The lateral island trapezius myocutaneous flap for circumferential reconstruction of hypopharynx and cervical esophagus

The lateral island trapezius was utilized for reconstruction of hypopharyngeal and cervical esophagus defects in high-risk patients, avoiding entry into the celomic cavities as an approach to decrease morbidity and mortality. Seven male patients were treated at the State University of New York between 1988 and 1991 and underwent reconstruction with the lateral island trapezius flap. There was no mortality, 2 patients developed pharyngocutaneous fistulas; 1 patient operated after radiation treatment failure remained with positive margins at resection but his fistula never healed, and another patient underwent a minor revision with successful closure of the fistula. All patients regained swallowing and none required dilatations. The preferred methods of reconstruction for the reasonable risk patient are gastric pull-up and free jejunal transfer; both of which require entry into cavities. The lateral island is a reliable alternate method of reconstruction for high-risk patients in whom intracavitary surgery may lead to unacceptably high morbidity and mortality. When the vascular anatomy is not favorable, rerouting of the vessels may be required utilizing microvascular reconstruction. The donor site defect is closed primarily or skin grafted, and subsequent functional limitations are minimal and well tolerated.

Transthoracic needle aspiration biopsy in inflammatory pseudotumors of the lung

The cytologic findings on transthoracic needle aspiration biopsy in four patients with pulmonary inflammatory pseudotumor are described. These findings have not been previously illustrated in the literature. The main cytologic components of this lesion are histiocytes, lymphocytes, fibroblasts, pneumocytes, and plasma cells. Familiarity with these features is essential to avoid misdiagnosis and possible overtreatment.

Dioctophyme larva in the subcutaneous tissues of a woman in Ohio

A nematode larva undistinguishable from Dioctophyme renale was found in the subcutaneous tissues of the abdomen of a 23-year-old woman from Ohio. This is the third case of Dioctophyme larva reported in humans. Although it is not known how the infection was acquired, we suggest that ingestion of raw fish was the probable source. We further hypothesize that such a larva could eventually migrate to the kidney and grow to the adult state.