of the disease. In some patients, previous treatments were

Antecedentes: dada su baja incidencia, diferencia citológica con el CFT, mayor diseminación linfática, escasa avidez por el I131 y menor sobrevida que el CFT, el carcinoma de células de Hürthle (CCH) es una entidad polémica y controvertida. Objetivo: informar la experiencia de dos centros oncológicos en el manejo de pacientes con diagnós-tico histológico de CCH. Material y métodos: el tratamiento quirúrgico preferido fue tiroidectomía total en 89,4%; en el 42% se agregó linfadenectomía laterocervical, II-IV en 6 casos y II-V con resección del músculo esternocleidomastoideo, vena yugular interna y nervio recurrente en 2. En 1 de estos se realizó resección de pared traqueal y traqueostomía. La congelación intraquirúrgica confirmó el diagnóstico en el 23%. El 31,5% de los pacientes no recibió tratamiento ablativo con yodo radiactivo. Resultados: tres pacientes fueron reintervenidos por recurrencias locorregionales. Dos evolucionaron con metástasis (mts) a distancia. En 3 se efectuó radioterapia externa ante enfermedad irresecable y 1 recibió inhibidores de tirosina quinasa. Conclusiones: el manejo de los pacientes con CCH, por su baja frecuencia y falta de evidencia de alta calidad, continúa presentando aspectos controvertidos. Se requieren estudios clínicos multicéntricos que incluyan mayor número de pacientes y prolongado tiempo de seguimiento para evaluar el impacto de las diferentes terapéuticas, así como profundizar en el conocimiento de la biología molecular de esta patología. RESUMEN ABSTRACTBackground: in view of its low incidence, cytological difference with follicular cells carcinoma (FCC), higher lymphatic spread, little 131I avidity and less specific survival than FCC, Hürthle Cells Carcinoma (HCC) is a polemic and controversial issue. Objective: to report experience of two oncologic Hospitals in the management of patients with histologic diagnosis of CCH. Material and methods: treatment of choice was total thyroidectomy in 89.4%. In 42% lateral neck dissection was done, II-IV in 6 patients and II-V in 2 patients with resection esternocleidomatoid muscle, internal yugular vein and recurrent nerve. In 1 of these, resection of tracheal wall and tracheostomy was done. Intraoperative frozen sections confirmed diagnosis in 23%. 31.5% did not received therapeutic ablative dosis of I 131. Results: 3 patients were surgically treated for local regional disease. 2 of them developed distant metastases. 3 received radiotherapy and 1 tirosin kinase inhibitors. Conclusions: given its low incidence and absence of high quality evidence, management of HCC is controversial. Other multicentric trials with more patients and follow up are required for evaluation of different therapies, as well as better study about molecular biology of this pathology.

Colgajos pediculados. Una alternativa no descartable en grandes defectos de la cabeza y el cuelloPedicled flaps. An alternative worth to be considered for large defects of the head and neck Antecedentes: la cirugía de cabeza y cuello requiere la reconstrucción de los defectos que crea la resección de lesiones neoplásicas de dicha área. Para ello, se necesita el aporte de tejidos vecinos o tomados a distancia. Los colgajos libres cumplen a la perfección con tales principios. Sin embargo, los colgajos pediculados podrían suplir en gran medida las falencias que la aparatología y el personal entrenado ocasionan en un servicio de la especialidad. Objetivo: analizar la aplicabilidad, las ventajas y complicaciones de los colgajos pediculados, sin que signifiquen la primera opción cuando hay que reconstruir un paciente. Resultados: los colgajos pediculados resultaron muy nobles en su aplicación tanto como cobertura como para reconstruir distintos sitios de la vía aerodigestiva superior. Solo se requirió una técnica depurada y la atenta preservación de su pedículo arteriovenoso. En general, se les reconocen ventajas y desventajas a todos. Sobresale entre ellos, el de trapecio lateral por la implícita posibilidad de incorporar hueso. La mayoría reveló reducida curva de aprendizaje, tiempo operatorio comparado con el de los colgajos libres y baja tasa de complicaciones. Conclusiones: los colgajos pediculados no son cosa del pasado. En todos los servicios que no cuenten con un microcirujano entrenado, los colgajos pediculados deben formar parte del menú de opciones reconstructivas en la cirugía de cabeza y cuello. 161-166. http://dx.doi.org/10.25132/raac.v109.n4.1307 RESUMEN ABSTRACTBackground: head and neck surgery requires reconstruction of defects after resection of neoplastic lesions. Although free flaps from close or distant locations may largely satisfy this need, pedicled flaps could replace the lack of aparatology and trained personnel in a specilized unit. Objective: to analyze applicability, advantages and complications of pedicled flaps. Results: pedicled flaps resulted a good option for coverage or reconstruction of different areas of the aerodigestive tract. A neat technique and a careful preservation of the arteriovenous pedicle were required. Although all of the pedicles used have advantages and disadvantages, the best of them resulted the lateral trapezius flap for it allows the association of bone to the flap. All pedicled flaps showed shorter learning curve , operative time and lower complication rate as compared to free flaps. Conclusions: pedicled flaps should not be considered a past issue. Any head and neck surgery unit without a trained microsurgeon should include pedicled flaps as an option for reconstructive procedures.