Microsurgical free flap in head and neck reconstruction

Microsurgical free flaps are today considered state of the art in head and neck reconstruction after composite tumor resections. Free flaps provide superior functional and aesthetic restoration with less donor‐site morbidity. This article details our approach to this challenging and complex procedure. Free tissue transfer can be viewed as consisting of 4 essential stages: (1) defect assessment, (2) preparation of recipient vessels, (3) flap selection and harvest, and (4) flap inset and microsurgical anastomoses. The essential details of each step are highlighted. Meticulous attention to each step is important because each plays a crucial role in the overall success of the procedure. Workhorse flaps in our practice are the anterolateral thigh, radial forearm, fibula, and jejunum flaps. Unique issues related to postoperative care and monitoring of head and neck free flaps are discussed. The management of complications, in particular those threatening flap survival, are reviewed in detail. © 2009 Wiley Periodicals, Inc. Head Neck, 2010     

Acantholytic dermatosis in chronic renal failure

A 53-year-old Chinese man with chronic renal failure complained of persistent small raised papules behind the ears and on the nape of the neck for the past 6 months. These lesions were slightly pruritic but nontender. He was diagnosed as having chronic renal failure secondary to chronic glomerulonephritis and had been on maintenance hemodialysis for the past 9 years. He had pulmonary tuberculosis 18 months earlier and had completed a full course of antituberculous therapy consisting of 2 months of 800 mg/day ethambutol, and 9 months of 450 mg/day rifampicin and 300 mg/day isoniazid. His present medications included 100 mg/day asprin, 0.25 μg/day calcitriol, daily calcium, and multivitamin supplements which he had been taking for the past 3 years. He worked mainly on a night shift as a cab driver for the past 20 years and gave no history of excessive sun exposure. There was no family history of any acantholytic disorder. Physical examination revealed an anemic patient with pallor and the sallow discoloration of chronic renal failure. Multiple discrete, brownish scaly papules (approximately 20 in number), measuring between 2 and 6 mm in diameter, were clustered behind both ears and on the nape of the neck just below the hairline (Fig. 1). Some of the firm papules had a central depression. The rest of the body was unaffected. There were no signs of significant sun damage present. Laboratory tests showed the following: hemoglobin 7.6 g/dL, white blood cell count 8000/mm³, platelets 234,000/mm³, urea 21.0 mmol/L, Na 135 mmol/L, K4.8 mmol/L, Cl 101 mmol/L, HCO₃20.0 mmol/L, blood glucose 5.9 mmol/L, creatinine 1176 nmol/L, total calcium 2.39 mmol/L, and inorganic phosphate 2.29 mmol/L. On biopsy, the papular lesions showed suprabasal clefts, focal acantholysis with corps ronds, and grains (Fig. 2). The adjacent dermis showed patchy infiltrates of lymphocytes and mononuclear cells. The histologic findings resembled Darier's disease. Most of the skin lesions were excised and followed by primary skin closure. No recurrence was noted after 6 months of follow-up.     

Castleman's disease of the kidney: Sonographic findings

We report a case of rare Castleman's disease of the kidney that mimicked a renal neoplasm with emphasis on the imaging and histologic findings. A 47‐year‐old man presented with dyspeptic symptoms. Ultrasound revealed a vascular, heterogeneous mass in the left kidney. Multiphasic CT scan confirmed an enhancing lesion with enlarged left para‐aortic lymph nodes suspicious for nodal metastases. The provisional diagnosis was renal cell carcinoma. Percutaneous biopsy yielded a diagnosis of Castleman's disease of the hyaline‐vascular type. Despite advancement in imaging modalities, differentiation of hyaline‐vascular variant of Castleman's disease from hypervascular renal neoplasm remains difficult and the final diagnosis requires histopathological confirmation. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :438–442, 2015     

Oxidative stress,antioxidant defenses,and schizophrenia

Schizophrenia is a complex neuropsychiatric disorder with a prevalence of nearly 1% of the world population. Accumulating evidence suggests that increase in production of reactive oxygen species (ROS) along with decrease in antioxidants and antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase) may be closely associated with the pathogenesis of schizophrenia. Genes associated with glutamate transmission, dopamine transmission, synaptic plasticity, mitochondrial function, oxidative stress, lipid metabolism, and neuroinflammation have been closely linked to schizophrenia. Proteins encoded by many of the above genes affect the level of ROS, and lipid mediators that regulate signaling in the brain through cross‐talk among glutamate, dopamine, and eicosanoid receptors. Under physiological conditions, this refines the communication between neurons, glial cells and vascular cells, but in schizophrenia, the cross‐talk might initiate and promote oxidative stress‐mediated abnormal neuronal signaling responsible for symptoms of the disease.