A New Technique for Reconstruction of the Cervical Trachea for the Treatment of Thyroid Cancer with Tracheal Invasion

We successfully reconstructed the airway after wide and circularresection of the trachea up to 12 rings for the treatment ofadvanced thyroid cancer. The technique is as follows:

1. The affected trachea is resected widely and an end-to-end anastomosisof the cut ends of the remaining trachea with a half defectdue to the insufficient tracheal wall is performed.
2. The tracheostomais built in the above defect.
3. Later, the tracheostoma is closedwith two sequential skin flaps.

We have applied this new technique to three patients so far,and have found no later complications. The technique seems tobe very useful for the treatment of thyroid cancer with trachealinvasion.     

Pull-Through Esophagectomy Without Thoracotomy

Twenty patients with carcinoma of the hypopharynx, esophagusand thyroid underwent pull-through esophagectomy. Seventeenof them received combined resection of the larynx and trachea.Dissection of the lymph nodes at the upper mediastinum was performedin 11 patients by sternotomy. Seven patients received mediastinaltracheostomy after combined resection of the trachea and thelarynx. Pull-through esophagectomy was followed by pharyngogastrostomywithout thoracotomy via the posterior mediastinum. This techniqueis described in detail. Because there is no thoracotomy andligation of the esophageal vessels is ensured, no pulmonarycomplications and no massive mediastinal hemorrhages occurred.There were no operative deaths. This operation offers excellentpalliation and little morbidity. Moreover, the use of sternotomyand mediastinal tracheostomy for pull-through esophagectomymade it possible to dissect the upper mediastinal lymph nodes,and we could resect the affected trachea with certainty.     

Successful treatment of psoriasis with topical application of active vitamin D3 analogue, 1α, 24-dihydroxycholecalciferol

We treated 11 psoriatic patients with topical 1 alpha,24-dihydroxycholecalciferol, a new synthetic analogue of active vitamin D3. In 10 of 15 tests the lesions cleared completely within 1-4 weeks, although some relapses occurred shortly after cessation of treatment. There were no side-effects. We suggest that 1 alpha, 24(OH)2D3 merits further investigation as a potentially useful topical therapy for psoriasis.     

Incontinentia pigmenti: eosinophil chemotactic activity of the crusted scales in the vesiculobullous stage

To investigate the mechanisms underlying eosinophil infiltration into the epidermis in incontinentia pigmenti (IP), we studied the eosinophil chemotactic activity in extracts of the crusted scales from three patients with IP in the vesiculobullous stage. Eosinophil chemotactic activity was detected in the eluates from a Sephadex G-75 chromatography column between the vitamin B12 and phenol red markers. The chemotactic activity was heat-stable and resistant to enzyme digestion, and recovered after ether extraction at low pH. Leukotriene B4 (LTB4) was demonstrated in the fractions with high eosinophil chemotactic activity. These findings suggest that LTB4 plays an important role in the accumulation of eosinophils within the epidermis in IP, in the vesiculobullous stage. Blood eosinophilia, however, may not be induced by the eosinophil chemotactic factors in the scales.     

HLA-DR antigen expression on keratinocytes in highly inflamed parts of psoriatic lesions

We have investigated the immunoperoxidase staining pattern in the epidermis and dermal infiltrates of highly inflamed portions of psoriatic lesions, selecting for biopsy early pinpoint lesions or margins of active plaque lesions. We found positive intercellular staining for HLA-DR antigens in localized areas of the epidermis in about half of the patients tested. In contrast, OKT6 antigen was found only on the dendritic cells in the epidermis and dermis in all cases. These findings support the hypothesis that an active cellular immune reaction involving the epidermis, possibly associated with the expression of HLA-DR antigens on keratinocytes, occurs in the highly inflamed areas of psoriatic lesions, particularly in early pinpoint lesions or at the edges of spreading plaque lesions.     

Autologous mixed lymphocyte reaction is reduced in patients with psoriasis

The autologous mixed lymphocyte reaction (auto-MLR) was studied to test the interactions between immunocompetent cells in patients with psoriasis. The auto-MLR in 20 patients with psoriasis was significantly lower than in 16 normal controls. Lower values were found in untreated psoriatic patients than in those in remission following treatment. The values in the latter group were significantly lower than in controls and in six patients with atopic dermatitis in remission. The tendency for an increase in the auto-MLR with a decrease in disease activity was further confirmed in five patients studied before and after treatment. In contrast, the allogeneic lymphocyte reaction (allo-MLR) in psoriatics was similar to that in normal controls.